RESUMO
BACKGROUND: Identification of the best embryos to transfer is a key element for success in assisted reproduction. In the last decade, several morphological criteria of oocytes and embryos were evaluated with regard to their potential for predicting embryo viability. The introduction of polarization light microscopy systems has allowed the visualization of the meiotic spindle and the different layers of the zona pellucida in human oocytes on the basis of birefringence in a non-destructive way. Conflicting results have been reported regarding the predictive value in ICSI cycles. OBJECTIVE: To assess the predictive ability of meiotic spindle and zona pellucida of human oocytes to implant by polarized microscopy in ICSI cycles. MATERIAL AND METHODS: Prospective and observational clinical study. 903 oocytes from 94 ICSI cycles were analyzed with polarized microscopy. Meiotic spindle visualization and zona pellucida birefringence values by polarized microscopy were correlated with ICSI cycles results. RESULTS: Meiotic spindle visualization and birefringence values of zona pellucida decreased in a direct basis with increasing age. In patients aged over the 35 years, the percentage of a visible spindle and mean zona pellucida birefringence was lower than in younger patients. Fertilization rate were higher in oocytes with visible meiotic spindle (81.3% vs. 64%; p < 0.0001), as well as embryo quality (47.4% vs. 39%; p=0.01). Fertilization rate was higher in oocytes with positive values of birefringence (77.5 % vs. 68.5% p=0.005) with similar embryo quality. Conception cycles showed oocytes with higher mean value of zona birefringence and visible spindle vs. no-conception cycles (p<0.05). CONCLUSIONS: Polarized light microscopy improves oocyte selection, which significantly impacts in the development of embryos with greater implantation potential. The use of polarized light microscopy with sperm selection methods, blastocyst culture and deferred embryo transfers will contribute to transfer fewer embryos without diminishing rates of live birth and single embryo transfer will be more feasible.
Assuntos
Oócitos/citologia , Injeções de Esperma Intracitoplásmicas , Adulto , Birrefringência , Feminino , Humanos , Microscopia de Polarização , Prognóstico , Estudos Prospectivos , Fuso Acromático , Zona PelúcidaRESUMO
This is a clinical study to evaluate the efficacy, clinical side effects and in lipid metabolism of a new hormonal contraceptive preparation containing 75 mcg. of ethinyloestradiol. Thirty Mexican health women in reproductive age were studied for 12 months, giving a total of 360 cycles. The medication was highly effective for contraception, because pregnancies did not occur in this period. The clinical side effects were mild and less frequent that the ones informed with the use of other available hormonal oral contraceptives. In lipid metabolism, we did not find the adverse effects most frequently observed with the use of previous progestagens. This study, like previous ones, concludes that the combination of gestodene and ethinylestradiol is highly effective as a contraceptive with a low incidence of collateral side effects and due to its lack of interference with the metabolism of lipids is particularly suited for cases of high risk to develop pathology associated with alterations in lipid metabolism.