Evaluación de la tasa de blastocistos euploides en fase folicular y lútea (DuoStim) en mujeres con pobre respuesta ovárica: estudio preliminar en México / Euploid blastocyst rate in follicular vs luteal phase (DuoStim) in women with poor ovarian response: Preliminary study in Mexico

Resumen: OBJETIVO: Comparar la tasa de blastocistos euploides obtenida después de la estimulación ovárica en fase folicular con la fase lútea en un mismo ciclo menstrual en pacientes con deficiente respuesta ovárica. MATERIALES Y MÉTODOS: Estudio clínico, prospectivo y comparativo llevado a cabo en el Centro de Reproducción Arcos, Nascere, entre los meses de enero a julio de 2019. Se incluyeron pacientes con pobre respuesta ovárica según los criterios de Bologna y con indicación de PGT-A. Las estimulaciones en fase folicular y lútea se efectuaron con antagonista de la GnRH y FSHr/LHr (2:1) a partir del día 3 del ciclo y 5 días después de la primera recuperación de los ovocitos. Para completar el proceso de maduración ovocitaria se utilizaron análogos de GnRH, se tomó una biopsia de trofoectodermo en día 5-7. RESULTADOS: Se estudiaron 20 pacientes. Al comparar la fase folicular con la lútea la tasa de fertilización fue de 79% (IC95%: 29-46) vs 55% (IC95%: 34-53), la tasa de blastocistos 42% (IC95%: 19-44) vs 45% (IC95%: 24-55) y la tasa de blastocistos euploides 100% (IC95%: 44-53) vs 70% (IC95%: 38-46), respectivamente. Solo la tasa de recuperación de ovocitos en metafase II mostró diferencias significativas entre ambas fases 40% (IC95%: 18-37) vs 59% (IC95%: 31-59), p = 0.0333 en la fase folicular y lútea, respectivamente. CONCLUSIONES: La estimulación ovárica bifásica (folicular-lútea), en el mismo ciclo menstrual (DuoStim), resultó en mayor tasa de recuperación de ovocitos en metafase II durante la fase lútea. Sin embargo, las tasas de desarrollo embrionario a día 5-6 (blastocistos) y de embriones euploides fueron similares entre ambas fases.

Abstract: OBJECTIVE: Euploid blastocyst rate comparison between ovarian stimulation in follicular vs luteal phase performed in the same menstrual cycle in patients with poor ovarian response. MATERIALS AND METHODS: Clinical, prospective and comparative study conducted at Centro de Reproducción Arcos S.C., "Nascere", during january-july, 2019. Patients with PGT-A indication and poor ovarian response according to Bologna criteria were included. Under a short GnRH-antagonist protocol, stimulations, both in follicular and luteal phase were performed using rFSH/rLH (2:1) from day 3 of the cycle and 5 days after the first oocyte retrieval. In addition, ovulation trigger with an GnRH agonist was used, finally, on day 5-6 of embryo development, trophoctoctoderm biopsy was performed. RESULTS: In this study, 20 patients were included; when comparing follicular phase vs luteal phase, we found that fertilization rate was 79% (95%CI 29-46) vs 55% (95%CI 34-53), blastocysts rate was 42% (95%CI 19-44) vs 45% (95%CI 24-55) and euploid embryo rate was 100% (95%CI 44-53) vs 70% (95%CI 38-46). Only the oocyte recovery rate in metaphase II showed significant differences between both phases 40% (IC 95% 18-37) vs 59% (IC 95% 31-59), p=0.0333. CONCLUSION: Biphasic ovarian stimulation (follicular/ luteal) in the same menstrual cycle (DuoStim) resulted in a higher metaphase II ooctye recovery rate during the luteal phase in comparison with the follicular phase. However, the rates of blastocysts and euploid blastocysts were similar between both phases.

Diagnóstico genético preimplantacional no invasivo; datos preliminares en México / Non-invasive preimplantation genetic diagnosis; preliminary data in Mexico

Resumen: OBJETIVO: Analizar las tasas de concordancia, falsos positivos y negativos entre el ADN embrionario circulante en medio de cultivo y su relación con los reportes de la biopsia de trofoectodermo. MATERIALES Y MÉTODOS: Estudio observacional, prospectivo y comparativo, llevado a cabo en el Centro de Reproducción Arcos Nascere en noviembre 2018. Criterios: de inclusión: parejas en esquema de fertilización in vitro, con diagnóstico genético preimplantacional de aneuploidias. Criterios de exclusión: pacientes con anomalías estructurales o enfermedades monogénicas. Criterio de eliminación: blastocistos con eclosión asistida. Variables de respuesta: tasa de concordancia, falsos positivos y negativos entre las biopsias de trofoectodermo y los medios de cultivo. El análisis estadístico se realizó con SPSS 25.0, con pruebas t de Student y χ2 con valor de p < 0.05 significativa. RESULTADOS: Se analizaron 20 blastocistos de 5 parejas y se obtuvieron resultados informativos de 17 (amplificación global exitosa); 70% en día 5 y 100% en día 6. La tasa general de concordancia entre las biopsias de trofoectodermo y los medios de cultivo fue de 68.7% (42.8% en día 5 y 88.8% en día 6). En cuanto a las discrepancias, solo se observaron 2 falsos negativos en los medios de cultivo vs la biopsia de trofoectodermo (14.2% en día 5 y 11.11% en día 6); hubo 3 casos de falsos positivos (la mitad en día 5 y ninguno en día 6-7). CONCLUSIONES: Con la prueba genética no invasiva de aneuploidias se alcanzaron altas tasas de concordancia, sobre todo en embriones en día 6.

Abstract: OBJECTIVE: Analyze the concordance, false positive and false negative rates between circulating free DNA of the culture media compared to the results of the trophectoderm biopsy. MATERIALS AND METHODS: Observational, prospective and comparative study, conducted at Arcos Reproduction Center S.C. Nascere in november 2018. Couples with indication of preimplantation genetic diagnosis of aneuploidies undergoing In vitro Fertilization were included; carriers of structural anomalies or monogenic diseases were excluded and blastocysts with assisted hatching were eliminated. The response variables were the concordance, false positives and false negatives rates between trophoctoctoderm biopsies and culture media. Statistical analysis was performed with SPSS 25.0, using t-Student and chi-square tests with a value of p <0.05 significant. RESULTS: Informative results were obtained in 17 of the 20 culture media (85% successful global amplification); 70% on day 5 and 100% on day 6. The general concordance rate between trophectoderm biopsies and culture media was 68.7% (42.8% on day 5 and 88.8% on day 6). Regarding discrepancies, only 2 false negatives were observed in the culture media compared to the trophectoderm biopsy (14.2% on day 5 and 11.1% on day 6). There were 3 cases false positives (42.8% on day 5 and 0% on day 6). CONCLUSIONS: High rates of concordance were reached with the non-invasive genetic aneuploidy test, mainly in embryos on day 6.

Efecto en los resultados reproductivos con la "magnetic-actived cell sorting (MACS)" para la eliminación de espermatozoides positivos a anexina V en parejas con infertilidad inexplicable / Effect on reproductive outcomes by using "magnetic-actived cell sorting (MACS)" for the elimination of sperm-positive annexin-V in couples with unexplained infertility

Resumen Objetivo: Determinar si la eliminación de espermatozoides positivos a marcadores tempranos de apoptosis en parejas con infertilidad inexplicable incrementa la tasa de nacidos vivos. Materiales y métodos: Ensayo piloto, con asignación al azar, controlado y triple ciego; y un estudio paralelo de dos grupos. Se incluyeron parejas con diagnóstico de infertilidad inexplicable que se asignaron en una proporción 1:1 al grupo A (método de capacitación espermática swim-up) o grupo B (método de capacitación espermática swim-up complementado con separación magnética de células activadas; magnetic-actived cell sorting; MACS). Posteriormente, a todas las muestras se les efectuó una inyección intracitoplasmática de espermatozoides, como técnica de fertilización. Por último, todos los embriones obtenidos se analizaron hasta la etapa de blastocisto y todas las transferencias se llevaron a cabo en la misma etapa. Resultados: Se incluyeron 40 parejas y no se encontraron diferencias en la tasa de fertilización. Con la aplicación de MACS se obtiene mayor porcentaje de embriones de buena calidad en día 3 (90.3 vs 99.5%; p = 0.03) y en día 5 (77.3 vs 90.1%; p = < 0.0001) disminuyó el porcentaje de embriones arrestados (16.3 vs 7.9%; p = 0.01). Por último, las tasas de implantación (42.1 vs 57.1%), embarazo clínico (60 vs 80%) y nacidos vivos (55 vs 80%) aumentaron, sin diferencias estadísticamente significativas. Conclusiones: La separación magnética de células activadas (MACS) en parejas con infertilidad inexplicable mejora el desarrollo embrionario. A pesar de no existir una diferencia significativa se observa una tendencia al incremento de embarazos clínicos y nacidos vivos.

Abstract Objective: To determine if the live births delivery rate with the eliminating sperm positive to early apoptotic events is higher in couples with unexplained infertility. Materials and methods: A pilot randomized controlled trialA pilot and triple-blinded; using a parallel study of two groups. We included a total of 40 couples with unexplained infertility assigned in a 1:1 proportion either to the group A (sperm training method swim-up) or to the group B (swim-up sperm training method supplemented with the use of "magnetic-actived cell sorting (MACS)"). Subsequently, all samples were submitted to intracytoplasmic sperm injection as a fertilization technique. Finally, all embryos obtained were analyzed until the blastocyst stage, and all the transfers were performed in the same stage. Results: There are no differences in the fertilization rate; however, with the use of "magnetic-actived cell sorting" there is a higher percentage of good quality embryos on day 3 (90.3% vs 99.5%, p = 0.03) and day 5 (77.3% vs 90.1%, p = <0.0001). In addition, a decrease in the percentage of arrested embryos was demonstrated (16.3% vs 7.9%, p = 0.01). Finally, implantation (42.1% vs 57.1%), clinical pregnancy (60% vs 80%) and live birth rates (55% vs 80%) increased; however, no statistically significant differences were reported. Conclusions: The use of "magnetic-actived cell sorting" in couples with unexplained infertility improves embryonic development. Although there is no significant difference, a trend is observed in relation to the increase in the number of clinical pregnancies and live births.

[Transabdominal oocyte retrieval: case report on an IVF cycle]. / Aspiración folicular mediante punción transabdominal: reporte de un caso en fertilización in vitro.

BACKGROUND: Ultrasound-guided transvaginal follicular aspiration is the standard of care in women undergoing oocyte retrieval during vitro fertilization (IVF). When this approach is inaccessible, there are alternative methods to extract the oocytes at the exact moment. One of these alternative options is the transabdominal ultrasound-guided follicular aspiration. We present a case report of a mixed follicular aspiration in a patient with ovaries of difficult access. CASE REPORT: A 36-year-old patient with primary infertility came for medical advice. Because of bilateral tubal occlusion, an in vitro fertilization cycle was started. Transvaginal sonograms revealed a normal left ovary, but the right one was completely attached to the anterior face of the uterus. After ovarian stimulation, transvaginal follicular aspiration was done on the left ovary, meanwhile, on the right ovary; transabdominal follicular aspiration was performed, retrieving 3 oocytes on metaphase II by this technique. Finally, there were no complications during the procedure and the patient got pregnant at the end of the treatment. CONCLUSIONS: Ultrasound-guided transabdominal follicular aspiration, is the safest and most effective technique when transvaginal access to the ovaries is compromised.

[Fetal acardia in a twin pregnancy achieved by in vitro fertilization]. / Acardia fetal en embarazo gemelar logrado por fertilización in vitro.

The frequency of fetal arcadia in the world is 1:35,000 to 1:48,000 pregnancies; is currently estimated that 1% of newborns in developed countries are the result of assisted reproduction techniques and the frequency of twin pregnancies is close to 18%, of these, an estimated relative risk for cardiac defect is 1.6. However, the association of acardiac fetus, twin pregnancy and assisted reproductive techniques is not fully established. In this paper, we describe a case of fetal acardia, in a pregnancy resulting from assisted reproduction and its obstetric care.

[Impact of male aging in the functional capacity of sperm through the expression of phosphatidyl serine and oligonucleomas]. / Impacto del envejecimiento masculino en la capacidad funcional del espermatozoide a través de la expresión de fosfatidil serina y oligonucleomas.

BACKGROUND: biomolecular processes associated with aging and programmed cell death during spermatogenesis are well known, but not its biological significance in ejaculated sperm, because it ignores the behavior of these apoptotic markers in relation to the age of man. OBJECTIVE: To evaluate the effect of aging on the functional capacity of sperm and their relationship to programmed cell death processes. MATERIAL AND METHODS: Prospective, cross-sectional and analytical performed with semen samples from 25 healthy subjects 20 to 70 years old, were divided into two groups [(A: under 40 years) and (B: over 40 years age)]. Semen parameters were evaluated WHO (1999) and transformation processes biomolecular membrane and the expression of oligonucleosomes in the terminal cascade of apoptosis. Were measured by flow cytometry with an argon laser as a source of reading at 480 nm, the degree of cellularity discriminate negative and positive for each of the indicators. RESULTS: The percentage of live cells with phosphatidylserine translocation in the membrane (annexin-V / PI) was significantly higher in men older than 40 years (p <0.05). These findings are enriched with a significant positive correlation (r = 0.50, P <0.008) between early biomarker and age of the subjects. With regard to DNA fragmentation, although no statistically significant differences were found, it is a clear trend of increase as older the subjects (r = 0.51). CONCLUSIONS: The increasing age of the man is associated with increased expression of apoptosis, as demonstrated by the increased expression of phosphatidylserine translocation at the Membrane. Thus, this study confirms that the subject's age is associated with a decline in some of the seminal parameters.

[Effect of merocianina-540 in the fertilizing capacity of sperm correlated with the expression of 3-OH terminal fragments]. / Efecto de la merocianina-540 en la capacidad fertilizante del espermatozoide correlacionada con la expresión de fragmentos 3-OH terminales.

BACKGROUND: The packaging of heterochromatin during spermatogenesis has been correlated with the expression of residual apoptotic bodies (which stain with merocyanine A) that will impact on sperm function in the fertilization process; as well as the joint expression of the transmembrane translocation phosphatidyl serine and oligonucleosomes. OBJECTIVE: To evaluate the expression of bodies stained with merocyanine in the functional processes of sperm and their level of agreement with apoptotic Annexin V and TUNEL biomarkers. MATERIAL AND METHOD: We performed a prospective, cross, including 11,000 cells belonging to semen samples from infertile men, were evaluated according to WHO criteria (1999), bounded by the lines of Tygerberg. The biomolecular transformation processing of the membrane and the expression of oligonucleosomes in the terminal cascade of apoptosis were quantified by cytometry flow, using an argon lasser as a reading source of 480 nm, discriminating the degree of cellularity, both negative and positive for each indicators. RESULTS: Because of the study design was found low quantification in semen parameters, motility, morphology and sperm concentration. The average expression of cells [DNA-PI(+) / dUTP-FITC(+)] (quantification of TUNEL) and [Annexin-V(+) / PI(-)] was 36.5 +/- 17.4% and 31.2 +/- 17.4%, respectively. By comparing the expression of TUNEL without the effect of M540 bodies (36.3 +/- 1.7% vs. 36 +/- 1.7%) a significant difference was not determined. CONCLUSIONS: This study shows that there is a remnant of the primary processes of spermiation, which can take an important role in apoptotic and functional processes of the sperm. However, its expression does not affect measurement of biomarkers of apoptosis seminal, whose determination changed the diagnosis and functional perception of reproductive parameters in the sperm.

[Intrauterine insemination versus programmed intercourse in cycles of controlled ovaric hyperstimulation]. / Inseminación intrauterina versus coito programado en ciclos de hiperestimulación ovárica controlada.

BACKGROUND: Assisted reproduction techniques are used more and more frequently in the treatment of coulples with infertility diagnosis. OBJECTIVE: To analyze the intrauterine insemination (IUI) value in controlled ovarian hyperstimulation cycles (COH). MATERIAL AND METHODS: An analytic, comparative, retrospective and longitudinal case-control study was performed. COH with IUI (group I) or with timed intercourse (TI) (group II) cycles from January 1st 2004 to December 31st 2006 were analyzed. Infertile patients aged between 24 and 42 years (group I) and between 23 and 36 years (group II) were included. The following variables were analyzed: Age, type, etiology and duration of infertility, sperm density and motility after capacitation or seminal analysis, number of total and mature follicles, endometrial thickness, gonadotropin type and dosage, insemination or TI cycle day. Pregnant vs non pregnant and pregnancies in both groups were analyzed. Results were analyzed with the STATA 7.0 and SPSS 12.0 programs. RESULTS: 873 COH+I UI cycles in 539 couples and 246 COH+ TI in 138 patients were analyzed the pregnancy rates per cycle were 13.1% and 5.2% for each group respectively. The mean woman's age was of 32.9 +/- 3.5 and 31.8 +/- 2.7 years for groups I and II respectively. There were significant differences in sperm density in both groups. The remaining variables showed no statistical differences. CONCLUSIONS: IUI versus TI do not seems to be superior with respect to the pregnancy rates in COH cycles.

[Effect of intramural and subserous myomas on in vitro fertilization cycles and their perinatal results]. / Efecto de los miomas intramurales y subserosos en los ciclos de fertilización in vitro y sus resultados perinatales.

OBJECTIVE: To evaluate the effect of intramural and subserous myomas in in vitro fertilization cycles, as well as its perinatal results. TYPE OF STUDY: Cases and controls. MATERIAL AND METHODS: All the IVF cycles between October 1999 and December 2004 were included. The variables of size and type of myomas, as well as variables of IVF cycles, implantation and pregnancy rates, and perinatal results were analyzed. We calculated the chi-square test to analyze the relationship between myomas and pregnancy. The t-Student test was used to establish the difference in the average between both groups regarding the studied variables. In the logistic regression analysis we controlled confusing variables. RESULTS: We analyzed 431 cycles made in 364 patients divided into two groups: study cases (with myomas-65 cycles) and control cases (without myomas-366 cycles). Age was two years older in the study group (35.7 vs 33.5, p < 0.001). There was no difference in: duration, type of infertility, days of stimulation, gonadotrophin dose, total and mature follicles, and fertilization and implantation rates. We only observed a difference in the recovered oocytes (8.0 vs 9.7, p = 0.027). The pregnancy, abortion and live-born children rates were of 20.0 vs 23.2, 46.1 vs 29.4, and 46.1 vs 58.8%, respectively (study and control groups; p > 0.05). Logistic regression showed that myomas do not affect the possibility of getting pregnant. CONCLUSION: Intramural and subserous myomas < 5 cm do not seem to have an effect in the IVF cycles nor in its perinatal results. In women with myomas < 5 cm that no dot distortion the uterine cavity it is questionable the usefulness of a myomectomy prior to IVF cycles.

[Prognostic factors of pregnancy in intrauterine insemination]. / Factores pronóstico de embarazo en inseminación intrauterina.

BACKGROUND: The artificial insemination is the introduction of spermatozoa in the feminine genital tract without carrying out sexual contact and with the purpose of obtaining the pregnancy. The insemination intrauterine has improved its rate of success thanks to the technological advances and the best knowledge of human reproductive physiology. OBJECTIVES: To evaluate the prognostic factors for the pregnancy success and calculate the cumulative rate per cycle in IUI (intrauterine insemination). PATIENTS AND METHODS: This study was descriptive, retrospective, analytic, and longitudinal. The cycles of IUI were analyzed from January 1st 2003 to December 31st 2005. Couples 24-41 years old with primary and secondary infertility were included. The following variables were studied: age of participant, type of infertility, length of infertility, aetiology, postcapacitation sperm density and motility, number of follicles, endometrial thickness, and the cycle number in which the IUI was performed. Patients carried out a protocol of ovarian stimulation and follicular follow up. The results were analyzed with 11.0 SPSS, continuous variables were analyzed and reported as means +/- SD with univariate logistic regression to determine statistic significance. Categoric variables were reported in frequencies and percentages. ROC curves were calculated to determine optimal cutting points. RESULTS: 668 cycles were analyzed in 391 couples. The pregnancy rate per cycle and couple was of 13.0 and 21.7% respectively. Means +/- SD patient age was 33.5 +/- 3.4 years old. The three variables with p < 0.05 were: the infertility duration, sperm motility and the cycle number in which IUI was performed. No statistical significance was found in the remaining variables. CONCLUSIONS: The greatest success in IUI will be achieved with infertility of 4 years or less, with sperm motility of 77.6% and in the first two cycles of treatment.

[Perinatal result of an institutional assisted reproduction program]. / Resultado perinatal de un programa de reproducción asistida institucional.

BACKGROUND: Assisted reproductive technology manipulates masculine gametes, embryos and implantation. It also aids the known or unknown factor of sterility without having the base problem correction as a target. In vitro fertilization and embryo transfer are among these techniques. OBJECTIVE: To describe the overall outcome and the final perinatal offspring after in vitro fertilization cycle in an institutional third level hospital. MATERIALS AND METHODS: IVF cycles were retrospectively analyzed from October 1999 to May 2004. Several variables were described like: age, fertilization rate, implantation and pregnancy rate, fetal status, time of gestation during labor, miscarriage follicle-stimulating hormone rate and take-home baby rate. Patients underwent hypophyseal supression with GnRH analog, using a long luteal phase protocol and stimulated with recombinant FSH. Overall data is expressed as average +/- standard deviation and percentage. RESULTS: 365 cycles were analyzed in 314 patients, average age was of 34 +/- 3.7 years, tubal factor was diagnosed in 63.3%, fertilization rate was of 60.4%, implantation rate of 37.1%, per transfer pregnancy rate of 25.1%, per transfer live born rate of 21.7%, multiple pregnancy rate of 29.3%, miscarriage rate of 28% and ectopic pregnancy rate of 4.8%. In 87.8% of the cases caesarean operation was made; multiple pregnancy offspring weighted more than 1250 g in 70% of them; 70.5% was born after 32 weeks of pregnancy; 90% was born live and with good prognosis. Glucose metabolism alterations were the most frequent maternal complication. CONCLUSION: Although the results obtained were similar to those of assisted reproduction centers, it suggests improving multiple pregnancy rate and abortion rate.

[Estrogen role in the luteal phase support in in vitro fertilization with embryo transfer cycles]. / Papel de los estrógenos en el soporte de la fase lútea en ciclos de fertilización in vitro con transferencia de embriones.

OBJECTIVE: To evaluate the effectiveness of estradiol administration for luteal phase support and to describe the progesterone and estradiol behavior in vitro fertilization-embryo transfer luteal phase. MATERIAL AND METHODS: Patients undergoing in vitro fertilization-embryo transfer with controlled ovarian hyperstimulation and using gonadotropin releasing hormone agonist. They were divided at random into two groups: group 1 would receive progesterone alone, and group 2 would take estrogen and progesterone. Serum concentrations of estradiol and progesterone were measured on days 7 and 14 post-embryo transfer. RESULTS: We examined 52 patients; 24 received progesterone alone and 28 took estrogen and progesterone. Significantly higher estradiol and progesterone concentrations on day 14 were found in pregnant women. It was not on day 7. A significant increment of estrogen was found in the estrogen and progesterone group. Progesterone did not increase significantly. Pregnancy rate was the same in both groups. CONCLUSIONS: For patients undergoing in vitro fertilization-embryo transfer, the addition of estradiol to the progesterone support regimen does not have beneficial effects in terms of pregnancy rate. On day 7 neither progesterone nor estradiol are good predictors of pregnancy.

[Changes in mitochondrial membrane potentials and its exponential relation with phosphatidylserine translocation in the plasma membrane as markers in the initial events of apoptosis: evaluation in different spermatic fractions]. / Alteración en los potenciales de membrana mitocondrial y su relación exponencial con la translocación de fosfatidilserina en la membrana plasmática como marcadores en los eventos iniciales de apoptosis: evaluación en diferentes fracciones espermáticas.

OBJECTIVE: To determine the integrity of the plasmatic membrane through phosphatidylserine (PS) translocation in two spermatic fractions and their correlation with the spermatic mitochondrial membrane potential. MATERIAL AND METHODS: The analysis of both spermatic fractions was carried out through a discontinuous gradient separation with Percoli, in order to obtain two samples with high and low mobility (90-40%). Twelve patients were recruited for the initial evaluation of seminal parameters. Mitochondrial membrane integrity was determined using a second antibody (Mitosensor), and was analyzed by fluorescence microscopy, evaluating an average of 200 cells. A 450-490 nm excitation filter was used for this analysis. Cytoplasmatic assessment was carried out by anexine V bonding to PS, in order to determine the initial events of cellular death. Non parameter tests were used in order to determine the differences between mitochondrial potentials and plasmatic membrane processes. Linear correlation tests were used for the anexine V and Mitosensor ratios. RESULTS: Due to the study's design, some differences were observed regarding the displacement parameters and the presence of apoptosis, both, in the plasmatic membrane and in mitochondrial membrane potentials. A positive correlation between both, mitochondrial and cytoplasmic membrane functions was also found. CONCLUSIONS: This is the first study performing a comparative analysis between mitochondrial membrane function and cytoplasmatic PS expression as early cellular death markers. The male infertility population is probably associated with an increase in this kind of apoptosis processes.

[Ovum-embryo competitiveness determined by the quantification of perifollicular indices in Doppler vascular micro-architecture]. / Competitividad óvulo-embrionaria determinada a través de la cuantificación de los índices perifoliculares en la microarquitectura vascular por Doppler.

OBJECTIVE: To obtain the linear correlation between Doppler flowmetry rates and follicular development and the observed embryo growth in ovarian hyperstimulation cycles in the IVFTE/ICSI results. MATERIAL AND METHODS: A prospective and observational study including 29 patients was carried out. The ovarian reserve was determined--by the ovaries morphometric conditions--as well as basal FSH. These were correlated with pulsatility rates (PR), resistance rates (RR), and the systole/diastole ratio (S/D) and the maximum flow rate (TAmax), using a USG pulse-colour Doppler. All these were correlated to embryo development. Covariance, regression lines and confidence intervals analyses were performed for its statistical determination. RESULTS: A correlation between RR and the formation of mature follicles was observed (p = 0.05), and, at the same time, a negative relationship between FSH and ovarian volume was found. CONCLUSIONS: A series of markers of ovarian reserve have been described, however, none of these is a specific marker when ovum quality is expressed through the administration of ovulation inducers. Considering the data obtained in our study, we can say that Doppler flowmetry rates can indicate follicular expression and the resulting ovum and embryo development.

[Pelvic surgery as a predictive marker of the follicular response to ovulation inducers]. / La cirugía pélvica como un marcador predictivo de la respuesta folicular a los inductores de ovulación.

OBJECTIVE: Comparing the follicular response in a group of patients with previous pelvic surgery submitted to in vitro fertilization. MATERIAL AND METHODS: Patients who were going to be submitted to controlled ovarian stimulation and in vitro fertilization were included. Two groups were formed: one with those patients who had had a previous pelvic operation and the other with those patients who had not. The characteristics which were analyzed included: age, weight, body mass index, FSH, LH and estradiol levels, as well as total ova numbers, grade of embryonic maturity, and number of transferred embryos. RESULTS: Ninety nine patients were studied: 46 had been submitted to pelvic surgery and 53 had not. Due to the design of the study there were no differences regarding age, weight, size and body mass index; the evaluation of the ovarian reserve was similar in both groups. However, the group of patients previously submitted to pelvic surgery presented a lower quantity of total ova (p = 0.004), less mature ova (p = 0.008) with a significantly lower pregnancy rate. CONCLUSIONS: Surgical procedures, combined with adherence processes, probably have a direct incidence on the characteristics of the perifollicular environment which interfere with adequate development of the ovum. All these can be observed in a decrease of fertilization processes and embryonic development, regardless of the expression of the adequate biochemical markers of the ovarian reserve. Our research shows that the group under study presents a decrease in follicular response affecting the quality of the ovum-embryo expressed in the pregnancy rate.

Estudio del volumen ovárico como factor predictivo de reserva ovular en respuesta a la estimulación exógena con gonadotropinas y su correlación con el desarrollo óvulo/embrionario en los resultados de FIVTE/ICSI / Study of ovarian volume as ovarian reserve predictive factor as aresponse of gonadotrophin exogenous stimulation and its correlation with ovule/embryo development in FIVTE/ICSI ouatcomes

La valoración de la reserva ovárica a la respuesta exógena con el uso de gonadotropinas está en relación directa a la interconexión de diversos factores intrafoliculares involucrados en los componentes ovulares, y por consiguiente, un mejor desarrollo embrionario, lo cual será reflejado en las tasas de embarazo en los programas de reproducción asistida. Se ha propuesto una serie de marcadores para la valoración dinámica de la respuesta ovárica: determinaciones hormonales (FSH, E2, índice FSH:LH), bioquímícos (inhibina-B), intrafoliculares (citoquinas, leptina), de neuromodulación (prueba de la GnRH), etc. No obstante ninguno de ellos ha demostrado una sensibilidad precisa para determinar con exactitud el tratamiento más apropiado dependiendo de los valores que estos puedan proporcionar. El objetivo del presente estudio fue valorar la capacidad de respuesta ovárica a partir de la valoración del volumen ovárico. Se estudiaron dos grupos de pacientes: grupo 1 (n=19) con un volumen ovárico basal menor de 3 cm3 y grupo 2 (n=21), aquellos con un volumen mayor de 3 cm3. Las pacientes del grupo dos mostraron una tendencia significativa hacia una mejor respuesta a la estimulación ovárica, así como también a la recuperación de óvulos de mejor calidad, incremento en las tasas de fertilización, segmentación y embarazo y un índice menor de cancelación comparadas con el grupo uno. Se puede concluir que las pacientes con un volumen ovárico menor de 3 cm3 el día previo a la estimulación, tendrán una respuesta más pobre a las gonadotropinas exógenas por lo que esta variable debe ser considerada como un marcador de la respuesta folicular ovárica.

Histerectomía vaginal asistida por laparoscopia. Estudio crítico y comparativo con histerectomía vaginal y abdominal en le Hospital A.B.C. de la Ciudad de México / Vaginal hysterectomy assisted by laparoscopy. Critical and comparativo study with vaginal hysterectomy, and abdominal, at A. B. C. Hospital, México City

La Histerectomía vaginal asistida por laparoscopia ofrece la posibilidad de convertir procedimientos abdominales en vaginales dando a la paciente los beneficios potenciales de este último abordaje. Se analizan los primeros 20 casos realizados en el servicio de ginecología-obstetricia del Hospital A. B. C. siendo comparados con abordajes abdominal y vaginal en divesos parámetros que incluyen: indicaciones, costos y días de hospitalización entre otros. La Histerectomía vaginal asistida por laparoscopia ofrece los beneficios de la vía vaginal con tiempos de hospitalización similares a los otros abordajes y mayores costos y tiempo operatorio. Aún queda por definir la función exacta de la histerectomía vaginal asistida en la práctica diaria

Nuevas perspectivas para un problema antiguo. El trabajo de parto pretérmino / New perspectives to an old trouble. The preterm labor

El parto pretérmino ha sido y continúa siendo uno de los mayores problemas en obstetricia. Es la causa más frecuente de mortalidad neonatal y origina una mortalidad elevada en los productos que sobreviven. La presencia de vaginosis bacteriana y otras infecciones genitales se asocia con aumento en el riesgo de parto pretérmino. Las citoquinas liberan prostaglandinas y han implicadas como causa de actividad uterina. Recientemente, se han desarrollado nuevos métodos para detectar el problema; tales como la ultrasonografía transvaginal y las mediciones de fibronectina fetal a nivel cervical. El atosibán, las citoquinas, el trinitrato de glicerilo y otros medicamentos se han propuesto como nuevos tratamiento y están bajo investigación. Estos fármacos permitirán un tratamiento eficaz con pocos efectos colaterales. La administración prenatal de TRH no se recomienda para uso clínico generalizado. Sin embargo, la aplicación prenatal de corticoesteroides a fetos con riesgo de nacer prematuramente; no solamente reduce el riesgo de síndrome de dificultad respiratoria, sino que disminuye de manera importante la mortalidad por hemorragia intraventricular

La incisión abdominal transversa para operción cesárea. ¿Maylard o Pfannenstiel? / Transversal abdominal incision for cesarea: Maylard or Pfannenstiel?

El objetivo de este estudio fue comparar la evolución y complicaciones de dos incisiones abdominales para efectuar cesáreas. Veinte pacientes fueron operadas utilizando la incisión de Pfannenstiel (grupo I) y veinte mujeres con al menos una cesárea realizada con técnica de Pfannenstiel se operaron con incisión tipo Maylard (grupo II). Fueron evaluados el resultado obstétrico y la evolución quirúrgica de las pacientes. El análisis estadístico se hizo con comparación de varianzas y X2. No hubo diferencias significaticas entre las variables estudiadas en los dos grupos. Los resultados sugieren que la evolución con ambas técnicas es equivalente. La incisión Maylard puede utilizarse cuando son esperadas extracciones difíciles

Síndrome de transfusión feto-feto: Un punto de vista actual / Twin-twin transfusion syndrome: a present overview

El síndrome de transfusión feto-feto es una complicación de los embarazos gemelares monocigóticos-monocoriónicos, que se presenta en el segundo trimestre, con una mortalidad perinatal mayor del 60 por ciento. La presencia de anastomosis vasculares dentro de la placenta es la responsable del síndrome. El diagnóstico requiere la comprobación ultrasonográfica de monocorionicidad, de la secuencia oligohidramnios-polihidramnios, de discordancia en el crecimiento fetal y valores divergentes de hemoglobina y hematócrito. La indometacina, la amniocentesis y la cirugía endoscópica fetal pueden disminuir la elevada tasa de mortalidad perinatal. Si bien el pronóstico perinatal parece estar relacionado con la morbimortalidad a corto plazo, es recomendable realizar segumiento a largo plazo