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OBJECTIVE: To describe the reproductive and obstetric outcomes of an intracytoplasmic sperm injection cycle with preimplantation genetic testing for aneuploidy in an advanced reproductive-age woman with high-grade mosaic Turner syndrome. METHODS: Case report of a 39-year-old woman diagnosed with mosaic Turner Syndrome 45,X[90]/46,XX[10] karyotype who underwent in vitro fertilization treatment with blastocyst trophectoderm biopsy for preimplantation genetic testing using next-generation sequencing. RESULT(S): Two of the four blastocysts biopsied were euploid. The patient achieved ongoing pregnancy after the first single euploid frozen embryo transfer, followed by the birth of a healthy child. CONCLUSION: Autologous intracytoplasmic sperm injection cycles can be considered in a select group of advanced reproductive-age women diagnosed with high-grade mosaic Turner syndrome.

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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.

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Summary Objective: To evaluate the effect of male factor infertility on intracytoplasmic sperm injection (ICSI) outcomes compared with a control group presenting isolated tubal factor. Method: This retrospective study included 743 couples undergoing ICSI as a result of isolated male factor and a control group consisting of 179 couples undergoing ICSI as a result of isolated tubal factor, performed in a private university- -affiliated in vitro fertilization center, between January/2010 and December/2016. Patients were divided into two groups according to maternal age: women ≤35 years old and >35 years old. The effects of infertility causes on laboratorial and clinical ICSI outcomes were evaluated using Student's t-test and (2 test. Results: No differences in controlled ovarian stimulation outcomes were observed between male factor cycles and tubal factor cycles in the two age groups. Implantation (male factor 35.5% vs. tubal factor 32.0%, p=0.340), pregnancy (male factor 46.9% vs. tubal factor 40.9%, p=0.184) and miscarriage (male factor 10.3% vs. tubal factor 10.6%, p=0.572) rates were similar between the infertility groups, irrespective of female age. Considering maternal age, the cancelation rate was higher in older women (>35 years old) undergoing ICSI as a result of male factor infertility (17.4% vs. 8.9%, p=0.013). Conclusion: Our results showed that there is no difference in the outcomes of pregnancy between couples with male or tubal factor infertility, which indicates that ICSI surpasses the worse specific outcomes associated with male factor.

Resumo Objetivo: Avaliar o efeito do fator masculino de infertilidade em resultados de injeção intracitoplasmática de espermatozoides (ICSI) em comparação com um grupo controle que apresenta o fator tubário isolado. Método: Este estudo retrospectivo incluiu 743 casais submetidos a ICSI por fator masculino e 179 casais por fator tubário, realizada em um centro privado de fertilização in vitro associado à universidade, entre janeiro de 2010 e dezembro de 2016. Os pacientes foram divididos em dois grupos de acordo com a idade materna: mulheres ≤ 35 e > 35 anos de idade. Os efeitos das causas de infertilidade nos resultados laboratoriais e clínicos da ICSI foram avaliados pelos testes T de Student e Qui-quadrado. Resultados: Não foram observadas diferenças nos parâmetros de estimulação ovariana entre os ciclos com fatores masculinos e com fatores tubários. A taxa de implantação (fator masculino 35,5% vs. fator tubário 32,0%, p=0,340), de gravidez (fator masculino 46,9% vs. fator tubário 40,9%, p=0,184) e de aborto (fator masculino 10,3% vs. fator tubário 10,6%, p=0.572) foram semelhantes entre os grupos de infertilidade, independentemente da idade feminina. Considerando a idade materna, a taxa de cancelamento foi maior em mulheres > 35 anos cuja causa de infertilidade era o fator masculino (17,4% vs. 8,9%, p=0,013). Conclusão: Não há diferenças nos resultados de gravidez entre casais com infertilidade dos fatores masculino ou tubário isolados, o que indica que ICSI supera os piores resultados associados ao fator masculino.

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Resumen: la infertilidad es una enfermedad que se caracteriza por la imposibilidad de lograr un embarazo después de más de 12 meses de relaciones sexuales; como consecuencia, existen tratamientospara manejar este trastorno. Uno de los tratamientos de reproducción asistida es la inyección intracitoplasmática de espermatozoides (ICSI), la cual fue implementada en 1992 para tratar parejas con el factor masculino asociado a la causa de infertilidad. Actualmente, esta técnica es indicada para la infertilidad sin causa aparente, fallas anteriores en los procesos de fertilización in vitro, edad materna avanzada, oocitos de mala calidad, entre otros. La inyección intracitoplasmática de espermatozoides comienza con una estimulación ovárica controlada mediante gonadotropinas y la aspiración folicular para obtener los oocitos. Simultáneamente se procesa la muestra de semen y posteriormente se realiza la microinyección del espermatozoide elegido al interior del oocito. Por otro lado, los parámetros seminales y funcionales han adquirido gran importancia debido al papel determinante en el éxito de la inyección intracitoplasmática de espermatozoides, especialmente la integridad del ADN espermático. Finalmente, la inyección intracitoplasmática de espermatozoides permite que los pacientes con alteraciones seminales tengan la posibilidad de concebir un hijo biológico.En esta revisión se describen los fundamentos de esta técnica y su relación con los parámetros seminales y la fertilidad.

Abstract: Infertility is a disease characterized by the inability to achieve pregnancy after more than 12 months of sexual intercourse; as a result, there are treatments to manage this disorder. One of the treatments of assisted reproduction is the intracytoplasmic sperm injection (ICSI), which was implemented in 1992 to treat couples with male factor associated with the cause of infertility. Currently, this technique is indicated to unexplained infertility, previous in vitro fertilization failures, advanced maternal age, poor quality oocytes, among others. Intracytoplasmic sperm injection begins with a controlled ovarian stimulation and follicular aspiration to obtain oocytes. Simultaneously the semen sample is prepared and the microinjection of the selected spermatozoa into the oocyte is performed. On the other hand, the seminal and functional parameters have become very important due to the determinant role in the success of the intracytoplasmic sperm injection, especially sperm DNA integrity. Finally, intracytoplasmic sperm injection allows patients with seminal alterations have the possibility to conceive a biological child. In this review, the basic of this tecniques and its relationship with sperm parameters and fertility are described.

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