Assisted reproductive techniques in Latin America: the Latin American Registry 2016.

RESEARCH QUESTION: What was the utilization, effectiveness and perinatal outcome of assisted reproductive technologies (ART) performed in Latin America during 2016? DESIGN: Retrospective collection of multinational data on ART performed in 178 institutions from 15 Latin American countries. RESULTS: This paper reports on 85,474 initiated cycles, 15,070 deliveries and 18,182 babies born in this period. Of all fresh autologous IVF/intracytoplasmic sperm injection (ICSI) cycles, 40.9% were performed in women aged 35-39 years, and 31.1% in women aged ≥40 years. After removing freeze-all cycles, delivery rate per oocyte retrieval was 20.31% for ICSI and 21.85% for IVF. Fresh single embryo transfer including all age categories represented 22.96%, with a 15.35% delivery rate per transfer. Double embryo transfer represented 61.58% of transfers, with a 27.62% delivery rate per transfer. Multiple births included 18.12% twins and 0.55% triplets and higher. In oocyte donation, delivery rate per transfer was 32.89%, with a twin and triplet rate of 23.48% and 0.73%, respectively. Overall, preterm deliveries reached 17.11% in singletons, 65.69% in twins and 95.51% in triplets. Perinatal mortality was 8.0‰ in singletons, 19.0‰ in twins, and 62.3‰ in high-order multiples. CONCLUSIONS: The number of initiated cycles continues to increase. Compared with previous years, the number of embryos transferred decreased while the proportion of single embryo transfers increased with a drop in multiple births. It is vital to motivate health care providers and consumers to continue this trend.

Assisted reproductive techniques in Latin America: the Latin American Registry, 2015.

RESEARCH QUESTION: What was the utilization, effectiveness and safety of assisted reproductive technologies (ART) performed in Latin American countries during 2015, and what were the regional trends? DESIGN: Retrospective collection of multinational data on assisted reproduction techniques (IVF and intracytoplasmic sperm injection [ICSI], frozen embryo transfer, oocyte donation, preimplantation genetic testing and fertility preservation), from 175 institutions in 15 Latin American countries. RESULTS: In total, 41.25% of IVF/ICSI cycles were performed in women aged 35-39 years, and 28.35% in women aged ≥40 years. After removing freeze-all cycles, delivery rate per oocyte retrieval was 21.39% for ICSI and 24.29% for IVF. Multiple births included 19.58% twins and 0.95% triplets and higher. In oocyte donation, delivery rate per transfer was 36.77%, with a twin and triplet rate of 27.65% and 1.06%, respectively. Overall, preterm deliveries reached 17.38% in singletons, 64.94% in twins and 98.41% in triplets. Perinatal mortality in 14,936 births and 18,391 babies born was 10.5 per 1000 in singletons, 17.9 per 1000 in twins, and 57.1 per 1000 in high-order multiples. Elective single embryo transfer represented 3.11% of fresh transfers, with a 31.78% delivery rate per transfer. Elective double embryo transfer represented 23.3% of transfers, with a 37.79% delivery rate per transfer. Out of 18,391 babies born, 63.22% were singletons, 34.4% twins, and 2.38% triplets and higher. CONCLUSIONS: Given the effect of multiple births on prematurity, morbidity and perinatal mortality, reinforcing the existing trend of reducing the number of embryos transferred remains mandatory.

Assisted reproduction techniques in Latin America: the Latin American Registry, 2014.

Multinational data on assisted reproduction techniques (IVF and intractytoplasmic sperm injection [ICSI], frozen embryo transfer, oocyte donation, preimplantation genetic diagnosis and fertility preservation) were collected from 159 institutions in 15 Latin American countries. A total of 41.34% of IVF-ICSI cycles were conducted in women aged 35-39 years and 23.35% in women aged 40 years and older. After removing freeze-all cases, delivery rate per oocyte retrieval was 25.05% for ICSI and 27.41% for IVF. Multiple births included 20.78% twins and 0.92% triplets and over. In oocyte donation, twins reached 28.93% and triplets 1.07%. Preterm deliveries reached 16.4% in singletons, 55.02% in twins and 76% in triplets. Perinatal mortality in 18,162 births was 23 per 1000 in singletons, 35 per 1000 in twins, and 36 per 1000 in high-order multiples. Elective single embryo transfer represented 2.63% of fresh transfers, with a 32.15% delivery rate per transfer. Elective double embryo transfer represented 23.74% of transfers, with a 41.03% delivery rate per transfer; 11,373 babies (62.6%) were singletons; 6398 (35.2%) twins, and 391 (2.2%), triplets and more. Given the effect of multiple births on prematurity, morbidity and perinatal mortality, reinforcing the existing trend of reducing the number of embryos transferred is mandatory.

Assisted reproductive techniques in Latin America: the Latin American Registry, 2013.

Multinational data on assisted reproduction techniques undertaken in 2013 were collected from 158 institutions in 15 Latin American countries. Individualized cycle-based data included 57,456 initiated cycles. Treatments included autologous IVF and intracytoplasmic sperm injection (ICSI), frozen embryo transfers, oocyte donations. In autologous reproduction, 29.22% of women were younger than 35 years, 40.1% were 35-39 years and 30.6% were 40 years or older. Overall delivery rate per oocyte retrieval was 20.6% for ICSI and 25.4% for IVF. Multiple births included 20.7% for twins and 1.1% for triplets and over. In oocyte donations, twins reached 30% and triplets 1.4%. In singletons, pre-term births were 7.5%: 36.58% in twins and 65.52% in triplets. The relative risk for prematurity was 4.9 (95% CI 4.5 to 5.3) in twins and 8.7 (95% CI 7.6 to 10.0) in triplets and above. Perinatal mortality was 29.4 per 1000 in singletons, 39.9 per 1000 in twins and 71.6 per 1000 in high order multiples. Elective single embryo transfer represented only 2% of cycles, with delivery rate of 39.1% in women aged 34 years or less. Given the effect of multiple births and prematurity, it is mandatory to reduce the number of embryos transferred in the region.

Assisted reproductive techniques in Latin America: The Latin American registry, 2016.

RESEARCH QUESTION: What was the utilization, effectiveness and perinatal outcome of assisted reproductive technologies (ART) performed in Latin America during 2016. DESIGN: Retrospective collection of multinational data on ART performed in 178 institutions from 15 Latin American countries. RESULTS: We are reporting 85,474 initiated cycles, 15,070 deliveries and 18,182 babies born in this period. Of all fresh autologous IVF/ICSI cycles, 40.9% were performed in women aged 35-39 years, and 31.1% in women aged ≥40 years. After removing freeze-all cycles, delivery rate per oocyte retrieval was 20.31% for ICSI and 21.85% for IVF. Fresh single embryo transfer including all age categories represented 22.96%, with a 15.35% delivery rate per transfer. Double embryo transfer represented 61.58% of transfers, with a 27.62% delivery rate per transfer. Multiple births included 18.12% twins and 0.55% triplets and higher. In oocyte donation, delivery rate per transfer was 32.89%, with a twin and triplet rate of 23.48% and 0.73%, respectively. Overall, preterm deliveries reached 17.11% in singletons, 65.69% in twins and 95.51% in triplets. Perinatal mortality was 8.0 ‰ in singletons, 19.0 ‰ in twins, and 62.3 ‰ in high-order multiples. CONCLUSIONS: The number of initiated cycles continues to increase. Compared with previous years, the number of embryos transferred decreased while the proportion of single embryo transfers increased with a drop in multiple births. It is mandatory to stimulate health care providers and consumers to continue in this trend.

Assisted Reproductive Techniques in Latin America: The Latin American Registry, 2015.

RESEARCH QUESTION: What was the utilization, effectiveness and safety of assisted reproductive technologies (ART) performed in Latin American countries during 2015, and what were the regional trends? DESIGN: Retrospective collection of multinational data on assisted reproduction techniques (IVF and intracytoplasmic sperm injection [ICSI], frozen embryo transfer, oocyte donation, preimplantation genetic testing and fertility preservation), from 175 institutions in 15 Latin American countries. RESULTS: In total, 41.25% of IVF/ICSI cycles were performed in women aged 35-39 years, and 28.35% in women aged ≥40 years. After removing freeze-all cycles, delivery rate per oocyte retrieval was 21.39% for ICSI and 24.29% for IVF. Multiple births included 19.58% twins and 0.95% triplets and higher. In oocyte donation, delivery rate per transfer was 36.77%, with a twin and triplet rate of 27.65% and 1.06%, respectively. Overall, preterm deliveries reached 17.38% in singletons, 64.94% in twins and 98.41% in triplets. Perinatal mortality in 14,936 births and 18,391 babies born was 10.5 per 1000 in singletons, 17.9 per 1000 in twins, and 57.1 per 1000 in high-order multiples. Elective single embryo transfer represented 3.11% of fresh transfers, with a 31.78% delivery rate per transfer. Elective double embryo transfer represented 23.3% of transfers, with a 37.79% delivery rate per transfer. Out of 18,391 babies born, 63.22% were singletons, 34.4% twins, and 2.38% triplets and higher. CONCLUSIONS: Given the effect of multiple births on prematurity, morbidity and perinatal mortality, reinforcing the existing trend of reducing the number of embryos transferred remains mandatory.

Evaluation of cross-reactivity to Taenia hydatigena and Echinococcus granulosus in the enzyme-linked immunoelectrotransfer blot assay for the diagnosis of porcine cysticercosis.

BACKGROUND: Taenia solium is an important zoonotic parasite that infects humans as definitive host (taeniasis) and pigs as intermediate host (cysticercosis). Serological diagnosis of porcine cysticercosis is limited to antigen detection using ELISA, which is known to cross-react with other Taenia species, and antibody detection using the lentil-lectin glycoprotein enzyme-linked immunoelectrotransfer blot (LLGP EITB), which has not been adequately evaluated for cross-reactivity to other parasites. Field studies suggest that the GP50 diagnostic band of the LLGP EITB may cross-react to Taenia hydatigena, a common non-zoonotic parasitic infection of pigs. The objective of this study was to evaluate the specificity of the LLGP EITB assay in pigs infected experimentally with T. hydatigena and Echinococcus granulosus. RESULTS: Twelve three-month-old seronegative were divided into two groups; six were each given an oral challenge with a single gravid proglottid of T. hydatigena and the other six were each given an oral challenge with 50 gravid proglottids of E. granulosus. Serum samples were collected biweekly until 14 weeks when all pigs underwent a detailed necropsy. Taenia hydatigena cysticerci were found in two of six pigs from the first group. Four T. hydatigena-exposed pigs were seropositive at the GP50-band only on EITB LLGP; two of these had cysts at necropsy while no seronegative pigs had cysts. One E. granulosus-exposed pig was positive to EITB LLGP, again with reactivity only to GP50; all six pigs had hepatic echinococcosis on necropsy. CONCLUSION: These results provide definitive evidence that the GP50 diagnostic band in pigs cross-reacts with T. hydatigena. Evidence of cross-reaction with E. granulosus was not conclusive.

Occurrence of Moniezia expansa (Rud, 1810) Blanchard, 1891 (Cestoda: Anoplocephalidae) in domestic pig (Sus scrofa domestica Linnaeus, 1758) in Perú.

The presence of Moniezia expansa (Rud, 1810) Blanchard, 1891, is reported in domestic pig (Sus scrofa domestica Linnaeus, 1758). Four tapeworms were collected and identified as M. expansa. This is the first report of M. expansa collected in a domestic pig in Perú.

Assisted reproductive techniques in Latin America: The Latin American Registry, 2014.

Multinational data on assisted reproduction techniques undertaken in 2014 were collected from 159 institutions in 15 countries in Latin America. Treatments included IVF/ ICSI, FET, OD, PGD and fertility preservation (FP). 41.34% of IVF/ICSI cycles were performed in women aged 35 to 39 years and 23.35% in women aged 40 and older. After removing cases with total freezing, delivery rate per oocyte retrieval was 25.05% for ICSI and 27.41% for IVF. Multiple births included 20.78% twins and 0.92 % triplets and over. In OD, twins reached 28.93% and triplets 1.07 %. Preterm deliveries reached 16.4% in singletons, 55.02% in twins and 76% in triplets. Perinatal mortality in 18,162 births was 23 per 1000 in singletons, 35 per 1000 in twins, and 36 per 1000 in high-order multiples. Elective single embryo transfer (eSET) represented only 2.63 % of fresh transfers, with a delivery rate of 32.15% per transfer. Elective double embryo transfer (eDET) represented 23.74% of transfers, with a delivery rate of 41.03% per transfer. Among babies born during this period 11,373 (62.6%) were singletons; 6,398 (35.2%) twins, and 391 (2.2%), triplets and more. Given the effect of multiple births on prematurity, morbidity and perinatal mortality, reinforcing the existing trend of reducing the number of embryos transferred is mandatory.

Expanded carrier screening in gamete donors of Venezuela.

OBJECTIVE: To discuss the implications of expanded genetic carrier screening for preconception purposes based on our practice. METHODS: One hundred and forty-three potential gamete donors aged 20-32 years old (µ=24, 127 females and 16 males), signed informed consent forms and were selected according to the REDLARA guidelines. Blood or saliva samples were examined by one of these genetic carrier screening methods: Genzyme screening for Cystic Fibrosis (CF), Fragile X and Spinal Muscular Atrophy (SMA); Counsyl Universal panel or Recombine Carrier Map. RESULTS: Genotyping results for all donors were analyzed; 41% (58/143) of donors were identified as carriers for at least one condition. We found a carrier frequency of 1/24 for CF, 1/72 for SMA and 0/120 for Fragile X syndrome. Among the high-impact most prevalent conditions in our study (Carrier Map group) were: 21-Hydroxilase-Deficient Congenital Nonclassical Adrenal Hyperplasia (1/8), Factor V deficiency (1/12), Hemochromatosis: Type 1: HFE Related (1/12), Short Chain Acyl-CoA (1/14) and MTHFR deficiency 1/3 (39%). CONCLUSIONS: The rate of gamete donors identified as carriers of at least one condition was 41%, which supports the offering of expanded carrier screening to our population. Studies in Latin American populations could help customize screening panels. The ART patient population has a unique opportunity to be offered expanded carrier screening and appropriate counseling, to make its best-informed decisions.

Zika virus detected in amniotic fluid and umbilical cord blood in an in vitro fertilization-conceived pregnancy in Venezuela.

OBJECTIVE: To describe the consequences of Zika virus infection at 10 weeks of gestation in an IVF-conceived pregnancy in Venezuela. DESIGN: A case report. SETTING: Private assisted reproduction unit. PATIENT(S): A 36-year-old patient who conceived her first pregnancy through IVF and became infected with Zika virus at 10 weeks' gestation in Venezuela. INTERVENTION(S): In vitro fertilization with fresh ET. Clinical, laboratory, and imaging Zika diagnostic methods. MAIN OUTCOME MEASURE(S): Zika virus detection by real-time polymerase chain reaction (PCR) in maternal plasma, PCR in amniotic fluid and umbilical cord blood. Ultrasonography findings of anatomic abnormalities. RESULT(S): Zika infection was confirmed at 10 weeks' gestation by real-time PCR; ultrasound results appeared normal. At 19 weeks' gestation, an ultrasound revealed biometry on three SDs below the means for all parameters but with no apparent anatomic abnormality. Zika virus was positive in maternal urine and amniotic fluid by PCR at 19 weeks' gestation. Ultrasound at 21 weeks + 4 days of gestation showed fetal cerebellar hypoplasia with ventricular dysmorphia, particularly marked on the left, consistent with microcephaly and ventriculomegaly. Because of the poor prognosis, pregnancy was interrupted at 24 weeks' gestation, in France. The PCR in umbilical cord blood taken in this procedure was positive for Zika virus. CONCLUSION(S): Initial ultrasound findings in pregnancy may not be informative. Only at 21 weeks + 4 days of gestation did an ultrasound reveal fetal microcephaly and ventriculomegaly. Combined clinical, laboratory, and imaging findings provided a complete picture of the severe damage caused by Zika infection.

Assisted reproductive techniques in Latin America: The Latin American Registry, 2013.

Multinational data on assisted reproduction techniques undertaken in 2013 were collected from 158 institutions in 15 Latin American countries. Individualized cycle-based data included 57,456 initiated cycles. Treatments included autologous IVF and intracytoplasmic sperm injection (ICSI), frozen embryo transfers, oocyte donations. In autologous reproduction, 29.22% of women were younger than 35 years, 40.1% were 35-39 years and 30.6% were 40 years or older. Overall delivery rate per oocyte retrieval was 20.6% for ICSI and 25.4% for IVF. Multiple births included 20.7% for twins and 1.1% for triplets and over. In oocyte donations, twins reached 30% and triplets 1.4%. In singletons, pre-term births were 7.5%: 36.58% in twins and 65.52% in triplets. The relative risk for prematurity was 4.9 (95% CI 4.5 to 5.3) in twins and 8.7 (95% CI 7.6 to 10.0) in triplets and above. Perinatal mortality was 29.4 per 1000 in singletons, 39.9 per 1000 in twins and 71.6 per 1000 in high order multiples. Elective single embryo transfer represented only 2% of cycles, with delivery rate of 39.1% in women aged 34 years or less. Given the effect of multiple births and prematurity, it is mandatory to reduce the number of embryos transferred in the region.

Molecular and morphological evidence of Taenia omissa in pumas (Puma concolor) in the Peruvian Highlands.

A total of 41 cestodes were collected during necropsy examination on 2 pumas (Puma concolor) that were found in 2 communities in Canchis province, Cuzco region, Peru, at 4500 meters above sea level (Peruvian Andes). The cestodes were evaluated morphologically and molecularly. A fragment of the mitochondrial cytochrome c oxidase subunit 1 gene (cox1) was used as a genetic marker. All the cestodes were identified as Taenia omissa. In the present report, we give a brief description by molecular and morphological diagnosis of the cestodes and compare nucleotide sequences with previous isolates from GenBank. Upon comparison, the sequences showed a difference in the cox1 gene of 5.1 to 5.3% with other teniids sequences. This finding constitutes the first report of T. omissa in Peru and expands the geographic distribution of this parasite.

Echogenic Catheters and Embryo Transfer Standardization.

OBJECTIVE: 1.To describe the standardization process and protocols of the ET method at our center. 2.To compare the performance of non-echogenic catheters with echogenic catheters during ultrasound-guided ET. METHODS: Retrospective analysis of 2630 ET performed at UNIFERTES during 1997-2014, to describe standardization process and to compare the percentage of difficult ET between echogenic and non-echogenic catheters. We tested 17 non-echogenic and three echogenic catheters. RESULTS: Many variables were associated with the ease of ET: informed patients, waiting time for the procedure, speculum use, clinical touch, uterine contractions, cervical mucus removal, presence of blood before or after the procedure, full bladder, ultrasound guidance, uterocervical angle, mock transfer, catheter type (soft or hard, echogenic or non-echogenic, with stylet or not), catheter loading technique, duration of embryo loading (time interval since the embryos were removed from the incubator for loading until the catheter is passed to the physician), transfer procedure (time interval from the catheter was handed to the physician until the embryos were discharged in the uterus), catheter tip placement, retained embryos, bed rest after ET, operator´s proficiency. The diversity of catheters used and the percentage of difficult transfers decrease as the use of echogenic catheters increases. This process is necessary to minimize variation, ensure high quality, safe and evidence-based practice, and improve outcomes. CONCLUSIONS: To standardize the ET method allowed a quicker and easier transfer. The use of echogenic catheters simplified ET procedures guided by abdominal ultrasound.

Evaluation of Plasmatic Concentration of Propofol 2.5µg/ml by TCI using Marsh Modified Model, during oocyte retrieval for IVF in Latin-American women (Venezuelans).

OBJECTIVE: To evaluate efficacy of Propofol at Cp 2.5 µg/ ml administered by Target Controlled Infusion (TCI) using Marsh Modified Model, in pre-medicated with midazolam/ fentanil Latin-American women (Venezuelans) during oocyte retrieval for In Vitro Fertilization. METHODS: Prospective, descriptive study included 72 women, 18-44 years old, ASA I-II, non obese, undergoing oocyte retrieval, pre-medicated with midazolam 0.04 mg/kg and fentanil 2µg/kg and received anesthesia based in Propofol at Cp 2.5µg/ml by Target Controlled Infusion using Marsh Modified Model. Demographic data, propofol doses, duration of procedure and recovery time was registered using descriptive statistic. Anesthesia efficacy was measured by Biespectral Analysis (BIS), Intra-Operative Movements Scale (0 to 5) graded, Postoperative Pain by Visual Analog Scale (VAS) and nausea/vomits incidence. ANOVA and Pearson Chi2 were used with an error of 0.05. RESULTS: Age average was 33.04±6 years old, procedure average time 18.06±8min, Propofol total doses 146.64±53 mgs, Propofol infusion doses average 155.2±3µg/Kg/min. During procedure, 70.8% of patients had no movement, 22.2% movement Grade I and 6.9% Grade II. (Grade I-II movement did not interfere with procedure continuity). 70.8% achieved BIS 40-50 and 93.1% had BIS equal o less than 60. There was a statistic significant correlation between BIS 40-50 and no movements. Recovery post-anesthesia time was 25.2±8 min. 98.6% of patients reported excellent comfort. CONCLUSION: With midazolam/fentanil pre-medication, Propofol at Cp 2.5µg/ml by TCI using Marsh Modified Model showed a 93% of effectiveness during oocyte retrieval in Latin-American women subjected to IVF, allowing an ultra- fast recovery time.

Longevity and viability of Taenia solium eggs in the digestive system of the beetle Ammophorus rubripes.

The present study evaluated the capacity of Ammophorus rubripes beetles to carry Taenia solium eggs, in terms of duration and viability of eggs in their digestive system. One hundred beetles were distributed into five polyethylene boxes, and then they were infected with T. solium eggs. Gravid proglottids of T. solium were crushed and then mixed with cattle feces. One gram of this mixture was placed in each box for 24 hours, after which each group of beetles was transferred into a new clean box. Then, five beetles were dissected every three days. Time was strongly associated with viability (r=0.89; P<0.001) and the calculated time to cero viability is 36 days. The eggs in the intestinal system of each beetle were counted and tested for viability. Taenia solium eggs were present in the beetle's digestive system for up to 39 days (13th sampling day out of 20), gradually reducing in numbers and viability, which was 0 on day 36 post-infection. Egg viability was around 40% up to day 24 post-infection, with a median number of eggs of 11 per beetle at this time. Dung beetles may potentially contribute towards dispersing T. solium eggs in endemic areas.

A case of nasal myiasis due to Oestrus ovis (Diptera: Oestridae) in a llama (Lama glama).

Infection by the larval form of Oestrus ovis (sheep bot fly) is common in many areas of Peru. This is an obligate parasite of sheep and goats, and it is the cause of oestrosis, or nasal myiasis, which can lead to severe clinical manifestations in livestock. A case of myiasis caused by O. ovis in a llama (Lama glama) in Cuzco, Peru, is reported here. This llama presented with respiratory distress and died due to bilateral hemorrhagic pneumonia. During the necropsy, six intact dipterous larvae were recovered from the nasal fossae and cranial sinuses being identified as O. ovis. This is the first report of nasal myiasis in llamas due to O. ovis in Peru.

Inducción de ovulación en pacientes bajas respondedoras en fecundación in vitro: microdosis de acetato de leuprolide vs priming de estradiol

Objetivo: Comparar los protocolos de microdosis de acetato de leuprolide y priming de estradiol. Métodos: Estudio retrospectivo de 115 pacientes bajas respondedoras (según criterios de Bologna), evaluadas en UNIFERTES desde enero 2010 a diciembre 2012, sometidas a hiperestimulación ovárica controlada según protocolo. La inducción ovárica constó de pauta fija con gonadotropinas (hormona folículo estimulante recombinante 450 UI/día + Gonadotropina menopaúsica humana 150 UI/día); realizando disparo de ovulación con 10.000 UI gonadotropina coriónica humana urinaria al obtener 2 o 3 folículos entre 17-18 mm de diámetro. Se realizó aspiración folicular con aguja bilumen a las 35 horas del disparo, fecundación in vitro en medios secuenciales y transferencia embrionaria al día 3. El soporte de fase lútea constó de progesterona natural micronizada 600 mg/día y valerato de estradiol 4 mg/día. Se realizó prueba de embarazo cuantitativa a los quince días y verificación de embriocardia al mes. Se compara: tasa de cancelación, días de estimulación, número de ovocitos aspirados, tasa de embarazo clínico por transferencia y tasa de aborto. Resultados: Se incluyeron 115 pacientes: 69 al protocolo de microdosis y 46 al de priming de estradiol. No hubo diferencias estadísticas entre ambos protocolos en cuanto a: número de ovocitos aspirados, tasa de embarazo clínico y aborto. Los días de estimulación y la dosis total de gonadotropinas fue mayor con microdosis. Conclusiones: Aunque no hubo diferencias estadísticamente significativas entre ambos protocolos, el de priming de estradiol por tener menos días de estimulación y dosis totales de gonadotropinas menores, implica mayor bienestar de la paciente.

Objective: To compare microdose leuprolide acetate protocols and Estradiol Priming. Methods: Retrospective study of 115 low-responding patients (according to Bologna Criteria), evaluated at UNIFERTES from January 2010 to December 2012, who underwent controlled ovarian hyperstimulation as per Microdose leuprolide acetate protocol or Estradiol Priming Protocols. Ovarian induction consisted of a set standard with gonadotropins, 450UI/day recombinant follicle-stimulating hormone + 150UI/day Human Menopausal Gonadotropin; performing an ovulation trigger shot with 10,000UI urinary human chorionic gonadotropin when obtaining 2 to 3 follicles of 17-18mm diameter. Follicular aspiration is performed with double lumen needle, 35 hours from trigger shot with in vitro fertilization in sequential media, and embryo transfer on day 3. Luteal phase support consisted of 600mg/day micronized natural progesterone and 4mg/day of estradiol valerate. Quantitative pregnancy test was carried out at fifteen days and embryo cardiac activity validation at one month. The following are compared: cancellation rate, stimulation days, number of aspirated oocytes, rate of clinical pregnancy by transfer and abortion rate. Results: 115 patients were included: 69 underwent microdose leuprolide acetate protocol flare and 46 underwent estradiol priming. There were no statistical differences between both protocols with regards to: number of aspirated oocytes, rate of clinical pregnancy by transfer and abortion rate. Stimulation days and therefore, gonadotropins total dosage was greater with microdose leuprolide acetate protocol. Conclusions: Even though there were no significant statistical differences between both protocols, estradiol priming entails greater patient’s wellbeing, since it requires less stimulation days and less gonadotropin total dosages.

Molecular and morphological evidence of Taenia omissa in pumas (Puma concolor) in the Peruvian Highlands / Evidência molecular e morfológica de Taenia omissa em onça-pardas (Puma concolor) dos Andes Peruanos

Abstract A total of 41 cestodes were collected during necropsy examination on 2 pumas (Puma concolor) that were found in 2 communities in Canchis province, Cuzco region, Peru, at 4500 meters above sea level (Peruvian Andes). The cestodes were evaluated morphologically and molecularly. A fragment of the mitochondrial cytochrome c oxidase subunit 1 gene (cox1) was used as a genetic marker. All the cestodes were identified as Taenia omissa. In the present report, we give a brief description by molecular and morphological diagnosis of the cestodes and compare nucleotide sequences with previous isolates from GenBank. Upon comparison, the sequences showed a difference in the cox1 gene of 5.1 to 5.3% with other teniids sequences. This finding constitutes the first report of T. omissa in Peru and expands the geographic distribution of this parasite.

Resumo Um total de quarenta e um cestóides foram coletados durante a necropsia de duas onça-pardas (Puma concolor) encontradas em duas comunidades na província de Canchis, em Cuzco, a 4500 metros acima do nível do mar, nos Andes peruanos. Os cestóides foram avaliados morfologicamente e molecularmente. Um fragmento do gene citocromo C oxidase subunidade 1 (cox1) foi utilizado como marcador genético. Todos os cestóides foram identificados como Taenia omissa. No presente relato, dá-se uma breve descrição dos cestóides e compara-se sequências de nucleotídeos com isolados anteriores presentes no GenBank. Após a comparação, as sequências mostraram uma diferença de 5,1-5,3% entre o gene cox1 e outras sequências de tênias. Esse achado constitui o primeiro relato de T. omissa no Peru e amplia a informação sobre a distribuição geográfica deste parasita.