RESUMO
OBJECTIVE: To estimate the effectiveness of Atosiban in improving the outcome after embryo transfer. The effectiveness of embryo transfer per cycle is still relatively low. One possible explanation might be uterine contractility that expels the transferred embryos. Atosiban improved the outcome of embryo transfer by reducing uterine contractility. METHODS: Data sources: A systematic review of papers in English using MEDLINE and EMBASE (1990-2019). Search terms included Atosiban, embryo transfer. Study selection: We included studies that compared the outcomes of embryo transfer with Atosiban and a control group. Data Extracting: Independent extraction of papers by two authors, using predefined data fields, including study quality indicators. RESULTS: All pooled analyses were based on a fixed-effect model. Four randomised controlled trials, including 1,025 women, and two non-randomised trials, including 686 patients, met our inclusion criteria. In both studies, the heterogeneity was moderate. Atosiban increased clinical pregnancy rates regardless of the indication for ART or type of embryo transferred. Pooled OR in randomized controlled trials reached 1.47 (1.18-1.82), and in non-randomised controlled trials it reached 1.50 (95% CI 1.10-2.05). CONCLUSION: Atosiban appears to increase the clinical pregnancy rates in women undergoing embryo transfer.
Assuntos
Transferência Embrionária/métodos , Fertilização in vitro/métodos , Antagonistas de Hormônios/administração & dosagem , Vasotocina/análogos & derivados , Ensaios Clínicos como Assunto , Feminino , Humanos , Gravidez , Taxa de Gravidez , Vasotocina/administração & dosagemRESUMO
RESEARCH QUESTION: What was the utilization, effectiveness and perinatal outcome of assisted reproductive technologies (ART) performed in Latin America during 2016. DESIGN: Retrospective collection of multinational data on ART performed in 178 institutions from 15 Latin American countries. RESULTS: We are reporting 85,474 initiated cycles, 15,070 deliveries and 18,182 babies born in this period. Of all fresh autologous IVF/ICSI cycles, 40.9% were performed in women aged 35-39 years, and 31.1% in women aged ≥40 years. After removing freeze-all cycles, delivery rate per oocyte retrieval was 20.31% for ICSI and 21.85% for IVF. Fresh single embryo transfer including all age categories represented 22.96%, with a 15.35% delivery rate per transfer. Double embryo transfer represented 61.58% of transfers, with a 27.62% delivery rate per transfer. Multiple births included 18.12% twins and 0.55% triplets and higher. In oocyte donation, delivery rate per transfer was 32.89%, with a twin and triplet rate of 23.48% and 0.73%, respectively. Overall, preterm deliveries reached 17.11% in singletons, 65.69% in twins and 95.51% in triplets. Perinatal mortality was 8.0 in singletons, 19.0 in twins, and 62.3 in high-order multiples. CONCLUSIONS: The number of initiated cycles continues to increase. Compared with previous years, the number of embryos transferred decreased while the proportion of single embryo transfers increased with a drop in multiple births. It is mandatory to stimulate health care providers and consumers to continue in this trend.
Assuntos
Infertilidade/epidemiologia , Infertilidade/terapia , Técnicas de Reprodução Assistida , Adulto , Transferência Embrionária/métodos , Transferência Embrionária/estatística & dados numéricos , Feminino , Humanos , Recém-Nascido , América Latina/epidemiologia , Nascido Vivo/epidemiologia , Masculino , Idade Materna , Gravidez , Resultado da Gravidez/epidemiologia , Gravidez Múltipla/estatística & dados numéricos , Sistema de Registros , Técnicas de Reprodução Assistida/estatística & dados numéricos , Estudos Retrospectivos , Adulto JovemRESUMO
RESEARCH QUESTION: What was the utilization, effectiveness and safety of assisted reproductive technologies (ART) performed in Latin American countries during 2015, and what were the regional trends? DESIGN: Retrospective collection of multinational data on assisted reproduction techniques (IVF and intracytoplasmic sperm injection [ICSI], frozen embryo transfer, oocyte donation, preimplantation genetic testing and fertility preservation), from 175 institutions in 15 Latin American countries. RESULTS: In total, 41.25% of IVF/ICSI cycles were performed in women aged 35-39 years, and 28.35% in women aged ≥40 years. After removing freeze-all cycles, delivery rate per oocyte retrieval was 21.39% for ICSI and 24.29% for IVF. Multiple births included 19.58% twins and 0.95% triplets and higher. In oocyte donation, delivery rate per transfer was 36.77%, with a twin and triplet rate of 27.65% and 1.06%, respectively. Overall, preterm deliveries reached 17.38% in singletons, 64.94% in twins and 98.41% in triplets. Perinatal mortality in 14,936 births and 18,391 babies born was 10.5 per 1000 in singletons, 17.9 per 1000 in twins, and 57.1 per 1000 in high-order multiples. Elective single embryo transfer represented 3.11% of fresh transfers, with a 31.78% delivery rate per transfer. Elective double embryo transfer represented 23.3% of transfers, with a 37.79% delivery rate per transfer. Out of 18,391 babies born, 63.22% were singletons, 34.4% twins, and 2.38% triplets and higher. CONCLUSIONS: Given the effect of multiple births on prematurity, morbidity and perinatal mortality, reinforcing the existing trend of reducing the number of embryos transferred remains mandatory.
Assuntos
Resultado da Gravidez/epidemiologia , Gravidez/estatística & dados numéricos , Técnicas de Reprodução Assistida/estatística & dados numéricos , Adulto , Feminino , Humanos , América Latina/epidemiologia , Sistema de Registros , Estudos RetrospectivosRESUMO
The aim of this review is to determine if the use of DHEA increases the likelihood of success in patients with POR. We searched MEDLINE and EMBASE using the terms "DHEA and diminished ovarian reserve", "DHEA and poor response", "DHEA and premature ovarian aging". A fixed effects model was used and Peto's method to get the odds ratio (OR) with 95% confidence intervals (CI 95%). For quantitative variables, Cohen's method was used to present the standardized mean differences (SMD) with their corresponding confidence intervals. Only five studied fulfilled the selection criteria. DHEA was administered in 25 mg doses, three times a day. In all studies, the authors corrected for the presence of confounding variables such as partner's age, infertility diagnosis and number of transferred embryos. The meta-analysis of the five selected studies assessed a total of 910 patients, who underwent IVF/ICSI, of which 413 had received DHEA. DHEA use was associated with a significant increase in pregnancy likelihood (OR 1.8, CI 95% 1.29 to 2.51, p=0.001). When analyzing the association between DHEA use and the likelihood of abortion, we found low heterogeneity between studies (I2=0.0%) and the use of DHEA to be associated to a significant reduction in the likelihood of abortion (OR 0.25, CI 0.07 to 0.95; p=0.045). Analysis of the association of DHEA with average oocyte retrieval showed high variability between studies (I2=98.6%), as well as no association between DHEA use and the number of oocytes retrieved (SMD -0.01, CI 95% -0.16 to 0.13; p<0.05).
Assuntos
Desidroepiandrosterona/uso terapêutico , Fármacos para a Fertilidade Feminina/uso terapêutico , Fertilização in vitro , Reserva Ovariana , Adulto , Desidroepiandrosterona/administração & dosagem , Feminino , Fármacos para a Fertilidade Feminina/administração & dosagem , Humanos , Recuperação de Oócitos , Gravidez , Taxa de Gravidez , Injeções de Esperma Intracitoplásmicas , Resultado do TratamentoRESUMO
The effects of acupuncture on IVF outcomes is still unknown. We carried out a systematic review and meta-analysis of RCT to determine whether acupuncture performed at the time of ET improves outcomes. We searched Medline and Embase from January 1990 to June 2017, for the following terms): (acupuncture; acupuncture therapy) and (reproductive techniques, assisted; in vitro fertilization; embryo transfer). We selected RCT that compared acupuncture with sham acupuncture or no treatment. We included only trials in which acupuncture involved the insertion of needles into traditional meridian points. We evaluated the methodological quality of the trials using the Cochrane risk of bias tool. The measure of treatment effect was the pooled odds ratio of achieving a clinical pregnancy, ongoing pregnancy, or live birth for women in the acupuncture group compared with women in the control group. For pooled data, summary test statistics were calculated using the Mantel-Haenszel method, using the Rev-Man software, version 5.1. We analyzed six studies, including 2,376. In all trials, there were no significant differences between the groups concerning the mean numbers of embryos transferred, the mean age of the women undergoing the procedure, diagnose and use of ICSI. Acupuncture performed the day of ET was associated with a reduced risk of clinical pregnancy (0.87, 95% confidence interval 0.77 to 0.98). The pooled rate difference was -0.06 (-0.12 to -0.01) for clinical pregnancy. None of the trials reported significant adverse effects of acupuncture.
Assuntos
Terapia por Acupuntura/efeitos adversos , Transferência Embrionária , Taxa de Gravidez , Feminino , Fertilização in vitro , Humanos , Gravidez , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
OBJECTIVE: Preeclampsia (PE) occurs in 4.6% of pregnancies worldwide. The social phenomenon of increasing maternal age has raised the demand for donor oocytes. Egg donation has allowed women with poor ovarian reserve, premature ovarian failure, genetic disorders or surgical menopause to get pregnant. Recipients provide a unique model of immune response because of the differences in the genetic makeup of mothers and fetuses. In PE, immune tolerance may be impaired as a result of having non-autologous eggs implanted. Egg donation is a highly successful assisted reproductive technology, despite the significant number of issues arising from the implantation of non-autologous eggs. This study aimed to determine whether there is an association between egg donation and preeclampsia. METHODS: A systematic review of the literature available in PubMed and Google Scholar was carried out from January of 1995 to August of 2016 using the terms 'oocyte donation, preeclampsia', 'oocyte donation, in vitro fertilization, preeclampsia', 'oocyte donation, preeclampsia, outcomes pregnancies', 'oocyte donation, obstetric outcome.' Only six retrospective cohort studies met the selection criteria. RESULTS: The meta-analysis revealed a statistically significant association between egg donation and onset of preeclampsia (OR 4.50; 95% CI: 3.28-6.19; p<0.0001). CONCLUSION: Oocyte donation is associated with increased risk of preeclampsia in singleton pregnancies. Therefore, it is crucial to properly record and assess this finding when egg donation is the chosen assisted reproductive technology to attain pregnancy.
Assuntos
Fertilização in vitro/efeitos adversos , Doação de Oócitos/efeitos adversos , Pré-Eclâmpsia/etiologia , Adulto , Feminino , Fertilização in vitro/métodos , Fertilização in vitro/estatística & dados numéricos , Humanos , Doação de Oócitos/métodos , Doação de Oócitos/estatística & dados numéricos , Pré-Eclâmpsia/diagnóstico , Pré-Eclâmpsia/epidemiologia , Gravidez , Resultado da Gravidez/epidemiologia , Fatores de RiscoRESUMO
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.
Assuntos
Aborto Habitual/etiologia , Técnicas de Reprodução Assistida , Glândula Tireoide/imunologia , Aborto Habitual/imunologia , Autoimunidade , Feminino , HumanosRESUMO
Multinational data on assisted reproduction techniques undertaken in 2014 were collected from 159 institutions in 15 countries in Latin America. Treatments included IVF/ ICSI, FET, OD, PGD and fertility preservation (FP). 41.34% of IVF/ICSI cycles were performed in women aged 35 to 39 years and 23.35% in women aged 40 and older. After removing cases with total freezing, delivery rate per oocyte retrieval was 25.05% for ICSI and 27.41% for IVF. Multiple births included 20.78% twins and 0.92 % triplets and over. In OD, twins reached 28.93% and triplets 1.07 %. Preterm deliveries reached 16.4% in singletons, 55.02% in twins and 76% in triplets. Perinatal mortality in 18,162 births was 23 per 1000 in singletons, 35 per 1000 in twins, and 36 per 1000 in high-order multiples. Elective single embryo transfer (eSET) represented only 2.63 % of fresh transfers, with a delivery rate of 32.15% per transfer. Elective double embryo transfer (eDET) represented 23.74% of transfers, with a delivery rate of 41.03% per transfer. Among babies born during this period 11,373 (62.6%) were singletons; 6,398 (35.2%) twins, and 391 (2.2%), triplets and more. Given the effect of multiple births on prematurity, morbidity and perinatal mortality, reinforcing the existing trend of reducing the number of embryos transferred is mandatory.
Assuntos
Resultado da Gravidez/epidemiologia , Técnicas de Reprodução Assistida/estatística & dados numéricos , Feminino , Humanos , América Latina/epidemiologia , Gravidez , Sistema de RegistrosRESUMO
Since 1992, the development of intra-cytoplasmic sperm injection (ICSI) has allowed infertile couples and couples affected by severe male factor infertility in particular, many of which with a history of failed traditional IVF, to become parents. This has generated considerable controversy over the safety of the procedure for the offspring. This systematic review seeks to determine whether evidence indicates that the use of ICSI increases the risk of congenital malformation in children born from singleton pregnancies versus naturally conceived children. Twenty-one of the 104 publications listed in the literature search were included in the analysis. Observational studies reported mostly an increased risk for congenital malformation; the risk of congenital malformations is 7.1% in ICSI and 4.0% in the general population (OR 1.99 (95% CI [1.87 - 2.11]). However, attributing higher risk solely to ICSI might seem far-fetched, as in vitro and simulation procedures, patient diseases, and ICSI indication may also be associated with higher risk of malformation.
Assuntos
Anormalidades Congênitas/epidemiologia , Injeções de Esperma Intracitoplásmicas , Feminino , Humanos , Masculino , Gravidez , Injeções de Esperma Intracitoplásmicas/efeitos adversos , Injeções de Esperma Intracitoplásmicas/estatística & dados numéricosRESUMO
OBJECTIVE: The main objective of this study was to assess the prevalence of overweight and obesity among patients undergoing assisted reproductive technology (ART) in Latin America and its consequences on treatment outcomes. METHODS: We used the Latin American Registry of ART to obtain women's age and body mass index (BMI), cancellation rate, number of oocytes retrieved and embryos transferred, clinical pregnancy, live birth and miscarriage rates from 107.313 patients undergoing autologous IVF and ICSI during four years; a multivariable analysis was performed to determine the effect of BMI on cancellation, oocytes retrieved, pregnancy, live birth and miscarriage, adjusting for age, number of embryos transferred and embryo developmental stage upon embryo transfer, when appropriate. RESULTS: The prevalence of overweight and obesity was 16.1% and 42.4%, respectively; correcting for age of female partner, overweight and obesity were associated to an increase in the odds of cancellation and to a lower mean number of oocytes retrieved; after adjusting for age, number of embryos transferred and stage of embryo development at transfer, we found that the BMI category was not associated to a change in the likelihoods of pregnancy, live birth and miscarriage. CONCLUSIONS: The prevalence of obesity among women seeking ART in Latin America is surprisingly high; however, BMI does not influence the outcome of ART performed in these women.
Assuntos
Obesidade/epidemiologia , Sobrepeso/epidemiologia , Complicações na Gravidez/epidemiologia , Resultado da Gravidez/epidemiologia , Técnicas de Reprodução Assistida/estatística & dados numéricos , Aborto Espontâneo/epidemiologia , Adulto , Índice de Massa Corporal , Estudos Transversais , Feminino , Humanos , Nascido Vivo/epidemiologia , GravidezRESUMO
The last two decades have seen an increase in the number of women diagnosed with infertility. The consequent growth in the use of assisted reproductive technologies (ART) calls for the determination of its long-term effects, including the risk of cancer. Many studies have attempted to answer this question, albeit with contradictory results. This review aimed to assess whether assisted reproductive technologies are associated with an increased risk of gynecological cancer. A search for papers in the literature was carried out on MEDLINE, TRIP DATABASE and NICE, resulting in 11 studies enrolling 3,900,231 patients altogether. Of these, 118,320 were offered ART. The incidence of gynecological cancer in the group offered ART was 0.6%, while the incidence in the group not offered ART was 2.1%. Taking all the studies into consideration, women offered ART were not at greater risk of having gynecological cancer; instead, a protective association was found.
Assuntos
Neoplasias dos Genitais Femininos/epidemiologia , Técnicas de Reprodução Assistida/estatística & dados numéricos , Feminino , Humanos , IncidênciaRESUMO
OBJECTIVE: ART has helped millions of infertile couples worldwide to overcome their childlessness. These successes have been accompanied by an increase in multiple deliveries, and perinatal complications associated. The explanation for this complication is the transfer of more than one embryo, to increase the odds of delivery. Our objective was to compare the outcome of elective dual embryo transfer (eDET) to that of the transfer of more than two embryos without embryo cryopreservation (TET), terms of delivery rate and multiple delivery. METHODS: We analyzed the data registered by 155 clinics members of the RLA: 11,024 eDET and 10,634 TET. RESULTS: The delivery rate was significantly higher when eDET was performed than when TET was performed (40.24% and 26.98%, p < 0.001). Also, the ratio of twin deliveries was higher in eDET (25.80% and 20.56%, p < 0.001). However, the ratio of triplets and more deliveries was higher in TET than in eDET (2.34%and 0.52%, p < 0.001). These findings were consistent across the different age categories of the female partner. CONCLUSION: Our findings suggest that eDET was associated with a statistically significant better delivery rate per embryo transfer, and lower ratio of triplet-and-higher deliveries, regardless of the woman's age. Therefore, there is no evidence that supports the transfer of more than two embryos.
Assuntos
Transferência Embrionária/métodos , Feminino , Humanos , América Latina , Gravidez , Complicações na Gravidez/epidemiologia , Complicações na Gravidez/etiologia , Complicações na Gravidez/prevenção & controle , Sistema de Registros , Técnicas de Reprodução Assistida , Estudos RetrospectivosRESUMO
STUDY QUESTION: Does the use of ICSI offer any outcome advantage over IVF in patients with non-male factor infertility? SUMMARY ANSWER: We did not find any outcome improvement that justifies the routine use of ICSI over IVF in non-male factor ART cycles. WHAT IS ALREADY KNOWN: Since its introduction in Latin America, the use of ICSI has increased substantially, even among patients without male factor infertility. However, it is not clear whether ICSI provides an advantage over IVF in non-male factor infertility. STUDY DESIGN SIZE DURATION: A retrospective cohort study of fresh cycles performed in 155 ART clinics located in 15 Latin American countries between 2012 and 2014. Records were assessed for 49,813 ART cycles (39,564 ICSI and 10,249 IVF) performed in infertile couples who did not have male factor infertility. Student's t-test was used to analyze normally distributed data, Wilcoxon test to analyze non-normally distributed data, and Fisher's exact test for categorical data. Logistic regression was used to quantify the effect of ICSI on delivery rate, adjusting for age of female partner, number of oocytes inseminated, number of embryos transferred, and transfer at blastocyst stage as possible confounding factors. Poisson regression analysis was used to quantify the effect of ICSI on fertilization rate, adjusting for age of female partner. PARTICIPANTS/MATERIALS SETTING METHOD: Cycles with the diagnosis of male factor and use of cryopreserved semen and with a freeze-all strategy were excluded. MAIN RESULTS AND THE ROLE OF CHANCE: After correcting for age of female partner, number of oocytes inseminated, number of embryos transferred and transfer at blastocyst stage, we found that the use of ICSI was associated with a significant decrease in the odds of delivery compared to IVF (odds ratio 0.88, 95% CI 0.84 to 0.93; P < 0.0001). LIMITATIONS REASONS FOR CAUTION: An important limitation of this study is the lack of randomization owing to its retrospective nature. This could result in selection bias, i.e. couples with the worst prognosis undergoing ICSI, or patients with a history of fertilization failure in IVF cycles undergoing ICSI. More than one cycle from the same couple may be included in the study. WIDER IMPLICATIONS OF THE FINDINGS: The lack of an outcome benefit-and, indeed, a reduced likelihood of delivery-following ICSI in non-male factor infertile couples suggests that ICSI may not be the most appropriate clinical approach in these patients. STUDY FUNDING/COMPETING INTERESTS: None.
RESUMO
Multinational data on assisted reproduction techniques undertaken in 2013 were collected from 158 institutions in 15 Latin American countries. Individualized cycle-based data included 57,456 initiated cycles. Treatments included autologous IVF and intracytoplasmic sperm injection (ICSI), frozen embryo transfers, oocyte donations. In autologous reproduction, 29.22% of women were younger than 35 years, 40.1% were 35-39 years and 30.6% were 40 years or older. Overall delivery rate per oocyte retrieval was 20.6% for ICSI and 25.4% for IVF. Multiple births included 20.7% for twins and 1.1% for triplets and over. In oocyte donations, twins reached 30% and triplets 1.4%. In singletons, pre-term births were 7.5%: 36.58% in twins and 65.52% in triplets. The relative risk for prematurity was 4.9 (95% CI 4.5 to 5.3) in twins and 8.7 (95% CI 7.6 to 10.0) in triplets and above. Perinatal mortality was 29.4 per 1000 in singletons, 39.9 per 1000 in twins and 71.6 per 1000 in high order multiples. Elective single embryo transfer represented only 2% of cycles, with delivery rate of 39.1% in women aged 34 years or less. Given the effect of multiple births and prematurity, it is mandatory to reduce the number of embryos transferred in the region.
Assuntos
Técnicas de Reprodução Assistida , Adulto , Fatores Etários , Feminino , Instalações de Saúde/estatística & dados numéricos , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Humanos , América Latina/epidemiologia , Masculino , Gravidez , Resultado da Gravidez , Sistema de Registros , Técnicas de Reprodução Assistida/efeitos adversos , Técnicas de Reprodução Assistida/estatística & dados numéricosRESUMO
OBJECTIVE: This report examines information on Assisted Reproduction Technologies performed in Latin America (LA) during 2012. METHODS: Multinational data were collected directly from 155 institutions in 14 countries. Individualized, case-bycase data include 47,326 ART cycles covering more than 80% of cycles performed in LA. Treatments included in vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI), frozen embryo transfers (FET), oocyte donations (OD) and fertility preservation. RESULTS: In 39% of ET IVF/ICSI was performed in women age 35-39 and 31% in women ≥40 years. Delivery rate (DR) per pick-up (OPU) in ICSI and IVF cycles, were 20.9% and 26.5%, respectively. Overall multiple births comprised 20.6% twins and 1.2% triplets. Furthermore, in OD, twins and triplets reached 27.8% and 2.4%, respectively. Pre term births in singletons were 14%. The relative risk of prematurity increased by 4.30 (95% CI 4.1-4.6) in twins, and 43.8 (95% CI 28.5-67.4) in ≥ triplets. Perinatal mortality increased from 25.2 in singletons, to 44.0 in twins and 80 in ≥ triplets. Elective single embryo transfer (eSET) was performed in only 1.4% of cycles with DR of 30% in women ≤34 years. CONCLUSION: Trends over the last 20 years show that eSET should be the way to go provided access is facilitated with public funding.
RESUMO
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.
Assuntos
Criopreservação/métodos , Técnicas de Cultura Embrionária , Transferência Embrionária/métodos , Fertilização in vitro/métodos , Adulto , Feminino , Humanos , Gravidez , Taxa de Gravidez , Gravidez Múltipla , Estudos Retrospectivos , Fatores de TempoRESUMO
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.
Assuntos
Adulto , Feminino , Humanos , Gravidez , Criopreservação/métodos , Técnicas de Cultura Embrionária , Transferência Embrionária/métodos , Fertilização in vitro/métodos , Taxa de Gravidez , Gravidez Múltipla , Estudos Retrospectivos , Fatores de TempoRESUMO
OBJECTIVE: To compare reproductive performance among pregnancies initiated with autologous oocytes and donated oocytes. DESIGN: Retrospective cohort analysis. SETTING: Clínica las Condes Hospital, a tertiary referral center in Chile; Fertility, Centro de Fertilizaçao Assistida, Brazil; and 130 institutions reporting to the Latin American Registry (RLA) of assisted reproductive technologies (ART). PATIENT(S): Cohort 1 evaluates 70 women who conceived during an IVF cycle, and simultaneously donated fresh oocytes to other 70 oocyte recipients who also conceived. Cohort 2 evaluates the follow-up of 31,550 pregnancies after IVF and 6,024 pregnancies in oocyte recipients, both reported to the RLA between 1995 and 2005. INTERVENTION(S): ART with autologous and donor oocytes. MAIN OUTCOME MEASURE(S): Embryo implantation rate, weight of newborns, gestational age at delivery, perinatal mortality and duration of lactation. RESULT(S): Oocyte donors and their recipients share similar embryo implantation rate, weight of newborns, gestational age at delivery, perinatal mortality, and duration of lactation. CONCLUSION(S): The establishment of pregnancy is as efficient with autologous as with donated oocytes. Embryos transferred into their progenitors or in different women have similar chances of implantation, weight at birth, and perinatal outcome. Embryo implantation is affected by the age of the recipient, suggesting that uterine senescence plays a role in fecundity.
Assuntos
Implantação do Embrião/fisiologia , Lactação , Doação de Oócitos/estatística & dados numéricos , Parto , Taxa de Gravidez , Doadores de Tecidos/estatística & dados numéricos , Adulto , Estudos de Coortes , Eficiência , Transferência Embrionária/estatística & dados numéricos , Feminino , Seguimentos , Humanos , Recém-Nascido , Lactação/fisiologia , Pessoa de Meia-Idade , Parto/fisiologia , Gravidez , Reprodução/fisiologia , Técnicas de Reprodução Assistida/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Tempo , Adulto JovemRESUMO
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.
Assuntos
Fertilização in vitro/normas , Hormônio Foliculoestimulante/uso terapêutico , Indução da Ovulação/normas , Feminino , Hormônio Foliculoestimulante Humano/uso terapêutico , Subunidade alfa de Hormônios Glicoproteicos/uso terapêutico , Humanos , Infertilidade Feminina/tratamento farmacológico , Gravidez , Taxa de GravidezRESUMO
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.