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OBJECTIVE: To evaluate the impact of patient follicular environment with oxidative stress on oocyte quality. METHODS: Patients on fertility treatment with either advanced maternal age or endometriosis were asked to donate follicular fluid collected during ovum pick-up. Follicular fluid (FF) was added (20%, 10% and 5%; %V/V) to in vitro maturation (IVM) medium with mouse oocytes. Following maturation culture, the oocytes were assessed for meiosis reinitiation. In a second setup, coenzyme Q10 was added to culture medium with FF. In addition to assessing meiotic maturation, a subset of oocytes was assessed for spindle structure and chromosome alignment. RESULTS: Supplementation of IVM medium with FF of patients of advanced maternal age (with or without antioxidants) did not have an effect on the maturation capacity of mouse oocytes. However, the addition of FF of individuals with endometriosis (without antioxidants) in the two highest concentrations affected oocyte maturation (61.5% & 57.0% maturation) compared with the lowest concentration (89.2% maturation) (p<0.05). Supplementation of medium with coenzyme Q10 did not improve the maturation rate of oocytes exposed to the FF of individuals with endometriosis (28.5±13.7%) (p<0.05). Nevertheless, preliminary analysis of spindle abnormality and chromosome alignment revealed that oocytes resuming meiosis in the presence of FF of patients with endometriosis displayed aberrant spindle morphology and chromosomal misalignment. CONCLUSION: The follicular environment of patients with endometriosis severely affected oocyte (nuclear) maturation. In vitro maturation in the presence of coenzyme Q10 appears to be a tool for rescuing oocytes exposed to such follicular environment.
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OBJECTIVE: To evaluate the follicular fluid oxidative balance of infertile patients of advanced-maternal-age and the correlation between oxidative imbalance in the follicular fluid and the embryological outcomes. METHODS: Follicular fluid (FF) from infertile patients of advanced-maternal-age undergoing ART treatments were collected and frozen in cryovials at -86°C until further use, and analyzed at the Biochemistry and Nutrition Institute of San Marcos University. As controls, we used FF from oocyte donors. The FF was then assayed for oxidative balance by ABTS, FRAP and TBARS assays. In order to establish the correlation between oxidative balance and embryo quality, we correlated the number of usable blastocysts (freshly transferred or frozen blastocysts) with the results from ABTS, FRAP and TBARS. RESULTS: Follicular fluid from patients of Advanced-maternal-age (AMA group) significantly differed from the values found in the control group; the ABTS value was higher and the FRAP value was lower, in comparison to the FF from oocyte donors (control group). The lipid peroxidation was not different between those two groups. Furthermore, there was no significant correlation among the results of the assays, or when correlated with the proportion of usable blastocysts. CONCLUSION: Ovarian oxidative balance seems to be critical for oocyte quality in advanced-maternal-age patients; however, we still need more studies on oxidative stress indicators, on a larger set of patients.
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OBJECTIVE: To evaluate the influence of ovarian follicular dominance on the outcome of oocyte in-vitro maturation. METHODS: This retrospective cohort study included 21 patients with polycystic ovaries or polycystic ovary syndrome (Rotterdam criteria, 2004) subjected to 24 invitro maturation (IVM) cycles between October 2015 and January 2017. Patients undergoing IVM received minimal gonadotropin stimulation starting on day 2 or 3 of the cycle; ovum pick-up typically occurred on days 6 to 8. No hCG-trigger shot was given. Following 30h of IVM, mature oocytes were inseminated by ICSI and the resulting embryos cultured up to the blastocyst stage. RESULTS: Ovarian follicular dominance was observed in nine of the 24 IVM cycles. Oocyte IVM yielded an overall maturation rate of 69.3±23.8%, and no difference was observed when the groups with or without a dominant follicle were assessed independently. The rates of fertilization and usable blastocysts per fertilized oocyte, mature oocyte (Metaphase II) or cumulus-oocyte-complex were nearly three times higher (28.7±22.5%) in the group without ovarian follicular dominance. No differences were found in the clinical pregnancy rates attained by the individuals with or without a dominant follicle after 21 vitrified-warmed blastocyst transfer cycles. CONCLUSION: Occurrence of ovarian follicular dominance during hormonal stimulation for in-vitro maturation negatively impacted embryological outcomes. Strategies devised to limit the appearance of ovarian follicular dominance must be further explored.
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Transferencia de Embrión , Técnicas de Maduración In Vitro de los Oocitos , Oocitos/patología , Folículo Ovárico/patología , Inducción de la Ovulación , Síndrome del Ovario Poliquístico/patología , Síndrome del Ovario Poliquístico/terapia , Adulto , Blastocisto/citología , Transferencia de Embrión/métodos , Transferencia de Embrión/normas , Femenino , Fertilización In Vitro/métodos , Humanos , Técnicas de Maduración In Vitro de los Oocitos/métodos , Técnicas de Maduración In Vitro de los Oocitos/normas , Infertilidad Femenina/diagnóstico , Infertilidad Femenina/etiología , Infertilidad Femenina/patología , Infertilidad Femenina/terapia , Oocitos/citología , Oogénesis/fisiología , Folículo Ovárico/citología , Inducción de la Ovulación/efectos adversos , Inducción de la Ovulación/métodos , Síndrome del Ovario Poliquístico/complicaciones , Síndrome del Ovario Poliquístico/diagnóstico , Embarazo , Índice de Embarazo , Estudios RetrospectivosRESUMEN
Introducción: La infertilidad es un diagnóstico cada vez más frecuente, tanto a nivel del mar como en las grandes alturas, y el desarrollo de técnicas de reproducción asistida de alta complejidad en los Andes del Perú es imprescindible. Objetivo: Definir los resultados de estas técnicas en una institución a 3 330 metros sobre el nivel del mar. Diseño: Estudio descriptivo y retrospectivo. Institución: Centro de Fertilidad y Ginecología del Sur, Cusco, Perú. Pacientes: 576 pacientes con infertilidad atendidas entre los años 2005 al 2015. Métodos: Se revisó los registros de los procedimientos realizados y se estableció las tasas de embarazo clínico según la edad y días de cultivo, tanto en ovocitos autólogos como en ovodonación. Lasignificancia estadística de las diferencias encontradas fue analizada por medio de la prueba exacta de Fisher. Principal medida de resultados: Tasa de embarazo clínico. Resultados: Las tasas de embarazo clínico fueron: 30,4% en ovocitos autólogos, 42,4% en ovodonación y 25,0% en maduración in vitro de ovocitos. La frecuencia de embarazo doble fue 31,6%, y triple, 7,9%. Conclusiones: Las tasas de embarazo clínico fueron similares a las observadas internacionalmente. Destaca la necesidad de estrategias para disminuir la pluralidad de los embarazos, así como para mejorar la tasa de embarazo en las mujeres ≥ 37 años.
Introduction: Infertility is currently a more frequent diagnosis, at sea level and at high altitudes, and development of high complexity assisted reproduction techniques in the Andes of Peru is essential. Objective: To define the results of the application of these techniques in an institution at 3 330 meters above sea level. Design: Descriptive and retrospective study. Setting: Centro de Fertilidad y Ginecología del Sur, Cusco, Peru. Patients: 576 patients with infertility attended between years 2005-2015. Methods: Records of the procedures performed were reviewed and rates of clinical pregnancy according to age and days of culture were established for both autologous oocytes and ovodonation. Statistical significance of differences found was analyzed by Fisher exact test. Main outcome measure: Rate of clinical pregnancy. Results: Rates of clinical pregnancy were: 30.4% in autologous oocytes, 42.4% in ovodonation, and 25% in in vitro maturation oocytes. Frequency of twin pregnancy was 31.6%, and of triple pregnancy, 7.9%. Conclusions: Rates of clinical pregnancy were similar to those observed internationally. This emphasizes the need of strategies to diminish the plurality of pregnancies, as well as to improve the rate of pregnancy in women ≥ 37 years old.
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Objetivo: Determinar el efecto de metformina en las tasas de éxito de fertilización in vitro (FIV) e inyección intracitoplasmática de espermatozoides (ICSI), en mujeres con ovario poliquístico. Diseño: Estudio retrospectivo. Institución: Centro de Fertilidad y Ginecología del Sur, Cusco. Participantes: Mujeres con infertilidad asociada a ovario poliquístico. Métodos: Se compara las tasas de éxito de FIV/ICSI de 7 mujeres con diagnóstico asociado de ovario poliquístico, usuarias de metformina, y de 9 mujeres con el mismo diagnóstico no usuarias del fármaco. Principales medidas de resultados: Embarazo. Resultados: La tasa de implantación fue 35%, la de embarazo bioquímico, 71,4%, y la de embarazo clínico, 57,1%, en las mujeres con ovario poliquístico usuarias de metformina. Las mujeres con ovario poliquístico no usuarias del fármaco tuvieron tasas de 0%, 11,1% y 0,0%, respectivamente. Conclusiones: El uso de metformina mejoro las tasas de éxito de FIV/ICSI en mujeres con ovario poliquístico.
Objectives: To determine metformin influence in in vitro fertilization (IVF) and intracytoplasmatic sperm injection (ICSI) success rates in women with polycystic ovaries (PCO). Design: Retrospective study. Setting: Fertility and Gynecology Southern Center, Cusco, Peru. Participants: Women with polycystic ovaries associated infertility. Methods: We compared IVF/ICSI success rates in 7 women with diagnosis of PCO who used metformin and 9 women with PCO who did not use metformin. Main out comes measures: Pregnancy. Results: In PCO women using metformin implantation rate was 35%, biochemical pregnancy rate 71,4%, and clinical pregnancy rate 57,1%. In PCO women not using metformin, success rates were respectively 0%, 11,1%, and 0%. Conclusions: Metformin use improved IVF/ICSI success rates in PCO women.
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Femenino , Humanos , Adulto , Fertilización In Vitro/métodos , Inyecciones de Esperma Intracitoplasmáticas , Metformina/uso terapéutico , Síndrome del Ovario Poliquístico , Estudios RetrospectivosRESUMEN
Introducción: Los procedimientos de congelación se hacen indispensables cuando se realiza una hiperestimulación y sobran embriones viables; los costos disminuyen y la tasa de embarazo por aspiración aumenta con la congelación-descongelación de embriones. Objetivos: Presentar nuestra experiencia con congelación-descongelación de embriones. Lugar: Servicio Médico y Laboratorio de Reproducción Asistida, Clínica Ricardo Palma. Diseño: Estudio clínico retrospectivo. Material biológico: Embriones obtenidos por fertilización asistida. Intervenciones: Hiperestimulación ovárica controlada en la fase lútea corta, captura ovular a las 36 horas postadministración de hCG, fertilización in vitro clásica o ICSI transporte como método de fecundación, procesos clásicos de criopreservación y descongelación de embriones. Principales medidas de resultados: Promedio de supervivencia embrionaria en el proceso congelación-descongelación. Resultados: Iniciamos el estudio en octubre de 2003. El número total de ciclos en que se congeló embriones en este periodo fue 154; de estos, solo se descongeló 58. La tasa de embarazo por transferencia fue 30,2 por ciento, obteniéndose 16 embarazos, de ellos 12 embarazos a término y 4 abortos. Conclusiones: Los resultados con criopreservación de embriones en nuestro servicio de reproducción asistida son comparables con los de otros centros de fertilidad.
Introduction: Freezing-unfreezing procedures are essential when hyperestimulation is followed by embryo overproduction; they lower costs and increase pregnancy rates per aspiration. Objectives: To present our experience with embryo freezing-unfreezing. Setting: Assisted Reproduction Medical Service and Laboratory, Clinica Ricardo Palma. Design: Clinical retrospective study. Biologic material: Embryos obtained by assisted fertilization. Interventions: Controlled ovarian hyperestimulation with short lutealphase, ova capture at 36 hours post hCG administration, classical in vitro fertilization or ICSI-transport, classical processes of embryo cryopreservation and unfreezing. Main outcome measures: Embryo survival in freezing-unfreezing process. Results: Westarted our study in October 2003. Number of cycles with frozen embryos during this period was 154; from these we unfroze only 58. Pregnancy rate per transference was 30,2 per cent, obtaining 16 pregnancies, including 12 term pregnancies and 4 abortions. Conclusions: Results with embryo cryopreservation at our assisted reproduction service are consistent with those of other fertility centers.
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Humanos , Blastómeros , Criopreservación , Estructuras Embrionarias , Estudios RetrospectivosRESUMEN
OBJECTIVE: Using a mouse embryo bioassay, we examined the embryotoxic properties of serum obtained from eight women who had ingested cocaine base paste (CBP) for a period of 1-3 years. STUDY DESIGN: Two-cell stage mouse embryos were cultured in the presence of serum extracted from eight CBP-smoking or control women. After 48h, embryos were evaluated to determine their developmental stage and then processed by Tarkoswki's technique to determine the proportion of embryos with micronuclei, in order to establish the number of micronuclei/embryo. RESULTS: Serum from CBP patients diminished the percentage of embryos progressing to the compacted morula stage, while increasing the proportion of embryos with micronuclei and the corresponding micronuclei/embryo ratio. CONCLUSION: These findings provide the first experimental evidence of embryotoxic compounds in the serum of CBP-smoking women. This study highlights the reproductive risk of chronically ingested CBP and demonstrates the need for further studies.
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Aberraciones Cromosómicas/inducido químicamente , Trastornos Relacionados con Cocaína/sangre , Cocaína/toxicidad , Desarrollo Embrionario/efectos de los fármacos , Teratógenos , Adulto , Animales , Estudios de Casos y Controles , Modelos Animales de Enfermedad , Técnicas de Cultivo de Embriones , Femenino , Humanos , Ratones , EmbarazoRESUMEN
Objetivo: Determinar la posibilidad de ciclos exitosos de fertilización in vitro (FIV) a 3,330 metros sobre el nivel del mar (m snm). Diseño: Estudio clínico prospectivo. Lugar: Centro de Fertilidad y Ginecología del Sur (CFGS), Cusco, Perú ciudad localizada a 3330 m snm. Participantes: Parejas con infertilidad inexplicada, obstrucción tubárica, disminución de la reserva ovárica o síndrome de Asherman. Intervenciones: Desde el año 2005, hemos realizado procedimientos FIV en 12 parejas en altura: en 8 se hizo FIV convencional; en 3 parejas, FIV con ovodonación; y en 1 pareja, FIV con útero subrogado. Principales medidas de resultados: Tasas de implantación, de embarazo bioquímico y de embarazo clínico. Resultados: En los grupos de FIV convencional y FIV con ovodonación, las tasas de implantación fueron 6,9 por ciento y 9,1 por ciento, las tasas de embarazo bioquímico fueron 37,5 por ciento y 33,3 por ciento, Y las tasas de embarazo clínico, 12,5 por ciento y 33,3 por ciento, respectivamente. Conclusiones: El procedimiento FIV es posible de ser realizado con éxito a 3,330 m snm. La altura podría ser un factor negativo para la implantación embrionaria.
Objective: To determine the feasibility of in vitro fertilization (IVF) procedures at 3 330 meters above sea level (masl). Design: Prospective clinical study. Setting: Centro de Fertilidad y Ginecología del Sur (CFGS), Cusco, Peru city localized at 3 330 masl. Participants: Couples with unexplained infertility, tubal obstruction, decreased ovarian reserve or Asherman syndrome. Interventions: Since 2005 we have performed IVF procedures in 12 couples: 8 by conventional IVF, 3 by egg donation and one by IVF surrogacy. Main outcome measures: Implantation, and biochemical and clinical pregnancies rates Results: In the conventional lVF and egg donation IVF groups the implantation rates were 6,9 per cent and 9,1 per cent, the biochemical pregnancy rates 37,5 per cent and 33,3 per cent, and the clinical pregnancy rates 12,5 per cent and 33,3 per cent, respectively. Conclusions: It is possible to have successful IVF procedures at 3 330 masl. The high altitude could be a negative factor for embryo implantation.