Gustavo Salata Romão

Why do older women have poor implantation rates? A possible role of the mitochondria.

Mitochondria are organelles responsible for oxidative phosphorylation, the main energy source for all eukaryotic cells. In oocytes and embryos, it seems that mitochondria provide sufficient energy for fecundation by supporting spindle formation during meiosis II, and for implantation. Since mitochondria are inherited from mother to child, it is important that oocyte mitochondria should be intact. Older women seem to have more mitochondrial DNA mutations, which can be responsible for poor implantation and aneuploidy, two conditions that occur more often in this group. In the present report we propose a new model to explain why older women have poor implantation rates.

Variations of Jitter and Shimmer Among Women in Menacme and Postmenopausal Women

The objective of the study was to analyze comparatively the jitter and shimmer values of spoken voice among women in menacme and menopausal women using or not hormonal replacement therapy (HRT). Forty-five women were studied, divided into the following groups: Control Group (CG), 15 women aged 20-40 years with regular menstrual cycles who did not take hormonal contraceptives; Treated Group (TG), 15 women aged 45-60 years with at least 2 years of menopause, under continuous HRT with 1 mg estradiol valerate + 90 microg norgestimate per day for at least 6 months; Untreated Group (UG), 15 women aged 45-60 years with at least 2 years of menopause who did not use HRT. Mean age was 30.3, 54.5, and 56.5 years for CG, TG, and UG, respectively. All subjects were submitted to acoustic analysis of jitter and shimmer for the sustained vowels /e/ and /i/. Mean jitter values were 0.56%, 0.64%, and 0.56% for the vowel /e/ and 0.88%, 0.79%, and 0.68% for the vowel /i/ for CG, TG, and UG, respectively. Mean shimmer values were 4.17%, 4.38%, and 4.77% for the vowel /e/ and 5.19%, 4.59%, and 5.37% for the vowel /i/ for CG, TG, and UG, respectively. There were no significant differences between the groups studied. The results obtained here by the methodology used suggest that there were no significant differences in jitter and shimmer when we assessed the sustained vowels /i/ and /e/ between menopausal women using or not HRT or between young and menopausal women treated or not.

Oocyte diameter as a predictor of fertilization and embryo quality in assisted reproduction cycles

OBJECTIVE To assess the impact of the mean oocyte diameter (MOD) on occurrence of fertilization and embryo quality in assisted reproduction cycles. DESIGN Prospective observational study. SETTING Sector of Human Reproduction of the University Hospital, Faculty of Medicine of Ribeirão Preto, University of São Paulo (HCFMRP-USP). PATIENT(S) Thirty-five women undergoing intracytoplasmic sperm injection (ICSI) at the University Hospital of Ribeirão Preto from May to October 2007. INTERVENTION(S) MOD assessment. MAIN OUTCOME MEASURE(S) Occurrence of fertilization and qualitative embryo classification on 2nd and 3rd day after ICSI. RESULT(S) We divided 160 metaphase II oocytes according to MOD into groups A (MOD below the 25th percentile), B (MOD between 25th and 75th percentile), and C (MOD above the 75th percentile). There was no statistically significant association between MOD and the occurrence of fertilization or the qualitative embryo classification on days 2 and 3. There was no statistically significant difference between groups regarding number of cells or the qualitative embryo classification on days 2 and 3. CONCLUSION(S) The MOD of mature oocytes does not seem to be related to the occurrence of fertilization or to the developmental quality of human embryos on days 2 and 3 after ICSI.

Noninvasive imaging of the meiotic spindle of in vivo matured oocytes from infertile women with endometriosis.

The objectives of this prospective study were to evaluate the nuclear maturation stage and the presence and location of meiotic spindles of in vivo matured oocytes from infertile women with and without endometriosis (male or tubal causes of infertility) undergoing stimulated cycles for intracytoplasmic sperm injection (ICSI). We also compared the ICSI outcomes among groups. We analyzed the meiotic spindles of oocytes from 36 patients with endometriosis I/II, 24 with endometriosis III/IV, and 60 without endometriosis (male or tubal causes of infertility). The oocytes were imaged using polarization microscopy. There were no differences in the number of oocytes in telophase I (mean [standard deviation]: 0.1 [0.5], 0.2 [0.4], and 0.2 [0.5], respectively, in the endometriosis I/II, endometriosis III/IV, and control groups), in metaphase II with visible spindles (4.2 [2.5], 3.1 [2.0], and 3.6 [2.2], respectively, in the endometriosis I/II, endometriosis III/IV, and control groups), and in spindle location among groups. We can conclude from this study that noninvasive analysis of spindles from in vivo matured oocytes of infertile patients with endometriosis did not demonstrate significant differences in terms of the nuclear maturation stage, the percentage of oocytes in metaphase II with visible spindles, and the spindle localization when compared to the control group. However, it is important to state that there are no studies evaluating the accuracy of polarization microscopy for the detection of meiotic anomalies in human oocytes, which would need to be better evaluated in future studies using an appropriate methodology.

Reduced aromatase activity in granulosa cells of women with endometriosis undergoing assisted reproduction techniques

The aim of the present study was to measure the in vitro aromatase activity in granulosa cells of women with endometriosis submitted to assisted reproduction techniques. A case–control study was conducted on eight patients with endometriosis and eight with other infertility causes submitted to in vitro fertilization or intracytoplasmic sperm injection. Granulosa cells were obtained from pre-ovulatory follicles during oocyte retrieval and cultured for 24 h in the presence or absence of testosterone (2×10−6 and 2×10−5 M), follicle-stimulating hormone (FSH) and insulin-like growth factor-I (IGF-I) (both at 50 ng/ml). Estradiol (radioimmunoassay) was measured in the obtained culture fluids. The basal production of estradiol and its production under testosterone addition to the culture (aromatase activity) were analyzed. Reduced aromatase activity was detected in cultured granulosa cells in endometriosis cases, compared with controls, when testosterone was added at the concentration at 2×10−6 M (p = 0.0303). The basal production of estradiol was also reduced in endometriosis patients (p = 0.0390). The effect of addition of FSH and IGF-I did not differ between groups. In conclusion, the in vitro basal production of estradiol and aromatase activity in granulosa cells were reduced in women with endometriosis submitted to assisted reproduction techniques, compared with the control group.

A síndrome dos ovários policísticos pode interferir nos resultados da fertilização in vitro

PURPOSE: to evaluate the results of ovulation hyperinduction followed by in vitro fertilization (IVF) in women with polycystic ovary syndrome (POS), as compared to normal cycle women. METHODS: a controlled retrospective study conducted on 36 women with POS (POS group) and on 44 women with infertility due to mild male factor (control group), submitted to IVF from 1997 to 2003. Subject ages ranged from 18 to 36 years. Ovulation hyperinduction was obtained with recombinant follicle-stimulating hormone and a gonadotrophin-releasing hormone agonist. The analyzed variables were the follicles with a mean diameter of 14 to 17 mm and the follicles with diameters of 18 mm or above on the day of human chorionic gonadotrophin administration, percentage of follicles >18 mm, the number of retrieved oocytes, fertilization rate, cleavage rate, incidence of ovarian hyperstimulation syndrome (OHS), clinical pregnancy rate, and abortion rate. The variables were analyzed by the unpaired t test, Fisher exact test and Mann-Whitney test, with level of significance set at p<0.05. RESULTS: the POS group presented a larger number of retrieved follicles, most of them measuring 14 to 17 mm in diameter, compared to the control group (64.8 vs 53.9%), a lower fertilization rate (59.43 vs 79.57%) and a higher incidence of OHS (38.9 vs 9.1%). The number of retrieved oocytes, cleavage rates, pregnancy rates per embryo transfer, abortion rates and live born rates did not differ between groups. CONCLUSION: the success of IVF is impaired in women with POS due to their larger number of retrieved follicles of reduced diameter, reduced fertilization rate and high OHS rates.

Factors Related to Coital Frequency of Women in Their Thirties.

This cross-sectional study aimed to identify factors related to coital frequency (CF) among 254 women in their 30s using a semistructured interview to collect sociodemographic, anthropometric, reproductive, clinical, and relationship data. CF was characterized as (a) never, (b) rarely (≤1 times/month), (c) occasionally (≤1 times /week), (d) regularly (2–3 times/week), or (e) frequently (>3 times/week). The mean age was 34.38 ± 0.43 years, mean body mass index (BMI) was 27.86 ± 6.52 kg, mean family income was US

Screening for prolactin isoforms in the follicular fluid of patients undergoing in vitro fertilization.

1,044.18 ± 796.19, mean number of children was 1.71 ± 0.89, and mean relationship duration was 8.87 ± 5.11 years. Eighty-seven women (35.2%) were taking hormonal contraceptives, 143 (98.0%) were employed, 239 (96.48%) had a secondary or higher education, and 9 (3.62%) had primary schooling. CF was classified as >3 times/week in 22 (8.66%), 2–3 times/week for 98 (38.58%), ≤1 times/week in 40 (15.75%), ≤1 times/month in 14 (5.51%), and never in 5 (1.97%). Women who reported having coitus >3 times/week a week had significantly higher body mass index (BMI; 32.72 ± 7.42 kg/m2) than those who had coitus 2–3 times/week (28.45 ± 6.76 kg/m2) and ≤1 times /week (26.81 ± 5.39 kg/m2) (p < 0.01 for both comparisons). Thus, coital frequency varies in women in their 30s. Obese women had a higher CF than normal-weight and overweight women.

Response to Letter to Editor Entitled “Obesity, Overweight, Female Sexual Function, and Penile-Vaginal Intercourse Frequency”

The purpose of this prospective and non-randomized study was to identify prolactin (PRL) isoforms in the follicular fluid (FF) of patients undergoing in vitro fertilization (IVF). The FF from 19 patients was obtained during oocyte retrieval at the University Hospital, Ribeirão Preto Medical School. The molecular weight of FF PRL was determined by column chromatography on Sephacryl S-200 HR combined with an immunometric assay. The only PRL isoform detected in FF exhibited a molecular weight of 20.5 kD. The molecular weights of FF PRL and small PRL are essentially identical. The 20.5-kD PRL accounted for 93.1 ± 9.1% (mean ± SD) of the recovered PRL after gel chromatography. Total PRL recovery was 74.2 ± 19%. Thus, the only PRL detected in the FF was the small PRL, the most potent one.

Freqüência de infecção pelo Mycoplasma hominis e Ureaplasma urealyticum em mulheres inférteis e relação com repercussões clínicas

We thank Drs. Costa & Brody for the interest and comments to our article. The Cambridge Advanced Learner’s Dictionary defines “coitus” as “the sexual act in which a man puts his penis into a woman’s vagina” (Press, 2008, p. 265). Furthermore, a search of the PubMed database retrieved only 99 results for “penile-vaginal intercourse” (PVI), but 8,530 for “coitus,” 349 for “coital frequency,” 117 for “intercourse frequency,” 15,646 for “intercourse,” and 9,341 for “sexual activity.” Thus, use of the terms “coital frequency” and “sexual intercourse” in our article (“Factors Related to Coital Frequency of Women in Their Thirties”) is appropriate and does not constitute a limitation of this study. However, the increasing knowledge of human sexual function has led to changes in how some terms are used. PVI seems to be a more specific term than “coitus” or “sexual intercourse,” even though PVI has yet to become established as a common term in the literature. A new model of female sexual response indicated that the major components of a woman’s sexual satisfaction parallel physical contact, such as intimacy, respect, the ability to be vulnerable, trust, communication, and many other dimensions (Basson et al., 2000). Also, Basson concluded that women are motivated to have sexual relations for numerous reasons, such as achieving emotional closeness (intimacy), which might be more important than sexual reward or gain (Basson, 2000). Many other studies support Basson’s model in that they identified additional factors that predict female sexual response, such as sexual assertiveness, sexual attitudes, and closeness with a partner in a relationship (Chang, Klein, & Gorzalka, 2013; Fahs & Swank, 2011; Hurlbert, Apt, & Rabehl, 1993). Additionally, individual and relationship variables act