Platelet-rich plasma or blood-derived products to improve endometrial receptivity?

The use of platelet-rich plasma (PRP) to improve endometrial receptivity is gaining increasing attention in assisted reproduction technologies. The authors report that autologous PRP intrauterine administration improves pregnancy and birth rates, particularly in cases of patients presenting poor endometrial growth. Different groups of scientists proposed a similar approach years ago using whole blood-derived products also to improve endometrial receptivity. The important role played by cytokines and growth factors during embryo implantation has been well-known for a long time. These signaling molecules are present and released by blood cells during physiological, normal endometrial growth and implantation. Similar blood mediators are released from platelet granules upon a blood vessel injury. Methods described for PRP preparation for intrauterine administration are not precise, and they seem to be similar to those used to prepare peripheral blood-derived products. Thus, it is possible that when preparing PRP from whole blood, the final plasma product used as "PRP" contains platelets in addition to the important cytokines and growth factors released by the peripheral blood mononuclear cells present in the whole blood. Precise knowledge of the identity, concentration, and effects of the individual blood factors, their origin, whether platelets or blood mononuclear cells, will greatly contribute to improve and to make results obtained in fertility treatments more repeatable.

The impact of age on blastocyst scoring after single and double embryo transfers.

OBJECTIVE: The aim of the present study was to assess the putative relationship between patient's age and blastocyst scores, in single (SET) or double (DET) transfer cycles, that resulted in single or twin pregnancy or non-pregnancy. Second, we analyzed the effect of maternal age on clinical gestation and implantation rates after single and double blastocyst transfers. METHODS: Retrospective analysis of 164 assisted reproduction cycles with embryo transfers. RESULTS: Data demonstrated that for both, young (<35 years of age) and older (≥35 years of age) women, trophectoderm (TE) score is the most important parameter to assess concerning embryo selection. However, inner cell mass (ICM) also plays an important role on blastocyst selection in the group of older patients. In addition, our data shows that for young women the transfer of a single blastocyst results in similar gestational rates as those for DET. CONCLUSION: We suggest that blastocyst grading for patients aged 35 years or above shall be performed using a strict grading policy, possibly not of a single parameter, but TE, ICM and expansion grades together, to choose the "best combined-score blastocyst". DETs should be considered, particularly after previous cycles with pregnancy failures.

Avaliaçäo dos critérios utilizados na interpretaçäo da histerossalpingografia em esterilidade conjugal / Evaluation of the criteria used for hysterosalpingographic interpretation in sterile couples

Este trabalho foi realizado com o objetivo de comparar os achados da histerossalpingografia (HSG) na rotina da esterilidade conjugal, quando realizada por radiologistas que avaliavam apenas a permeabilidade tubária e por radiologistas que avaliavam, além dessa, outros fatores de comprometimento tubário. Foram estudadas 100 pacientes que consultaram a Fundaçao Universitária de Endocrinologia e Fertilidade. Os achados histerossalpingográficos foram comparados aos achados de laparoscopias diagnósticas (LD). Os serviços de radiologia foram divididos em dois grupos: A - quando o único critério de avaliaçao era a permeabilidade ou nao das trompas; B - quando, além desse, outros critérios como dilataçoes, fimoses, enovelamentos, dificuldade de escoamento, etc. eram avaliados e descritos no laudo radiológico. A concordância global entre os dois métodos (HSG e LD) ocorreu, somente, em 51 casos (51 por cento). Entretanto, nas pacientes do primeiro grupo (47 casos), houve concordância em apenas sete casos (14,89 por cento); de outro modo, no segundo grupo (53 casos), a concordância foi de 44 casos (83,1 por cento). Conclui-se, portanto, que o critério único de permeabilidade das trompas nao traduz com fidelidade o estado de patologia tubária, induzindo o clínico a um diagnóstico incorreto de higidez tubária com sérias implicaçoes no prognóstico e na terapêutica a ser instituída.