Carlos E. Sueldo

The effect of peritoneal fluid from patients with endometriosis on murine sperm-oocyte interaction.

It has been demonstrated that PF contains some factor or factors that interfere with effective gamete interaction as determined by an in vitro animal assay. PF from patients with mild endometriosis has an increased activity of this substance and/or additional inhibitory factors. In endometriosis, this peritoneal fluid factor or factors appear to be filterable and to a significant degree heat-labile. This observation may be of importance in explaining subfertility associated with early stages of endometriosis.

Evaluation of interceed(TC7) for reduction of postoperative adhesions in rabbits.

OBJECTIVEnTo evaluate the effectiveness of Interceed(TC7) (Johnson and Johnson, New Brunswick, NJ) in the prevention of postoperative adhesions in a rabbit uterine horn model. Interceed(TC7) was tested in the presence and absence of absorbable suture.nnnDESIGN, SETTING, PARTICIPANTSnForty-one New Zealand white rabbits had lesions created on bilateral uterine horns at laparotomy. Lesions were randomly allocated to treatment with Interceed(TC7) or control. The effect of Interceed(TC7) was evaluated on sutured lesions (4-0 polyglactin 910; Ethicon, Inc., Somerville, NJ) as well as on open cut lesions (no sutures applied).nnnMAIN OUTCOME MEASURESnAdhesion formation, using a grading system ranging from 0 to 3.nnnRESULTSnInterceed(TC7)-treated animals in the sutured group (average adhesion score +/- SD = 2.15 +/- 1.3) did not differ from controls (average score +/- SD = 2.35 +/- 0.93) in adhesion formation, P = 0.47. Rabbits with open cut lesions treated with Interceed(TC7) (average adhesion score +/- SD = 1.89 +/- 1.1) did not differ from control animals (average score +/- SD = 1.83 +/- 1.2), P = 0.88.nnnCONCLUSIONSnInterceed(TC7) was not an effective adhesioprophylactic agent in the presence or absence of nonreactive absorbable suture.

The use of calcium channel blockade for the prevention of postoperative adhesion formation

Prevention of postoperative adhesion formation is an issue of fundamental concern to the reproductive surgeon. The disappointing results of current adjunctive regimens have prompted a search for more potent antiadhesion therapies. Administration of nifedipine hydrochloride, a prototypical calcium channel blocking agent, to hamsters receiving a standardized traumatic lesion of the left uterine horn significantly inhibited primary adhesion formation as compared to control animals. These preliminary results suggest that calcium channel blockade may have the potential to favorably influence events related to peritoneal repair; further study of these agents as surgical adjuvants in the treatment of chronic pelvic adhesive disease is indicated.

Detection of endotoxin in human in vitro fertilization by the zona-free mouse embryo assay

Endotoxin has been found to be a contaminant in human in vitro fertilization (IVF), leading to low pregnancy rates, mostly through embryo fragmentation. We wished to determine if standard quality control assays (one-cell and two-cell mouse embryo culture) were able to detect the presence of endotoxin and how they compared with the zona-free mouse embryo assays. Endotoxin was detected by the zona-free mouse embryo assays but not by the one- or two-cell mouse embryo assays. When excessive embryo fragmentation is noticed in the human IVF system, the use of zona-free mouse embryo assays is recommended.

Changes in DNA fragmentation during sperm preparation for intracytoplasmic sperm injection over time

OBJECTIVEnTo compare the DNA fragmentation of semen samples established by terminal deoxynucleotide transferase-mediated dUTP nick-end labeling (TUNEL) after incubation in polyvinylpyrrolidone (PVP) and hyaluronic acid (HA) for different time periods.nnnDESIGNnComparative prospective study.nnnSETTINGnCenter for reproductive medicine.nnnPATIENT(S)nTwenty-seven semen samples from infertile patients.nnnINTERVENTION(S)nNone.nnnMETHODSnSemen analysis and DNA fragmentation assays (TUNEL) were performed. Two groups were established: A) normal TUNEL (<20%); and B) Abnormal TUNEL (≥ 20%). TUNEL was performed in neat (T0), postgradient (TG), 1-hour postgradient (TG1), and 2-hour postgradient (TG2) samples and in TG2 samples after 0.5, 1.0, and 1.5 hours of incubation in PVP or HA.nnnRESULT(S)nTUNEL levels were significantly reduced after gradient separation compared with neat values. In group A, TUNEL levels were significantly higher in the TG2 + 1.5 hours in PVP and HA samples but did not reach abnormal levels. In group B, TUNEL levels were significantly higher in the TG2 + 1 hour in PVP and HA samples.nnnCONCLUSION(S)nSperm DNA fragmentation significantly decreased after centrifugation gradient, regardless of the initial levels of the sample. Samples with TUNEL ≥ 20% were more susceptible to a significant increase in DNA fragmentation over time, with similar increases being observed over time for samples that were incubated in HA or PVP. These data may be relevant for sperm preparation for intracytoplasmic sperm injection.

Misleading reporting and interpretation of results in major infertility journals

OBJECTIVEnTo evaluate the proportion of randomized controlled trials (RCTs) published in top infertility journals indexed on PubMed that reported their results with proper effect estimates and their precision estimation, while correctly interpreting both measures.nnnDESIGNnCross-sectional study evaluating all the RCTs published in top infertility journals duringxa02014.nnnSETTINGnNot applicable.nnnPATIENT(S)nNot applicable.nnnINTERVENTION(S)nNot applicable.nnnMAIN OUTCOME MEASURE(S)nProportion of RCTs that reported both relative and absolute effect size measures and its precision.nnnRESULT(S)nAmong the 32 RCTs published in 2014 in the top infertility journals reviewed, 37.5% (95% confidence interval [CI], 21.1-56.3) did not mention in their abstracts whether the difference among the study arms was statistically or clinically significant, and only 6.3% (95% CI, 0.8-20.8) used a CI of the absolute difference. Similarly, in the results section, these elements were observed in 28.2% (95% CI, 13.7-46.7) and 15.6% (95% CI, 5.3-32.8), respectively. Only one study clearly expressed the minimal clinically important difference in their methods section, but we found related proxies in 53% (95% CI, 34.7-70.9). None of the studies used CIs to draw conclusions about the clinical or statistical significance. We found 13 studies where the interpretation of the findings could be misleading.nnnCONCLUSION(S)nRecommended reporting items are underused in top infertility journals, which could lead to misleading interpretations. Authors, reviewers, and editorial boards should emphasize their use to improve reporting quality.

Quality of reporting in infertility journals

OBJECTIVEnTo evaluate whether fertility and top gynecology journals indexed in PubMed require the use of reporting guidelines and to identify the percentage of randomized controlled trials (RCTs) published in 2013 that were written following CONSORT guidelines in the top four fertility journals (by their highest impact factor).nnnDESIGNnCross-sectional study evaluating instructions for authors and RCTs published in fertility journals.nnnSETTINGnAcademic institution.nnnPATIENT(S)nNone.nnnINTERVENTION(S)nNone.nnnMAIN OUTCOME MEASURE(S)nProportion of instruction-for-authors documents that suggested or required the use of reporting guidelines, and proportion of RCTs published in 2013 that accomplished the CONSORT checklist.nnnRESULT(S)nIn 47% (16/34) of the journals one or more reporting guidelines were mentioned in the instructions for authors documents. PRISMA and CONSORT were the most commonly mentioned reporting guidelines. None of the analyzed RCTs completed the 25 items of CONSORT guideline. Sequence generation or allocation concealment was not described in 69% of the studies. One-third of the journals did not publish a flowchart, 72% did not show relative and absolute size-effect measures, and 42% did not use measures of imprecision. In the summaries, 42% did not discuss the limitations of the study and 78% did not mention the generalizability of the results.nnnCONCLUSION(S)nLess than half of the analyzed peer-reviewed journals request the authors to use reporting guidelines. Nevertheless, among the top fertility and gynecology journals, reporting guidelines are widely mentioned. Overall, accomplishment of CONSORT items was suboptimal. Editorial boards, reviewers, and authors should join efforts to improve the quality of reporting.

Virtual Hysterosalpingography: A New Diagnostic Technique for the Study of the Female Reproductive Tract

Imaging studies in infertile patients have become an important aspect in the evaluation of the female reproductive tract. Although conventional hysterosalpingography (HSG) remains the study most commonly requested, new technologies have been introduced which overcome the limitations associated with HSG. Over the past decade the development of multidetector computed tomography (MDCT) technology, with a capacity for exceptionally high spatial and temporal resolution, has revolutionized the examination of the heart, colon (Carrascosa et al., Acta Gastroenterol Latinoam 33(3):145–149, 2003), and airways. Virtual hysterosalpingography is an emerging application that combines the capabilities of multidetector CT with the established technique of hysterosalpingography, allowing for a more comprehensive evaluation of the female reproductive system.

In vitro fertilization: simple or complex?

In vitro fertilization and embryo transfer (IVF-ET) is a technique with extensive global application. At the last IVF World Congress in Norfolk, teams from 35 countries were represented: countries with different buying power and access to technology, countries where sometimes the government has control of the health-care system and treatment of infertility has little or no support, countries where the basic supplies for IVF many times are not easy to get or where the know-how and/or parts needed for repair of equipment are unsatisfactory (1). Therefore, for IVF to continue to be a viable therapeutic modality with wide application, simplification is desirable. One of the most dramatic steps in this direction was the introduction of ultrasound for oocyte retrieval (2), especially through the vaginal route, where using local or no anesthesia has reduced the complexity and the cost of this important step.

Physicians and patients’ motivations to perform elective single or double-embryo transfers: A nationwide survey

OBJECTIVESnTo evaluate motivations to perform an elective single embryo transfer (e-SET).nnnMETHODSnCross-sectional surveys to reproductive medicine specialists and to infertile patients undergoing assisted reproductive treatments.nnnRESULTSnIn the physicians survey (nu202f=u202f278), we found that the main reasons for not offering e-SET were the physicians belief that patients prefer optimizing the pregnancy rates regardless of the potential complications (57.1%). Regarding the decision making process, 76.7% of physicians thought that patients and doctors should make these decisions together and 93.3% would like to have a more formal decision-aid to help with counseling. In the patients survey (nu202f=u202f100), 21.3% chose e-SET, while 33% mentioned that complications associated to multiple pregnancies were insufficiently discussed. Among those patients, none chose to have e-SET, while 30% of those who had a full discussion selected e-SET (pu202f=u202f0.05).nnnCONCLUSIONSnMost physicians did not offer e-SET based on potential patients negative feelings. Also, almost 30% take important decisions without the patients participation. Patients that discussed more thoroughly this topic, more frequently selected e-SET. Almost all the physicians surveyed agreed that decision-aids could help in this important shared-decision process.nnnPRACTICE IMPLICATIONSnDecision aids about e-SET vs DET are needed to help patients in the decision making process.