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1.
Fertil Steril ; 116(1): 198-207, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34148584

RESUMO

OBJECTIVE: To evaluate the evidence addressing the association between the use of ovarian stimulation drugs and the risk of breast cancer. DESIGN: Systematic review and meta-analysis. SETTING: Not applicable. PATIENT(S): Women without any previous history of breast cancer undergoing ovarian stimulation. INTERVENTION(S): Electronic databases were searched from 1990 until January 2020. All cohort studies reporting new incidences of breast cancer in infertile women using ovarian stimulating drugs were included. Treated (exposed) infertile women were compared with the unexposed general population with unexposed infertile women as controls. MAIN OUTCOME MEASURE(S): New diagnosis of breast cancer within an infertile and general population after exposure to ovarian stimulation drugs. RESULT(S): Overall, the quality of evidence was very low because of the serious risk of bias and indirectness (nonrandomized studies). There was no significant increase in the risk of breast cancer among women treated with any ovarian stimulation drug for infertility compared with that in unexposed controls from the general population and the infertile population (pooled odds ratio 1.03, 95% Confidence interval 0.86 to 1.23, 20 studies, I2 = 88.41%, very low quality of evidence). Furthermore, no significant increase in the risk of breast cancer was found with the use of clomiphene citrate or gonadotropins, alone or in combination. CONCLUSION(S): The current study found that the use of clomiphene citrate and gonadotropins in infertile women was not associated with an increased risk of breast cancer.


Assuntos
Neoplasias da Mama/induzido quimicamente , Fármacos para a Fertilidade Feminina/efeitos adversos , Infertilidade Feminina/tratamento farmacológico , Indução da Ovulação/efeitos adversos , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/epidemiologia , Feminino , Fertilidade/efeitos dos fármacos , Humanos , Incidência , Infertilidade Feminina/epidemiologia , Infertilidade Feminina/fisiopatologia , Gravidez , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
2.
Fertil Steril ; 116(1): 36-47, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34148587

RESUMO

OBJECTIVE: To provide evidence-based recommendations to practicing physicians and others regarding the efficacy of oocyte cryopreservation (OC) for donor oocyte in vitro fertilization and planned OC. METHODS: The American Society for Reproductive Medicine conducted a literature search, which included systematic reviews, meta-analyses, randomized controlled trials, and prospective and retrospective comparative observational studies published from 1986 to 2018. The American Society for Reproductive Medicine Practice Committee and a task force of experts used available evidence and through consensus developed evidence-based guideline recommendations. MAIN OUTCOME MEASURE(S): Outcomes of interest included live birth rate, clinical pregnancy rate, obstetrical and neonatal outcomes, and factors predicting reproductive outcomes. RESULT(S): The literature search identified 30 relevant studies to inform the evidence base for this guideline. RECOMMENDATION(S): Evidence-based recommendations were developed for predicting the likelihood of live births after planned OC, autologous OC in infertile women, and donor OC, as well as factors that may impact live birth rates. Recommendations were developed regarding neonatal outcomes after using fresh vs. cryopreserved oocytes in cases of autologous or donor oocytes. CONCLUSION(S): There is insufficient evidence to predict live birth rates after planned OC. On the basis of limited data, ongoing and live birth rates appear to be improved for women who undergo planned OC at a younger vs. older age. Although there are no significant differences in per transfer pregnancy rates with cryopreserved vs. fresh donor oocytes, there is insufficient evidence that the live birth rate is the same with vitrified vs. fresh donor oocytes. Neonatal outcomes appear similar with cryopreserved oocytes compared with fresh oocytes. Future studies that compare cumulative live birth rates are needed.


Assuntos
Criopreservação/normas , Preservação da Fertilidade/normas , Fertilização In Vitro/normas , Infertilidade Feminina/terapia , Recuperação de Oócitos/normas , Oócitos , Medicina Reprodutiva/normas , Adulto , Consenso , Medicina Baseada em Evidências/normas , Feminino , Fertilidade , Preservação da Fertilidade/efeitos adversos , Fertilização In Vitro/efeitos adversos , Humanos , Infertilidade Feminina/diagnóstico , Infertilidade Feminina/fisiopatologia , Nascido Vivo , Recuperação de Oócitos/efeitos adversos , Gravidez , Complicações na Gravidez/etiologia , Taxa de Gravidez , Fatores de Risco , Resultado do Tratamento
3.
Tech Vasc Interv Radiol ; 24(1): 100736, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-34147190

RESUMO

Fallopian tube obstruction (FTO) is a common cause of female infertility. In the setting of proximal FTO, fallopian tube recanalization (FTR) is a minimally invasive, ambulatory procedure with a technical success rate of up to 100%, with minimal postprocedural adverse events. One-year pregnancy rate following FTR is approximately 41%, with successful delivery of full-term infants in 84% of pregnancies. This minimally invasive, outpatient, image-guided procedure is an alternative to vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) and should be top-of-mind in the setting of infertility due to proximal FTO.


Assuntos
Cateterismo , Doenças das Tubas Uterinas/terapia , Tubas Uterinas , Infertilidade Feminina/terapia , Radiografia Intervencionista , Cateterismo/efeitos adversos , Doenças das Tubas Uterinas/diagnóstico por imagem , Doenças das Tubas Uterinas/fisiopatologia , Tubas Uterinas/diagnóstico por imagem , Tubas Uterinas/fisiopatologia , Feminino , Fertilidade , Humanos , Infertilidade Feminina/diagnóstico por imagem , Infertilidade Feminina/fisiopatologia , Radiografia Intervencionista/efeitos adversos , Resultado do Tratamento
4.
Fertil Steril ; 116(3): 896-908, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-33975729

RESUMO

OBJECTIVE: To describe molecular and paracrine signaling changes produced by human bone marrow-derived stem cells (BMDSC) in human ovarian cortex. DESIGN: Experimental study. SETTING: University hospital research laboratories. PATIENT(S): Ovarian cortex from poor responder women (n = 7). ANIMALS: Immunodeficient NOD/SCID female mice (n = 18). INTERVENTION(S): Human ovarian cortex strips were xenografted into ovariectomized NOD/SCID female mice. A week later, mice were infused with phosphate-buffered saline, 1 × 106 BMDSC, or 3 × 105 CD133+ cells via tail vein. Gene expression changes and enriched pathways were assessed by RT2 Profiler Arrays. Several upregulated genes were validated in individual samples by real-time quantitative PCR, and transcriptomic results were reinforced by a proteomic assessment. MAIN OUTCOME MEASURE(S): Gene expression changes, enriched Kyoto Encyclopedia of Genes and Genomes pathways, and paracrine factors. RESULT(S): Seventy-four Kyoto Encyclopedia of Genes and Genomes pathways were upregulated, with the PI3K-Akt signaling pathway the most enriched after BMDSC and CD133 treatments. The greatest transcriptomic changes were seen on day 14 in the BMDSC group, affecting the regulation of paracrine factors such as KITLG, THBS1, SERPINF1, and TIMP2. Proteomics data verified changes in FoxO signaling, actin cytoskeleton remodeling, and apoptosis by BMDSC. CONCLUSION(S): We identified paracrine factors and pathways regulated by BMDSC that may be future targets of treatment for the increasing number of poor responder women. Our findings suggest that BMDSC upregulated soluble factors such as KITLG, THBS1, SERPINF1, and TIMP2 as well as PI3K-Akt signaling and regulation of actin cytoskeleton pathways. The identification of these putative underlying mechanisms informs future experiments aiming to optimizing clinical application of BMDSC.


Assuntos
Células da Medula Óssea/metabolismo , Infertilidade Feminina/metabolismo , Ovário/metabolismo , Comunicação Parácrina , Animais , Apoptose , Transplante de Medula Óssea , Proliferação de Células , Feminino , Regulação da Expressão Gênica , Redes Reguladoras de Genes , Humanos , Infertilidade Feminina/genética , Infertilidade Feminina/patologia , Infertilidade Feminina/fisiopatologia , Camundongos Endogâmicos NOD , Camundongos SCID , Neovascularização Fisiológica , Reserva Ovariana , Ovariectomia , Ovário/patologia , Ovário/fisiopatologia , Ovário/transplante , Proteoma , Transdução de Sinais , Transcriptoma
5.
BMC Pregnancy Childbirth ; 21(1): 348, 2021 May 02.
Artigo em Inglês | MEDLINE | ID: mdl-33934703

RESUMO

BACKGROUND: No previous study directly compares the fixed day-5 initiation versus the flexible initiation of GnRH antagonist administration in IVF/ICSI for those patients who are predicted as high ovarian responders without PCOS. To evaluate whether the number of oocytes retrieved is different by using the two GnRH antagonist protocols in Chinese women with predicted high ovarian response except PCOS. METHODS: A randomized controlled trial of 201 infertile women with predicted high ovarian response except PCOS undergoing in vitro fertilization. Ovary stimulation was performed using recombinant FSH and GnRH antagonists. GnRH antagonist ganirelix (0.25 mg/d) was started either on day 5 of stimulation (fixed group) or when LH was > 10 IU/L, and/or a follicle with mean diameter > 12 mm was present, and/or serum E2 was > 600 pg/ml. Patient monitoring was initiated on day 3 of stimulation in flexible group. RESULT(S): No significant difference was observed between the fixed and flexible groups regarding the number of oocytes retrieved (16.72 ± 7.25 vs. 17.47 ± 5.88, P = 0.421), the Gonadotropin treatment duration (9.53 ± 1.07 vs. 9.67 ± 1.03, P = 0.346) and total Gonadotropin dose (1427.75 ± 210.6 vs. 1455.94 ± 243.44, P = 0.381). GnRH antagonist treatment duration in fixed protocol was statistically longer than the flexible protocol (6.57 ± 1.17 vs 6.04 ± 1.03, P = 0.001). There was no premature LH surge in either protocol. CONCLUSION(S): Fixed GnRH antagonist administration on day 5 of stimulation appear to achieve a comparable oocyte retrieved compared with flexible antagonist administration. TRIAL REGISTRATION: NCT02635607 posted on December 16, 2015 in clinicaltrials.gov.


Assuntos
Infertilidade Feminina/terapia , Ovário/efeitos dos fármacos , Indução da Ovulação/métodos , Síndrome do Ovário Policístico/fisiopatologia , Adulto , Gonadotropina Coriônica/administração & dosagem , Feminino , Fertilização In Vitro/métodos , Hormônio Foliculoestimulante Humano/administração & dosagem , Hormônio Liberador de Gonadotropina/administração & dosagem , Hormônio Liberador de Gonadotropina/análogos & derivados , Humanos , Infertilidade Feminina/fisiopatologia , Ovário/metabolismo , Ovário/fisiopatologia , Síndrome do Ovário Policístico/complicações , Gravidez , Taxa de Gravidez , Proteínas Recombinantes/administração & dosagem , Resultado do Tratamento , Pamoato de Triptorrelina/administração & dosagem , Adulto Jovem
6.
Fertil Steril ; 116(3): 741-756, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-33926722

RESUMO

OBJECTIVE: To report the utilization, effectiveness, and safety of practices in assisted reproductive technology (ART) globally in 2013 and assess global trends over time. DESIGN: Retrospective, cross-sectional survey on the utilization, effectiveness, and safety of ART procedures performed globally during 2013. SETTING: Seventy-five countries and 2,639 ART clinics. PATIENT(S): Women and men undergoing ART procedures. INTERVENTION(S): All ART. MAIN OUTCOME MEASURE(S): The ART cycles and outcomes on country-by-country, regional, and global levels. Aggregate country data were processed and analyzed based on methods developed by the International Committee for Monitoring Assisted Reproductive Technology (ICMART). RESULT(S): A total of 1,858,500 ART cycles were conducted for the treatment year 2013 across 2,639 clinics in 75 participating countries with a global participation rate of 73.6%. Reported and estimated data suggest 1,160,474 embryo transfers (ETs) were performed resulting in >344,317 babies. From 2012 to 2013, the number of reported aspiration and frozen ET cycles increased by 3% and 16.4%, respectively. The proportion of women aged >40 years undergoing nondonor ART increased from 25.2% in 2012 to 26.3% in 2013. As a percentage of nondonor aspiration cycles, intracytoplasmic sperm injection (ICSI) was similar to results for 2012. The in vitro fertilization (IVF)/ICSI combined delivery rates per fresh aspiration and frozen ET cycles were 24.2% and 22.8%, respectively. In fresh nondonor cycles, single ET increased from 33.7% in 2012 to 36.5% in 2013, whereas the average number of transferred embryos was 1.81-again with wide country variation. The rate of twin deliveries after fresh nondonor transfers was 17.9%; the triplet rate was 0.7%. In frozen ET cycles performed in 2013, single ET was used in 57.6%, with an average of 1.49 embryos transferred and twin and triplet rates of 10.8% and 0.4%, respectively. The cumulative delivery rate per aspiration was 30.4%, similar to that in 2012. Perinatal mortality rate per 1,000 births was 22.2% after fresh IVF/ICSI and 16.8% after frozen ET. The data presented depended on the quality and completeness of the data submitted by individual countries. This report covers approximately two-thirds of world ART activity. Continued efforts to improve the quality and consistency of reporting ART data by registries are still needed. CONCLUSION(S): Reported ART cycles, effectiveness, and safety increased between 2012 and 2013 with adoption of a better method for estimating unreported cycles.


Assuntos
Saúde Global/tendências , Infertilidade Feminina/terapia , Infertilidade Masculina/terapia , Medicina Reprodutiva/tendências , Técnicas de Reprodução Assistida/tendências , Estudos Transversais , Feminino , Fertilidade , Disparidades em Assistência à Saúde/tendências , Humanos , Infertilidade Feminina/epidemiologia , Infertilidade Feminina/fisiopatologia , Infertilidade Masculina/epidemiologia , Infertilidade Masculina/fisiopatologia , Nascido Vivo , Masculino , Gravidez , Taxa de Gravidez/tendências , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
7.
J Tradit Chin Med ; 41(2): 203-211, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33825399

RESUMO

OBJECTIVE: To investigate whether Zichong granules (, ZCKL), a very effective herbal formula for treating infertility, have an impact on the differentiation of ovarian granulosa cells from human embryonic stem cells (hESCs) in vitro, and to explore the cellular mechanisms of its clinical effects. METHODS: Serum from ZCKL-medicated rats was prepared and used to treat mesoderm cells derived from hESCs for 6 d. Normal rat serum and a set of growth factors were used as negative and positive controls, respectively. RESULTS: ZCKL-medicated rat serum, but not normal rat serum, induced hESCs-derived mesoderm cells to differentiate into functional ovarian granulosa-like cells (OGLCs) in a similar manner to defined growth factors. The induced OGLCs resembled the morphology of native human granulosa cells, expressed granulosa cell-specific markers at both the mRNA and protein levels, produced high levels of estradiol and strongly responded to follicle-stimulating hormone stimulation. Furthermore, mRNA levels of follistatin, mothers against decapentaplegic homolog 8 and bone morphogenetic protein 6 were dynamically changed during the process. CONCLUSION: In the ZCKL treatment of infertility, one mechanism by which ZCKL may act is by influencing ovarian granulosa cell differentiation and development, possibly through the follistatin and BMP/SMAD signaling pathways.


Assuntos
Diferenciação Celular/efeitos dos fármacos , Medicamentos de Ervas Chinesas/farmacologia , Fármacos para a Fertilidade Feminina/farmacologia , Células da Granulosa/efeitos dos fármacos , Células-Tronco Embrionárias Humanas/efeitos dos fármacos , Infertilidade Feminina/fisiopatologia , Animais , Células Cultivadas , Feminino , Células da Granulosa/citologia , Células-Tronco Embrionárias Humanas/citologia , Humanos , Infertilidade Feminina/tratamento farmacológico , Ovário/citologia , Ovário/efeitos dos fármacos , Ratos
8.
Fertil Steril ; 116(1): 218-231, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33838869

RESUMO

OBJECTIVE: To investigate the impact of controlled ovarian hyperstimulation (COH) for in vitro fertilization (IVF) on thyroid function. DESIGN: Systematic review and meta-analysis. SETTING: Not applicable. PATIENT(S): Infertile women undergoing conventional IVF or intracytoplasmic sperm injection. INTERVENTION(S): Systematic search of PubMed, MEDLINE, Embase, Scopus, and Web of Science from inception until November 2020. Studies could be included only if they met the following criteria: subjects were classified as euthyroid or hypothyroid; serum thyroid-stimulating hormone (TSH) and/or free thyroxine (FT4) levels were evaluated before COH; and the same thyroid function test was reassessed after COH (i.e., at the time of trigger for final follicle maturation and/or at pregnancy test). MAIN OUTCOME MEASURE(S): Mean difference (MD) between the serum TSH or FT4 levels assessed after COH and before COH. RESULT(S): In euthyroid women, the serum TSH levels assessed at the time of trigger and at the time of pregnancy test were significantly higher than those at baseline (MD: 0.69 mIU/L, 95% confidence interval [CI]: 0.30-1.08, I2 = 93% and MD: 0.67, 95% CI: 0.49-0.85, I2 = 72%, respectively). The serum FT4 levels did not undergo significant changes. Subanalysis confirmed an increase in the TSH level after restricting the analysis to women treated with gonadotropin-releasing hormone agonist protocols and to those who achieved pregnancy. A pronounced increase in the TSH level was observed in women treated for hypothyroidism (MD: 1.50 mIU/L, 95% CI: 1.10-1.89, I2 = 0%). CONCLUSION(S): Pooling of the results showed a significant increase in serum TSH level in women undergoing COH for IVF. This change was particularly pronounced in women treated for hypothyroidism. New thyroid function screening strategies for women undergoing COH are warranted.


Assuntos
Fertilização In Vitro , Hipotireoidismo/fisiopatologia , Infertilidade Feminina/tratamento farmacológico , Indução da Ovulação/efeitos adversos , Ovulação/efeitos dos fármacos , Glândula Tireoide/efeitos dos fármacos , Biomarcadores/sangue , Feminino , Fertilidade/efeitos dos fármacos , Humanos , Hipotireoidismo/sangue , Hipotireoidismo/diagnóstico , Infertilidade Feminina/diagnóstico , Infertilidade Feminina/fisiopatologia , Masculino , Gravidez , Fatores de Risco , Injeções de Esperma Intracitoplásmicas , Glândula Tireoide/metabolismo , Glândula Tireoide/fisiopatologia , Tireotropina/sangue , Tiroxina/sangue , Resultado do Tratamento
9.
Medicine (Baltimore) ; 100(17): e25361, 2021 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-33907092

RESUMO

ABSTRACT: We aimed to investigate ovarian reserve status, and explore differences in ovarian reserve between fertile and infertile healthy Chinese women of reproductive age.We recruited 442 fertile women aged 23 to 49 years (mean: 35.22 ±â€Š4.91 years) as subjects, and 196 infertile women aged 23 to 46 years (mean: 32.34 ±â€Š4.34 years) as controls. For all participants, a number of parameters were tested on days 2 to 4 of a spontaneous cycle, including basal serum follicle-stimulating hormone (FSH), estradiol (E2), luteinizing hormone (LH), total testosterone, anti-Müllerian hormone (AMH), ovarian response prediction index (ORPI), and antral follicle count (AFC).There were significant differences in terms of AFC, serum AMH levels, and ORPI among subject subgroups (10.58 ±â€Š5.80; 2.533 ±â€Š2.146 ng/mL; 1.28 ±â€Š1.87; respectively), and among control subgroups (12.44 ±â€Š5.69; 3.189 ±â€Š2.551 ng/mL; 1.88 ±â€Š2.68; respectively) (P < .01 for all). For both subjects and controls, AFC, AMH levels, and ORPI decreased gradually with increasing age, and presented with similar age-related trends; there were positive correlations between AMH and AFC (P < .001), and negative correlations between age and AFC, AMH, ORPI (P < .05 for all). There was a significant difference in age (P < .001), serum E2 (P < .01), and AMH (P < .01) levels between subjects and controls; however, when controlling for confounding factors (age, body mass index, total testosterone, and LH), we found no differences between the 2 groups with regards to the serum levels of AMH, FSH, E2, and AFC (P > .05 for all). Moreover, receiver operating characteristic curve analysis indicated that the significant variables of subjects and controls for evaluating ovarian reserve included age, AMH and ORPI, and ORPI was more valuable than other variables.A diminished ovarian reserve was one of the manifestations caused by female aging. When confounding factors were controlled for, we found no differences in ovarian reserve when compared between fertile and infertile women, and no correlation with infertility.


Assuntos
Envelhecimento/fisiologia , Fertilidade/fisiologia , Infertilidade Feminina/fisiopatologia , Reserva Ovariana/fisiologia , Adulto , Fatores Etários , Hormônio Antimülleriano/sangue , China , Estradiol/sangue , Feminino , Hormônio Foliculoestimulante/sangue , Humanos , Infertilidade Feminina/sangue , Hormônio Luteinizante/sangue , Pessoa de Meia-Idade , Folículo Ovariano/crescimento & desenvolvimento , Curva ROC , Testosterona/sangue , Adulto Jovem
10.
Fertil Steril ; 115(6): 1416-1423, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33827766

RESUMO

Luteal phase deficiency (LPD) is a clinical diagnosis associated with an abnormal luteal phase length of ≤10 days. Potential etiologies of LPD include inadequate progesterone duration, inadequate progesterone levels, or endometrial progesterone resistance. LPD has not only been described in association with medical conditions but also in fertile, normally menstruating women. Although progesterone is important for the process of implantation and early embryonic development, LPD has not been proven to be an independent entity causing infertility or recurrent pregnancy loss. Controversy exists regarding the multiple proposed measures for diagnosing LPD and, assuming it can be diagnosed accurately, whether treatment improves outcomes. This document replaces the document entitled "Current clinical irrelevance of luteal phase deficiency: a committee opinion," last published in 2015 (Fertil Steril 2015;103:e27-e32).


Assuntos
Aborto Espontâneo/prevenção & controle , Fertilidade , Infertilidade Feminina/terapia , Fase Luteal/sangue , Progesterona/sangue , Medicina Reprodutiva/normas , Técnicas de Reprodução Assistida/normas , Aborto Espontâneo/sangue , Aborto Espontâneo/diagnóstico , Aborto Espontâneo/fisiopatologia , Biomarcadores/sangue , Consenso , Feminino , Humanos , Infertilidade Feminina/sangue , Infertilidade Feminina/diagnóstico , Infertilidade Feminina/fisiopatologia , Valor Preditivo dos Testes , Gravidez , Progesterona/deficiência , Fatores de Risco , Resultado do Tratamento
11.
Fertil Steril ; 116(1): 272-274, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33757671

RESUMO

OBJECTIVE: To study uterine peristalsis using step-by-step 4-dimensional (4D) ultrasound assessment video, explore its relationship with progesterone levels in a select in vitro fertilization population, and assess the reproducibility of the technique. DESIGN: Four-dimensional uterine ultrasound and a retrospective analysis of outcomes in relation with progesterone levels. The videos were also analyzed by a senior doctor, junior doctor, and a nurse for their reproducibility. SETTING: Instituto Bernabeu of Alicante is a private clinic. PATIENT(S): The study included 197 consecutive patients undergoing in vitro fertilization (from 2018 to 2019) with a history of recurrent implantation failure (defined as unsuccessful implantation of a total number of ≥3 blastocysts originated from oocyte donation cycles). Because it is known that most failures are attributed to the quality of the embryo, we deemed it important to explore the potential uterine factors explaining the failures in oocyte donation cycles, the use of which decreases the probability of embryo-related factors influencing it. INTERVENTION(S): The participants were evaluated for uterine contractions and serum progesterone levels (10-30 minutes before the embryo transfer procedure). Uterine contractility (UC) was assessed by recording a 6-minute-long video using a 4D mode (Voluson E10; General Electric, Boston, MA), which was performed by a single operator (B.M.). MAIN OUTCOMES MEASURE(S): The contractions were seen like waves going through the endometrial cavity. They were counted on a ×15 accelerated recording video. To define high-frequency UC, we separated uterine peristalsis (contractions per minute [cpm]) into quartiles. The highest quartile defined the hypercontractility group (>1.51 cpm; n = 41), considering the remaining quartiles as the normal contractility group (≤1.51 cpm; n = 156). The Mann-Whitney U test was performed. The intraclass correlation coefficient was used to validate variability. P <.05 was considered significant. SPSS version 21.0 was used for the statistical analysis. The institutional review board's approval was obtained. RESULT(S): Overall, an average of 1.1 cpm was found in the study population. There were no differences between the groups (hypercontractility vs. normal contractility) in terms of patient age and the presence of any uterine factor (adenomyosis, myomas, adhesions, or polyps). An inverse association was observed between UC and progesterone levels. Low progesterone levels (15.9 vs. 19.5 ng/mL; P = .027) were observed in the HUP and NUP group, respectively. The intraclass correlation coefficient to evaluate the interobserver variability was 0.75 (0.63-0.85; P = .000). CONCLUSION(S): Four-dimensional ultrasound assessment provides a dynamic view of uterine contractions, including their directionality and frequency. Even though recurrent implantation failure is yet a title of obscure definition and probably associated with multiple factors, a subgroup of patients with elevated UC associated with "low" progesterone levels may have a potential effect on their outcomes. Four-dimensional scan evaluation of UC constitutes a promising diagnostic tool in clinical practice; however, larger studies confirming our initial results are still pending.


Assuntos
Infertilidade Feminina/diagnóstico por imagem , Peristaltismo , Ultrassonografia , Contração Uterina , Útero/diagnóstico por imagem , Biomarcadores/sangue , Implantação do Embrião , Transferência Embrionária , Feminino , Fertilização In Vitro , Humanos , Infertilidade Feminina/sangue , Infertilidade Feminina/fisiopatologia , Infertilidade Feminina/terapia , Valor Preditivo dos Testes , Progesterona/sangue , Retratamento , Fatores de Tempo , Falha de Tratamento , Útero/fisiopatologia
12.
Reprod Sci ; 28(8): 2144-2146, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-33616884

RESUMO

Although there is no known difference between the clinical manifestations of SARS-CoV-2 in pregnant and non-pregnant women based on the studies published until now, in vitro fertilization (IVF) treatments were suspended during the pandemic due to uncertainties with the suggestions of associated societies. However, we do not have enough data on the exact effects of SARS-CoV-2 on fertility and pregnancy and whether there are damaging effects on IVF outcome. There is no available evidence about the transmission of SARS-CoV-2 by either sexual way or through intrauterine insemination (IUI) or IVF. Up until now, there is no report to document the presence or absence of viral RNA in follicular fluid of SARS-CoV-2-positive women. In this paper, we present a case of oocyte retrieval from a SARS-CoV-2-positive woman and the search for viral RNA by polymerase chain reaction (PCR) in the follicular fluid aspirates.


Assuntos
Teste de Ácido Nucleico para COVID-19 , COVID-19/diagnóstico , Líquido Folicular/virologia , Infertilidade Feminina/terapia , Recuperação de Oócitos , RNA Viral/genética , SARS-CoV-2/genética , Injeções de Esperma Intracitoplásmicas , Adulto , COVID-19/virologia , Feminino , Humanos , Infertilidade Feminina/diagnóstico , Infertilidade Feminina/fisiopatologia , Valor Preditivo dos Testes
13.
Fertil Steril ; 115(3): 531-532, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33581853

RESUMO

Recurrent pregnancy loss (RPL), defined as two to three spontaneous pregnancy terminations occurring before 12 weeks of gestation, affects approximately 1% of the general population. The causes may include congenital factors that originate with the quality of the gametes (sperm or oocyte) or the resulting embryo, or factors that originate within the uterus. Alterations of endometrial receptivity from endometriosis and/or endometritis, which are associated with impaired action of progesterone, have also been implicated in RPL. Finally, immunologic factors and thrombophilia, congenital and acquired, have also been suspected to cause RPL.


Assuntos
Aborto Habitual/fisiopatologia , Endométrio/fisiopatologia , Infertilidade Feminina/fisiopatologia , Aborto Habitual/diagnóstico , Feminino , Humanos , Infertilidade Feminina/diagnóstico , Masculino , Oócitos/fisiologia , Gravidez , Espermatozoides/fisiologia , Útero/fisiopatologia
14.
Toxicol Appl Pharmacol ; 413: 115409, 2021 02 15.
Artigo em Inglês | MEDLINE | ID: mdl-33476676

RESUMO

There is increasing evidence that bisphenols BPS and BPF, which are analogues of BPA, have deleterious effects on reproduction even at extremely low doses. Indirect exposure via the maternal route (i.e. across the placenta and/or by breastfeeding) is underestimated, although it can be assumed to be a cause of idiopathic female infertility. Therefore, we hypothesised the deleterious effects of exposure to BPA analogues during breastfeeding on the ovarian and oocyte quality of offspring. A 15-day exposure period of pups was designed, whilst nursing dams (N ≥ 6 per experimental group) were treated via drinking water with a low (0.2 ng/g body weight/day) or moderate (20 ng/g body weight/day) dose of bisphenol, mimicking real exposure in humans. Thereafter, female pups were bred to 60 days and oocytes were collected. Immature oocytes were used in the in-vitro maturation assay; alternatively, in-vivo-matured oocytes were isolated and used for parthenogenetic activation. Both in-vitro- and in-vivo-matured oocytes were subjected to immunostaining of spindle microtubules (α-tubulin) and demethylation of histone H3 on the lysine K27 (H3K27me2) residue. Although very low doses of both BPS and BPF did not affect the quality of ovarian histology, spindle formation and epigenetic signs were affected. Notably, in-vitro-matured oocytes were significantly sensitive to both doses of BPS and BPF. Although no significant differences in spindle-chromatin quality were identified in ovulated and in-vivo-matured oocytes, developmental competence was significantly damaged. Taken together, our mouse model provides evidence that bisphenol analogues represent a risk to human reproduction, possibly leading to idiopathic infertility in women.


Assuntos
Compostos Benzidrílicos/toxicidade , Fertilidade/efeitos dos fármacos , Infertilidade Feminina/induzido quimicamente , Lactação/metabolismo , Leite/metabolismo , Oócitos/efeitos dos fármacos , Ovário/efeitos dos fármacos , Fenóis/toxicidade , Sulfonas/toxicidade , Animais , Animais Lactentes , Compostos Benzidrílicos/metabolismo , Epigênese Genética , Feminino , Regulação da Expressão Gênica no Desenvolvimento , Técnicas de Maturação in Vitro de Oócitos , Infertilidade Feminina/metabolismo , Infertilidade Feminina/patologia , Infertilidade Feminina/fisiopatologia , Exposição Materna , Camundongos Endogâmicos ICR , Oócitos/metabolismo , Oócitos/patologia , Reserva Ovariana/efeitos dos fármacos , Ovário/metabolismo , Ovário/fisiopatologia , Fenóis/metabolismo , Gravidez , Medição de Risco , Fuso Acromático/efeitos dos fármacos , Fuso Acromático/metabolismo , Fuso Acromático/patologia , Sulfonas/metabolismo
15.
J Assist Reprod Genet ; 38(3): 645-650, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33454901

RESUMO

PURPOSE: To determine the utility of the endometrial receptivity analysis (ERA) in women with prior failed embryo transfers (ET). METHODS: This was a retrospective study of patients who underwent an ERA test with a subsequent frozen ET. Women were classified based on their indication for an ERA test: (1) ≥ 1 prior failed ET (cases), or (2) as a prophylactic measure (controls). A subset analysis of women with ≥ 3 prior failed transfers was performed. Pregnancy outcomes of the subsequent cycle were examined, including conception, clinical pregnancy, and ongoing pregnancy/live birth. RESULTS: A total of 222 women were included, 131 (59%) women with ≥ 1 prior failed ET and 91 (41%) controls. Among the 131 women with ≥ 1 prior failed ET, 20 women (9%) had ≥ 3 prior failed ETs. The proportion of non-receptive ERA tests in the three groups were the following: 45% (≥ 1 prior failed ET), 40% (≥ 3 prior failed ETs), and 52% (controls). The results did not differ between cases and controls. The pregnancy outcomes did not differ between women with ≥ 1 prior failed ET and controls. In women with ≥ 3 prior failed ETs, there was a lower ongoing pregnancy/live birth rate (28% vs 54%, P = 0.046). CONCLUSION: Women with ≥ 1 prior failed ET and ≥ 3 prior failed ETs had a similar prevalence of non-receptive endometrium compared to controls. Women with ≥ 3 prior failed ETs had a lower ongoing pregnancy/live birth rate despite a personalized FET, suggesting that there are additional factors in implantation failure beyond an adjustment in progesterone exposure.


Assuntos
Endométrio/fisiopatologia , Fertilização In Vitro/métodos , Infertilidade Feminina/terapia , Nascido Vivo/epidemiologia , Adulto , Implantação do Embrião , Transferência Embrionária , Feminino , Humanos , Infertilidade Feminina/fisiopatologia , Gravidez , Resultado da Gravidez , Taxa de Gravidez , Estudos Retrospectivos
16.
Acupunct Med ; 39(1): 20-29, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33040570

RESUMO

OBJECTIVE: To evaluate the efficacy of acupuncture compared to placebo acupuncture for women undergoing in vitro fertilisation (IVF) in a systematic review and meta-analysis. METHODS: A search was conducted in seven English-language biomedical databases from their inception to 3 April 2019 to identify studies evaluating acupuncture as an adjunct to IVF treatment. Randomised controlled trials (RCTs) that compared acupuncture with placebo acupuncture using a non-invasive placebo acupuncture device in women undergoing a fresh or frozen IVF cycle were eligible, as were studies that tested placebo acupuncture as the intervention. Outcomes were clinical pregnancy rate, ongoing pregnancy rate, miscarriage rate, live birth rate and adverse events. RESULTS: Eight RCTs involving 3607 women were included. Studies were judged to be low risk for most of the risk of bias domains. Acupuncture around the time of embryo transfer was not significantly different to placebo acupuncture in terms of the clinical pregnancy rate (6 RCTs, 2473 women, risk ratio (RR) = 0.99 (95% confidence interval (CI) = 0.88, 1.11), I2 = 51%, moderate certainty evidence), ongoing pregnancy rate (4 RCTs, 1459 women, RR = 0.88 (95% CI = 0.75, 1.02), I2 = 50%, moderate certainty evidence), miscarriage rate (4 RCTs, 502 women, RR = 1.23 (95% CI = 0.89, 1.71), I2 = 30%, high certainty evidence) or live birth rate (4 RCTs, 1835 women, RR = 0.87 (95% CI = 0.75, 1.01), I2 = 0%, high certainty evidence). Outcomes with placebo acupuncture were not significantly different to usual care. Adverse events relating to acupuncture, such as discomfort and bruising, were mild to moderate. CONCLUSION: Acupuncture administered around the time of embryo transfer did not have a statistically significant effect on IVF outcomes compared with placebo acupuncture.


Assuntos
Terapia por Acupuntura , Infertilidade Feminina/terapia , Adulto , Feminino , Fertilização In Vitro , Humanos , Infertilidade Feminina/fisiopatologia , Masculino , Efeito Placebo , Gravidez , Resultado da Gravidez , Ensaios Clínicos Controlados Aleatórios como Assunto
17.
Adv Anat Embryol Cell Biol ; 232: 9-24, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33278005

RESUMO

The existence of endometriosis has been known since at least the nineteenth century, yet the lack of understanding of causes of infertility and therefore inadequate treatment approaches in endometriosis creates a significant challenge in reproductive medicine. Women worldwide suffer not only pain and infertility but also economical, societal, and physiological burdens. Studies of reproductive events in women are difficult to conduct due to a host of confounding personal and environmental factors and ethically limited due to the very nature of working with reproductive tissues and cells, especially embryos. Animal models are a viable adjunct to study mechanisms causing human reproductive anomalies and infertility in endometriosis. This chapter discusses reproductive anomalies causing infertility in endometriosis and well-established animal models which help decipher the problems and lead to heretofore unknown nonsurgical, nonhormonal methods to manage endometriosis in women. In addition, studies of effects of developmental exposure to endometriosis are revealing for the first time, in both female and male offspring, transgenerational subfertility in a rat model providing insights into the familial nature of endometriosis and possible epigenetic involvement.


Assuntos
Endometriose/complicações , Fertilidade/fisiologia , Infertilidade Feminina/etiologia , Animais , Endometriose/fisiopatologia , Feminino , Humanos , Infertilidade Feminina/fisiopatologia , Ratos
18.
Reprod Biol ; 20(4): 541-546, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33371944

RESUMO

Obesity is becoming pandemic and is associated with impaired reproductive potential. Oxidative stress, low-grade chronic inflammation and mitochondrial dysfunctions, which characterize obesity, strongly affect oocyte environment and function. Supplementation with antioxidant and anti-inflammatory compounds has been suggested to improve fertility. Here we evaluated the effect of α-lipoic acid and myo-inositol supplementation on the oocyte environment of infertile obese women. Nineteen normal-weight and twenty-three obese women, infertile for non-ovarian reasons, were recruited. For two months before ovarian stimulation, all women received 400 µg/die folic acid, whereas 15 obese were additionally supplemented with 800 mg α-lipoic acid, 2 g myo-inositol/die. Antioxidant capacity was measured in follicular fluid by enzymatic assay; mitochondrial DNA (mtDNA) content and mRNA levels of two respiratory chain subunits were analyzed in granulosa cells by Real-time PCR. Pregnancy rate was similar between normal-weight and treated obese, and lower in untreated obese patients. Supplemented women showed significantly higher antioxidant levels in follicular fluid compared to the two groups taking only folic acid. Conversely, granulosa cells mtDNA content was decreased in treated and higher in untreated obese patients compared to normal-weight women, suggesting mtDNA increases to compensate for oxidative-stress damages. Reduced expression of respiratory subunits in untreated obese may confirm mitochondria impairment. Interestingly, mtDNA levels inversely correlated to both total and metaphase II oocyte number. In this preliminary study, combined supplementation of α-lipoic acid and myo-inositol in infertile obese women was associated with amelioration in the oxidative status of the oocyte environment, possibly contributing to a higher pregnancy rate.


Assuntos
Infertilidade Feminina/terapia , Inositol/administração & dosagem , Obesidade/fisiopatologia , Oócitos/efeitos dos fármacos , Ácido Tióctico/administração & dosagem , Adulto , Anti-Inflamatórios/administração & dosagem , Antioxidantes/administração & dosagem , DNA Mitocondrial/análise , Suplementos Nutricionais , Feminino , Fertilização In Vitro , Células da Granulosa/química , Humanos , Infertilidade Feminina/fisiopatologia , Mitocôndrias/efeitos dos fármacos , Mitocôndrias/fisiologia , Obesidade/complicações , Oócitos/fisiologia , Indução da Ovulação , Estresse Oxidativo/efeitos dos fármacos , Gravidez , Taxa de Gravidez
19.
Medicine (Baltimore) ; 99(46): e23250, 2020 Nov 13.
Artigo em Inglês | MEDLINE | ID: mdl-33181716

RESUMO

To analyze risk factors associated with heterotopic pregnancy and the uterine pregnant outcome of those patients after surgery.We retrospectively analyzed 22 patients diagnosed as HP after in vitro fertilization (IVF) between January 2015 and December 2018.HP was diagnosed at gestation age of 55.4 ±â€Š11.8 days. HP were presented as irregular vaginal bleeding, abdominal pain, and sometimes no symptoms. 81.8% of ectopic lesion in HP occurred at fallopian tubes, especially ampullary; cornual pregnancy takes up 13.6%. Compared with clinical intrauterine pregnancy (IUP), IVF with tubal infertility factors had higher risks of HP (OR 4.185, 95% CI 1.080- 16.217); IVF with pelvic adhesion also had higher risks of HP (OR 5.552 95% CI 1.677-18.382); IVF with more than 2 embryos transferred increased risks of HP (OR 23.253, 95% CI 1.804-299.767). The abortion rates of surgery-treated HP and IUP after IVF were 27.8% versus 10.3% (P = .042).These results demonstrate IVF with tubal infertility, pelvic adhesion or multiembryos transfer are risk factors of HP. Furthermore, surgery could induce abortion.


Assuntos
Tubas Uterinas/anormalidades , Fertilização In Vitro/normas , Infertilidade Feminina/etiologia , Gravidez Heterotópica/etiologia , Aderências Teciduais/complicações , Adulto , China/epidemiologia , Feminino , Fertilização In Vitro/métodos , Fertilização In Vitro/estatística & dados numéricos , Humanos , Infertilidade Feminina/fisiopatologia , Gravidez , Gravidez Heterotópica/diagnóstico , Gravidez Heterotópica/epidemiologia , Estudos Retrospectivos , Fatores de Risco
20.
Sci Rep ; 10(1): 18555, 2020 10 29.
Artigo em Inglês | MEDLINE | ID: mdl-33122722

RESUMO

When ovarian stimulation is unfeasible, in vitro maturation (IVM) represents an alternative option for fertility preservation (FP). This retrospective study aims to evaluate the feasibility of performing within a short time frame two IVM cycles for FP. Seventeen women with breast cancer, 18-40 years of age, having undergone 2 cycles of IVM followed by oocyte vitrification were included. Non parametric analyses were used. No difference was observed between IVM1 and IVM2 outcomes. No complication was reported. The respective contributions of IVM1 and IVM2 for the number of cryopreserved oocytes were comparable irrespective of the delay between both procedures, even when performed during the same menstrual cycle. Those findings suggest that repeating IVM cycles may constitute a safe option for increasing the number of vitrified mature oocytes for FP. These two retrievals may be performed during the same cycle, providing additional argument for a physiologic continuous recruitment during follicular development.


Assuntos
Criopreservação/métodos , Preservação da Fertilidade/métodos , Infertilidade Feminina/fisiopatologia , Recuperação de Oócitos/métodos , Oócitos/fisiologia , Adulto , Neoplasias da Mama/fisiopatologia , Feminino , Humanos , Técnicas de Maturação in Vitro de Oócitos/métodos , Indução da Ovulação/métodos , Estudos Retrospectivos , Vitrificação , Adulto Jovem
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