RESUMO
In general population, it is estimated that 1/560 -1/1100 of the individuals are carriers of a balanced structural alteration and, in general, do not present an abnormal phenotype. For patients who have balanced rearrangements, a family planning alternative is to perform an In Vitro Fertilization (IVF) cycle with the embryonic analysis by Preimplantation Genetic Testing for Chromosomal Structural Rearrangements (PGT-SR). This test aims to reduce the time to obtain a healthy chromosomally pregnancy, to minimize the risk of miscarriage and a live birth with a chromosomopathy. The present work reports a case in which the couple had a history of implantation failure and biochemical pregnancy. They had not performed the karyotype exam to verify the parents' chromosomal content. After two embryo transfers without achieving pregnancy, the couple was directed to the Preimplantation Genetic Testing for Aneuploidies (PGT-A). The result presented in PGT-A in the couple's first cycle using the embryo selection technique showed recurrent segmental aneuploidies the trophectoderm biopsies. The couple was given genetic counselling, and they decided to investigate their karyotype, which showed a balanced chromosomal rearrangement in one of the parents. With this investigation and genetic counselling, it was possible to apply the correct embryonic analysis strategy, which contributed to a healthy pregnancy and birth with a living child.
RESUMO
OBJECTIVE: To validate a morphokinetic implantation model developed for EmbryoScope on embryos with known outcome, compared to standard morphology in a retrospective single center study. METHODS: Morphokinetic annotation of 768 embryos with known outcome between 2013 -2015; corresponding to 116 D3 fresh embryos, 80 D6 frozen blastocysts, and 572 D5 blastocysts, fresh or frozen. The embryos were ranked by the KIDScore into five classes, KID1-5, and grouped into four classes based on standard morphology. Pregnancy rates, clinical pregnancy rates and live birth rates were compared. Combinations of morphology and morphokinetics were evaluated for implantation rates and live births. RESULTS: Live birth rate increased with increasing KIDScore, from 19% for KID1 to 42% for KID5. Of all live births, KID5 contributed with 71%, KID4 with 20%, KID3 with 4%, KID2 with 4%, and KID1 with 2%. For morphology, the corresponding figure was 43% for Top Quality, 47% for Good Quality, 4% for Poor Quality, and 5% for Slow embryos. For day 3 embryos, KID5 embryos had the highest live birth rates, and contributed to 83% of the live births; whereas the second best morphological class had the highest live birth rate and contributed to most of the live births. For blastocysts, the KIDScore and morphology performed equally well. Combining morphology and morphokinetics indicated stronger predictive power for morphokinetics. CONCLUSIONS: Overall, the KIDScore correlates with both implantation and live birth in our clinical setting. Compared to morphology, the KIDScore was superior for day 3 embryos, and equally good for blastocysts at predicting live births.
Assuntos
Técnicas de Cultura Embrionária , Implantação do Embrião/fisiologia , Desenvolvimento Embrionário/fisiologia , Fertilização in vitro/métodos , Adulto , Coeficiente de Natalidade , Transferência Embrionária/métodos , Feminino , Humanos , Gravidez , Resultado da Gravidez , Taxa de Gravidez , Estudos Retrospectivos , Imagem com Lapso de TempoRESUMO
OBJECTIVE: To describe a patient selection method for elective single embryo transfer (eSET), emphasizing inclusion criteria and results. METHODS: This retrospective study included all cases seen in a private clinic between June 2011 and December 2016, in La Paz, Bolivia (3600 meters above sea level). Elective single embryo transfer was the method of choice in 34 IVF/ICSI cycles, all in the blastocyst stage. Gardner's blastocyst classification criteria were used. Between the two stages of the study (July 2015), each embryo grade implantation rate was recalculated, which led to the expansion of the inclusion criteria. RESULTS: The clinical pregnancy rate of the 34 cases in the first transfer group was 55.9% (19/34). Twin or multiple pregnancies did not occur. The cumulative pregnancy rate to date is 64% [(19+3)/34]. The first stage comprised 2.56% (12/468) of the patients offered elective single embryo transfers; the implantation rate was 58.3% (7/12). In the second stage, 14.29% (22/154) of the patients were eligible, and the implantation rate was 54.55% (12/22). CONCLUSIONS: The implementation of an eSET program based on in-depth morphological embryo assessment combined with the calculation of the implantation potential of each embryo grade led to acceptable clinical outcomes and fewer multiple pregnancies in patients transferred two embryos. Each clinic should be aware of the implantation rates of each embryo grade in its own setting.
Assuntos
Embrião de Mamíferos/citologia , Seleção de Pacientes , Resultado da Gravidez , Transferência de Embrião Único/métodos , Adulto , Tamanho Celular , Implantação do Embrião , Feminino , Fertilização in vitro/efeitos adversos , Fertilização in vitro/métodos , Fertilização in vitro/estatística & dados numéricos , Humanos , Masculino , Gravidez , Resultado da Gravidez/epidemiologia , Taxa de Gravidez , Gravidez Múltipla/estatística & dados numéricos , Estudos Retrospectivos , Transferência de Embrião Único/estatística & dados numéricos , Injeções de Esperma Intracitoplásmicas/métodosRESUMO
El juicio ético se realiza mediante la integración interdisciplinar del sentido natural de los procesos biológicos con su significado humano. Las Técnicas de Reproducción Asistida son paradigmáticas de una experimentación que no cumple los requisitos científicos ni éticos. La biología de la fecundación ha sido pasto de ficciones al no reconocer los límites naturales. Sobre esa pseudo-biología, la bioética ha sufrido la embestida de la ideología del hombre autónomo, que se arroga reinventar al hombre y dirigir el progreso con base en poder tecnológico. La ética de la bioética exige una nueva reflexión que parta de una ciencia libre de prejuicios.
Ethical judgment is made by the interdisciplinary integration of the natural sense of the biological processes and its human meaning. Assisted reproduction techniques are a paradigm of experiments that do not fulfill both the scientific and the ethical requirements. Fecundation biology has been a subject of frictions as it has not recognized the natural boundaries. On that pseudo-biology, bioethics has suffered the attack of the autonomous man's ideology, which claims that it re-invents the concept of mankind and manages progress, based on technological power. The ethics of bioethics demands a new reflection based on a prejudice-free science.
O juízo ético se realiza mediante a integração interdisciplinar do sentido natural dos processos biológicos com seu significado humano. As Técnicas de Reprodução Assistida são paradigmáticas de uma experimentação que não cumpre os requisitos científicos nem éticos. A biologia da fecundação foi pasto de ficções ao não reconhecer os limites naturais. Sobre essa pseudobiologia, a bioética sofreu a investida da ideologia do homem autônomo, que se arroga reinventar ao homem e dirigir o progresso com base em poder tecnológico. A ética da bioética exige uma nova reflexão que parta de uma ciência cesses and its human meaning. Assisted reproduclivre de preconceitos.
RESUMO
We report a case of right adnexal torsion during the embryo implantation period of an IVF/ICSI cycle. A 26-yearold woman who diagnosed as primary infertility was included in an IVF/ICSI program. In the following period right adnexal torsion occurred at the sixth day of the embryo transfer. Laparoscopic detortion was successfully performed with preserving the adnexia. The patient had positive pregnancy test in the subsequent week.
RESUMO
El diagnóstico genético preimplantacional (DGP) es el estudio de alteraciones cromosómicas y genéticas en el embrión, antes de su transferencia a la madre. Permite conocer aquellos embriones libres de anomalías cromosómicas o mutaciones genéticas. En esta revisión se describe la experiencia de un centro de reproducción asistida en Perú, realizando diagnóstico genético preimplantacional a embriones en día 3 de desarrollo. Se muestra resultados de cinco años, con 711 ciclos. El diagnóstico genético preimplantacional sería una herramienta eficaz para seleccionar los embriones con mayor potencial de implantación, que puedan dar origen a un nacido vivo sano.
Preimplantation genetic diagnosis (PGD) is the study of chromosomal or genetic alterations in the human embryo before transfer to the mother. It determines those embryos free of chromosomal abnormalities or genetic mutations. This review describes the 5-year experience including 711 cycles of an assisted reproduction center in Peru, performing PGD to embryos on day 3 of development. Preimplantation genetic diagnosis would be an effective tool to select embryos with higher implantation potential, which may lead to a healthy live birth.