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OBJECTIVE: The posterior cingulate cortex (PCC)/precuneus is a key hub of the default mode network, whose function is known to be altered in epilepsy. Glutamate and γ-aminobutyric acid (GABA) are the main excitatory and inhibitory neurotransmitters in the central nervous system, respectively. Glutathione (GSH) is the most important free radical scavenging compound in the brain. Quantification of these molecules by magnetic resonance spectroscopy (MRS) up to 4 T is limited by overlapping resonances from other molecules. In this study, we used ultra-high-field (7 T) MRS to quantify their concentrations in patients with different epilepsy syndromes. METHODS: Nineteen patients with temporal lobe epilepsy (TLE) and 16 with idiopathic generalized epilepsy (IGE) underwent magnetic resonance imaging scans using a 7-T research scanner. Single-voxel (8 cm3 ) MRS, located in the PCC/precuneus, was acquired via stimulated echo acquisition mode. Their results were compared to 10 healthy volunteers. RESULTS: Mean concentrations of glutamate, GABA, and the glutamate/GABA ratio did not differ between the IGE, TLE, and healthy volunteer groups. The mean ± SD concentration of GSH was 1.9 ± 0.3 mmol·L-1 in healthy controls, 2.0 ± 0.2 mmol·L-1 in patients with TLE, and 2.2 ± 0.4 mmol·L-1 in patients with IGE. One-way analysis of variance with post hoc Tukey-Kramer test revealed a significant difference in the concentration of GSH between patients with IGE and controls (P = .03). Short-term seizure freedom in patients with epilepsy was predicted by an elevated concentration of glutamate in the PCC/precuneus (P = .01). In patients with TLE, the concentration of GABA declined with age (P = .03). SIGNIFICANCE: Patients with IGE have higher concentrations of GSH in the PCC/precuneus than healthy controls. There is no difference in the concentrations of glutamate and GABA, or their ratio, in the PCC/precuneus between patients with IGE, patients with TLE, and healthy controls. Measuring the concentration of glutamate in the PCC/precuneus may assist with predicting drug response.
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Epilepsia/metabolismo , Ácido Glutâmico/análise , Glutationa/análise , Giro do Cíngulo/química , Lobo Parietal/química , Ácido gama-Aminobutírico/análise , Adulto , Idoso , Estudos de Casos e Controles , Epilepsia Generalizada/metabolismo , Epilepsia do Lobo Temporal/metabolismo , Humanos , Espectroscopia de Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Adulto JovemRESUMO
The default mode network (DMN) is a major neuronal network that deactivates during goal-directed tasks. Recent advances in neuroimaging have shed light on its structure and function. Alterations in the DMN are increasingly recognized in a range of neurological and psychiatric conditions including epilepsy. This review first describes the current understanding of the DMN in health, normal aging, and disease as it is acquired via resting-state functional magnetic resonance imaging (MRI), before focusing on how it is affected in various types of focal and generalized epilepsy. These findings support the potential use of DMN parameters as future biomarkers in epilepsy research, diagnosis, and management.
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Encéfalo/diagnóstico por imagem , Rede de Modo Padrão/diagnóstico por imagem , Epilepsia/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos , Descanso , Encéfalo/fisiopatologia , Mapeamento Encefálico/métodos , Rede de Modo Padrão/fisiopatologia , Epilepsia/fisiopatologia , Feminino , Humanos , Masculino , Rede Nervosa/diagnóstico por imagem , Rede Nervosa/fisiopatologia , Descanso/fisiologiaRESUMO
RESEARCH QUESTION: What are the safety and feasibility of repeated subcutaneous doses of gonadotrophin-releasing hormone (GnRH) agonist for luteal support in IVF cycles triggered by a GnRH agonist? DESIGN: In this prospective trial, patients exhibiting oestradiol concentrations of over 2500 pg/ml after use of a GnRH agonist for triggering ovulation were initially randomized to GnRH agonist luteal support (0.1 mg subcutaneously every other day, starting on day 3 after embryo transfer) or to a control group supported by 80 µg of recombinant human chorionic gonadotrophin (HCG) on day 3 after embryo transfer. All patients underwent a day 5 blastocyst transfer. Randomization to the HCG luteal support was stopped owing to two cases of ovarian hyperstimulation syndrome (OHSS) and the study was continued solely with GnRH agonist luteal support. RESULTS: The study included 39 women in the repeated GnRH agonist luteal support group and seven in the HCG micro dose group. There were no cases of OHSS among patients supported by a GnRH agonist, and no other adverse events were recorded. There were no cases of bleeding before the pregnancy test, and hence no cases of an insufficient luteal phase. A clinical pregnancy rate of 43.6% was achieved with GnRH agonist luteal support. Hormone dynamics during the stimulation cycle reflected rising LH and progesterone concentrations after the introduction of GnRH agonist support. CONCLUSIONS: Repeated doses of GnRH agonist every other day as a method of luteal support provided safe and effective luteal support for women who underwent GnRH agonist triggering in a GnRH antagonist IVF cycle.
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Corpo Lúteo/efeitos dos fármacos , Transferência Embrionária , Hormônio Liberador de Gonadotropina/agonistas , Fase Luteal/efeitos dos fármacos , Adulto , Blastocisto , Estradiol/metabolismo , Feminino , Fertilização in vitro , Humanos , Oócitos/citologia , Síndrome de Hiperestimulação Ovariana , Indução da Ovulação/métodos , Gravidez , Taxa de Gravidez , Progesterona/metabolismo , Estudo de Prova de Conceito , Estudos ProspectivosRESUMO
AIM: To evaluate the number of oocytes retrieved as a criterion - when to use a "freeze-all" or low-dose "rescue human chorionic gonadotropin (hCG)" strategy. METHODS: A retrospective study. Instead of the classic hCG trigger, an E2 level of ≥3,000 pg/mL was used to trigger ovulation with GnRH agonist. The decision whether to "freeze all" or perform fresh embryo transfer (ET) with a bolus of hCG was made based on a maximum number of 20 oocytes retrieved. Beyond this cut off, a "freeze-all" strategy was implemented. Below this cut-off value, a fresh ET using a single bolus of 62.5 µg hCG on day 3 following oocyte pick-up was performed. The main outcome measures were clinical pregnancy rates and ovarian hyperstimulation syndrome (OHSS). RESULTS: E2 and progesterone levels increased after the rescue hCG bolus administration (E2 from 643.4 ± 311.1 to 1,086.1 ± 574.7 pg/mL, p = 0.003 and progesterone from 13.1 ± 4.8 to 39.2 ± 28.7 ng/mL, p < 0.0001). The clinical pregnancy rates were 25% in the freeze-all group and 32% in the rescue hCG group (p = 0.57). OHSS was not reported in either group. CONCLUSIONS: Both strategies seem to be efficacious and safe. An upper limit of 20 retrieved oocytes appears to be safe for applying a rescue hCG strategy.
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Criopreservação/métodos , Hormônio Liberador de Gonadotropina/uso terapêutico , Recuperação de Oócitos/métodos , Oócitos/efeitos dos fármacos , Indução da Ovulação/métodos , Adulto , Feminino , Humanos , Recuperação de Oócitos/estatística & dados numéricos , Síndrome de Hiperestimulação Ovariana/prevenção & controle , Projetos Piloto , Gravidez , Taxa de Gravidez , Estudos RetrospectivosRESUMO
The aim of our study was to evaluate time lapse microscopy (TLM) as a selection tool for single-embryo transfer (SET) on day 5, blastocyst stage. An observational cohort study was conducted. Patients who had SET were compared to patients who had double embryo transfer (DET). A total of 108 patients were included in analysis, 83 had SET, and 25 underwent DET. Embryos were incubated and evaluated using TLM. The pregnancy rates were similar between the groups (42.2% in SET and 48.0% in DET). However, the multiple pregnancy rate was significantly higher in the DET group compared to the SET group (41.7% versus 2.9%, respectively; p < 0.001). This study concludes that SET with TLM do not decrease pregnancy rates compared to DET. However, transfers of two embryos increase the rate of multiple pregnancies.
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Transferência Embrionária/métodos , Microscopia/métodos , Gravidez Múltipla , Transferência de Embrião Único/métodos , Adulto , Feminino , Humanos , GravidezRESUMO
OBJECTIVE: To determine factors that affect the success rate of GnRH antagonist protocol in in vitro fertilization (IVF) treatment. DESIGN: Retrospective cohort study. PATIENTS: Patients who underwent IVF cycle with their first GnRH antagonist protocol. INTERVENTION: Antagonist protocol during IVF treatment. The main outcome measurements were; Number of retrieved oocytes, embryo quality and pregnancy rate. RESULTS: Gravidity was negatively correlated with number of eggs (p = 0.017), while total follicle number ≥15 (p = 0.044) and E(2) on day of human chorionic gonadotropin (HCG) (p = 0.000) had a positive correlation with number of eggs. Maximum follicle size at HCG administration showed a trend toward an inverse correlation (p = 0.053). Addition of LH to drug stimulation was negatively correlated with number of eggs in comparison to rFSH only (p = 0.013 and 0.0000, respectively). Age and number of frozen eggs were negatively correlated with successful pregnancy (p = 0.025 and 0.004, respectively), while embryo quality, gravidity and number of embryos were positive (p = 0.011 and 0.014, respectively). CONCLUSION: Controlled parameters like timing of antagonist start, duration of antagonist and the optimal leading follicle diameter for HCG triggering had no effect on treatment outcomes.
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Estradiol/sangue , Fármacos para a Fertilidade/uso terapêutico , Hormônio Liberador de Gonadotropina/antagonistas & inibidores , Antagonistas de Hormônios/uso terapêutico , Folículo Ovariano/diagnóstico por imagem , Indução da Ovulação/métodos , Taxa de Gravidez , Adulto , Gonadotropina Coriônica/uso terapêutico , Protocolos Clínicos , Estudos de Coortes , Técnicas de Apoio para a Decisão , Transferência Embrionária , Embrião de Mamíferos , Feminino , Fertilização in vitro , Hormônio Foliculoestimulante/uso terapêutico , Humanos , Modelos Lineares , Hormônio Luteinizante/uso terapêutico , Menotropinas/uso terapêutico , Recuperação de Oócitos , Gravidez , Proteínas Recombinantes/uso terapêutico , Estudos Retrospectivos , Resultado do Tratamento , UltrassonografiaRESUMO
Sandfly viruses are arthropod-borne viruses that are endemic in the Mediterranean basin. The Toscana virus (TOSV) is the only serotype of sandfly viruses known to cause neurological symptoms in humans, usually aseptic meningitis or meningoencephalitis. We report a case of a 39-year-old man who was admitted to our department with progressive paresthesias of the lower limbs followed by dysesthesias of the upper thorax after a hiking trip to the Netherlands. The patient had also been suffering from epididymitis for several weeks before the neurological symptoms appeared but was treated by antibiotics accordingly. Lumber puncture results demonstrated mononuclear pleocytosis with elevated protein levels. MRI of the lumbar spine revealed polymyeloradiculopathy. Positive IgM antibodies against the Toscana serotype of sandfly virus were discovered in the patient's blood and CSF. There was also evidence for a recent infection by Mycoplasma pneumoniae. The patient was treated conservatively with improvement in his neurological state. To the best of our knowledge, this is the first case report of an association between TOSV infection and polymyeloradiculopathy.
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Parestesia/diagnóstico , Parestesia/patologia , Febre por Flebótomos/diagnóstico , Radiculopatia/diagnóstico , Vírus da Febre do Flebótomo Napolitano/isolamento & purificação , Adulto , Anticorpos Antivirais/sangue , Anticorpos Antivirais/líquido cefalorraquidiano , Humanos , Masculino , Parestesia/virologia , Febre por Flebótomos/patologia , Febre por Flebótomos/virologia , Radiculopatia/patologia , Radiculopatia/virologia , Medula Espinal/patologia , Medula Espinal/virologiaRESUMO
Cortical excitability can be modulated using repetitive transcranial magnetic stimulation (rTMS). Previously, we showed that rTMS combined with cognitive training (rTMS-COG) has positive results in Alzheimer's disease (AD). The goal of this randomized double-blind, controlled study was to examine the safety and efficacy of rTMS-COG in AD. Fifteen AD patients received 1-h daily rTMS-COG or sham treatment (seven treated, eight placebo), five sessions/week for 6 weeks, followed by biweekly sessions for 3 months. The primary outcome was improvement of the cognitive score. The secondary outcome included improvement in the Clinical Global Impression of Change (CGIC) and Neuropsychiatric Inventory (NPI). There was an improvement in the average ADAS-cog score of 3.76 points after 6 weeks in the treatment group compared to 0.47 in the placebo group and 3.52 points after 4.5 months of treatment, compared to worsening of 0.38 in the placebo (P = 0.04 and P = 0.05, respectively). There was also an improvement in the average CGIC score of 3.57 (after 6 weeks) and 3.67 points (after 4.5 months), compared to 4.25 and 4.29 in the placebo group (mild worsening) (P = 0.05 and P = 0.05, respectively). NPI improved non-significantly. In summary, the NeuroAD system offers a novel, safe and effective therapy for improving cognitive function in AD.
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Doença de Alzheimer/reabilitação , Doença de Alzheimer/terapia , Terapia Cognitivo-Comportamental/métodos , Estimulação Magnética Transcraniana/métodos , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Método Duplo-Cego , Feminino , Seguimentos , Humanos , Imageamento por Ressonância Magnética , Masculino , Testes Neuropsicológicos , Cooperação do Paciente , Escalas de Graduação Psiquiátrica , Resultado do TratamentoRESUMO
PURPOSE: Despite availability of commercial EEG software for automated epileptiform detection, validation on real-world EEG datasets is lacking. Performance evaluation of two software packages on a large EEG dataset of patients with genetic generalized epilepsy was performed. METHODS: Three epileptologists labelled IEDs manually of EEGs from three centres. All Interictal epileptiform discharge (IED) markings predicted by two commercial software (Encevis 1.11 and Persyst 14) were reviewed individually to assess for suspicious missed markings and were integrated into the reference standard if overlooked during manual annotation during a second phase. Sensitivity, precision, specificity, and F1-score were used to assess the performance of the software packages against the adjusted reference standard. RESULTS: One hundred and twenty-five routine scalp EEG recordings from different subjects were included (total recording time, 310.7 hours). The total epileptiform discharge reference count was 5,907 (including spikes and fragments). Encevis demonstrated a mean sensitivity for detection of IEDs of 0.46 (SD 0.32), mean precision of 0.37 (SD 0.31), and mean F1-score of 0.43 (SD 0.23). Using the default medium setting, the sensitivity of Persyst was 0.67 (SD 0.31), with a precision of 0.49 (SD 0.33) and F1-score of 0.51 (SD 0.25). Mean specificity representing non-IED window identification and classification was 0.973 (SD 0.08) for Encevis and 0.968 (SD 0.07) for Persyst. CONCLUSIONS: Automated software shows a high degree of specificity for detection of nonepileptiform background. Sensitivity and precision for IED detection is lower, but may be acceptable for initial screening in the clinical and research setting. Clinical caution and continuous expert human oversight are recommended with all EEG recordings before a diagnostic interpretation is provided based on the output of the software.
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OBJECTIVE: To evaluate if monitoring patients by ultrasound (US) only during in vitro fertilization (IVF) treatment is safe. DESIGN: Randomized prospective study. INTERVENTION: Patients undergoing their first IVF treatment were randomized into two groups. The ultrasound only group (study group) was monitored by US for follicle size and endometrial thickness without blood tests. In this group, only one blood test was taken before human chorionic gonadotropin (hCG) injection, to ensure a safe level of estradiol (E(2)) regarding ovarian hyperstimulation syndrome (OHSS) risk. The control group was monitored by ultrasound plus serum estradiol and progesterone concentration at each visit. MAIN OUTCOME MEASURE: Clinical pregnancy rate. RESULTS: No differences were found between the groups in the parameters of IVF treatment, induction days, number of ampoules, E(2) level of hCG, as well as embryo quality. The clinical pregnancy rate was not statistically different between the groups, 57.5% vs. 40.0%, respectively (p = 0.25). No OHSS cases were found among the study or control groups. CONCLUSION: Ultrasound as a single monitoring tool for IVF cycles is reliable, safe, patient friendly, and reduces treatment expenses. In an era of cost effectiveness awareness, this regimen should be considered for routine management in IVF programs.
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Fertilização in vitro , Monitorização Fisiológica/métodos , Ultrassonografia Pré-Natal , Adulto , Análise Química do Sangue/métodos , Análise Química do Sangue/estatística & dados numéricos , Transferência Embrionária/métodos , Endométrio/diagnóstico por imagem , Feminino , Fertilização in vitro/métodos , Humanos , Infertilidade Feminina/sangue , Infertilidade Feminina/diagnóstico por imagem , Infertilidade Feminina/terapia , Ciclo Menstrual/sangue , Ciclo Menstrual/fisiologia , Folículo Ovariano/diagnóstico por imagem , Síndrome de Hiperestimulação Ovariana/diagnóstico por imagem , Síndrome de Hiperestimulação Ovariana/prevenção & controle , Indução da Ovulação/métodos , Projetos Piloto , Gravidez , Taxa de GravidezRESUMO
BACKGROUND AND PURPOSE: Derangements in brain glutamate, glutathione, and γ-amino butyric acid (GABA) are implicated in a range of neurological disorders. Reliable methods to measure these compounds non-invasively in vivo are needed. We evaluated the reproducibility of their measurements in brain regions involved in the default mode network using quantitative MRS at 7-Tesla in healthy individuals. METHODS: Ten right-handed healthy volunteers underwent 7-Tesla MRI scans on 2 separate days, not more than 2 weeks apart. On each day two scanning sessions took place, with a re-positioning break in between. High-resolution isotropic anatomical scans were acquired prior to each scan, followed by single-voxel 1H-MRS using the STEAM pulse sequence on an 8 mL midline cubic voxel, positioned over the posterior cingulate and precuneus regions. Concentrations were corrected for partial-volume effects. RESULTS: Maximal Cramér-Rao lower bounds for glutamate, glutathione, and GABA were 2.0, 8.0, and 14.0%, respectively. Mean coefficients of variation within sessions were 5.9 ± 4.8%, 9.3 ± 7.6%, and 11.5 ± 8.8%, and between sessions were 4.6 ± 4.5%, 8.3 ± 5.7%, and 9.2 ± 8.7%, respectively. The mean (±SD) Dice's coefficient for voxel overlap was 90 ± 4% within sessions and 86 ± 7% between sessions. CONCLUSION: Glutamate, glutathione, and GABA can be reliably quantified using STEAM MRS at 7-Tesla from the posterior cingulate and precuneus cortices of healthy human subjects. STEAM MRS at 7-Tesla may be used to study the metabolic behavior of this important resting-state hub in various disease states.
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The default mode network (DMN) is the main large-scale network of the resting brain and the PCC/precuneus is a major hub of this network. Glutamate and GABA (γ-amino butyric acid) are the main excitatory and inhibitory neurotransmitters in the CNS, respectively. We studied glutamate and GABA concentrations in the PCC/precuneus via magnetic resonance spectroscopy (MRS) at 7T in relation to age and correlated them with functional connectivity between this region and other DMN nodes in ten healthy right-handed volunteers ranging in age between 23-68 years. Mean functional connectivity of the PCC/precuneus to the other DMN nodes and the glutamate/GABA ratio significantly correlated with age (r = 0.802, p = 0.005 and r = 0.793, p = 0.006, respectively) but not with each other. Glutamate and GABA alone did not significantly correlate with age nor with functional connectivity within the DMN. The glutamate/GABA ratio and functional connectivity of the PCC/precuneus are, therefore, independent age-related biomarkers of the DMN and may be combined in a multimodal pipeline to study DMN alterations in various disease states.
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Ácido Glutâmico/análise , Rede Nervosa/fisiologia , Lobo Parietal/metabolismo , Descanso/fisiologia , Ácido gama-Aminobutírico/análise , Adulto , Fatores Etários , Idoso , Mapeamento Encefálico/métodos , Feminino , Ácido Glutâmico/metabolismo , Voluntários Saudáveis , Humanos , Espectroscopia de Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Imageamento por Ressonância Magnética Multiparamétrica/métodos , Rede Nervosa/diagnóstico por imagem , Lobo Parietal/diagnóstico por imagem , Adulto Jovem , Ácido gama-Aminobutírico/metabolismoRESUMO
BACKGROUND: IVF cycles which result in only one good quality embryo, and a second poor quality embryo present a dilemma when the decision involves transferring two embryos. The aim of this study was to evaluate whether a poor quality embryo has a negative effect on a good quality embryo when transferred along with a good quality embryo. METHODS: We retrospectively evaluated in vitro fertilization (IVF) cycles involving single embryo transfers (SET) and double embryo transfers (DET). Embryo quality was divided into poor "P" and good "G" quality. The main outcome measures were: live birth, implantation rate, miscarriage rate, clinical pregnancy rate and multiple pregnancy ratio. RESULTS: Six hundred three women were included. The study group consisted of 180 (29.9%) patients who had a double embryo transfer (DET) with one poor quality embryo and one good quality embryo (P + G). Control 1 group included 303 (50.2%) patients who had DET with two good quality embryos (G + G), and control 2 group consisted of 120 (19.9%) patients who had a single embryo transfer (SET) with one good quality embryo (G). Live birth rates were not significantly different when compared between study groups: 30.8% in the SET group (G), 27.2% in the (G + P) group and 33.7% in the (G + G) group. The SET group had the highest implantation rate (33.9%) compared to the DET groups (21.8% (G + P), 25.4% (G + G)) (P =0.022). The clinical pregnancy rate was 33.3% in the SET group (G), 33.3% in the (G + P) group, and 39.3% in the (G + G) group (P =0.39). The miscarriage rate was comparable in all groups. CONCLUSION: A poor quality embryo does not negatively affect a good quality embryo, when transferred together in a double embryo transfer.
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Transferência Embrionária , Embrião de Mamíferos , Fertilização in vitro , Taxa de Gravidez , Adulto , Implantação do Embrião , Feminino , Humanos , Infertilidade Feminina/etiologia , Razão de Chances , Gravidez , Resultado da Gravidez , Estudos Retrospectivos , Transferência de Embrião ÚnicoRESUMO
BACKGROUND: Use of TPA to treat patients with acute ischemic stroke was introduced in Assaf Harofeh Medical Center (AHMC) in Israel in November 2007 initially with strict adherence to the inclusion/exclusion criteria of the pivotal NINDS TPA studies published in 1995. The treatment window was expanded in 2010 to 4.5h following the results of ECASS-III. Application of the 2013 AHA/ASA Guidelines resulted in further expanded inclusion and relaxed exclusion criteria. DESIGN/METHODS: A retrospective chart review was conducted of patients who received TPA at AHMC to evaluate the additional impact of applying the 2013 guidelines. Number of patients treated, outcomes at discharge, and safety were compared between two periods: May 2011-January 2013 (the 21months preceding the 2013 Guidelines); and February 2013-October 2014 (the 21months after publication of the 2013 Guidelines). Statistical analysis was done using z-tests for differences between proportions, and t-tests to compare means. RESULTS: 63 patients were treated during the immediate pre-2013 Guideline period (36/year, or approximately 5% of patients with ischemic stroke), and 105 during the post-2013 Guidelines period (60/year, approximately 8.3% of patients with ischemic stroke) (p<0.001). During the two periods, respectively: discharges home were 22(34%) and 55(52%) (p<0.05); facility discharges were 29(46%) and 33(31%); and inter-hospital transfers were 6(9%), and 11(10% of treated patients). Most transfers were for endovascular treatment. Total treatment-related symptomatic bleeds in the two periods, respectively, was: 4(6%) and 4(4%), and the number of in-hospital deaths was 6 (9%) and 6 (6%) (unchanged). CONCLUSIONS: Application of the 2013 AHA/ASA Guidelines resulted in a 64% increase in the number of acute ischemic stroke patients treated with TPA at AHMC with no worsening of aggregate outcomes and no increase in bleeds or deaths.
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Isquemia Encefálica/complicações , Medicina Clínica/normas , Fibrinolíticos/uso terapêutico , Acidente Vascular Cerebral/tratamento farmacológico , Acidente Vascular Cerebral/etiologia , Ativador de Plasminogênio Tecidual/uso terapêutico , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Hospitais/normas , Humanos , Israel/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Acidente Vascular Cerebral/epidemiologia , Resultado do TratamentoRESUMO
OBJECTIVE: Testing the ability to program IVF GnRH-antagonist cycles to avoid weekend oocyte retrieval. STUDY DESIGN: Preliminary randomized clinical trial. Patients presenting an indication for IVF or IVF-ICSI were assigned into either the Treatment Group - GnRH antagonist protocol, programmed to start stimulatory agents on a Friday, with oral 2mg estradiol valerate twice a day from the 2nd day of cycle until the first Friday to follow, or to the Control Group - long luteal GnRH agonist protocol. RESULTS: The performance of 27 Treatment Group patients and 24 Control Group patients was analyzed. Cycle dynamics were not clinically or statistically different except for a significant difference in the number of follicles measuring ≥18 mm on hCG administration day. There were no differences in the number of aspirated ova, fertilization rates, embryo quality or number of embryos to be transferred. Pregnancy rate was 41.7% in the Treatment Group and 50% in the Control Group (P>0.5). Only one patient assigned to the Treatment Group had a weekend retrieval. CONCLUSIONS: Preliminary results demonstrate no compromise related to follicular estrogen programming in a GnRH antagonist protocol and provide reassurance regarding the ability to achieve programming goals.
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Estradiol/análogos & derivados , Hormônio Liberador de Gonadotropina/agonistas , Hormônio Liberador de Gonadotropina/antagonistas & inibidores , Indução da Ovulação/métodos , Adulto , Estradiol/administração & dosagem , Feminino , Humanos , Gravidez , Taxa de Gravidez , Adulto JovemRESUMO
Total motile count (TMC) is a useful tool for sperm evaluation, comprising both quantitative and motility parameters. Although frequently used, TMC has not yet been evaluated as a contributory variable for intracytoplasmic sperm injection (ICSI) cycles. In this study we evaluate the possible role of TMC as a prognostic parameter in cycles designated for ICSI. We also test the existence of a possible TMC-threshold value that might be predictive for ICSI cycle outcome in the everyday practice. This is a retrospective cohort study in which the research question is addressed by a locally weighted regression (LOESS) analysis. Primary outcome measures are fertilization rate, good quality embryos rate and implantation rate. A total of 666 patients were included, contributing 1456 cycles. The effect of TMC over the fertilization rate was significant, depicting an inverted U-shaped curve: with up to approximately 10 million motile sperm, fertilization rates increased as TMC increased, but from this point on decreased. A slight increment in the rate of good embryo formation with increasing value of TMC was noted, but this did not reach a statistical significance. TMC values demonstrated no effect in the case of implantation rates. ICSI may offer an advantage related to fertilization rates for the sub-fertile male population, with a motile sperm count up to 10 million.