COVID-19 and assisted reproductive technology services: repercussions for patients and proposal for individualized clinical management.

The prolonged lockdown of health services providing high-complexity fertility treatments -as currently recommended by many reproductive medicine entities- is detrimental for society as a whole, and infertility patients in particular. Globally, approximately 0.3% of all infants born every year are conceived using assisted reproductive technology (ART) treatments. By contrast, the total number of COVID-19 deaths reported so far represents approximately 1.0% of the total deaths expected to occur worldwide over the first three months of the current year. It seems, therefore, that the number of infants expected to be conceived and born -but who will not be so due to the lockdown of infertility services- might be as significant as the total number of deaths attributed to the COVID-19 pandemic. We herein propose remedies that include a prognostic-stratification of more vulnerable infertility cases in order to plan a progressive restart of worldwide fertility treatments. At a time when preventing complications and limiting burdens for national health systems represent relevant issues, our viewpoint might help competent authorities and health care providers to identify patients who should be prioritized for the continuation of fertility care in a safe environment.

SARS-CoV-2 infection negatively affects ovarian function in ART patients.

Several organs, such as the heart, breasts, intestine, testes, and ovaries, have been reported to be target tissues of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. To date, no studies have demonstrated SARS-CoV-2 infection in the female reproductive system. In the present study, we investigated the effects of SARS-CoV-2 infection on ovarian function by comparing follicular fluid (FF) from control and recovered coronavirus disease 2019 (COVID-19) patients and by evaluating the influence of these FF on human endothelial and non-luteinized granulosa cell cultures. Our results showed that most FFs (91.3%) from screened post COVID-19 patients were positive for IgG antibodies against SARS-CoV-2. Additionally, patients with higher levels of IgG against SARS-CoV-2 had lower numbers of retrieved oocytes. While VEGF and IL-1ß were significantly lower in post COVID-19 FF, IL-10 did not differ from that in control FF. Moreover, in COV434 cells stimulated with FF from post COVID-19 patients, steroidogenic acute regulatory protein (StAR), estrogen-receptor ß (Erß), and vascular endothelial growth factor (VEGF) expression were significantly decreased, whereas estrogen-receptor α (ERα) and 3ß-hydroxysteroid dehydrogenase (3ß-HSD) did not change. In endothelial cells stimulated with post COVID-19 FF, we observed a decrease in cell migration without changes in protein expression of certain angiogenic factors. Both cell types showed a significantly higher γH2AX expression when exposed to post COVID-19 FF. In conclusion, our results describe for the first time that the SARS-CoV-2 infection adversely affects the follicular microenvironment, thus dysregulating ovarian function.

[Antagonists: from physiology to assisted reproduction]. / Antagonistas: de la fisiología a la reproducción asistida.

The objective of this article was to make a detailed review of the biological and clinical effects of a relatively new medication: the gonadotropin-releasing hormone antagonists. The GnRH antagonists have had an increasingly consumption since their release in the last three years. This review will discuss current strategies and potential applications for the GnRH antagonists. According to this, results on assisted reproduction procedures will be analyzed.

[A study of two different routes of administration of micronized progesterone in assisted reproduction]. / Estudio de dos vías diferentes de administración de progesterona micronizada en reproducción asistida.

BACKGROUND: Progesterone is almost completely absorbed after administration by oral route when its preparation is micronized, but, due to the important metabolic inactivation during the first hepatic pass, bioavailability of oral progesterone is notably poor reaching values lesser than 10%. OBJECTIVE: To compare two different routes of administration of progesterone for luteal phase support in artificial insemination protocols. MATERIAL AND METHODS: 24 patients were randomly allocated in the 2 arms of the study, 200 mg/daily, vaginally or p.o. Plasma levels of progesterone were analyzed and ultrasound was performed to compare endometrium pattern and thickness. RESULTS: No differences were found in terms of indication, semen parameters, number of preovulatory follicles and progesterone serum levels. Endometrial pattern and thickness were clinical and statistically better in group I as the pregnancy rate. DISCUSSION: Taking in account our results we can argue that vaginal progesterone improve endometrial features favoring implantation and pregnancy rates without modifying progesterone serum levels.

Healthy girl born after cryopreservation of gametes and ICSI in a patient with seminoma.

This study reports birth in a case of intracytoplasmic sperm injection with cryopreserved oocytes and spermatozoa banked after radiotherapy and prior to chemotherapy due the occurrence of two non-synchronous seminomas. A 30-year-old male with a diagnosis of seminoma cryopreserved six vials of spermatozoa. After oncological treatment was completed, his partner, a 24-year-old woman, underwent ovarian stimulation. Seventeen oocytes were retrieved; one was at the germinal vesicle stage and two were injected, resulting in two embryos. Fourteen metaphase II oocytes were frozen. The woman presented moderated ovarian hyperstimulation syndrome, and embryo cryopreservation was indicated. After endometrial preparation, two embryos were transferred and a pregnancy was achieved. The woman suffered eclampsia during week 28 of gestation. Caesarean section was performed and a preterm girl weighing 1000 g was born, but died 2 weeks after delivery. A year later, a second procedure was begun. Frozen oocytes and one vial of semen were thawed. Eight of the 14 oocytes survived and were microinjected; two became fertilized and one good quality cleaved embryo was transferred. Pregnancy was achieved and a healthy girl was born with a birth weight of 2800 g. Oocyte cryopreservation associated with sperm banking in cancer patients is a useful tool for couples seeking deferred parenthood.

Azoospermias secretoras: posibilidades terapèuticas actuales / Secretory azoospermias: current therapeutic possibilities

En este trabajo pretendemos presentar los resultados del Instituto Valenciano de Infertilidd obtenidos tras la ICSI con espermatozoides procedentes de testículo en pacientes con azoospermias no obstructivas