Atosiban improves the outcome of embryo transfer. A systematic review and meta-analysis of randomized and non-randomized trials.

OBJECTIVE: To estimate the effectiveness of Atosiban in improving the outcome after embryo transfer. The effectiveness of embryo transfer per cycle is still relatively low. One possible explanation might be uterine contractility that expels the transferred embryos. Atosiban improved the outcome of embryo transfer by reducing uterine contractility. METHODS: Data sources: A systematic review of papers in English using MEDLINE and EMBASE (1990-2019). Search terms included Atosiban, embryo transfer. Study selection: We included studies that compared the outcomes of embryo transfer with Atosiban and a control group. Data Extracting: Independent extraction of papers by two authors, using predefined data fields, including study quality indicators. RESULTS: All pooled analyses were based on a fixed-effect model. Four randomised controlled trials, including 1,025 women, and two non-randomised trials, including 686 patients, met our inclusion criteria. In both studies, the heterogeneity was moderate. Atosiban increased clinical pregnancy rates regardless of the indication for ART or type of embryo transferred. Pooled OR in randomized controlled trials reached 1.47 (1.18-1.82), and in non-randomised controlled trials it reached 1.50 (95% CI 1.10-2.05). CONCLUSION: Atosiban appears to increase the clinical pregnancy rates in women undergoing embryo transfer.

The effects of aging on semen parameters and sperm DNA fragmentation.

INTRODUCTION: This study aimed to look into possible correlations between male age and different sperm parameters derived from semen analysis and sperm deoxyribonucleic acid (DNA) fragmentation. METHODS: This retrospective descriptive study included 2681 male patients who underwent semen analysis at Clínica Las Condes (CLC), Santiago, Chile, between January 2014 and May 2017; correlations between age and sperm parameters were analyzed. RESULTS: Males above the age of 50 were significantly more likely to present anomalies in semen volume, sperm concentration, and sperm DNA fragmentation; males aged 41+ years were more likely to have lower sperm concentration levels; males aged 31+ years were more likely to have decreased sperm motility; when concentration was constant, more volume and motility anomalies were seen as age increased; when volume was kept constant, more motility and concentration anomalies were seen as age increased; and when motility was constant, normal semen volumes decreased as age increased. CONCLUSION: Our study showed that male age significantly affects sperm parameters that might have an impact on male fertility.

Outcome of assisted reproductive technology in overweight and obese women.

OBJECTIVE: The main objective of this study was to assess the prevalence of overweight and obesity among patients undergoing assisted reproductive technology (ART) in Latin America and its consequences on treatment outcomes. METHODS: We used the Latin American Registry of ART to obtain women's age and body mass index (BMI), cancellation rate, number of oocytes retrieved and embryos transferred, clinical pregnancy, live birth and miscarriage rates from 107.313 patients undergoing autologous IVF and ICSI during four years; a multivariable analysis was performed to determine the effect of BMI on cancellation, oocytes retrieved, pregnancy, live birth and miscarriage, adjusting for age, number of embryos transferred and embryo developmental stage upon embryo transfer, when appropriate. RESULTS: The prevalence of overweight and obesity was 16.1% and 42.4%, respectively; correcting for age of female partner, overweight and obesity were associated to an increase in the odds of cancellation and to a lower mean number of oocytes retrieved; after adjusting for age, number of embryos transferred and stage of embryo development at transfer, we found that the BMI category was not associated to a change in the likelihoods of pregnancy, live birth and miscarriage. CONCLUSIONS: The prevalence of obesity among women seeking ART in Latin America is surprisingly high; however, BMI does not influence the outcome of ART performed in these women.

Semen quality before cryopreservation and after thawing in 543 patients with testicular cancer.

OBJECTIVE: The main objective of this study was to assess semen characteristics of patients with testicular cancer before cryopreservation and after thawing, to evaluate the consequences of this technique on sperm quality in patients with testicular cancer. METHODS: Five hundred eighty-nine samples from 543 patients with testicular cancer were cryopreserved between 1995 and 2015, one aliquot per patient was used for a thawing test to assess the impact of cryopreservation on sperm motility; semen analysis was performed before cryo preservation and after thawing, the result interpretation was carried out using the 2010 World Health Organization (WHO) Laboratory Manual, and consent forms were signed by the patients for freezing and when sperm was used for reproductive purposes. RESULTS: Hypospermia was observed in 28.7% of samples, the median sperm concentration was 18 million/mL with 35% oligozoospermia; twenty-two patients (4.1%) had azoospermia and 12.7% had severe oligozoospermia, the median sperm count was 31.3 million and 261 semen samples (44.3%) were normal in all parameters according to the WHO; total motile sperm count before cryopreservation and after thawing was 12 (0-412.2) and 7 (0-303.9) million sperm, respectively (p < 0.00001, 95% CI 5.48-14.91), which represents a 32% reduction; concerning the utilization of cryopreserved semen samples, only twelve patients (2.2%) used their frozen sperm for reproductive purposes. CONCLUSIONS: An impairment in semen quality was found in almost half of the samples from patients with testicular cancer, only few patients had azoospermia or severe oligozoospermia; sperm cryopreservation significantly reduces sperm motility and total motile sperm count and very few patients use their frozen sperm for reproductive purposes.

Access to Assisted Reproductive Technologies in Chile.

Assisted reproductive technology (ART) is present in almost all Latin American countries. However, it is accessible only to few couples, those who have the economic capacity to cover out of pocket funding. The number of initiated cycles per year in Chile covers less than 4% of the population who would theoretically need treatment. It corresponded to 609 cycles per 1.000.000 women between 18 and 45 years in 2009. This is in contrast with the reality of several European countries, where the numbers can be as high as 20,000 cycles per million women in reproductive age. Although availability of ART treatments is a reality in almost every country in the region, this inequality in the access is mainly due to socioeconomic reasons, which are discussed in this article.

Sibling embryo blastocyst development as a prognostic factor for the outcome of day-3 embryo transfer.

This study assessed the development of sibling embryos to blastocyst as a prognostic factor for patients undergoing embryo transfer at day 3. A retrospective analysis of a clinical and embryology database including 353 patients who underwent 393 cycles of intracytoplasmic sperm injection with day-3 embryo transfer and excess embryos, maintained in culture until day 5, was performed. Cycles were divided into group A and group B (with and without blastocyst formation, respectively). Age and basal FSH were similar in both groups. Statistically significant differences in clinical pregnancy rates (55.8% versus 40.6%; P=0.0031), live birth rates (50.0% versus 37.2%; P=0.012) and implantation rates (34.2% versus 23.7%; P=0.0035) were observed in groups A and B, respectively. Odds ratios showed women from group A had 1.85- and 1.68-times the odds of patients from group B of achieving clinical pregnancy and a live birth, respectively. Cumulative live birth rate for group A, after one cycle of vitrified-warmed blastocyst transfer, was 66.4%. The development of sibling embryos to blastocyst is a prognostic factor for the outcome of the cycle in which transfer is performed at day 3 and provides valuable information about the prognosis of subsequent cycles.

Postergación de la maternidad en Chile: Una realidad oculta / Association between motherhood postponement and socioeconomic status

Background: Delayed motherhood is a common phenomenon in the developed world, where the age at frst delivery is around 30 years. In Chile the National Institute of Statistics established that this age has remained around 23 years for more than two decades. Motherhood postponement may be modulated by socioeconomic status. Aim: To determine whether the age at frst delivery is higher in a private clinic compared to a public hospital. Patients and Methods: Two cohorts of primiparous women delivering in 1998 and 2008 in the public hospital San Borja Arriarán (HSBA) and a private setting Clínica Las Condes (CLC), were analyzed. Results: The age of all delivering women was significantly lower in HSBA than in CLC in both study periods (26.3 ± 0.8 and 25.7 ± 0.9 compared to 31.6 ± 0.1 and 32.7 ± 0.1 years, respectively). Likewise, the frequency of adolescent pregnancy was significantly higher in HSBA than CLC in both study periods (38.8 and 42.2 percent compared to 1.7 and 1.6 percent respectively). The age at frst delivery was significantly lower in both periods in HSBA (21.8 and 21.3 years compared to 28.6 and 30.6 years, respectively). Excluding primiparous women of less than 20 years, the difference in age was smaller, but remained still significant (24.6 and 24.2 versus 29.9 and 31.0 years, respectively). Conclusions: In Santiago, the postponement of motherhood is more marked among women of high socioeconomic status.

[Association between motherhood postponement and socioeconomic status]. / Postergación de la maternidad en Chile: Una realidad oculta.

BACKGROUND: Delayed motherhood is a common phenomenon in the developed world, where the age at first delivery is around 30 years. In Chile the National Institute of Statistics established that this age has remained around 23 years for more than two decades. Motherhood postponement may be modulated by socioeconomic status. AIM: To determine whether the age at first delivery is higher in a private clinic compared to a public hospital. PATIENTS AND METHODS: Two cohorts of primiparous women delivering in 1998 and 2008 in the public hospital San Borja Arriarán (HSBA) and a private setting Clínica Las Condes (CLC), were analyzed. RESULTS: The age of all delivering women was significantly lower in HSBA than in CLC in both study periods (26.3 ± 0.8 and 25.7 ± 0.9 compared to 31.6 ± 0.1 and 32.7 ± 0.1 years, respectively). Likewise, the frequency of adolescent pregnancy was significantly higher in HSBA than CLC in both study periods (38.8 and 42.2% compared to 1.7 and 1.6% respectively). The age at first delivery was significantly lower in both periods in HSBA (21.8 and 21.3 years compared to 28.6 and 30.6 years, respectively). Excluding primiparous women of less than 20 years, the difference in age was smaller, but remained still significant (24.6 and 24.2 versus 29.9 and 31.0 years, respectively). CONCLUSIONS: In Santiago, the postponement of motherhood is more marked among women of high socioeconomic status.

Surgical treatment and follow-up of women with intermenstrual bleeding due to cesarean section scar defect.

STUDY OBJECTIVE: Previous cesarean delivery scar (PCDS) defect has been described as a cause of intermenstrual bleeding in women with no other uterine pathology except for a pouch on the anterior uterine segment at the site of the cesarean scar. The objective of this study was to assess the effectiveness of hysteroscopic surgery to correct this anatomic defect and eliminate the bleeding disturbance in a group of women with this symptom. DESIGN: Retrospective study (Canadian Task Force classification XX). SETTING: Private hospital, department of obstetrics and gynecology. PATIENTS: Twenty-four women, age 29-41 years, who reported intermenstrual bleeding, especially postmenstrual spotting, with no other gynecologic pathology except for the presence of a PCDS defect. Diagnosis was established with transvaginal ultrasound, when a fluid-filled, triangular defect was seen in the anterior uterine isthmus, in relation to the cesarean section scar. INTERVENTION: Hysteroscopic resection of fibrotic tissue that overhangs underneath the triangular pouch, facilitating blood drainage through the cervix and fulguration of endometrial glands and/or dilated blood vessels. MEASUREMENTS AND MAIN RESULTS: The mean number of previous cesarean-section deliveries was 2.75. Postoperative follow-up was 24 months in 21 patients and at least 14 months in the other 3 patients. Eleven of these patients with the desire to become pregnant were unable to conceive after trying for a period of at least 2 years before hysteroscopy. Infertility work-up in the 11 patients revealed 9 with unknown infertility, 1 with male infertility, and 1 with failed tubal reversal surgery. Nine of them became pregnant between 14- and 24-months of follow-up. Eighty-four percent of patients (20/24) remained asymptomatic (without bleeding disturbances) after surgery. CONCLUSION: Previous cesarean delivery scar defect may be the cause of intermenstrual bleeding, and it is possible that it also may impair fertility, but it can be successfully treated by hysteroscopic surgery.

The cesarean delivery scar pouch: clinical implications and diagnostic correlation between transvaginal sonography and hysteroscopy.

OBJECTIVE: We sought (1) to describe an anatomic defect of the uterine cavity in the anterior isthmus diagnosed by transvaginal sonography in a group of premenopausal women with previous cesarean deliveries, (2) to establish whether there is an association between the presence of the pouch and a bleeding disturbance, and (3) to compare the diagnostic efficacy of transvaginal sonography versus hysteroscopy for the detection of this defect. METHODS: We performed a retrospective study of 92 premenopausal women with histories of at least 1 cesarean delivery. Age, number of previous cesarean deliveries, time elapsed between last cesarean delivery and first consultation, and total area of the pouch were recorded in groups of women with and without abnormal bleeding. Hysteroscopy was also performed in 43.8% of the patients who had abnormal bleeding. RESULTS: In all women, transvaginal sonography revealed the presence of a pouch on the anterior uterine segment at the site of the expected previous cesarean delivery scar. Hysteroscopy showed 100% correlation with transvaginal sonography in detection of this pouch. CONCLUSIONS: The high correlation between bleeding disturbances and the presence of a pouch, in the absence of other pathologic entities, suggests this anatomic defect as the possible cause, especially in view of the fact that women who had heavier and longer bleeding episodes tended to have a larger pouch. Transvaginal sonography is a very simple, noninvasive, low-cost examination that should be considered as the first choice for screening, because it highly correlates (100%) with hysteroscopy in the diagnosis of this defect and may help rule out other causes.