Hyaluronan-binding system for sperm selection enhances pregnancy rates in ICSI cycles associated with male factor infertility.

OBJECTIVES: The aim of the present study was to compare two procedures for sperm selection in ICSI cycles - conventional morphology sperm selection (ICSI-PVP) and chemical selection through Hyaluronan-treated petri dishes (PICSI), when male factor was associated. METHODS: The evaluated parameters were semen quality, fertilization and cleavage rates, chemical and clinical pregnancy rates, as well as abortion rate. Fifty-six ICSI cycles were included in this report, 19 cycles using PICSI and 37 using conventional ICSI. RESULTS: PICSI and ICSI showed, respectively, the following outcome: fertilization rates 71.93% (123/171) and 64.14% (127/198); cleavage rates 95.12% (117/123) and 95.27% (121/127); chemical pregnancy rates 63.15% (12/19) and 27.03% (10/37); clinical pregnancy rates 42.10% (8/19) and 16.21% (6/37); and abortion rates 33.33% (4/12) and 40.00% (4/10). According to both Fisher's Exact Test and Chi-square Test, chemical pregnancy (p = 0.05) and clinical pregnancy (p = 0.09) rates were significantly higher in the PICSI group. p values ≤ 0.05 were consider statistically significant. CONCLUSIONS: The present data indicates that ICSI cycles that used the PICSI technique had a considerably higher chance (≈5 fold) to achieve pregnancy than those who had sperm selected only by morphology assessment. Teratozoospermic patients were those who benefited most with PICSI. Therefore, the technique should be included in laboratory routine with low cost, avoiding the selection of immature sperm with increased rates of peroxidation and DNA fragmentation. Prospective and randomized studies should be applied to strengthen this suggestion.

O papel do hormônio anti-Mulleriano na determinação da reserva ovariana / The role of anti-Mullerian hormone in the assessment of ovarian reserve

Os autores reafirmam a importância da determinação da reserva ovariana previamente aos procedimentos de reprodução assistida. São feitas referências a um novo método de avaliação da reserva ovariana, que é a determinação do hormônio anti-Mulleriano (AMH), ressaltando-se que a má resposta à estimulação ovariana em ciclos de TRA associa-se a concentrações diminuídas de AMH. Embora a determinação do AMH, em nosso meio, ainda não esteja incluída na rotina da avaliação da reserva ovariana, o método parece promissor e pode ter, em futuro próximo, papel relevante na investigação da função gonadal feminina, podendo ser empregado para predizer a má resposta ovariana e os resultados das técnicas de reprodução assistida