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Introdução: A aprovação na Assembleia da República, em dezembro de 2021, da lei aplicável à Gestação de Substituição, suscita a reflexão acerca dos aspetos práticos em que o regime se concretizará e das orientações necessárias para os profissionais de saúde envolvidos. Por esse motivo, foram definidos como objetivos: analisar um conjunto de recomendações para a prática clínica no âmbito da Gestação de Substituição em países com experiência no procedimento e promover uma discussão com peritos na área da Procriação Medicamente Assistida. Material e Métodos: Foi realizada uma análise documental das publicações e documentos oficiais sobre o tema que serviu de base para o estudo de desenho qualitativo baseado em grupos focais com diferentes profissionais -médicos e psicólogos- com experiência em Procriação Medicamente Assistida. A discussão foi concretizada através de sessões via Zoom®, realizadas separadamente com os dois grupos focais. Resultados: Na discussão os peritos fizeram as suas apreciações e propostas de melhoria em relação à versão inicial do documento resultante da análise documental. Conclusão: Obteve-se uma versão consolidada do conjunto de orientações para os profissionais de saúde com as dimensões a avaliar e acompanhar junto da gestante e parte beneficiária na Gestação de Substituição.

Introducción : La aprobación por el Parlamento portugués, en diciembre de 2021, de la ley aplicable a la Gestación Subrogada, plantea la reflexión sobre los aspectos prácticos en los que se implementará el esquema y las directrices necesarias para los profesionales de la salud involucrados. Por este motivo, se definieron los siguientes objetivos: analizar un conjunto de recomendaciones para la práctica clínica en el ámbito de la gestación subrogada en países con experiencia en el procedimiento y promover un debate con expertos en el campo de la Reproducción Médicamente Asistida. Material y Métodos : Se realizó un análisis documental de publicaciones y documentos oficiales sobre el tema, que sirvió de base para el estudio de diseño cualitativo basado en focus group con diferentes profesionales -médicos y psicólogos- con experiencia en Reproducción Médicamente Asistida. La discusión se realizó a través de sesiones via Zoom®, celebradas por separado con los dos focus group. Resultados : En la discusión, los expertos realizaron sus apreciaciones y propuestas de mejora respecto a la versión inicial del documento resultante del análisis documental. Conclusión : Se obtuvo una versión consolidada del conjunto de directrices para los profesionales de la salud con las dimensiones para evaluar y dar seguimiento a la madre sustituta y a los beneficiarios en la Gestación Subrogada.

Introduction: The approval by the Portuguese Parliament, in December 2021, of the law applicable to Surrogate Pregnancy, raises reflection on the practical aspects in which the scheme will be implemented and the necessary guidelines for health professionals involved. For this reason, the following objectives were defined: to analyze a set of recommendations for clinical practice in surrogacy in countries with experience in the procedure and to promote a discussion with experts in Medically Assisted Reproduction. Material and Methods: A documental analysis of publications and official documents on the theme was conducted. This served as a basis for the qualitative design study based on focus groups with different professionals -physicians, and psychologists- with experience in Medically Assisted Reproduction. The discussion was realized through sessions via Zoom®, held separately with the two focus groups. Results : In the debate, the experts made their appreciation and proposals for improvement concerning the initial version of the document resulting from the document analysis. Conclusion : A consolidated version of the set of guidelines for health professionals was obtained with the dimensions to evaluate and follow up with the surrogate and beneficiaries in Surrogacy.

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This integrative review synthesizes the scientific evidence on fertility preservation counseling prior to oncological treatment for women of reproductive age diagnosed with cancer. Bibliographic research was conducted on databases PubMed, CINAHL, LILACS, EMBASE, Scopus, and Web of Science. The structured search strategy for the review question was "counseling AND antineoplastic agents AND fertility preservation". The use of controlled descriptors and keywords was adapted for each database. Study selection through the Rayyan platform was independent and blinded. The final sample comprised seven studies emphasizing the importance of clarifying factors related to the risk of infertility due to oncological treatment and fertility preservation techniques, such as success rate, pregnancy rate, cost, available options, and side-effects, as well as discussing the possibilities of adoption and surrogacy. This review provided evidence reinforcing the importance of counseling for fertility preservation, promoting motherhood for women who face oncological treatment. Organized networks linking oncology and reproductive medicine units are crucial to facilitate patient referral between these services and interprofessional communication.

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Male infertility is a great matter of concern as out of 15% of infertile couples in the reproductive age, about 40% are contributed by male factors alone. For DNA condensation during spermatogenesis, constrained DNA nicking is required, which if increased beyond certain level results in infertility in men. High sperm DNA Fragmentation (SDF) majorly contributes to male infertility and its association with regards to poor natural conception and assisted reproductive technology (ART) outcomes is equivocal. Apoptosis, protamination failure and the excess of reactive oxygen species (ROS) are considered to be the main causes of SDF. It's testing came into existence because of the limitations of the conventional methods in explaining infertility in normozoospermic infertile individuals. Over the past 25 years, SDF's several testing strategies have been proposed to diagnose the aetiology of infertility. Various treatments combined with sperm selection techniques are being used alone or in combination to reduce DNA fragmentation index (DFI) and obtain spermatozoa with high quality chromatin for assisted reproduction. This review summarises SDF's main causes, its impact on fertility and clinical outcomes in assisted reproduction, the need to perform test, testing procedures, and the treatment strategies.

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The aim of this study was to carry out a systematic literature review to investigate the main immune cells responsible for implantation failures. We selected papers from PubMed, Embase and Virtual Health Library databases. Eligible articles included publications between January 1, 2010 and April 24, 2022. Inclusion criteria were: observational and case-control studies; and the exclusion criteria were: review papers, letters to the editor, abstracts, animal studies and case reports. We extracted the following information: day of collection, number of patients, control group, age of patients, type of sample used, immune cells and cytokines. As main findings in our mapping, we found that in peripheral blood, CD3+, CD4+, CD8+, CD16+, CD56+, CD57+, CD69+, CD154+, CD158a+, NKp46 cells were increased and the CD4+, CD45+, Foxp3 and NKp46 markers were reduced. From the endometrial biopsies, there was an increase in CD3+, CD4+, CD5+, CD8+, CD16+, CD25+, CD45+, CD56+, CD57+, CD68+, CD127+ and a reduction in CD45+, CD56+, NKp46 and FoxP3 cells. Cytokines found increased in peripheral blood included IL-6, IL-10, IL-17, INF-γ, TGF-ß, TNF-α; while IL-4, IL-6, IL-10, IL-35, FoxP3, TGF-ß, SOCS3 were reduced. As for the biopsies, there was an increase in IL-2, IL-6, IL-17, IL-22, IL-23, INF-A1, INF-B1, INF-γ, TNF-R and a reduction in IL-6, IL-10, INF-γ, TGFß, TNF-α. We concluded that immune cells can be modulated during pregnancy failure, but further studies are needed to elucidate the modulating effect of the immune system on the endometrium of these patients.

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Preventing a luteinizing hormone (LH) surge is a major concern in controlled ovarian stimulation (COS). Several strategies have been developed over the years, including protocols with Gonadotrophin Releasing Hormone agonists and antagonists. More recently Progestin Primmed Ovarian Stimulation (PPOS) has shown to be equally effective in pituitary suppression, with comparable clinical and laboratorial outcomes. This is the case of a 34 year old female, with a previous diagnosis of primary infertility due to tubal factor and high ovarian reserve markers. The initial plan was to perform IVF/ICSI. followed by fresh blastocyst transfer. The chosen COS strategy was to use Alfacorifolitropin 150mg (Elonva®) and Cetrorelix acetate 0,25mg (Cetrotide®) in a flexible pituitary suppression protocol. However, because of elevated risk for Ovarian Hyper-stimulation Syndrome (OHSS) detected during ultrasound and hormonal monitoring, in order to diminish financial burden and to have a more patient friendly protocol, we switched cetrorelix acetate to oral dydrogesterone. COS was successful and resulted in 24 retrieved oocytes (16 metaphase 2 oocytes) without any premature LH peak. No OHSS symptoms occurred. Our main goal with this case report is to reinforce the feasibility and efficacy of this innovative approach, especially in patients aiming for a fresh embryo transfer, who present alert sings of OHSS during the stimulation. Developing friendlier and cheaper protocols in assisted reproduction makes the treatment more accessible and affordable.

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Although oocyte in vitro maturation (IVM) is routinely used for in vitro embryo production in mice and rats, its use in wild rodents remains unexplored. Evidence suggests that hormone and growth factor supplementation influence oocyte meiotic resumption. This study evaluated the synergistic effects of follicle-stimulating hormone (FSH) and epidermal growth factor (EGF) on the IVM and parthenogenetic development of red-rumped agouti oocytes. Initially, we evaluated the IVM rates, mature oocyte quality, oocyte morphometry, and early embryonic development during IVM in the presence of 10, 50, and 75 mIU/mL FSH. No differences among the FSH concentrations were observed for IVM rates, oocyte morphometry, cumulus cell expansion, and viability. Although oocytes matured with 50 mIU/mL FSH showed a higher rate of cumulus expansion index (CEI), only oocytes matured with 10 mIU/mL FSH resulted in morulae after chemical activation (7.9% ± 4.2%). Thus, 10 mIU/mL FSH was used for further experiments. We subsequently evaluated the synergistic effects of 10, 50, and 100 ng/mL EGF and 10 mIU/mL FSH on the same parameters. No differences among the groups were observed in IVM rates, oocyte morphometry, and cumulus viability. Nevertheless, FSH with 10 ng/mL EGF showed a CEI superior to that of the other groups. Furthermore, oocytes matured with FSH alone or with both FSH and 10 or 50 ng/mL EGF developed morulae after activation (5.8%-8.3%). In conclusion, oocytes matured with 10 mIU/mL FSH and 10 ng/mL EGF are recommended for use in red-rumped agouti oocyte IVM, as they positively influence embryonic development.

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Resumen El síndrome de Mayer-Rokitansky-Küster-Hauser (SMRKH) es una anomalía del tracto genital femenino caracterizada por ausencia congénita del útero y porción superior de la vagina. Ocurre en uno de cada 4,500 nacimientos y se diagnostica normalmente durante la adolescencia al presentarse amenorrea primaria. Su función ovárica está preservada, pero la información actual respecto al potencial reproductivo de estas pacientes es limitada. Se presenta el caso de una mujer con diagnóstico de SMRKH sometida a estimulación ovárica para transferencia de embriones a útero subrogado y se discute su potencial reproductivo: técnicas de reproducción asistida, intervenciones e impacto psicológico.

Abstract Mayer-Rokitansky-Küster-Hauser syndrome (MRKH) is a congenital anomaly of the female genital tract characterized by congenital absence of the uterus and upper part of the vagina. It occurs in 4,500 female births and diagnosis is usually made during adolescence when primary amenorrhea presents. They have functioning ovaries but data regarding their reproductive potential is limited. We hereby report the case of a woman diagnosed with MRKH syndrome in whom assisted reproductive techniques were used to try to achieve pregnancy by gestational surrogacy and their reproductive potential is discussed: assisted reproductive techniques, procedures, and psychological impact.

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Abstract Objective To understand the impact of the coronavirus disease 2019 pandemic on in vitro fertilization (IVF) clinical pregnancy rates and analyze factors that may have influenced their outcome. Methods This was a retrospective observational study conducted at a tertiary-care Brazilian fertility center. All fresh IVF and embryo warming cycles performed from March 11 to December 31, 2018-2021 were analyzed, and their data were used to calculate fertilization, embryo cleavage, cycle cancellation, embryo transfer (ET), and clinical pregnancy rates. Statistical tests were used to evaluate the alterations found. Logistic regression models were used to explore the association of the categorical variables with the observed clinical pregnancy rates. Data from 2018 and 2019 (prepandemic) and 2020 and 2021 (pandemic) were grouped. Results A total of 756 cycles were analyzed (n = 360 prepandemic and n = 396 pandemic). The age group of the patients, fertilization rates, and cleavage rates did not have significant differences (p > 0.05). There was a reduction in the percentage of fresh IVF and an increase in embryo warming cycles (p = 0.005) during the pandemic. There was also an increase in fresh cycle cancellations (p < 0.001) and a reduction in ET rates (p < 0.001). The pandemic had a negative impact on clinical pregnancy rates (p < 0.001) especially due to the increase in fresh cycle cancellations (p < 0.001). Conclusion Embryo warming cycles with subsequent frozen-thawed ET were presented as a viable alternative to continue assisted reproductive treatments against pandemic restrictions on fresh cycles, ensuring clinical pregnancy, albeit at a lower rate than that of the prepandemic period.

Resumo Objetivo Compreender os impactos da pandemia de COVID-19 nas taxas de gravidez clínica em fertilização in vitro (FIV) e analisar fatores que possam ter influenciado seu resultado. Métodos Foi realizado um estudo observacional retrospectivo em um centro brasileiro de reprodução assistida. Todos os ciclos de FIV com embriões frescos e descongelados realizados entre 11 de março e 31 de dezembro, 2018-2021 foram analisados, e seus dados utilizados para cálculo das taxas de fertilização, clivagem embrionária, cancelamento de ciclos, transferência de embriões (TE) e gravidez clínica. Testes estatísticos avaliaram significância das alterações encontradas e modelos de regressão logística exploraram associação das variáveis categóricas estudadas com as taxas de gravidez clínica observadas. Os dados de 2018 e 2019 (pré-pandemia) e 2020 e 2021 (pandemia) foram agrupados. Resultados Foram analisados um total de 756 ciclos (n = 360 na pré-pandemia e n = 396 na pandemia). A faixa etária das pacientes e as taxas de fertilização e de clivagem não tiveram alterações significativas (p > 0,05). Na pandemia, houve redução da porcentagem de ciclos de FIV com embriões frescos e aumento dos com descongelamento (p = 0,005). Também foi notado aumento das taxas de cancelamentos de ciclos com embriões frescos (p < 0,001) e redução do número de TEs (p < 0,001). A pandemia exerceu impacto negativo na taxa de gravidez clínica (p < 0,001), especialmente devido ao aumento de cancelamentos dos ciclos a fresco (p < 0,001). Conclusão Frente às limitações pandêmicas impostas aos ciclos com embriões frescos, os ciclos de descongelamento de embriões se apresentaram como alternativa viável à continuidade dos ciclos de FIV, garantindo gravidez clínica ainda que em taxas inferiores às do período pré-pandêmico.

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OBJECTIVE: To describe the natural history of hydatidiform mole (HM) after intracytoplasmic sperm injection (ICSI), emphasizing the clinical and oncological outcomes, as compared to patients who had HM after spontaneous conception (SC). STUDY DESIGN: Retrospective historical cohort study of patients with HM followed at the Rio de Janeiro Federal University, from January 1st 2000-December 31st 2020. RESULTS: Comparing singleton HM after SC to those following ICSI there were differences in terms of maternal age (24 vs 34 years, p < 0.01), gestational age at diagnosis (10 vs 7 weeks, p < 0.01), preevacuation human chorionic gonadotropin levels (200,000 vs 99,000 IU/L, p < 0.01), occurrence of genital bleeding (60.5 vs 26.9%, p < 0.01) and hyperemesis (23 vs 3.9%, p = 0.02) at presentation, and time to remission (12 vs 5 weeks, p < 0.01), respectively. There were no differences observed in the cases of twin mole, regardless of the form of fertilization that gave rise to HM, except molar histology with greater occurrence of partial hydatidiform mole (10.7 vs 40.0%, p = 0.01) following ICSI. Univariate logistic regression for occurrence of postmolar GTN after ICSI identified no predictor variable for this outcome. However, after adjusting for maternal age and complete hydatidiform mole histology, multivariable logistic regression showed the risk of GTN with HM after ICSI had an adjusted odds ratio of 0.22 (95%CI:0.05-0.93, p = 0.04), suggesting a possible protective effect when compared to HM after SC. CONCLUSIONS: Singleton HM after ICSI are diagnosed earlier in gestation, present with fewer medical complications, and may be less likely to develop GTN when compared with HM after SC.

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The objective was to study clinical cases and understand the link between cesarean section scar defect with hydrometra and secondary infertility. A retrospective case series from an assisted reproductive center and infertility treatment clinic in the United Arab Emirates. We had five patients with secondary infertility diagnosed with cesarean section scar defect with persistent hydrometra based on high resolution transvaginal ultrasound assessment. The patients underwent surgical repair for the cesarean section scar defect followed by infertility treatment. Transvaginal ultrasound examination showed a normal endometrial cavity with triple lining endometrium and absence of hydrometra; and clinical pregnancy was the main outcome measure. Surgical correction of cesarean section scar defect was successfully performed in the cases presented. The patients had their fertility restored. Clinical studies revealed that cesarean section scar defect may lead to abnormal uterine bleeding, dysmenorrhea, pre-/post-menstrual spotting, heavy or prolonged menses, pelvic pain and secondary infertility. Theoretically, an inflammatory response, such as a wound healing process in the uterus due to hydrometra associated with scar defect may impair embryo implantation. The clinical case studies presented here are based on the correct diagnosis of the cesarean section scar defect with hydrometra and its successful surgical repair. The patients in our study had their symptoms resolved and attained clinical pregnancy.

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This study aimed to compare domestic cats' pregnancy rates using fresh semen for the bilateral intrauterine insemination (BIUI) method and the novel uterine body insemination (UBI) method. Queens received a single injection of equine chorionic gonadotropin (eCG) (200 IU; IM) to induce ovarian follicular development and, after 83 h, an injection of human chorionic gonadotropin (hCG) (100 IU; IM) for final oocyte maturation and ovulation induction. Thirty-four hours after hCG administration, 3 × 106fresh spermatozoa were used for insemination by the BIUI (n = 8 queens) or by the UBI (n = 7 queens) techniques,respectively. Pregnancy rates were 75.00% (6/8) by BIUI and 42.85% (3/7) by the UBI method. Themean litter size was 3.0 ± 0.86 for the BIUI, and 2.0 ± 1.0 for the UBI method. Spontaneous abortion occurred on day 35 of pregnancy in one queen following the UBI method. Our findings showed that the BIUI of queens with fresh semen resulted in higher pregnancy rates than the novel UBI method; also, acceptable pregnancy rates were achieved following BIUI with fresh semen in the domestic cat.(AU)

O objetivo deste estudo foi comparar as taxas de prenhez em gatas domésticas usando sêmen fresco para o método de inseminação intrauterina bilateral (BIUI) e o novo método de inseminação do corpo uterino (UBI). As gatas receberam uma única injeção de gonadotrofina coriônica equina (eCG) (200 UI; IM) para induzir o desenvolvimento folicular ovariano e, após 83 h, uma injeção de gonadotrofina coriônica humana (hCG) (100 UI; IM) para maturação final do oócito e ovulação indução. Trinta e quatro horas após a administração de hCG, 3 × 106 espermatozoides frescos foram utilizados para inseminação pelas técnicas de BIUI (n = 8 gatas) ou UBI (n = 7 gatas), respectivamente. As taxas de gravidez foram de 75,00% (6/8) pela BIUI e 42,85% (3/7) pelo método UBI. O tamanho médio da ninhada foi de 3,0 ± 0,86 para o método BIUI e 2,0 ± 1,0 para o método UBI. Aborto espontâneo ocorreu no dia 35 de gestação em uma gata seguindo o método UBI. Nossos achados mostraram que a BIUI de gatas com sêmen fresco resultou em maiores taxas de prenhez do que o novo método UBI; também, taxas de prenhez aceitáveis foram alcançadas após BIUI com sêmen fresco no gato doméstico.(AU)

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BACKGROUND: To solve infertility, modern science has promoted assisted reproduction techniques such as in vitro fertilization, ovulation induction, and artificial insemination. Quadruple-type multiple pregnancies occur in 1 of every 500,000 pregnancies, and it is estimated that 90% occur due to assisted reproductive techniques, which often lead to numerous complications. CASE PRESENTATION: Here we present a case of a 33-year-old woman, who desired pregnancy, but had a history of primary infertility diagnosed by hysterosalpingography, and endometriosis, which was treated by fulguration and medical management. Concomitantly, the patient was anovulatory. To fulfill her wish, she underwent homologous artificial insemination, after treatment, she successfully conceived quadri-chorionic quadri-amniotic infants, who were born at 37.2 weeks, without perinatal or maternal complications. CONCLUSION: This paper presented the parameters of prenatal care, appropriate management approach, and successful resolution without maternal-fetal complications despite the inherent risks of this type of pregnancy.

RESUMEN: INTRODUCCIóN: Para solucionar la infertilidad, la ciencia moderna ha promovido las técnicas de reproducción asistida, como la fecundación in vitro, la inducción de la ovulación y la inseminación artificial. Los embarazos múltiples de tipo cuádruple se producen en 1 de cada 500.000 embarazos, y se estima que el 90% ocurren debido a las técnicas de reproducción asistida, que a menudo conllevan numerosas complicaciones. PRESENTACIóN DEL CASO: Presentamos el caso de una mujer de 33 años, que deseaba un embarazo, pero tenía antecedentes de infertilidad primaria diagnosticada por histerosalpingografía, y endometriosis, que fue tratada mediante fulguración y manejo médico. Al mismo tiempo, la paciente era anovulatoria. Para cumplir su deseo, se sometió a una inseminación artificial homóloga y, tras el tratamiento, concibió con éxito niños cuadri-coriónicos cuadri-amnióticos, que nacieron a las 37,2 semanas, sin complicaciones perinatales ni maternas. CONCLUSIóN: Este trabajo presentó los parámetros de atención prenatal, el enfoque de manejo adecuado y la resolución exitosa sin complicaciones materno-fetales a pesar de los riesgos inherentes a este tipo de embarazo.

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Standard protocols for clinical in vitro fertilization (IVF) laboratories recommend incubating semen at 37°C in 5% CO2 without strictly specifying which medium should be used or for how long. This study aimed to test the most common different incubation media used in Latin American andrology and micromanipulation laboratories and verify which, if any, is the most appropriate medium to improve asthenozoospermic semen samples' motility in the infertile male population. Ejaculates (136) collected from asthenozoospermic men were divided into two cohorts with similar characteristics (cohort 1; n = 28 and cohort 2; n = 108). Cohort 1 was used to evaluate the optimal incubation time with regard to unprepared asthenozoospermic sample sperm motility. After defining an optimal incubation period of 2 h, cohort 2 was used to evaluate which of the four media commonly used in IVF clinics (continuous single culture medium = CSCM®; SpermRinse medium = SR®; in vitro fertilization medium = G-IVF® and human tubal fluid medium = HTF®) was preferred for semen samples from asthenozoospermic patients. Overall, it was determined that a 2-h incubation in CSCM® medium led to the highest asthenozoospermic sperm motility. Thus, this simple, cost-effective, easily reproducible protocol could prove extremely useful for andrology laboratories working with IVF clinics dealing with asthenozoospermic semen specimens. This is particularly relevant since the incidence of the latter is on the rise as semen quality decreases around the globe.Abbreviations: ANOVA: Analysis of variance; ARTs: Assisted reproductive techniques; BWW: Biggers, Whitten, and Whittingham; CO2: Carbon dioxide; CPM: counted per minute; CSCM: Continuous Single Culture Medium; DAB: 3.3'- diaminobenzidine; DFI: DNA Fragmentation Index; DMSO: Dimethyl sulfoxide; G-IVF: In Vitro Fertilization Medium; GSH: Glutathione; GPx: glutathione peroxidase; HDS: High DNA Stainability; HSA: Human Serum Albumin; HTF: Human Tubal Fluid; HYP: Hyperactivity; ICSI: Intracytoplasmic sperm injection; IUI: Intrauterine insemination; IVF: in vitro fertilization; LIN: Linearity; ROS: Reactive Oxygen Species-level; SC: Sperm concentration; SCA: Sperm Computer Analysis; SCSA: Sperm Chromatin Structural Assay; SR: SpermRinse medium; SSS: Synthetic Serum Substitute; STR: Straightness; SOD: superoxide dismutase; TNE: Tris-Borate-EDTA; TSC: Total sperm count; VAP: Mean velocity; VCL: Curvilinear velocity; VSL: Linear velocity; WHO: World Health Organization; WOB: Wobble; spz: spermatozoa; AO: antioxidant.

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The impact of gonadotropins used for COS on the rate of embryo aneuploidy in patients without the negative effects of age as a confounding factor, is still a subject of lively debate. We ran a systematic search for studies in MEDLINE, PubMed, Google Scholar and the Cochrane Library. A librarian coordinated the search in December of 2020. We included all original peer-reviewed papers in English, irrespective of study-design. There were no restrictions concerning method of amplification or platform used to analyze the amplified DNA. We used the PICO model to select the study population. We included women/couples submitted to COS for IVF with the intention to genetically analyze her/their embryos through PGT. The primary outcome was the rate of aneuploidy. We used the Newcastle-Ottawa scale (NOS) score to evaluate the quality of the studies included. The search yielded 73 citations, and 14 were eligible for analysis, which included data on 4805 cycles. Media quality NOS score was 8. Although it has been demonstrated that natural cycles are associated with aneuploidy, it does seem that more robust stimulations are indeed associated with a higher proportion of aneuploidy. Nevertheless, a higher response is associated with an increased number of euploid embryos available for transfer, which translates into more embryo-transfer cycles with a prospective higher cumulative live birth rate. Further evidence is needed to ascertain if there is a negative impact of COS, especially at the cellular level.

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Resumen ANTECEDENTES: La agenesia cervical congénita es una anomalía poco común del sistema de Müller, que generalmente se reconoce durante la menarquia. Hasta hace poco, el tratamiento de primera elección era la histerectomía, debido a que no se consideraba una enfermedad compatible con la fertilidad. Hoy en día, gracias a las técnicas de reproducción asistida, se han desarrollado procedimientos quirúrgicos menos agresivos que sí preservan la fertilidad de las pacientes. OBJETIVO: Revisar un caso de agenesia cervical a partir de su tratamiento quirúrgico y seguimiento de la reconstrucción cervical con la conexión entre la vagina y el útero, revisar la bibliografía y cómo establecer el pronóstico a largo plazo. CASO CLÍNICO: Paciente de 12 años llevada a consulta ante la ausencia de menstruación. El procedimiento diagnóstico transcurrió sin que se encontraran alteraciones; sin embargo, en la laparoscopia diagnóstica operatoria efectuada a los 14 años, indicada por dolor pélvico cíclico, se advirtieron la ausencia del cuello del útero, un hematometra y endometriosis grado IV. En el segundo tiempo quirúrgico, practicado en conjunto con el cirujano pediatra, se practicó, por laparotomía, la comunicación entre el útero y la vagina. En la actualidad, la paciente tiene 19 años y sus menstruaciones son cíclicas, no dolorosas. En el último ultrasonido se visualizó la conexión entre el útero y la vagina. CONCLUSIONES: Hoy en día, la anastomosis útero vaginal es un procedimiento capaz de mantener la función del útero y permitir el embarazo, con los cuidados adecuados.

Abstract BACKGROUND: Congenital cervical agenesis is a rare anomaly of the Müllerian system, usually recognized during menarche. Until recently, the treatment of first choice was hysterectomy, because it was not considered a disease compatible with fertility. Today, thanks to assisted reproductive techniques, less aggressive surgical procedures have been developed that do preserve the fertility of patients. OBJECTIVE: To review a case of cervical agenesis from its surgical treatment and follow-up cervical reconstruction with the connection between the vagina and the uterus, review the literature and how to establish the long-term prognosis. CLINICAL CASE: A 12 years old female patient was brought for consultation due to absence of menstruation. The diagnostic procedure was carried out without finding any alterations; however, in the operative diagnostic laparoscopy performed at the age of 14, indicated by cyclic pelvic pain, the absence of the cervix, a hematometra and endometriosis grade IV were noticed. In the second surgery, performed in conjunction with the pediatric surgeon, the communication between the uterus and the vagina was performed by laparotomy. At present, the patient is 19 years old and her menses are cyclical, not painful. In the last ultrasound the connection between the uterus and the vagina was visualized. CONCLUSIONS: Today, utero-vaginal anastomosis is a procedure capable of maintaining the function of the uterus and allowing pregnancy, with proper care.

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la utilización de la reproducción asistida va en aumento cada día con resultados más efectivos; la presente indagación toma como punto de partida el análisis de estos procedimientos desde la óptica de la ciencia jurídica, exponiendo el proceso de aprehensión por el derecho de estas cuestiones y las posturas legislativas fundamentales sobre los impactos que el desarrollo biocientífico ha traído para el derecho internacional. Su implementación más frecuente ha generado una polémica en los ámbitos médicos, éticos y consecuentemente en el área de derecho; la regulación y selección de las técnicas que se emplean, el acceso a las mismas y su aplicación, se vinculan con los derechos humanos y son interrogantes relevantes jurídicamente hablando que no pueden soslayarse ante la magnitud del avance científico que representan por sí solos. Se hace necesaria su regulación con una visión menos restrictiva y conservadora que ampare la mayor cantidad de relaciones jurídicas posibles, con modelos familiares y de realización personal, basada en el respeto a los derechos humanos, así como en los principios y valores jurídicos.

the use of assisted reproduction is increasing every day with more effective results; the present investigation takes as a starting point the analysis of these procedures from the point of view of legal science, exposing the process of apprehension by the law of these issues and the fundamental legislative positions on the impacts that bio-scientific development has brought to international law. Its most frequent implementation has generated controversy in the medical and ethical fields and consequently in the area of law; the regulation and selection of the techniques used, the access to them, and their application, are linked to human rights and are legally relevant questions that cannot be avoided in view of the magnitude of the scientific progress they represent by themselves. It is necessary to regulate them with a less restrictive and conservative vision that covers the greatest possible number of legal relationships, with family models and personal fulfillment, based on respect for human rights and legal principles and values.

a utilização da reprodução assistida vem aumentando a cada dia com resultados mais efetivos. Este questionamento toma como ponto de partida a análise desses procedimentos sob a ótica da ciência jurídica, expondo o processo de apreensão pelo direito dessas questões e as posturas legislativas fundamentais sobre os impactos que o desenvolvimento biocientífico vem trazendo para o direito internacional. Sua implementação mais frequente vem causando uma controvérsia nos âmbitos médicos, éticos e, consequentemente, na área de direito; a regulamentação e seleção das técnicas utilizadas, o acesso a elas e sua aplicação estão vinculadas com os direitos humanos e são interrogantes relevantes, juridicamente falando, que não podem eludir ante a magnitude do avanço científico que representam por si só. Faz-se necessária sua regulamentação com uma visão menos restritiva e conservadora que ampare a maior quantidade de relações jurídicas possíveis, com modelos familiares e de realização pessoal, baseada no respeito aos direitos humanos, bem como nos princípios e valores jurídicos.

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Abstract Objective It has been suggested that excess body weight could represent a risk factor for infertility outcomes. The present study aimed to evaluate the association of overweight and anovulation among infertile women with regular menstrual cycles. Methods We conducted a retrospective case-control study with consistently anovulatory patients undergoing assisted reproduction treatment. The patients were stratified into normal weight (body mass index [BMI]: 18.5-24.9kg/m2) and overweight (BMI: 25.0- 29.9kg/m2).Those with polycystic ovary syndrome or obesity were excluded. The groups were matched for age, duration of infertility, prolactin, follicle stimulating hormone (FSH), thydroid stimulating hormone (TSH), luteinizing hormone (LH), and estradiol levels. Results Overweight was significantly associated with anovulation, when using the World Health Organization (WHO) criteria for anovulation: progesterone levels>5.65 ng/ml and ultrasonography evidence of follicle collapse (odds ratio [OR]: 2.69; 95% confidence interval [CI95%]: 1.04-6.98). Conclusion Body mass index above the normal range jeopardizes ovulation among non-obese infertile women with regular menstrual cycles.

Resumo Objetivo O excesso de peso corporal tem sido associado como fator de risco para infertilidade. Este estudo teve como objetivo avaliar a associação de sobrepeso e anovulação entre mulheres inférteis com ciclos menstruais regulares. Métodos Realizamos um estudo retrospectivo de caso-controle com mulheres com anovulação consistente em tratamento por reprodução assistida. As pacientes foram estratificadas entre aquelas com peso normal (índice de massa corporal [IMC]: 18,5- 24,9 Kg/m2) e as com sobrepeso (IMC: 25,0-29,9 Kg/m2). As pacientes com síndrome do ovário policístico ou obesidade foram excluídas. Os grupos foram pareados por idade, duração da infertilidade, níveis de prolactina, hormônio folículo-estimulante (FSH), hormônio tiroestimulante (TSH), hormônio luteinizante (LH) e estradiol. Resultados O excesso de peso associou-se significativamente à anovulaçãoquando usados os critérios de anovulação da Organização Mundial de Saúde (OMS): níveis de progesterona>5,65 ng/ml e evidência ultrassonográfica de colapso folicular (razão de chances [RC]: 2,69; IC95%: 1,04-6,98). Conclusão O IMC acima da faixa normal compromete a ovulação em mulheres inférteis não obesas com ciclos menstruais regulares.

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Submucous myomas have negative effects on fertility. To maintain fertility, conservative treatment should be suggested to women who wish to become pregnant, especially young patients. The patient was a 33-year-old woman, who had had secondary infertility for 3 years. Upon vaginal ultrasound, we noticed a submucous myoma measuring 26 mm x 31 mm with a compressive effect on the anterior surface of the endometrium. Ovarian reserve was low. The gold standard of myoma treatment is surgical intervention. But, for the following reasons: the adverse effects of surgery on the endometrium (intrauterine adhesion), the patient's refusal to undergo a myomectomy and her request for pregnancy, our strategy for treating was to reduce volume of submucous myoma and start the assisted reproductive techniques (ART) cycle, simultaneously. We administered three courses of Gonadotropin-releasing hormone analogues (GnRHa) and then induced controlled ovarian hyperstimulation. Ovum pick up was done. Finally, we transferred two embryos (4 and 6 cells). In subsequent patient visits, ßhCG was positive after 14 days. At the last patient visit, the heart of the embryo was formed. From this finding, it may be concluded that combined GnRHa and ART is the treatment of choice for infertile women with uterine submucous myoma, considering the reduced ovarian reserve and response.

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OBJECTIVE: The present study aimed to evaluate reproductive outcomes and determine the predictors of clinical pregnancy and live birth in women with elevated baseline follicle-stimulating hormone (FSH) levels, who have undergone intracytoplasmic sperm injection (ICSI) treatment. METHODS: This retrospective study included 1011 ICSI cycles of women with high baseline FSH levels (> 10 IU/L), from a tertiary university IVF center between 2010 and 2015. Logistic regression analysis was performed to evaluate the prognostic factors of clinical pregnancy and live birth. RESULTS: Among the 1011 ICSI cycles, the clinical pregnancy and live birth rates per oocyte retrieval were 19.5% and 14.3%, respectively. The live birth rates were 21.1% and 1.7% in women aged ≤30 years and those aged ≥40 years, respectively. In addition, the live birth rate was 1.47-fold higher in women from whom >3 oocytes were retrieved, compared to those from whom ≤3 oocytes were retrieved (p=0.047). Logistic regression analysis indicated that the age categories ≤30y, 36-39y and ≥40y, level of baseline FSH (≥20 IU/L) and the ovarian response (≤3 or >3 oocytes retrieved) were significantly associated with live birth. CONCLUSIONS: Our study indicated that age, baseline FSH level, and ovarian response are independent predictive factors for clinical pregnancy and live birth among women with baseline FSH levels >10 IU/L.

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