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Women submitted to ART treatments represent a select subgroup of individuals. Several studies have described the relationship between TAI and pregnancy outcomes as a result of ART, with contradictory results. The purpose of this systematic review was to determine the association between TAI and the risk of miscarriage in pregnancies resulting from ART. MEDLINE via PubMed, LILACS and Embase were searched for studies published in peer-reviewed journals from 1999 to 2017. The studies were summarized using the fixed effects model and the Peto's method to calculate RR in order to flesh out the association between TAI and spontaneous abortion. Only four papers were included in this systematic review and meta-analysis. Thirty-one miscarriages were observed in 210 clinical pregnancies of women with antithyroid antibodies; and 158 miscarriages were seen in 1,371 pregnancies without antithyroid antibodies. The meta-analysis failed to find an association between TAI and higher risk of reproductive loss, RR=0.94 95% confidence interval: 0.71-1.24; p=0.879. In conclusion, the presence of antithyroid antibodies was not associated with increased reproductive loss in patients submitted to ART treatments. It is our opinion that the presence of antithyroid antibodies should be considered as a secondary biomarker of autoimmune disease, rather than an actual cause of miscarriage in patients undergoing ART. Due to the small amount of evidence on the matter, the determination of TAI before the initiation of ART should be limited to research contexts.

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BACKGROUND: Multiple pregnancies are the main complication associated to assisted reproduction, due to the transfer of more than one embryo. Embryo cryopreservation allows the sequential transfer of all generated embryos, thus diminishing the risk of multiple pregnancies. However, it leads to accumulation of cryopreserved embryos. To reduce their accumulation in our unit, we started to preserve embryos as blastocysts, that have a rate of successful pregnancies of approximately 40%. AIM: To perform a sensitivity analysis of this change of policy on the accumulation of embryos. MATERIAL AND METHODS: Records of 571 cycles of in vitro fertilization since 2007 were reviewed, assuming a transference rate of two embryos in women aged less than 35 years and three embryos in older women. The number of embryos that would be preserved as zygotes, eight cell stage or blastocysts, was analyzed. RESULTS: Multiple component logistic regression analysis showed a 20% reduction in the odds ratio of cryopreservation per year of age. There was a 95% reduction in the ratio, when comparing the preservation of third and first day embryos and a 99% reduction when comparing preservation of embryos in blastocyst stage and first day embryos. CONCLUSIONS: Cryopreservation at blastocyst stage effectively decreased the frequency of embryo cryopreservation.

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Background: Multiple pregnancies are the main complication associated to assisted reproduction, due to the transfer of more than one embryo. Embryo cryopre-servation allows the sequential transfer of all generated embryos, thus diminishing the risk of multiple pregnancies. However, it leads to accumulation of cryopreserved embryos. To reduce their accumulation in our unit, we started to preserve embryos as blastocysts, that have a rate of successful pregnancies of approximately 40%. Aim: To perform a sensitivity analysis of this change of policy on the accumulation of embryos. Material and Methods: Records of 571 cycles of in vitro fertilization since 2007 were reviewed, assuming a transference rate of two embryos in women aged less than 35 years and three embryos in older women. The number of embryos that would be preserved as zygotes, eight cell stage or blastocysts, was analyzed. Results: Multiple component logistic regression analysis showed a 20% reduction in the odds ratio of cryopreservation per year of age. There was a 95% reduction in the ratio, when comparing the preservation of third and first day embryos and a 99% reduction when comparing preservation of embryos in blastocyst stage and first day embryos. Conclusions: Cryopreservation at blastocyst stage effectively decreased the frequency of embryo cryopreservation.

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We report the first successful live birth after the transfer of embryos obtained by fertilization of vitrified oocytes. A couple with primary infertility due to teratozoospermy and chronic an ovulation decided to undergo assisted reproductive technology after 4 failed cycles of super ovulation and intrauterine insemination. The woman underwent a standard luteal phase agonist protocol, with controlled ovarian hyper stimulation with daily 150 IU recombinant gonadotropin and 75 IU urinary gonadotropin for 12 days. Due to the high risk of ovarian hyper stimulation syndrome the couple was advised to delay embryo transfer. Eighteen mature oocytes were recovered, eight were vitrified and 10 fertilized and cryopreserved as pro-nuclei. Two months later, four vitrified oocytes were thawed, and three morphologically-normal embryos were transferred to an estrogen-progesterone-primed uterus, obtaining triple clinical pregnancy. The pregnancy was uneventful until 32 weeks of amenorrhea, when pre-term delivery started. After inducing lung maturity, a cesarean section was performed and three healthy fetuses were delivered. Nowadays, the babies are two and a half years old, and have had a normal psycho-motor development.

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We report the first successful live birth after the transfer of embryos obtained by fertilization of vitrified oocytes. A couple with primary infertility due to teratozoospermy and chronic an ovulation decided to undergo assisted reproductive technology after 4 failed cycles of super ovulation and intrauterine insemination. The woman underwent a standard luteal phase agonist protocol, with controlled ovarian hyper stimulation with daily 150IU recombinant gonadotropin and 75IU urinary gonadotropin for 12 days. Due to the high risk of ovarian hyper stimulation syndrome the couple was advised to delay embryo transfer. Eighteen mature oocytes were recovered, eight were vitrified and 10 fertilized and cryopreserved as pro-nuclei. Two months later, four vitrified oocytes were thawed, and three morphologically-normal embryos were transferred to an estrogen-progesterone-primed uterus, obtaining triple clinical pregnancy. The pregnancy was uneventful until 32 weeks of amenorrhea, when pre-term delivery started. After inducing lung maturity, a cesarean section was performed and three healthy fetuses were delivered. Nowadays, the babies are two and a half years old, and have had a normal psycho-motor development.

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BACKGROUND: Gene expression profiling of normal receptive endometrium has been characterized, but intrinsic defects in endometrial gene expression associated with implantation failure have not been reported. METHODS: Women who had previously participated as recipients in oocyte donation cycles and repeatedly exhibited implantation failure (Group A, study group) or had at least one successful cycle (Group B, control group) and spontaneously fertile women (Group C, normal fertility group) were recruited. All were treated with exogenous estradiol and progesterone to induce an endometrial cycle, and an endometrial biopsy was taken on the seventh day of progesterone administration. RNA from each sample was analysed by cDNA microarrays to identify differentially expressed genes between groups. RESULTS: 63 transcripts were differentially expressed (>or=2-fold) between Groups A and B, of which 16 were subjected to real time RT-PCR. Eleven of these were significantly decreased in Group A with regard to Groups B and C. Among the dysregulated genes were MMP-7, CXCR4, PAEP and C4BPA. CONCLUSIONS: Repeated implantation failure in some oocyte recipients is associated with an intrinsic defect in the expression of multiple genes in their endometrium. Significantly decreased levels of several transcripts in endometria without manifest abnormalities is demonstrated for the first time and shown to be associated with implantation failure.

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It is agreed that reliability of hormonal products, starting with recombinant technology, has improved uniformity of ovarian response to a specified dosage, and that this has resulted in better pregnancy rates. Nevertheless, IVF cycle cancellation rate has not experienced a substantial decline in the last 5-10 years. We feel that further improvement will be more likely to be achieved once we gain better understanding of factors intrinsic to oocyte biology, such as oocyte ageing and oocyte depletion.

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The clomiphene citrate challenge test is a tool to predict ovarian reserve and fertility. It has mainly been used as a predictor of success of IVF/intracytoplasmic sperm injection (ICSI) cycles. Infertile young women with diminished ovarian reserve have a worse prognosis than women with adequate ovarian reserve attempting IVF/ICSI cycles. Nothing is known regarding the outcome of young women with diminished ovarian reserve undergoing low-complexity assisted reproductive treatment such as ovulation induction plus intrauterine insemination (IUI). This study included all women under 37 years who consulted in the authors' centre between May 2004 and August 2005 who underwent ovulation induction and IUI. Ninety-six women younger than 37 years with adequate ovarian reserve, and 50 women with diminished ovarian reserve were found. The pregnancy rate and pregnancy rate per cycle in the adequate ovarian reserve group were significantly higher than those of the diminished ovarian reserve group (46.7% versus 25%, P < 0.02 ; 15.9% versus 7.6%, P < 0.02 respectively). It is concluded that the clomiphene citrate challenge test is a good predictor of low-complexity infertility intervention outcome, and represents an effective tool to establish a prognosis. Therefore, it is very useful in planning therapy, and advising the infertile couple.

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BACKGROUND: It is not well defined whether the elapsed time after vasectomy has any influence on the outcome of IVF-ICSI using epididymal sperm. We analysed retrospectively the results of 151 ICSI cycles in which sperm of vasectomized men were used at different time periods after vasectomy. METHODS: Oocytes were obtained after a desensitizing ovarian stimulation protocol using GnRH agonist in association with recombinant FSH and HCG. Sperm were retrieved by percutaneous epididymal sperm aspiration. The cycles were split into three groups: < or =10 years after vasectomy (group 1, n = 47), 11-19 years after vasectomy (group 2, n = 79), and > or =20 years after vasectomy (group 3, n = 25). RESULTS: As might be expected, the mean age of men differed in the three groups (group 3 > group 2 > group 1), and the mean age of the women was also significantly higher in group 3 than in groups 1 and 2, although no differences were described between groups 2 and 3. All other laboratory and clinical parameters were similar in the three groups. Ongoing pregnancy and implantation rates (34, 25, 8% and 22, 15, 6% respectively) decreased significantly from group 1 to group 3. CONCLUSION: Pregnancy and implantation rates after ICSI with sperm from vasectomized men are negatively correlated with the time interval from vasectomy, which cannot be explained purely by male or female ageing.

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This retrospective review study, carried out in a private IVF clinic, compared pregnancy and implantation rates with day 3 versus day 5 embryo transfers in a selected group of patients. Participants were patients who failed to achieve pregnancy in at least one previous attempt with embryo transfer on days 2 or 3, and had more than five oocytes fertilized. A total of 296 patients who had undergone day 3 (group A) transfers were compared with 154 who had undergone day 5 transfers (group B). Interventions were intracytoplasmic sperm injection (ICSI), day 3 and day 5 embryo transfer. Outcome measures were pregnancy, implantation, multiple gestation and blastocyst formation rates. Overall, 86.4% of embryos were at the six- to eight-cell stage at 72 h and 30% developed to blastocyst by day 5. The mean number of embryos transferred was 4.0 on day 3 and 3.0 on day 5. Pregnancy and implantation rates were 34.8 and 11.5% in group A, versus 45.3 and 18.5% in group B. Multiple gestation rate was 47.1% in group A and 28.5% in group B. Prolonging embryo culture in vitro to day 5 improved embryo selection and implantation rates. A significant decrease in high order gestations was achieved by reducing the number of embryos transferred, without compromising the pregnancy rates.

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Os autores fazem uma análise prospectiva de 77 casos de fertilizaçao assistida (GIFT, ZIFT e IVF) distribuídos de forma randomizada para suporte da fase lútea com HCG (2000 UI nos dias 3, 6, 9 e 12 após a aspiraçao folicular) ou progesterona natural (5Omg, injeçao diária durante 14 dias). Nessa análise observaram taxas de gravidez, de implantaçao, de abortamento, níveis hormonais e complicaçoes com ênfase à hiperestimulaçao ovariana. A comparaçao entre os dois grupos nao mostrou diferença com relaçao às taxas de gravidez, implantaçao e abortamento. A incidência de prenhez ectópica e múltipla também nao foi diferente. No entanto, os níveis de estrogênio e progesterona nos dias 8 e 12, após a aspiraçao folicular, foi estatisticamente superior no grupo do HCG. Observamos uma incidência aumentada de hiperestimulaçao ovariana no grupo do HCG, demonstrando que o uso dessa medicaçao para suporte da fase lútea deve obedecer a critérios rigorosos a serem ainda melhor definidos.

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Os autores apresentam os resultados obtidos em 14 casos de FIV e três casos de GIFT. Todas as pacientes haviam sido estimuladas anteriormente por diferentes indutores e estavam catalogas no grupo de resposta pobre. Foi usado um protocolo onde o análogo LH-RH, acetato de leuprolide, começou a ser administrado na fase lútea do ciclo anterior. Este protocolo foi comparado com um grupo controle em que foi utilizado o citrato de clomifene e hMG. Foram obtidas três gestaçöes no grupo tratado com acetato de leuprolide. A análise dos resultados mostra que o uso deste análogo na induçäo dos casos de Reproduçäo Assistida é extremamente útil, pois o número de oócitos e o índice de fertilizaçäo säo maiores

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El GIFT es una técnica nueva para el tratamiento de la esterilidad cuando han fallado otros métodos convencionales y que puede convertirse en una alternativa a la IVF-ET cuando al menos una de las trompas de Falopio es permeable. Esta técnica consiste en la colocación de oocitos y esperematozoides en la porción ampular de la trompa. Los trabajos experimentales se han llevado a cabo en 25 monos rheseus divididos en 2 grupos, 20 ( Grupo I) recibieron hormonas menopáusicas humanas para la estimulación del desarrollo folicular y 5 (Grupo II) sirvieron de grupo de control sin estimulación hormonal. Todos los animales fueron sometidos a laparotomía para realizar la técnica GIFT. Se obtuvieron 6 embarazos (1 gemelar) que terminaron en 1 parto a término y 6 abortos espontáneos( 1 en el 2 tercio el embarazo). La fase clínica del GIFT se efectuó en 117 pacientes distribuidas en 5 series. Se estimuló el desarrollo folicular con citrato de clomifeno, gonadotropina coriónica humana con control diario a base de ultrasonido y determinaciones séricas de estradiol. La aspiración folicular se realizó cuando se obtuvieron 2 folículos mayores de 16 mm U:S o 700 pg/ml de estradiol sérico. Los oocitos se colocaron en el mismo cáteter junto con la preparación de semen obtenida 2 horas antes de la cirugía. Se realizó la transferencia en la porción ampular de cada trompa(laparoscopia o minilaparotomía). Como resultado se han obtenido 34 embarazos(10 gemelares y 1 de trillizos). Han ocurrido 15 partos, hay 2 embarazos evolucionando en el tercer trimestre, 5 en el segundo. Se produjeron 10 abortos y 2 embarazos ectópicos(tubáricos)

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