Differential proMMP-2 and proMMP-9 secretion in human pre-implantation embryos at day 5 of development.

Morphological development is the most common non-invasive criterion used to select in vitro human embryos for implantation. With this criterion, however, embryos in cellular arrest go unnoticed. A more accurate criterion is needed to improve the success rate of implantation. Extracellular matrix metalloproteases type 2 (MMP-2) and MMP-9 are key markers of embryonic development and the implantation process, according to various animal studies. The first objective of this study was to examine proMMP-2 and proMMP-9 activity in the culture media of human embryos with good morphological development. Secondly, the results of proMMP-2 and proMMP-9 activity in the culture medium were compared between pregnant and non-pregnant. Forty-two patients were approved by the Ethics and Research Committees of the Instituto Nacional de Perinatología in México City hospital, based on institutional inclusion criteria for in vitro fertilization. On day 5 of development, embryos were transferred to patients, and the culture media secretion profile of proMMP-2 and proMMP-9 activity was determined by substrate gel zymography. After analysis of embryo sac development, each patient was assigned to the pregnant (n=17) or non-pregnant (n=25) group. Our results demonstrate that proMMP-2 was active in the culture media corresponding to all 17 women achieving full-term pregnancy and proMMP-9 in the media corresponding to 11 of these women. Contrarily proMMP-2 and proMMP-9 were active in the culture media corresponding to 3 and 11 of the 25 non-pregnant patients, respectively. The clinical implications of this study suggest the activity evaluation of proMMP-2 and proMMP-9 in embryonic culture media on day 5 of development appears to be a reliable indicator of the quality of embryos and their capacity to establish a pregnancy.

Müllerian Anomalies Prevalence Diagnosed by Hysteroscopy and Laparoscopy in Mexican Infertile Women: Results from a Cohort Study.

BACKGROUND: To evaluate the prevalence of Müllerian anomalies (MAs) in a cohort of infertile Mexican women candidates for infertility treatments (intrauterine insemination or IVF (In vitro fertilization) cycles). METHODS: We performed a retrospective observational study on a cohort of consecutive women, who underwent hysteroscopy and laparoscopy as part of the basic infertility workup from 2002 to 2014, at our center. Our aim was to calculate the prevalence of MAs and each subtype. RESULTS: A total of 4005 women were included in the study. The MA prevalence was 4.4% (95% CI; 3.8-5.1; n = 177). Among women with MAs, the prevalence of different MA types was: septate uterus 54.2% (n = 96), arcuate uterus 15.8% (n = 28), bicornuate uterus 10.7% (n = 19), unicornuate uterus 8.5% (n = 15), didelphys uterus 6.2% (n = 11) and hypoplasia/agenesis 3.4% (n = 6), unclassifiable 1.1% (n = 2). Women with MAs who achieved pregnancy were: 33.3% (n = 59). The MA associated with the highest pregnancy rate was septate uterus after hysteroscopic correction, at 38.5% (37/96). CONCLUSIONS: The prevalence of MAs among infertile Mexican women can be considered as low, but not negligible. The septate uterus is the most common MA in women with infertility.

Prevalencia de las causas de pérdida gestacional recurrente en un centro médico de tercer nivel de atención / Prevalence of the causes of recurrent pregnancy loss in a third-level health care center

Resumen OBJETIVO: Determinar la prevalencia de los principales factores etiológicos de pérdida gestacional recurrente en la población de un hospital de tercer nivel de atención. MATERIALES Y MÉTODOS: Estudio retrospectivo, transversal y descriptivo llevado a cabo en pacientes con protocolo de estudio de dos o más pérdidas gestacionales recurrentes que iniciaron el control prenatal en el servicio de Obstetricia o que ingresaron al Instituto Nacional de Perinatología con diagnóstico de infertilidad entre los meses de enero de 2017 a enero de 2020. En cada grupo se revisaron los factores etiológicos descritos en la bibliografía internacional como posibles causas de pérdida gestacional recurrente. RESULTADOS: Se estudiaron 280 pacientes y el factor con mayor prevalencia de pérdida gestacional recurrente fue el endocrino con el 56.78% (n = 159), seguido del anatómico-uterino con el 42.14% (n = 118) y en tercer lugar el infeccioso con 40.35% (n = 113). En las 75 pacientes del grupo de infertilidad, el factor etiológico más prevalente fue el endocrino (88%; n = 66), seguido del anatómico-uterino (53.3%; n = 40) y a continuación del masculino (50.6%; n = 38). En las pacientes del grupo de Obstetricia, el factor con mayor prevalencia fue el endocrino (45.36%; n = 93), seguido del anatómico-uterino (38.04%; n = 78) y el infeccioso (37%; n = 76). CONCLUSIONES: Los factores relacionados con la pérdida gestacional recurrente, descritos en la bibliografía internacional y analizados en este estudio, mostraron prevalencias similares en población institucional. Las que difieren están influidas por las características de la población estudiada, los recursos de la institución e, incluso, el diagnóstico y servicio por el que ingresaron como pacientes al INPer.

Abstract OBJECTIVE: To determine the prevalence of the main etiological factors of recurrent gestational loss in the population of a tertiary care hospital. MATERIALS AND METHODS: Retrospective, cross-sectional, descriptive study carried out in patients with study protocol of two or more recurrent gestational losses who initiated prenatal control in the Obstetrics service or who were admitted to the Instituto Nacional de Perinatologia with a diagnosis of infertility between the months of January 2017 to January 2020. In each group, the etiological factors described in the international literature as possible causes of recurrent gestational loss were reviewed. RESULTS: 280 patients were studied and the factor with the highest prevalence of recurrent gestational loss was endocrine with 56.78% (n = 159), followed by anatomic-uterine with 42.14% (n = 118) and thirdly infectious with 40.35% (n = 113). In the 75 patients in the infertility group, the most prevalent etiologic factor was endocrine (88%; n = 66), followed by anatomic-uterine (53.3%; n = 40) and then male (50.6%; n = 38). In patients in the obstetrics group, the factor with the highest prevalence was endocrine (45.36%; n = 93), followed by anatomic-uterine (38.04%; n = 78) and infectious (37%; n = 76). CONCLUSIONS: The factors related to recurrent gestational loss, described in the international literature and analyzed in this study, showed similar prevalences in institutional population. Those that differ are influenced by the characteristics of the population studied, the resources of the institution and, even, the diagnosis and service for which they were admitted as patients to the INPer.

Prevalencia de patología endometrial detectada por histeroscopia en un centro de tercer nivel / Prevalence of endometrial pathology by hysteroscopy among infertile patients in a tertiary referral hospital

Resumen OBJETIVO: Describir la prevalencia de patología endometrial diagnosticada mediante histeroscopia en pacientes infértiles atendidas en un centro de tercer nivel. MATERIALES Y MÉTODOS: Estudio descriptivo, retrospectivo y observacional efectuado en pacientes con diagnóstico de infertilidad atendidas en el Departamento de Biología de la Reproducción Humana del Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Ciudad de México. Criterios de inclusión: pacientes infértiles entre 18 y 43 años a quienes se realizó histeroscopia. Criterios de exclusión: pacientes del servicio de Reproducción Humana a quienes no se les realizó histeroscopia o ésta fue fallida. Se utilizó el paquete estadístico para las ciencias sociales (SPSS Statistics) versión 20.0. El análisis estadístico fue descriptivo, con media, desviación estándar o porcentaje. RESULTADOS: Se analizaron los expedientes físicos de 440 pacientes infértiles a quienes se efectuó histeroscopia. Las características demográficas incluyeron edad, IMC, tipo y años de infertilidad. Los hallazgos histeroscópicos fueron: cavidad uterina normal 38.4% y anormal 61.6%, pólipo o endometrio polipoide en 34.3%, malformación mülleriana 13.4%, sinequias 10.7%, leiomioma 7.3%, hiperplasia endometrial 1.4%, adenomiosis 0.9%, cuerpo extraño 0.9%. El 7.5% consiguió el embarazo espontáneo y a 21.8% se les practicaron distintas técnicas de reproducción asistida y se logró el embarazo en 34.3%. CONCLUSIONES: La evaluación de la cavidad uterina es un requisito indispensable del estudio de las pacientes infértiles; en esta búsqueda más de la mitad tuvieron hallazgos histeroscópicos anormales.

Abstract OBJECTIVE: To describe the prevalence of endometrial pathology by hysteroscopy among infertile patients in a tertiary referral hospital, from January 2015 to December 2016. MATERIALS AND METHODS: This is a descriptive, retrospective and observational study. The inclusion criteria were patients between 18 and 43 years of age, who had a hysteroscopy due to infertility. The exclusion criteria were patients from Reproductive Science Department who did not undergo hysteroscopy or for whom it failed. We used the software Statistical Package for the Social Sciences (SPSS) version 20.0 Data in this study were analyzed using mean ± standard deviation or expressed as percentages. RESULTS: Four hundred forty infertile women underwent hysteroscopy. Data from physical patient records were retrieved. Demographic characteristics included age, BMI, type of infertility, years of infertility. Hysteroscopic findings were: normal uterine cavity 38.4%, abnormal 61.6%. Some patients had 2 or more findings: polyp or endometrial polypoid 34.3%, müllerian malformation 13.4%, synechia 10.7%, leiomyoma 7.3%, endometrial hyperplasia 1.4%, adenomyosis 0.9%, foreign body 0.9%. In 7.5%, spontaneous pregnancy occurred, 21.8% underwent assisted reproduction technique, achieving pregnancy in 34.3%. CONCLUSIONS: Assessing of uterine cavity should be an indispensable requirement of infertile patients, since in this study more than half of them had abnormal hysteroscopic findings.