Mariangela Badalotti

Successful birth after injection of frozen human oocytes with frozen epididymal spermatozoa

A couple (female 31, male 42 years old) with infertility due to obstructive azoospermy returned to the clinic in order to attempt pregnancy using their frozen oocytes and epididymal sperm cells, which had been cryopreserved at the time of a previous IVF attempt. Two days before the scheduled transfer, eight oocytes were thawed; 5/8 (63%) oocytes survived and 4/5 (80%) oocytes fertilized after intracytoplasmic sperm injection (ICSI) with the previously frozen epididymal spermatozoa. All four fertilized ova cleaved (100%). On day 2 after thawing, four embryos were transferred; three with two cells (grade II) and one with three cells (grade III). Hormonal support for the established pregnancy was maintained with oestradiol and progesterone orally until 12 weeks of gestation, and the patient was delivered by Caesarean section at 40 weeks of gestation; the baby boy weighed 3025 g, and measured 51 cm, with Apgar of 10 in the 1st and 5th min. The cryopreservation and warming protocol used for this study yielded very favourable results, comparing well with reports in the literature. This case report demonstrates that it is possible to obtain high rates of oocyte survival following thawing and high rates of fertilization after ICSI, with viable development of the resulting embryos.

Comparison of embryo quality between sibling embryos originating from frozen or fresh oocytes

Human embryo cryopreservation techniques allow storage of surplus embryos created during assisted reproduction procedures; however, the existence of these same surplus embryos has sparked further debate. What can be their fate once they are no longer desired by their parents, or if the parents are deceased? Thus, the level of interest in the cryopreservation of oocytes has increased, as has the necessity for further scientific study. This study had the objective of comparing embryo quality from 16 women who underwent intracytoplasmic sperm injection, where approximately half of the retrieved oocytes per cycle were inseminated fresh after collection, and the remainder cryopreserved for subsequent fertilization. Normal fertilization rates were not significantly different between the two oocyte-treatment groups. There was no significant difference in the frequency of good quality embryos (morphology grades I and II) on the second day of laboratory evaluation between embryos derived from the two oocyte-treatment groups. It is interesting to note that embryo transfer from fresh oocytes produced no pregnancies, which shows that even embryos derived from frozen oocytes that are fragmented or have a slower cleavage rate are viable embryos, capable of producing healthy babies.

Experience of freezing human oocytes using sodium-depleted media

Human embryo cryopreservation techniques enable the storage of surplus embryos created during assisted reproduction procedures; however, the existence of these same surplus embryos has sparked further debate. What can be their fate once they are no longer desired by their parents or if the parents are deceased? Thus, the level of interest in the cryopreservation of oocytes has increased, as has the necessity for further scientific study. This study had the objective of reporting 10 years of experience of freezing and thawing human oocytes from patients who did not wish to freeze embryos. A total of 159 cycles using frozen–thawed oocytes were performed (mean age 33.7 years). Survival and fertilization rates were 57.4% and 67.2%, respectively. Cleavage rate was 88.4% and the pregnancy rate was 37.7%. Clinical pregnancy was observed in 43 cycles (27.0%) with 14.5% of transferred embryos implanted. These pregnancies delivered 19 boys and 23 girls, two pregnancies are ongoing and nine were miscarriages. The average gestational week was 37.6 weeks and birthweight was 2829.2 g. These data suggest that the use of frozen–thawed oocytes in IVF represents a reasonable alternative for those patients not comfortable with the cryopreservation of supernumerary embryos.

Septo uterino, duplicação cervical e septo vaginal: relato de rara malformação mülleriana com gestação a termo

This report describes an unusual case of spontaneous pregnancy in a patient with Mullerian anomaly. The patient was a 34-years old, white, nulligravida, with regular menstrual cycles, and suspected uterine septum observed during a routine ultrasonographic examination. The gynecological examination revealed a complete longitudinal vaginal septum and two uterine cervices. Three-dimensional pelvic ultrasonography showed cervix duplication, uterine septum from isthmus to endometrial cavity and absence of uterine body division, compatible with complete uterine septum and true dual cervices. She returned after one month and reported unprotected sexual intercourse and delayed menstrual period. She was pregnant, had a good pregnancy evolution, and delivered a healthy term baby girl, by cesarean section, at 37 weeks of pregnancy. This report describes a case of normal-term pregnancy in a patient with a rare anomaly (vaginal septum and two cervices) who became spontaneously pregnant without treatment.

Recomendações para a proteção da privacidade do paciente

Concerns regarding the bioethical aspects of the privacy of the individual and the confidentiality of their medical treatment data is increasing in the medical community. The current preliminary clinical and therapeutic processes require the multidisciplinary involvement of a number of individuals, especially in the case of hospitalization. The transmission and storage of clinical and laboratory patient information involves different media, with inherent problems of accessibility and protection of information. The authors describe hypothetical situations that exemplify issues commonly addressed in the work of a clinical bioethics committee, contextualizing these problems in Brazil and globally, and suggest steps to minimize potential problems of the breaching of privacy and confidentiality.

Análise da coagulação sangüínea em pacientes submetidas à hiperestimulação ovariana para fertilização in vitro

BACKGROUND: Hyperestrogenic conditions have been related to alterations in the coagulation parameters. The objective of this study was to identify changes in coagulation parameters in women undergoing in vitro fertilization and embryo transfer (IVF-ET). METHODS: A group of 15 patients was studied prospectively, immediately before and during the course of an IVF-ET cycle. Blood was drawn in the preovulatory period of the cycle preceeding IVF-ET for complete blood count, fibrinogen, prothrombin time (TP), thromboplastin partial actived time (ATTP), coagulation time and estradiol. A another blood sample for the same tests was collected during controlled ovarian hyperstimulation, on the hCG day. Both samples were compared by a paired t-test RESULTS: There was an increase in fibrinogen (340.9 pg/mL to 383.1 pg/mL, p = 0.01). On the other hand, hematocrit levels decreased (40.5% to 38.4 %, p = 0.0001). The other coagulation tests showed no difference. Estradiol levels increased (167 pg/mL to 1435 pg/ml, p=0.0001), as expected during such treatment. CONCLUSIONS: The data suggest a tendency towards an increase in coagulability, as expected in hyperestrogenic situations. However, even considering the statistical significance of the results, they might have limited clinical impact, since they were within the normal range. This study suggests that, despite the marked increase in estradiol and changes in coagulation parameters, IVF-ET is a safe procedure in terms of thromboembolic risks.

MP35-08 IMPACT OF SEMINAL QUALITY ON THE ANEUPLOIDY EMBRYONIC RATE

INTRODUCTION AND OBJECTIVES: The male factor is implicated in approximately 50% of couples undergoing Assisted Reproductive Technology. It has been known semen alterations could be responsible for chromosomal abnormalities, poor embryonic development and repeated miscarriage.The main objective of this study was to evaluate the possible impact of oligospermia on the aneuploidy embryonic rate, comparing oligo and normospermics patients. METHODS: This study compared 203 oligo and normospermics couples who underwent in vitro fertilization with subsequent embryo biopsy for preimplantation genetic screening (PGS) during the period from July 2014 to October 2016. The female mean age was 38.9. The seminal parameters were evaluated according to WHO 2010. Were biopsied 741 embryos. The biopsies were performed on either day 3 or day 5. The techniques used for the analysis were Array Comparative Genomic Hybridization (aCGH) or Next-Generation Sequencing (NGS). The results were analyzed by the T test (p <0.05). RESULTS: Of the 203 patients, 40 patients (19.7%) were considered oligospermic and obtained 160 biopsied embryos. Of these, 42 (26.2%) were considered euploid embryos. Normospermics patients obtained 581 biopsied embryos, and 151 (25.9%) were considered euploid. Therefore, when considering only the seminal concentration, there is no difference between the aneuploidy embryonic rate. CONCLUSIONS: This study showed no correlation between low seminal concentration and aneuploidy embryonic rate. Although low sperm quality is an indication for PGS, it has not yet been elucidated that there is a decrease in the rate of euploidy during in vitro fertilization as it is expected to occur with the natural conception. Therefore, it is advisable that further studies on the subject be carried out in order to corroborate these primary results.

Effects of an extended flexible regimen of an oral contraceptive pill containing 20 μg ethinylestradiol and 3 mg drospirenone on menstrual-related symptoms: a randomised controlled trial

Abstract Objectives: The aim of the study was to assess the efficacy for menstrual-related symptoms of an extended flexible regimen of an oral contraceptive pill containing 20 μg ethinylestradiol and 3 mg drospirenone in comparison with a 24/4 d cyclical regimen of the same formulation. Methods: This randomised, non-inferiority, open-label, multicentre study was conducted in women aged 18–39 years. Their menstrual-related symptoms were assessed using the Penn Daily Symptom Rating (DSR17). Participants were randomised to use an extended flexible regimen of 20 μg ethinylestradiol and 3 mg drospirenone (EE/DRSPe.flex), comprising 168 consecutive days with a 4-d hormone-free interval (HFI, allowing for management of unexpected bleeding) or a conventional 24/4 cyclical regimen of the same pill (EE/DRSP24/4). The primary measure of efficacy was the percentage change in DSR17 total score from baseline to cycle 6. The secondary measures of efficacy were the percentage changes in DSR17 total score from baseline after each 28-d interval throughout the entire study and in the scores for individual DSR17 symptoms. Results: The primary analysis demonstrated that EE/DRSPe.flex was not inferior to EE/DRSP24/4 (Mean DSR17 score 9.1; 95% confidence interval (CI) − 2.5, 20.6; p = 0.123). Analysis at intervals throughout the entire evaluation period showed greater reduction in DSR17 total score for EE/DRSPe.flex than for the 24/4 regimen (p < 0.001). The decreases in individual scores for the symptoms ‘poor coordination’ and ‘depression/feeling sad/down or blue’ were greater for the extended flexible regimen than for the cyclical regimen (p < 0.05). Conclusion: The extended flexible regimen was not inferior to the 24/4 cyclical regimen in terms of the primary endpoint. It significantly improved symptoms in the interval analysis, and the effects on specific DSR17 symptoms, compared with the cyclical regimen.

Falência ovariana precoce associada a deleção no braço longo do cromossomo: relato de dois casos e revisão da literatura

Premature ovarian failure may be idiopathic or associated with several autoimmune and genetic disorders as X chromosome deletions. We report two cases of preamture ovarian failure associated with a deletion in the long arm of X chromosome. Both patients were nulligravidas presenting secondary amenorrhea and complaints of infertility, without family history of premature ovarian failure and reporting normal puberal development. Their karyotypes showed deletions of the distal long arm of all X chromosomes and were 46,X, del(Xq22) and 46,X, del(Xq13q28), respectively. After the diagnosis the patients decided to be submitted to an in vitro fertilization with egg donation.