Code of Ethics and Conduct of the Brazilian Association of Embryologists - PRONÚCLEO.

For more than three decades, Brazilian Clinical Embryologists have been working without specific regulations and following the standards adopted by other healthcare professionals. This document aims to guide behavior and decision-making, while providing directions to embryologist with the purpose of aiding professionals involved with assisted reproduction procedures and their patients. The Code of Ethics and Conduct is an important breakthrough and the first step toward regulating Clinical Embryology as a profession.

Importância dos parâmetros seminais nos resultados de inseminaçäo intra-uterina / Importance of seminal parameters for intrauterine insemination outcomes

OBJETIVOS: analisar a relevância dos parâmetros seminais nos resultados dos ciclos de inseminaçäo intra-uterina (IIU) em pacientes com causa masculina de infertilidade e salientar o caráter prognóstico de cada parâmetro para o sucesso da técnica. MÉTODOS: duzentos e trinta e nove ciclos de IIU (155 casais) foram analisados durante período de 15 meses. Todos as pacientes foram submetidas à induçäo da ovulaçäo de acordo com protocolos do I Consenso Brasileiro de Induçäo de Ovulaçäo. A análise seminal foi realizada de acordo com os critérios da Organizaçäo Mundial da Saúde (OMS) para parâmetros como concentraçäo e motilidade e critério estrito de Kruger para avaliaçäo da morfologia. O preparo da amostra para IIU foi realizado por meio de gradientes descontínuos de densidade (ISolate®). Foram formados dois grupos de pacientes de acordo com o resultado de gestaçäo: grupo G - gestaçäo positiva e grupo NG - gestaçäo negativa. RESULTADOS: näo houve diferença significativa nos valores obtidos relacionados à concentraçäo total de espermatozóides/mL de sêmen, motilidade total, motilidade de formas progressivas antes e depois do processamento seminal. Quando a morfologia estrita de Kruger foi comparada entre os dois grupos, diferenças significativas foram encontradas (grupo G=10,6 por cento de formas normais; grupo NG=6,4 por cento de formas normais; p<0.05) quando o número de espermatozóides/mL inseminados foi superior a 15 milhöes/mL, a taxa de gravidez foi significantemente maior. CONCLUSÖES: tanto a morfologia estrita de Kruger como o número de espermatozóides inseminados parecem ser fatores prognósticos positivos para o estabelecimento da gestaçäo, devendo ser salientados na investigaçäo do homem infértil

Pronuclear and morphological features as a cumulative score to select embryos in ICSI (intracytoplasmic sperm injection) cycles according to sperm origin.

PURPOSE: To analyze best parameter to select embryos according to sperm origin in ICSI cycles. METHODS: One hundred seventy-two ICSI cycles were divided among three different groups: A (ejaculated spermatozoa from nonmale factor infertility), B (ejaculated spermatozoa from oligospermia), and C (spermatozoa from azoospermia). Embryos were divided on Day 1 into two patterns: S0 (pronuclei (PN) aligned and close with normal arrangement of nucleoli) and S1 (when these characteristics were absent) and also on transfer day according to morphological features. RESULTS: Relationships of PN patterns related to sperm origin were noted. More S0 embryos were detected with better sperm quality. Higher number of good quality embryos was obtained when male factor was absent. Ejaculated and epididymal spermatozoa provide better quality embryos than do testicular spermatozoa. CONCLUSIONS: PN classification associated with transfer day morphology is valuable additional noninvasive criterion for elective embryo transfer, mainly in the cases with severe male factor.

Different intervals between vasectomy and sperm retrieval interfere in the reproductive capacity from vasectomized men.

PURPOSE: To evaluate the relationship between the postvasectomy period and sperm reproductive capacity after ICSI. METHODS: Seventy-seven ICSI cycles with percutaneous epididymal sperm aspiration (PESA) were reviewed. Patients were divided into 4 groups according to the interval after vasectomy: 0 - 5 years (G1); 6 - 8 years (G2); 9 - 14 years (G3), and > 15 years (G4). RESULTS: Clinical and ongoing pregnancy rates did not correlate significantly with the time period of vasectomy until 14 years. Although the higher implantation rate observed in G1, no significant differences were noted among Groups 1-3. The miscarriage rates increased from G1 to G4, reaching a statistical significance among G1, G2, and G3 compared with G4. When groups were also divided according to the maternal age, the same results were obtained. CONCLUSIONS: The interval between the vasectomy and the sperm retrieval procedure has no effect on the outcome until the interval of 14 years.

Testicular sperm results in elevated miscarriage rates compared to epididymal sperm in azoospermic patients.

CONTEXT: Several sperm retrieval techniques are available for use on azoospeermic men. Comparisons between spermatozoa retrieved from the testicles and epididymis in relation to pregnancy and miscarriage rates are not well established. OBJECTIVE: To compare pregnancy and miscarriage rates using sperm retrieved from the testes and epididymis using intracytoplasmic sperm injection. Furthermore, we evaluated the fertilization and pregnancy rates according to the status of the spermatozoa retrieved (motile or immotile). DESIGN: Retrospective study. SETTING: A private center for assisted fertilization. PARTICIPANTS: One hundred and eight consecutive patients who presented with azoospermia were included in our study, on whom a total of 144 retrieval procedures were performed. PROCEDURES: Of the 144 retrieval procedures, 104 were testicular sperm aspirations (TESA) and 40 were epididymal sperm aspirations (PESA). PESA was the first approach in obstructive patients (n = 68), whereas TESA was used when the former failed. For non-obstructive patients (n = 40), TESA was the method of retrieval. MAIN MEASUREMENTS: Pregnancy and miscarriage rates according to spermatozoa characteristics (motile or immotile). RESULTS: The number of cycles performed using spermatozoa retrieved from the testicles and epididymis was 81 and 30, respectively. Motile spermatozoa had higher fertilization (2PN) and pregnancy rates compared to immotile spermatozoa (p < 0.05). Also, motile spermatozoa had lower miscarriage rates compared to immotile spermatozoa (p < 0.0001). No differences were seen in pregnancy rates with testicular spermatozoa (n = 28) compared to epididymal spermatozoa (n = 13) (p = 0.1). However, the miscarriages rates were higher in spermatozoa retrieved from the testicles (n = 12) compared to epididymis retrievals (n = 1) (p = 0.01). CONCLUSIONS: Although pregnancy rates were similar when the intracytoplasmic sperm injection was performed with spermatozoa retrieved from the testicles and epididymis, the use of testicular spermatozoa yields a significantly higher miscarriage rate. It is possible that the higher miscarriage rate seen in patients using spermatozoa retrieved from the testicles is linked to high genetic sperm abnormalities.

Testicular sperm results in elevated miscarriage rates compared to epididymal sperm in azoospermic patients

CONTEXT: Several sperm retrievel techniques are available for use on azoospeermic men. Comparisons between spermatozoa retrieved from the testicles and epidymis in relation to pregnancy and miscarriage rates are not well established. OBJECTIVE: To compare pregnancy and miscarriage rates using sperm retrieved from the testes and epididymis using intracytoplasmic sperm injection. Furthermore, we evaluated the fertilization and pregnancy rates according to the status of the spermatozoa retrieved (motile or immotile). DESIGN: Retrospective study. SETTING: A private center for assisted fertilization. PARTICIPANTS: One hundred and eight consecutive patients who presented with azoospermia were included in our study, on whom a total of 144 retrieval procedures were performed. PROCEDURES: Of the 144 retrieval procedures, 104 were testicular sperm aspirations (TESA) and 40 were epididymal sperm aspirations (PESA). PESA was the first approach in obstructive patients (n = 68), whereas TESA was used when the former failed. For non-obstructive patients (n = 40), TESA was the method of retrieval. MAIN MEASUREMENTS: Pregnancy and miscarriage rates according to spermatozoa characteristics (motile or immotile). RESULTS: The number of cycles performed using spermatozoa retrieved from the testicles and epididymis was 81 and 30, respectively. Motile spermatozoa had higher fertilization (2PN) and pregnancy rates compared to immotile spermatozoa (p < 0.05). Also, motile spermatozoa had lower miscarriage rates compared to immotile spermatozoa (p < 0.0001). No differences were seen in pregnancy rates with testicular spermatozoa (n = 28) compared to epididymal spermatozoa (n = 13) (p = 0.1). However, the miscarriages rates were higher in spermatozoa retrieved from the testicles (n = 12) compared to epididymis retrievals (n = 1) (p = 0.01). CONCLUSIONS: Although pregnancy rates were similar when the intracytoplasmic sperm injection was performed with spermatozoa retrieved from the testicles and epididymis, the use of testicular spermatozoa yields a significantly higher miscarriage rate. It is possible that the higher miscarriage rate seen in patients using spermatozoa retrieved from the testicles is linked to high genetic sperm abnormalities

Tratamento da infertilidade conjugal com a técnica de injeçäo intracitoplasmática de espermatozóide (ICSI) / Infertility treatment for couple using intracytoplasmic sperm injection (ICSI)

Relatar nossa experiência com ICSI para o tratamento da infertilidade conjugal. Estudo retrospectivo de 1267 ciclos de ICSI (892 pacientes/idade média=34,7 anos). Foram puncionados 19.707 oocistos e obtidos 14.263 oocitos (72,4 por cento). ICSI ocorreu em 11.046oocitos (77,4 por cento) e 9.880 (89,4 por cento) permaneceram intactos após o procedimento. Fertilizaçäo normal (2PN) foi obtida em 6.876 oocitos (69,5 por cento) e fertilizaçäo anormal (1PN e 3PN) em 798 (8 por cento) e 569 (5,7 por cento) células, respectivamente. Em 12,4 por cento dos casos näo houve transferência (158 casos), em virtude do congelamento de todos os embriöes (49 casos - 3,9 por cento) ou problemas intrínsecos do oocito (109 casos - 8,6 por cento). Congelamento embrionário foi realizado em 20,4 por cento dos casos (260 ciclos). As taxas de gestaçäo por ciclo, por transferência e por paciente foram de 23 por cento, 26,3 por cento, 32,7 por cento, respectivamente. A taxa de implantaçäo obtida foi de 16,3 ñ 6.7. Independentemente da indicaçäo ou da idade da paciente, a falha de fertilizaçäo em ICSI e FIV foi comparada. (2,4 por cento vs. 15,7 por cento, ICSI e FIV respectivamente). A ICSI é uma técnica que fornece boas taxas de fertilizaçäo e transferência embrionária e aumenta as taxas de sucesso para casais inférteis