ART in Latin America: the Latin American Registry, 2020.

RESEARCH QUESTION: What was the utilization, effectiveness and safety of assisted reproductive technology (ART) in Latin America during 2020? DESIGN: Retrospective collection of multinational data on ART performed by 188 institutions in 16 countries. RESULTS: Overall, 87,732 initiated cycles resulted in 12,778 deliveries and 14,582 births. The major contributors were Brazil (46.0%), Mexico (17.0%) and Argentina (16.8%). However, the highest utilization (cycles/million inhabitants) was Uruguay with 558, followed by Argentina with 490 and Panama with 425 cycles/million. Globally, women aged ≥40 years increased to 34% while women ≤34 dropped to 24.7%. After removing freeze-all cycles, the delivery rate per oocyte retrieval was 14.8% for intracytoplasmic sperm injection and 15.6% for IVF. Single-embryo transfer (SET) represented 38.3% of all fresh transfers, with delivery rate per transfer of 20.0%; this increased to 32.4% for elective SET (eSET) and 34.2% for blastocyst eSET, compared with blastocyst elective double embryo transfer (eDET) of 37.9%. However, multiple births increased from 1% in eSET to 30.5% in eDET. Perinatal mortality increased from 7.7‰ in singletons to 24.4‰ in twins and 64.0‰ in triplets. Frozen embryo transfer (FET) represented 66.6% of all transfers, with a delivery rate/transfer of 29.0%, significantly higher than 23.9% after fresh transfers at all ages (P < 0.0001). Preimplantation genetic testing, reported in 8920 cycles, significantly improved delivery rate and decreased miscarriage rates at all ages (P ≤ 0.041), including oocyte donation (P = 0.002). Endometriosis was diagnosed in 28.3% of cases. The delivery rate in 5779 women after removal of peritoneal endometriosis was significantly better than tubal and endocrine factors in women aged 35-39 (P = 0.0004) and women aged ≥40 (P = 0.0353). CONCLUSIONS: Systematic collection and analysis of big data in a south-south cooperation model allow regional growth by implementing evidence-based reproductive decisions.

[The value of paternal age on the outcome of intrauterine insemination]. / El valor de la edad paterna en los resultados de inseminación intrauterina.

BACKGROUND: Although age to conceive has been delayed in both males and females, male age is controversial as decisive for this purpose. OBJECTIVE: To describe the results of intrauterine insemination pregnancy according to the age of the man. To determine whether this variable modifies semen parameters. To analyze whether pregnancy outcomes are modified by sperm morphology. PATIENTS AND METHODS: A descriptive, retrospective, longitudinal and analytical study. We analyzed 2,276 intrauterine insemination cycles performed in the Mexican Center for Fertility CEPAM from January 2000 to December 2012. We included only women under 35 years old without tubal occlusion. Semen parameters were evaluated after capacitation and the pregnancy rate by male age group and sperm morphology was analyzed. The results were analyzed with SPSS 20. Continuous variables were reported as means and their standard deviations and logistic regression univariate to determine the statistical significance. The categorical variables were evaluated in frequencies and percentages. RESULTS: 2,276 intrauterine insemination cycles were pooled according to the age of the male. The lower pregnancy rate was found in the group of men over 50 years. There was negative correlation between the increasing age with the total motile cell volume and morphology. There was only one pregnancy from a male over 50 years. When morphology was less than 4%, the pregnancy rate was significantly lower after 45 years; if it was more than 4% this effect was not observed. CONCLUSION: Male age affects pregnancy outcomes in intrauterine insemination cycles, as long as the sperm morphology is altered.

[Report of the seminal characteristics in patients with consecutive pregnancy to intrauterine insemination and his perinatal complications]. / Influencia del estudio seminal en el éxito de la inseminación intrauterina y en las complicaciones perinatales.

BACKGROUND: It is reported that pregnancies achieved through assisted reproductive techniques have increased risk of complications. There is doubt as to whether this increase is attributable to the underlying infertility or to the assisted reproduction techniques. Postcapacitation seminal parameters have been mentioned as determinants of success. OBJECTIVES: To describe semen parameters of patients at the Mexican Fertility Center (CEPAM) who achieved pregnancy with intrauterine insemination and compare the causes of perinatal morbidity and mortality with those of the general population. PATIENTS AND METHODS: A descriptive, retrospective (2004-2009), analytical and longitudinal study based on analysis of intrauterine insemination cycles that achieved pregnancy with prenatal care and childbirth. The variables studied were: pregnancy, obstetric complications and postcapacitation semen parameters. For the analysis the data was divided according to sperm morphology. The results were analyzed using SPSS-20. Continuous variables were reported as means, and their standard deviations and logistic regression as univariate to determine the statistical significance. The categorical variables were evaluated in frequencies and percentages. RESULTS: 133 cases were analyzed, 78% with normal morphology over 4%, mean semen parameters: 0.63 mL volume, density 82.72 million/mL, progressive motility 88.5% and normal morphology over 4% of 5.93%. The 16.6% of pregnancies were twins. 18.5% was abortion, 69% was cesarean section and 30% vaginal delivery. No differences were found in any of the variables when comparing normal sperm morphology groups lower and higher than 4%, except in patients with abortion. There was no increased incidence of perinatal complications than in the general population. CONCLUSIONS: Perinatal complications incidence is similar to the general population, except in multiple pregnancy. There is more success in intrauterine insemination when the postcapacitation morphology is over 4%.

ART in Latin America: the Latin American Registry, 2020.

RESEARCH QUESTION: What was the utilization, effectiveness and safety of assisted reproductive technology (ART) in Latin America during 2020? DESIGN: Retrospective collection of multinational data on ART performed by 188 institutions in 16 countries. RESULTS: Overall, 87,732 initiated cycles resulted in 12,778 deliveries and 14,582 births. The major contributors were Brazil (46.0%), Mexico (17.0%) and Argentina (16.8%). However, the highest utilization (cycles/million inhabitants) was Uruguay with 558, followed by Argentina with 490 and Panama with 425 cycles/million. Globally, women aged ≥40 years increased to 34% while women ≤34 dropped to 24.7%. After removing freeze-all cycles, the delivery rate per oocyte retrieval was 14.8% for intracytoplasmic sperm injection and 15.6% for IVF. Single-embryo transfer (SET) represented 38.3% of all fresh transfers, with delivery rate per transfer of 20.0%; this increased to 32.4% for elective SET (eSET) and 34.2% for blastocyst eSET, compared with blastocyst elective double embryo transfer (eDET) of 37.9%. However, multiple births increased from 1% in eSET to 30.5% in eDET. Perinatal mortality increased from 7.7‰ in singletons to 24.4‰ in twins and 64.0‰ in triplets. Frozen embryo transfer (FET) represented 66.6% of all transfers, with a delivery rate/transfer of 29.0%, significantly higher than 23.9% after fresh transfers at all ages (p<0.0001). Preimplantation genetic testing, reported in 8920 cycles, significantly improved delivery rate and decreased miscarriage rates at all ages (p≤0.041), including oocyte donation (p=0.002). Endometriosis was diagnosed in 28.3% of cases. The delivery rate in 5779 women after removal of peritoneal endometriosis was significantly better than tubal and endocrine factors in women aged 35-39 (p=0.0004) and women aged ≥40 (p=0.0353). CONCLUSIONS: Systematic collection and analysis of big data in a south-south cooperation model allow regional growth by implementing evidence-based reproductive decisions.

Cirugía pancreatobiliar laparoscópica: experiencia inicial en el hospital regional de alta especialidad.

BACKGROUND: At present benign and malignant pancreatobiliar diseases, required a multidisciplinary management, and the different techniques to solve this pathology has been improve with new technology and surgeons training. OBJECTIVE: The purpose of this article is to describe that de minimally invasive surgery on benign and malignant pancreatobiliar diseases is feasible and offer good results. METHOD: In Hospital regional ISSSTE Puebla from July 2013 to July 2018, 30 consecutive patients with different pancreas and biliary pathologies have been operated by totally laparoscopic, by the same surgeon and surgical team, and following for up to 4 years. RESULTS: None all the patients presented sever complications during surgery or after immediate surgery and no reoperations. Surgical time and blood loss was acceptable. CONCLUSION: The results we obtained are positive and encouraging because the morbidity and mortality are similar to the different sources we reviewed, nevertheless, this study is our initial experience and we required more cases to obtain a significant sample.

ANTECEDENTES: En la actualidad las enfermedades benignas y malignas de las vías biliares y del páncreas requieren un manejo multidisciplinario, y las técnicas para resolver este tipo de padecimientos han avanzado gracias al mejoramiento en la tecnología y la capacidad del personal humano. OBJETIVO: El propósito de este trabajo es presentar varios casos y demostrar que la cirugía de mínima invasión en patología benigna y maligna pancreatobiliar es viable y se pueden obtener adecuados resultados. MÉTODO: De julio de 2013 a julio de 2018, 30 pacientes consecutivos han sido intervenidos quirúrgicamente por vía laparoscópica por diversas enfermedades que involucran páncreas y vías biliares, por el mismo cirujano y equipo quirúrgico, con un seguimiento de hasta 4 años. RESULTADOS: Ninguno de los pacientes intervenidos presentó complicaciones graves en el transoperatorio ni en el posquirúrgico inmediato, ninguno fue sometido a una segunda cirugía y los tiempos quirúrgicos y el sangrado fueron aceptables. CONCLUSIÓN: Los resultados son positivos y muy alentadores, ya que la morbilidad fue muy similar a la de las series que se revisaron; sin embargo, este estudio es nuestra experiencia inicial y requerimos aumentar el número de casos para obtener una muestra significativa.

Laparoscopic pancreatoduodenectoy.

BACKGROUND: Pancreatoduodenectomy or Whipple's operation, is the elective surgical procedure to treat different periampullary diseases. Through the years this surgery has been doing open, but in the lasts decades thanks to the improve technology and trained surgeons, today is feasible doing it laparoscopic with good results. OBJECTIVE: To present the initial experience and results in totally laparoscopic pancreatoduodenectomy in Hospital Regional ISSSTE Puebla, reporting the second number of cases in México. METHOD: Since July 2014-July 2018, 8 patients has been operated by totally laparoscopic pancreatoduodenectomy, 7 in Hospital Regional ISSSTE Puebla and 1 in a private Hospital. RESULTS: Evaluating all the patients, not one had mortality during operation, no morbidity or immediate reoperation, so the results are favourable. CONCLUSION: Laparoscopic pancreatoduodenectomy is a very complex procedure but feasible, and good results depends on various factors, like the appropriate patient selection.

ANTECEDENTES: La pancreatoduodenectomía o cirugía de Whipple es el procedimiento de elección en el tratamiento de las enfermedades periampulares. A través de los años se ha realizado de manera abierta, y actualmente, gracias a la mejora de los recursos humanos y tecnológicos, se realiza este procedimiento por mínima invasión con buenos resultados. OBJETIVO: Presentar la experiencia inicial en la pancreatoduodenectomía totalmente laparoscópica en el Hospital de Alta Especialidad del Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE) de Puebla, dando a conocer la segunda serie de casos reportada en México. MÉTODO: De julio de 2014 a julio de 2018 se han realizado ocho pancreatoduodenectomías totalmente laparoscópicas, siete en el hospital de alta especialidad ISSSTE Puebla y una en un hospital privado. RESULTADOS: En todos los pacientes intervenidos los resultados son favorables, sin mortalidad transoperatoria y sin presentar complicaciones graves ni reintervención. CONCLUSIÓN: La pancreatoduodenectomía laparoscópica es un procedimiento de alta complejidad que, teniendo una adecuada selección de pacientes y un manejo multidisciplinario, se puede llevar a cabo con excelentes resultados.