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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 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 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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Transferência Embrionária , Técnicas de Maturação in Vitro de Oócitos , Oócitos/patologia , Folículo Ovariano/patologia , Indução da Ovulação , Síndrome do Ovário Policístico/patologia , Síndrome do Ovário Policístico/terapia , Adulto , Blastocisto/citologia , Transferência Embrionária/métodos , Transferência Embrionária/normas , Feminino , Fertilização in vitro/métodos , Humanos , Técnicas de Maturação in Vitro de Oócitos/métodos , Técnicas de Maturação in Vitro de Oócitos/normas , Infertilidade Feminina/diagnóstico , Infertilidade Feminina/etiologia , Infertilidade Feminina/patologia , Infertilidade Feminina/terapia , Oócitos/citologia , Oogênese/fisiologia , Folículo Ovariano/citologia , Indução da Ovulação/efeitos adversos , Indução da Ovulação/métodos , Síndrome do Ovário Policístico/complicações , Síndrome do Ovário Policístico/diagnóstico , Gravidez , Taxa de Gravidez , Estudos RetrospectivosRESUMO
El tema de aborto recurrente ha tenido diversos planteamientos, de acuerdo a los progresos en la genética y biología molecular y conforme se avanzó en mejores métodos clínicos de diagnóstico. En la presente revisión, hacemos un alcance sobre losactuales conocimientos sobre la etiología, diagnóstico y manejo del aborto recurrente, así como su repercusión en la pareja que sufre de subfertilidad por esta causa.
Recurrent pregnancy loss study approach has been related to progress in genetics and molecular biology as well as better diagnosis methods. In this review we recall current knowledge on the etiology, diagnosis and treatment of recurrent pregnancy loss, as well as its repercussion in the couple with subfertility due to this cause.
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Humanos , Aborto , Aborto Habitual , Alergia e Imunologia , Diagnóstico , GenéticaRESUMO
Objetivo: Revisar los casos de endometriosis encontrada durante la laparoscopia o laparotomía en mujeres evaluadas por infertilidad o aborto recurrente. Diseño: estudio retrospectivo descriptivo de corte transversal. Material y método: 675 mujeres con infertilidad aborto recurrente fueron sometidas a laparotomía o laparoscopia. Lugar: Servicio de Reproducción Humana del Hospital Nacional Edgardo Rebagliati Martins de EsSalud. Resultados: La prevalencia de endometriosis fue 47 por ciento (317 pacientes). Siendo más frecuente en mujeres entre 30 y 39 años. La endometriosis fue mínima en siete casos (2.2 por ciento), leve en 101 (31.9 por ciento), moderada en 128 (40,4 por ciento) y severa en 81 casos (25,6 por ciento). En 38 casos se halló uno o más endometriomas. La localización más frecuente fue en fondo de saco posterior, ligamentos uterosacros y en la superficie ovárica. Se encontró, además salpingitis crónica en 26 por ciento (81 casos), con hidrosálpinx en 20 casos. Gestaron 55 pacientes (17,4 por ciento), haciendo énfasis en que el seguimiento no fue óptimo. Conclusiones: La frecuencia de endometriosis es alta en mujeres con infertilidad o aborto recurrente. El diagnóstico de la enfermedad ha sido en esta revisión por laparoscopía y laparotomía, intervenciones durante las cuales se realiza la fulguración de los focos y la eliminación de los endometriomas, así como se lisa las adherencias y se restituye la anatomía funcional de las trompas de falopio.