Evaluation of growth hormone co-treatment in in vitro fertilization in patients responding better to the GnRH antagonist short protocol.

OBJECTIVE: The present study aims at evaluating the results obtained after in vitro fertilization in bad responders, using controlled ovarian hyperstimulation together with the use of gonadotrophin releasing hormone (GnRH) antagonist (cetrorelix acetate) in a short protocol. METHODS: This is an analytical, longitudinal, retrospective and controlled study involving patients who underwent in vitro fertilization (IVF) procedures in the assisted reproduction program of the Reproferty clinic, in the municipality of São José dos Campos/SP, from January 2012 to December 2016. We collected the data obtained from the medical records of patients considered to have undergone controlled ovarian hyperstimulation using GnRH antagonist (cetrorelix acetate) and Growth Hormone (GH) in a short cycle protocol. The patients considered controls were those submitted to the same hyperstimulation process, without using GH. RESULTS: There were significant differences in the following analyzed parameters: gonadotrophin regimen dose, stimulation duration, and estradiol levels on the day of HCG administration, number of follicles, number of retrieved oocytes, number of mature oocytes and number of good-quality embryos. On the other hand, the GH administration was not significant in the number of cycles that achieved transfer, the number of embryos transferred and the number of frozen cycles. In the case group, there was no increase in the number of cycles that reached pregnancy rate ßhCG+; however, the clinical pregnancy rates and live birth rates were significant. CONCLUSION: The present investigation demonstrated that GH administration as a supplement in poor responders improves the majority of the parameters to achieve a full term pregnancy in these patients.

Morphokinetic parameters as auxiliary criteria for selection of blastocysts cultivated in a time-lapse monitoring system.

OBJECTIVE: To describe embryonic profile up to blastocyst stage in a time-lapse system. METHODS: A retrospective, longitudinal, analytical study of patients submitted to in vitro fertilization. The embryos were grouped according to the degree of expansion, internal cell mass and trophectoderm classification, the morphokinetic parameters were associated with the time periods stated in each evolution phase. RESULTS: The appearance of a second polar corpuscle (CPap) occurred earlier in the embryos classified as excellent (2.99h; p<0.05), in relation to the embryos classified as good (3.40h), average (3.48h) and poor (3.55h). The embryos classified as excellent took less time for the pronuclei to disappear (PNbd) (21.80h; p<0.05), when compared to the good embryos (22.96h), the average (23.21h) and the poor (23.47h). As for the morphokinetic parameter, the end of the two-cell division (T2) occurred first in the excellent blastocysts (24.38h; p<0.05), when compared to the other groups: good (25.57h), average (25.53h) and poor (25.78h). With respect to synchronization with the division of three to four cells (S2), the poor embryos presented longer times for such division to occur (3.67h; p<0.05). When compared to the embryos from the groups excellent (1.97h), good (2.70h) and average (2.09h). At the time point of the blastocoel formation (TB), the excellent embryos (104.04h) did not differ from the good embryos (104.10h). However, when compared to average (107.27h) and poor (106.86h) embryos, there was statistical significance (p<0.05). CONCLUSIONS: Embryos of better quality had a shorter time in some morphokinetic parameters when compared to the other groups, thus increasing the possibilities to establish new parameters for the classification and selection of embryos.

Code of Ethics and Conduct of the Brazilian Association of Embryologists - PRONÚCLEO.

For more than three decades, Brazilian Clinical Embryologists have been working without specific regulations and following the standards adopted by other healthcare professionals. This document aims to guide behavior and decision-making, while providing directions to embryologist with the purpose of aiding professionals involved with assisted reproduction procedures and their patients. The Code of Ethics and Conduct is an important breakthrough and the first step toward regulating Clinical Embryology as a profession.

[The age as a predictive factor in in vitro fertilization cycles]. / A idade como fator prognóstico nos ciclos de fertilização in vitro.

PURPOSE: to evaluate the patient's age as an outcome predictor in an in vitro fertilization (IVF) program. METHODS: transversal study, which has included 302 women with ages varying from 24 to 46 years old, submitted to IVF, from May 2005 to July 2007. The patients were divided in three groups, according to their age: Gor=40 (n=52). The number of collected oocytes, the fertilization rates, the number of transferred embryos, the embryonary quality and the pregnancy rate were evaluated. Statistical analysis was realized through Kruskal-Wallis variance analysis and chi(2) test. RESULTS: in the Gor=40 group, 1.6. The number of oocytes obtained in G>or=40 group was significantly lower than in the other two groups (p<0.001).The fertilization rate was similar in the three groups, 61.4, 65.8 e 64.6% (p=0.2288), respectively. The percentage of good quality embryos was not statistically different among the three groups either, with rates of 57.4, 63.2 and 56.0% (p=0.2254), respectively. The average number of transferred embryos in each group was 3.1 (Gor=40), respectively, with statistically significant decrease in the G>or=40 group (p<0.001). Concerning pregnancy rates, the G>or=40 group has presented a rate of 9.6%, a result which is significantly lower (p=0.0330) than the one presented by the G

A tecnologia time-lapse pode predizer a qualidade embrionária antes dos resultados do PGD (diagnósticogenético pré-implantacional)? / Technology time-lapse can predict embryo quality of results before PGD(pre-implantation genetic diagnosis)?

Objetivo: Verificar se há correlação entre os resultados obtidos via diagnóstico genético préimplantacional (PGD) e os dados obtidos via monitoramento em tempo real (time-lapse) durante os três dias de desenvolvimento embrionário. Método: Estudo retrospectivo no qual foram avaliados embriões de ciclos de injeção intracitoplasmática de espermatozóides (ICSI) de março a junho de 2012. Após a ICSI, os embriões foram colocados em incubadora vertical com monitoramento time-lapse durante três dias. A seguir os embriões foram submetidos ao PGD. Os resultados obtidos foram baseados na análise do tempo de aparecimento e desaparecimento dos dois pró-núcleos, de início da primeira e da segunda clivagem e de intervalo entre esses eventos, além da observação dos corpúsculos polares. Resultados: Dados mostraram que 84,6% dos embriões apresentaram um padrão de ciclo celular assincrônico e a inviabilidade comprovada com os resultados do PGD, 7,7% dos embriões considerados normais nos resultados do PGD mostraram ter ciclos celulares fora dos padrões e 7,7% dos embriões com ciclo celular normal apresentaram ao PGD anomalias múltiplas. As diferenças foram estatisticamente significantes para p < 0,05. Embriões com PGD normal podem apresentar um ciclo celular assincrônico, o que afeta sua implantação. Conclusões: O estudo preliminar mostra que os dados obtidos com a metodologia time-lapse, em primeiro momento, podem ser usados para avaliar a qualidade embrionária em conjunto com a avaliação morfológica deles, independentemente dos resultados do PGD, pois alterações no padrão de desenvolvimento celular embrionário parecem afetar a implantação, salvo algumas exceções. Porém, como o N amostral ainda é pequeno, necessita-se de um período maior para a certificação dos eventos observados.

Objective: Investigate whether there is correlation between results obtained with PGD and data obtained monitoring “time lapse” during 3 days of embryonic development. Method: This is a retrospective study in which we assessed embryos ICSI cycles from March to December 2012. Upon completion ICSI, embryos were placed in an incubator with vertical monitoring “time lapse” for 3 days, then embryos were subjected to PGD. The results were based on analysis of the time of appearance of two pronuclei, disappearance, the start time of first and second cleavage and intervals between these events, and the observation of polar bodies. Results: Data show that 84.6% of the embryos exhibited a pattern of cell cycle asynchronous and viability confirmed by the results of PGD, and 7.7% of embryos considered normal results of PGD, proved to have cell cycle asynchronous, 7.7% of embryos with normal cell cycle PGD showed multiple anomalies, differences were statistically significant at p < 0.05. PGD embryos with normal can present asynchronous cell cycle, affecting its implantation. Conclusion: The preliminary study shows that data obtained with method “time-lapse”, can be used to evaluate the embryo quality together with morphological evaluation same regardless outcome of PGD, because changes in pattern development of embryonic cell seem to affect development, with some exceptions. However, such as sample size remains small needs to be a longer period for certification of observed events.

A idade como fator prognóstico in vitro / The age as a predictive factor in in vitro fertilization cycles

OBJETIVO: avaliar a idade da paciente como fator indicador de resultados em um programa de fertilização in vitro. MÉTODOS: estudo transversal que incluiu 302 mulheres, com idade variando entre 24 e 46 anos, submetidas ao tratamento com fertilização in vitro (FIV), no período de Maio de 2005 a Julho de 2007. As pacientes foram divididas em três grupos, de acordo com a faixa etária: G≤35 (n=161), G36-39 (n=89) e G≥40 (n=52). Foram avaliados: número de oócitos aspirados, taxas de fertilização, número de embriões transferidos, qualidade embrionária e taxas de gravidez. A análise estatística foi realizada pela análise de variância de Kruskal-Wallis e pelo teste do χ2. RESULTADOS: no Grupo G≤35, obteve-se a média de 8,8 oócitos por paciente; no Grupo G36-39, a média foi de 7,4 oócitos por paciente; e no Grupo G≥40, 1,6 oócitos por paciente. O número de oócitos obtidos no Grupo G≥40 foi significantemente menor que nos Grupos G≤35 e G36-39 (p<0,001). As taxas de fertilização nos três grupos foram semelhantes: 61,4%, 65,8% e 64,6%, respectivamente (p=0,2288). O percentual de embriões de boa qualidade também não foi estatisticamente diferente entre os grupos estudados, encontrando-se, respectivamente, taxas de 57,4%, 63,2% e 56,0% (p=0,2254). O número médio de embriões transferidos em cada grupo foi de 3,1 (G≤35), 2,8 (G36-39) e 1,5 (G≥40), havendo redução estatisticamente significante no Grupo G≥40 (p<0,001). Com relação às taxas de gravidez, o Grupo G≥40 apresentou taxa de 9,6%, resultado significantemente inferior (p=0,0339) aos Grupos G≤35 e G36-39 (26,1 e 27,0%, respectivamente), que não apresentaram diferenças significantes entre si. CONCLUSÕES: embora a qualidade embrionária, do ponto de vista morfológico, não seja diferente entre mulheres de diferentes faixas etárias, o número de oócitos coletados, o número de embriões transferidos e as taxas de gravidez confirmam que a idade da mulher é um importante fator preditivo das taxas de sucesso das técnicas...

PURPOSE: to evaluate the patient’s age as an outcome predictor in an in vitro fertilization (IVF) program. METHODS: transversal study, which has included 302 women with ages varying from 24 to 46 years old, submitted to IVF, from May 2005 to July 2007. The patients were divided in three groups, according to their age: G≤35 (n=161), G 36-39 (n=89) e G≥40 (n=52). The number of collected oocytes, the fertilization rates, the number of transferred embryos, the embryonary quality and the pregnancy rate were evaluated. Statistical analysis was realized through Kruskal-Wallis variance analysis and χ2 test. RESULTS: in the G≤35 group, an average of 8.8 oocytes by patient was obtained; in the G 36-49 group, 7.4; and in the G≥40 group, 1.6. The number of oocytes obtained in G≥40 group was significantly lower than in the other two groups (p<0.001).The fertilization rate was similar in the three groups, 61.4, 65.8 e 64.6% (p=0.2288), respectively. The percentage of good quality embryos was not statistically different among the three groups either, with rates of 57.4, 63.2 and 56.0% (p=0.2254), respectively. The average number of transferred embryos in each group was 3.1 (G≤35), 2.8 (G 36-39) and 1.5 (G≥40), respectively, with statistically significant decrease in the G≥40 group (p<0.001). Concerning pregnancy rates, the G≥40 group has presented a rate of 9.6%, a result which is significantly lower (p=0.0330) than the one presented by the G≤35 and G 36-39 groups (26.1 e 27.0%, respectively), with no significant difference between themselves. CONCLUSIONS: though the embryonary quality is not different among women from different age groups, the number of collected oocytes, the number of transferred embryos and the pregnancy rate indicate that the women’s age is an important predictive factor of success for the techniques of assisted reproduction and should be taken into consideration when this kind of treatment is proposed to women over 40.