Colocación del dispositivo intratubárico Essure® en pacientes con hidrosalpinx antes de someterse a técnicas de reproducción asistida como un método alternativo para salpinguectomía - revisión / Intratubal placement of Essure® device in patients with hydrosalpinx prior to assisted reproductive technology treatment as an alternative method for salpingectomy - review

El objetivo de este trabajo es la revisión de literatura disponible actualmente sobre datos que corroboren a eficacia del sistema Essure® en pacientes con hidrosalpinx antes de la FIV-TE como un método alternativo viable para la salpinguectomía. La búsqueda de publicaciones se realiza en las bases de datos Medline y Cochrane. Y de los artículos seleccionados se revisan los artículos incluidos en su bibliografía.Los datos obtenidos de estos estudios indican tasas de nacidos vivos por transferencia embrionaria tras el uso del sistema Essure® muy parecidas a las observadas tras la salpinguectomía. Aunque los resultados actuales en pacientes diagnosticadas de hidrosalpinx y tratadas mediante la colocación del microinserto antes de someterse a TRA son muy prometedores, parece razonable esperar con su uso general en este grupo de pacientes hasta que estudios prospectivos aleatorizados avalen su eficacia y seguridad (AU)

The aim of this article is to review currently available studies comparing efficacy of intratubal placement of Essure® to salpingectomy prior to ART treatment. Review of up to date available studies was performed including search for studies in Medline and Cochrane databases together with search for studies included in their corresponding bibliography. Currently available data indicate similar live-birth rates after embryo transfer for both intratubal Essure® placement and salpingectomy carried out prior to ART. Current outcomes in patients diagnosed with hydrosalpinx and treated with Essure® before embryo transfer are optimistic. However general use of this treatment in patients with hydrosalpinx and undergoing ART treatment should not be offered until randomized controlled trials will confirm both its efficacy and safety (AU)

Niveles de PAPP-A y fßhCG en gestantes gemelares bicoriónicas concebidas por técnicas de reproducción asistida (FIV-IAH) y sus implicaciones en el cálculo del riesgo del cribado prenatal del primer trimestre / PAPP-A and fBhCG levels in dichorionic twin pregnancies conceveid by assisted reproductive technologies (IVF-AIH) and their implications to calculate the prenatal risk on first trimestry

Objetivo: Evaluar los niveles de proteína plasmática placentaria (PAPP-A) y fracción libre de la βhCG (fßhCG) en gestaciones gemelares bicoriónicas concebidas mediante técnicas de reproducción asistida tipo fertilización in vitro (FIV) o inseminación artificial (IA) en nuestra población. Posterior cálculo de los factores de corrección necesarios a aplicar para el screening de primer trimestre en gestantes gemelares concebidas mediante FIV. Población en estudio: Se han estudiado 171 gestantes gemelares. Un grupo compuesto por 71 gestaciones bicoriónicas concebidas mediante FIV, con una edad media de 36,3 años; un grupo control de 76 gestaciones bicoriónicas concebidas por gestación espontánea, con una edad media de 31,8 años; y un último grupo de 24 gestaciones bicoriónicas concebidas por IA, con una edad media de 32,9 años. Resultados: Las gestantes gemelares bicoriónicas concebidas mediante FIV respecto el grupo control, concebidas espontáneamente, presentan unos niveles estadísticamente inferiores de PAPP-A (2,17 MoM versus 2,41 MoM, p<0,008) y valores superiores no significativos de fßhCG (2,33 MoM versus 2,05 MoM, p=0,144). Las medias de la translucencia nucal (Tn) entre ambos grupos tampoco muestran diferencias significativas (p=0,178). Esta misma tendencia se observa en los valores de PAPPA y fßhCG para las gestaciones concebidas mediante IA, pero con un número menor de gestantes no significativo. Conclusiones: Las mujeres con gestaciones gemelares concebidas por técnicas de reproducción asistida han sido sometidas a tratamientos para la estimulación de la ovulación. Este hecho se ha postulado como una de las causas que podrían explicar la presencia de valores de PAPP-A significativamente inferiores y de fßhCG superiores, aunque no significativos, a las gestantes gemelares espontáneas. Por ello se aconseja la elaboración de curvas propias con gestantes gemelares FIV, o en su defecto, el empleo de factores de corrección para disminuir este efecto. Se comprueba que con la aplicación de estos factores de corrección la tasa de falsos positivos de los gemelares bicoriónicos concebidos por FIV baja de 4,22% a 1,41% en nuestra población, con la consecuente disminución de biopsias de corion que son especialmente complejas en gestaciones gemelares (AU)

Objective: Evaluation of levels of PAPP-A and fßhCG in dichorionic twin pregnancies conceived by Assisted Reproductive Technology, i.e. In Vitro Fertilization (IVF) and Artificicial Insemination (AI) in our population. Calculate the necessary correction factors for first trimester screening in pregnancies conceived by IVF. Study population: One hundred seventyone twin pregnancies were considered within this study. One group was composed by 71 dichorionic twin pregnancies conceived by IVF with an average maternal age of 36.6 years. The control group was composed by 76 dichorionic twin pregnancies conceived spontaneously with an average maternal age of 31.8. A third group was composed by 24 dichorionic twin pregnancies conceived by AI with an average maternal age of 32.9 years. Results: Dichorionic twin pregnancies conceived by IVF present statistically significant lower values for PAPP-A than the control group (2.17 MoM versus 2.41 MoM, p<0.008) and higher values of fßhCG though this difference is not significant (2.33 MoM versus 2.05 MoM, p=0.144). In the other hand, average nuchal translucency (NT) does not show statistical differences between these two groups (p=0.178). Twin pregnancies conceived by AI present these same results tendencies for PAPP-A, fßhCG, and NT, with a lower number of patients not significant. Conclusions: Women with twin pregnancies conceived by Assisted Reproductive Technology (ART) have undergone treatments to induce ovulation. These treatments are proposed as one of the causes that may justify lower PAPP-A values and higher (though not significant) fßhCG values, when twin pregnancies conceived by ART are compared to spontaneously conceived twin pregnancies. Construction of normality curves for twin pregnancies conceived by IVF or calculation of correction factors is advised, in order to decrease this effect in the studied biochemical parameters. Applying these correction factors to our population data, the rate of false positives in first trimester screenings in dichorionic twin pregnancies conceived by IVF is decreased from a 4.22% to a 1.41%; this consequently implies a reduction of chorion biopsies, which are specially complicated in twin pregnancies (AU)

Ventajas e inconvenientes de la transferencia embrionaria en +3 y en blastocisto / Advantages and disadvantages of embryo transfer in day 3 and blastocyst stage

Objetivo: Entre los diversos factores con influencia en las tasas de implantación y gestación evolutiva, la calidad del embrión es uno de los factores pronósticos más importantes. Sin embargo, la elección del embrión con el mayor potencial de implantación para transferir sigue siendo uno de los puntos críticos dentro del laboratorio de fecundación in vitro (FIV). Hoy en día, a pesar de la existencia de múltiples sistemas de selección no invasivos, los parámetros morfológicos siguen siendo uno de los criterios más utilizados por los embriólogos. Los avances en los medios de cultivo embrionario han permitido a los laboratorios de FIV el cultivo óptimo de embriones hasta el estadio de blastocisto. La razón principal para realizar una transferencia en esta etapa es mejorar la sincronía entre ambiente uterino y desarrollo embrionario y la selección de los embriones más viables. El objetivo de este estudio es realizar una revisión bibliográfica con el fin de poder determinar en que situaciones la transferencia de blastocistos (día 5 y 6) mejora las tasas de implantación comparado con los embriones tempranos (día 2 y 3), y evaluar las posibles ventajas e inconvenientes en cada caso. Material y métodos: Se han analizado 10 estudios randomizados que comparan la efectividad de la transferencia de blastocistos y embriones en estadios más precoces. Conclusión: Existe una pequeña diferencia en la tasa de recién nacido vivo (RNV) y de implantación a favor del cultivo a blastocisto. Se ha observado que la transferencia en estadio de blastocisto podría incrementar las tasas de implantación en pacientes jóvenes con un mínimo de embriones de buena calidad en día 3, dando lugar a una mayor sincronía con el ambiente endometrial y coincidiendo con un menor grado de contracciones uterinas en el día de la transferencia. Este estadio permite hacer una selección embrionaria más precisa, ya que la activación del genoma embrionario se produce cuando los embriones están a 8 células aproximadamente. También se observa un menor número de embriones aneuploides, ya que la prolongación del cultivo permite incrementar la selección del embrión más viable. Es necesario establecer cuidadosamente aquellos grupos de pacientes a los que la transferencia en blastocisto representaría una mejora en los resultados del ciclo, reduciendo al máximo las posibilidades de cancelación de ciclo y favoreciendo la transferencia electiva de un único embrión (SET: single embryo transfer), el único método realmente efectivo para evitar las gestaciones múltiples, una de las complicaciones más importantes de los tratamientos de FIV (AU)

Among several factors that influence implantation rate and pregnancy outcome, embryo quality is one of the most important. However, the election of the embryo with the highest implantation potential is still a matter of debate at the vitro fertilization laboratory (IVF). Nowadays, despite the existence of multiple noninvasive selection systems, morphological parameters remain one of the main criteria used by embryologists. Advances in embryo culture media have allowed IVF laboratories to successfully grow embryos to the blastocyst stage. The main reason to perform the embryo transfer at this stage is to improve the synchrony between the uterine environment and embryonic development and the selection of the most viable embryo. The aim of this study was to review the literature in order to determine in which transfer at blastocyst stage (day 5 and 6) improves implantation rates compared to transfer at earlier stages (day 2 and 3), and to evaluate the potential advantages and disadvantages in each case. Methods:We analyzed 10 randomized trials comparing the effectiveness of early cleavage versus blastocyst stage transfers. Conclusion: There is a small difference in live birth rate (LBR) and implantation in favour of transfer at blastocyst stage. It has been observed that this could increase implantation rates in young patients with a minimal of three top quality embryos on day 3, resulting in greater synchrony with the endometrial environment and coinciding with a lower degree of uterine contractions on the day of transfer. Blastocyst stage allows more accurate embryo selection, because the activation of the embryonic genome occurs approximately at 8 cells stage. Moreover, due to the culture extension, fewer aneuploidembryos are observed. It is necessary to establish carefully those groups of patients who will benefit from a blastocyst transfer, minimizing the chance of cycle cancellation and favouring elective transfer of a single embryo (SET: single embryo transfer), which is the most effective method to avoid multiple pregnancies (AU)

Prognostic factors for sperm retrieval in non-obstructive azoospermia.

Testicular sperm retrieval techniques associated with intracytoplasmic sperm injection have changed the field of male infertility treatment and given many azoospermic men the chance to become biological fathers. Despite the current use of testicular sperm extraction, reliable clinical and laboratory prognostic factors of sperm recovery are still absent. The objective of this article was to review the prognostic factors and clinical use of sperm retrieval for men with non-obstructive azoospermia. The PubMed database was searched for the Medical Subject Headings (MeSH) terms azoospermia, sperm retrieval, and prognosis. Papers on obstructive azoospermia were excluded. The authors selected articles that reported successful sperm retrieval techniques involving clinical, laboratory, or parenchyma processing methods. The selected papers were reviewed, and the prognostic factors were discussed. No reliable positive prognostic factors guarantee sperm recovery for patients with non-obstructive azoospermia. The only negative prognostic factor is the presence of AZFa and AZFb microdeletions.

Prognostic factors for sperm retrieval in non-obstructive azoospermia

Testicular sperm retrieval techniques associated with intracytoplasmic sperm injection have changed the field of male infertility treatment and given many azoospermic men the chance to become biological fathers. Despite the current use of testicular sperm extraction, reliable clinical and laboratory prognostic factors of sperm recovery are still absent. The objective of this article was to review the prognostic factors and clinical use of sperm retrieval for men with non-obstructive azoospermia. The PubMed database was searched for the Medical Subject Headings (MeSH) terms azoospermia, sperm retrieval, and prognosis. Papers on obstructive azoospermia were excluded. The authors selected articles that reported successful sperm retrieval techniques involving clinical, laboratory, or parenchyma processing methods. The selected papers were reviewed, and the prognostic factors were discussed. No reliable positive prognostic factors guarantee sperm recovery for patients with non-obstructive azoospermia. The only negative prognostic factor is the presence of AZFa and AZFb microdeletions.

[Assisted reproductive technologies reported in the National Registry of Israel 1995-1996].

National registration of the results of assisted reproductive technology (ART) is maintained by many countries. The Israel Committee for Registry of ART asked 19 in-vitro fertilization (IVF) units in 1995 and 20 in 1996 to report on their activities and results. Data were collected by questionnaires and analyzed by computer. The most common ovarian stimulation was the combination of GnRH agonist and gonadotropins. There were 10.89 treatment cycles in 1995, of which 45% were with intracytoplasmic sperm injection (ICSI). In 1996, of 12.72 cycles, 54% were with the ICSI procedure. Embryos were transferred into the uterine cavity in 90% of the conventional IVF cycles and in 95% of the ICSI cycles. The overall pregnancy rate was 22% per embryo transfer in the conventional IVF and ICSI cycles. The delivery rate was 13.7% and 15.4% per embryo transfer in the conventional IVF and ICSI cycles, respectively. The rates for abortion and tubal pregnancy were 24% and 1.3%, respectively. These results are better than in previous years and are comparable with results in some western European countries. Efforts are being made to convert the registry into a real-time computerized system.

Profiling assisted reproductive technology: outcomes and quality of infertility management.

OBJECTIVE: To critically appraise the content of the American Society for Reproductive Medicine (ASRM)/Society for Reproductive Technology (SART) Registry. DESIGN: English-language literature review. PATIENT(S): Women undergoing treatment with assisted reproductive technology (ART). INTERVENTION(S): Current ART treatments, including IVF, GIFT, zygote intrafollopian transfer (ZIFT), oocyte micromanipulation, and cryopreserved embryo transfers. MAIN OUTCOME MEASURE(S): Compliance with clinical practice guidelines, and casemix-adjusted rates of live delivery, clinical pregnancy, ectopic pregnancy, miscarriage, birth defects, implantation, fertilization, and retrieval. RESULT(S): Outcomes should be adjusted for variation in patient characteristics known to affect prognosis, including maternal age, the duration of infertility, the presumed cause(s) of infertility, the patient's prior history of treatment for infertility, and diethylstilbestrol exposure. Outcome rates should be reported using the patient as the denominator, as well as cycle, retrieval, and transfer. The statistical significance of observed differences in events rates should be indicated. Because widely accepted clinical practice guidelines related to performance of ART procedures are not available, compliance with practice guidelines cannot currently be assessed. CONCLUSION(S): Reports based on ASRM/SART Registry data can be enhanced by refined casemix adjustment, assessing outcome rates per patient, as well as per component of ART procedure, and by providing an indication of the statistical significance of observed differences in event rates. In addition, a critical appraisal of available evidence related to particular aspects of infertility management would help clarify the areas in which there is an evidentiary basis for formulation of practice guidelines, as well as topics requiring additional clinical research.