Correlations between clinical parameters, blastocyst morphological classification and embryo euploidy.

OBJECTIVE: The aim of the present study was to evaluate clinical and embryo parameters to predict embryo ploidy. METHODS: In this retrospective analysis, we studied 838 biopsied day-5 blastocysts from 219 patients in the period from May 2021 to July 2022. All embryos were morphologically classified before biopsy and were divided into two groups according to genetic test results. Euploid embryos (299) were compared with aneuploid embryos (539) based on maternal age, anti-Mullerian hormone, antral follicle count, and embryo morphology. RESULTS: Maternal age (36.2±3.0) of euploid embryos was lower than maternal age (37.1±2.5) of aneuploid embryos (p<0.0001). AMH levels were higher (3.9±1.2) in the group of euploid embryos than in the group of aneuploid embryos (3.6±1.3, p<0.0001). However, the AFC was not different in the group of euploid embryos (15.3±6.0) compared to the group of aneuploid embryos (14.5±5.9, p=0.07). The presence of aneuploidy was negatively correlated with top embryo quality (embryos 4AA and 4AB). All euploid embryos (299) were top quality versus 331 of 539 (61.49%) aneuploid embryos (p<0.0001). CONCLUSIONS: We found that euploid embryos were associated with lower maternal age, higher AMH levels, and higher quality embryos.

Which ovarian reserve marker relates to embryo quality on day 3 and blastocyst; age, AFC, AMH?

OBJECTIVE: The aim of the present prospective study was to evaluate which ovarian reserve marker would be more reliable as the quality of the A + B embryos (day 3 and blastocyst). METHODS: We ran a prospective study with 124 infertile women, aged 24-48 years, from 2017 to 2018. The patients were divided into 3 groups according to age and the subgroups were compared for AMH, AFC, number of A+B embryos. New division of the 3 groups was performed based on the AMH, and the subgroups were compared for age, AFC and number of A+B embryos. Finally, we divided the patients into 3 groups, based on the AFC, and we compared the subgroups for age, AMH and number of A+B embryos. P<0.05 was considered statistically significant. RESULTS: When the 124 patients were divided according to age, we found a significant fall in an A+B embryo quality (day3; blastocyst) after 35 years (p<0.038; p<0.035), and more severely after 37 years (p<0.032; p<0.027). When the 124 patients were divided according to AMH, there was a significant fall in A+B embryo quality (day 3; blastocyst), with AMH<1ng/ml (p<0.023; p<0.021). When the 124 patients were divided according to AFC, there was a significant fall in A+B embryo quality (day 3; blastocyst) with AFC<7 (p<0.025; p<0.023). These markers had significant associations with embryo quality (p<0.005). CONCLUSION: Age, AFC and AMH have significant associations with A +B embryo quality on day 3 and blastocyst.

The impact of dehydroepiandrosterone in poor ovarian responders on assisted reproduction technology treatment.

One in six couples worldwide will experience at least one infertility problem during their reproductive years. Between 5.6% and 35.1% of women will exhibit poor ovarian response. A variety of methods have been applied to improve ovarian response, including dehydroepiandrosterone. In the ovaries, dehydroepiandrosterone promotes follicular development and granulosa cell proliferation by increasing intraovarian androgen concentrations while simultaneously enhancing the level of follicular insulin-like growth factor-1, which promotes folliculogenesis. Dehydroepiandrosterone supplementation may improve in vitro fertilization outcomes and ovarian response in patients with poor ovarian response. However, a few questions still loom over the effectiveness of dehydroepiandrosterone.

A comparison of the effects of three luteal phase support protocols with estrogen on in vitro fertilization-embryo transfer outcomes in patients on a GnRH antagonist protocol.

OBJECTIVE: This study aimed to evaluate the effects of three different luteal phase support protocols with estrogen on the pregnancy rates and luteal phase hormone profiles of patients undergoing in vitro fertilization-embryo transfer (IVF-ET) cycles. A secondary objective was to evaluate which ovarian reserve markers correlated with pregnancy rates. METHODS: This retrospective observational study was carried out at a private tertiary reproductive medicine teaching and research center. The study enrolled 104 patients undergoing intracytoplasmic sperm injection (ICSI) on an antagonist protocol for controlled ovarian hyperstimulation (COH). The women were divided into three groups based on the route of administration of estrogen (E2) for luteal phase support: oral (Primogyna); transdermal patches (Estradott); or transdermal gel (Oestrogel Pump). The administration of estrogen provided the equivalent to 4 mg of estradiol daily. All women received 600mg of vaginal progesterone (P) per day (Utrogestan) for luteal phase support. Blood samples were drawn on the day of hCG administration and on the day of beta hCG testing to measure E2 and P levels. Clinical pregnancy rate (PR) was the main endpoint. RESULTS: The patients included in the three groups were comparable. No significant differences were found in implantation rates, clinical PR, miscarriage rates, multiple-pregnancy rates, E2 or P levels on the day of beta hCG measurement. Concerning ovarian reserve markers, significant correlations between testing positive for clinical pregnancy and AMH (r = 0.66, p<0.0001) and E2 levels on beta hCG measurement day (r = 0.77; p<.0001) were observed. CONCLUSIONS: No significant differences were seen in the pregnancy rates of patients submitted to IVF-ET cycles with GnRH antagonists given oral, transdermal patches, or transdermal gel E2 during the luteal phase. A correlation was found between clinical pregnancy rate and AMH and E2 levels on beta hCG testing day.

O diagnóstico clínico e a histopatologia renal em gestantes com síndrome hipertensiva grave / Clinical diagnosis and renalmorphology in women with severe hypertension in pregnancy

Para análise clínico-histopatológica da hipertensäo na gravidez, foram efetuadas biópsias renais no pós-parto, em 67 pacientes com síndromes hipertensivas da gestaçäo {doença hipertensiva específica da gravidez (DHEG) grave, DHEG associada, hipertensäo arterial crônica e nefropatia}. Os diagnósticos clínicos de DHEG, DHEG superposta e hipertensäo arterial crônica foram estabelecidos segundo os critérios emitidos pelo Colégio Americano de Obstetras e Ginecologistas, em 1972, com algumas modificaçöes sugeridas pelo National High Blood Pressure Education Program Working. Os diagnósticos de nefropatias foram estabelecidos pelo serviço de nefrologia do Hospital das Clínicas da UFMG. O material foi examinado por dois patologistas, independentemente, e sem prévio conhecimento do diagnóstico clínico. A metodologia utilizada foi a microscopia óptica (MO) e as coloraçöes usadas para o estudo foram: hemotoxilina-eosina, ácido periódico de Schiff e prata metenamina. As pacientes com diagnóstico de DHEG pura e DHEG superposta compunham o grupo a ser estudado. As pacientes com hipertensäo arterial crônica e nefropatia sem sinais de DHEG foram utilizadas como controles. A comparaçäo entre diagnóstico clínico e histopatologia foi realizada na tentativa de confirmar o diagnóstico de endoteliose e, ainda, para corrigir erros diagnósticos, se porventura houvessem. A comparaçäo entre os resultados histopatológicos dos dois observadores visava validar o método de MO avaliando a sua confiabilidade. A MO apresentou alta sensibilidade (91,3 por cento) e alto valor de prediçäo positiva(84,0 por cento). Entretanto, näo revelou presença de doença renal em qualquer paciente previamente diagnosticada como DHEG ou DHEG superposta. A MO mostrou rim normal em 15,5 por cento. Outro dado interessante foi a associaçäo observada entre a multiparidade e o encontro de endoteliose sem outras lesöes renais. Concluindo: a biópsia renal é procedimento seguro para ser realizado no puerpério no estudo das síndromes hipertensivas na gestaçäo; o achado de endoteliose à MO é útil para confirmar o diagnóstico clínico de DHEG, mas näo para excluí-lo