Paula Andrea de Albuquerque Salles Navarro

Impact of endometriosis and its staging on assisted reproduction outcome: systematic review and meta-analysis.

To evaluate whether the presence or severity of endometriosis affects the outcome of assisted reproductive techniques (ART).

Comparative analysis of the spindle and chromosome configurations of in vitro–matured oocytes from patients with endometriosis and from control subjects: a pilot study

Preliminary data from a prospective controlled study did not demonstrate an increased percentage of meiotic abnormalities for in vitro-matured oocytes obtained from stimulated cycles of endometriosis and control patients. However, the tendency toward a higher proportion of telophase I in apparently matured oocytes observed in endometriosis patients suggests an impairment or delay of the completion of meiosis I which requires further evaluation.

Preimplantation development and expression of Hsp-70 and Bax genes in bovine blastocysts derived from oocytes matured in alpha-MEM supplemented with growth factors and synthetic macromolecules.

In vitro culture conditions affect both the maternal and embryonic expression of genes and is likely to alter both oocyte and embryo developmental competence. The search for better and less variable culture conditions simulating those in vivo has led to the development of defined culture media, with lower impact on the molecular reprogramming of oocytes and embryos. We evaluated embryo development and relative abundance (RA) of Hsp-70 and Bax transcripts in bovine blastocysts produced from oocytes matured in a chemically defined IVM system with synthetic polymers. Immature cumulus oocyte complexes (COCs) were matured for 22-24h in alpha-MEM supplemented with IGF-1, insulin, 0.1% polyvinyl alcohol (PVA), or 0.1% polyvinylpyrrolidone (PVP), but without FSH or LH. The control group consisted of COCs matured in TCM plus FSH and 10% estrous cow serum. After fertilization, presumptive zygotes were co-cultured with cumulus cells until 224 h post-insemination. Total RNA was isolated from embryo pools, reverse transcribed into cDNA, and subjected to transcript analysis by real-time PCR. Cleavage rate was higher (P<0.05) for the control group (68.3%) than for the PVA (54.4%) and PVP-40 (58.3%) groups. Nevertheless, there was no difference among the PVA, PVP-40 and control groups in blastocyst or hatching rates. Similarly, no difference in relative abundance of Hsp-70 and Bax transcripts was detected in comparison to the control group. We inferred that bovine oocytes can be matured in serum- and gonadotrophin-free medium supplemented with PVA or PVP, enriched with IGF-I and insulin, without altering post-cleavage development and relative abundance of some genes associated with stress and apoptosis.

Lipid peroxidation and vitamin E in serum and follicular fluid of infertile women with peritoneal endometriosis submitted to controlled ovarian hyperstimulation: a pilot study.

OBJECTIVE To assess the level of lipid peroxidation (LP) and vitamin E in the follicular fluid and serum of infertile patients, with or without endometriosis, who were submitted to ovulation induction for assisted reproduction procedures. DESIGN Prospective study. SETTING Assisted conception unit, university hospital. PATIENT(S) Infertile patients 20 to 38 years of age were selected prospectively and consecutively and were divided into the endometriosis group (17 patients with pelvic endometriosis) and the control group (19 patients with previous tubal ligation or male factor and without endometriosis). INTERVENTION(S) Peripheral blood samples were collected on D1 (before the beginning of the use of gonadotropins), D2 (day of hCG administration), and D3 (day of oocyte retrieval). On D3, follicular-fluid samples free from blood contamination also were collected and stored. MAIN OUTCOME MEASURE(S) Lipid peroxidation was assessed by malondialdehyde quantification by spectrophotometry, and measurement of vitamin E was performed by HLPC. RESULT(S) On D1, no significant difference in LP was observed between groups. However, vitamin E levels were significantly higher in the control group. On D2, LP levels were significantly higher in the endometriosis group compared with in the control group, and vitamin E levels continued to be significantly higher in the control group. On D3, there was no significant difference in serum and follicular-fluid levels of LP and vitamin E between groups. However, on D3, vitamin E levels were found to be significantly higher in serum than in follicular fluid in both groups, whereas malondialdehyde levels were significantly lower in follicular fluid than in serum only in the control group. CONCLUSION(S) Before the beginning of ovulation induction, a significant decrease in vitamin E was observed in patients with endometriosis, perhaps because antioxidants are consumed during oxidation reactions. After ovulation induction with exogenous gonadotropins, the group of patients with endometriosis not only presented increased lipid peroxidation but also maintained lower vitamin E levels than the control group, a fact that hypothetically could compromise oocyte quality in endometriotic patients. However, on the day of oocyte retrieval, both serum LP potential and vitamin E levels were found to be similar in the two groups.

Marcadores séricos de estresse oxidativo em mulheres inférteis com endometriose

OBJETIVO: comparar marcadores sericos de estresse oxidativo entre pacientes inferteis com e sem endometriose e avaliar a associacao destes marcadores com o estadiamento da doenca. METODOS: estudo prospectivo envolvendo a inclusao consecutiva de 112 pacientes inferteis, nao-obesas, com idade inferior a 39 anos, divididas em dois grupos: Endometriose (n=48, sendo 26 com endometriose minima e leve - Estadio I/II e 22 com endometriose moderada e grave - Estadio III/IV) e Controle (n=64, com fator tubario e/ou masculino de infertilidade). Durante a fase folicular precoce do ciclo menstrual, foram coletadas amostras sanguineas para analise dos niveis sericos de malondialdeido, glutationa e niveis totais de hidroperoxidos, por espectrofotometria e vitamina E, por cromatografia liquida de alto desempenho. Os resultados obtidos foram comparados da seguinte forma: os grupos endometriose versus controle; endometriose estadio I/II e controle, endometriose estadio III/IV e controle e entre os dois subgrupos de endometriose. Em todas as analises, foi considerado o nivel de significância de 5% (p<0,05). RESULTADOS: os niveis de vitamina E e glutationa foram mais baixos no soro de mulheres inferteis com endometriose moderada/grave (21,7±6,0 µMol/L e 159,6±77,2 nMol/g proteina, respectivamente) quando comparadas a mulheres com endometriose minima e leve (28,3±14,4 µMol/L e 199,6±56,1 nMol/g proteina, respectivamente). Os niveis totais de hidroperoxidos foram significativamente mais elevados no grupo endometriose (8,9±1,8 µMol/g proteina) em relacao ao Grupo Controle (8,0±2 µMol/g proteina) e nas portadoras de doenca III/IV (9,7±2,3 µMol/g proteina) em relacao a I/II (8,2±1,0 µMol/g proteina). Nao se observou diferenca significativa nos niveis sericos de malondialdeido entre os diversos grupos. CONCLUSOES: foi evidenciada uma associacao positiva entre infertilidade relacionada a endometriose, avanco do estadiamento da doenca e aumento dos niveis sericos de hidroperoxidos, sugerindo aumento da producao de especies reativas em portadoras de endometriose. Esses dados, associados a reducao dos niveis sericos de vitamina E e glutationa, sugerem a ocorrencia de estresse oxidativo sistemico em portadoras de infertilidade associada a endometriose.

Time‐lapse embryo imaging for improving reproductive outcomes: systematic review and meta‐analysis

To identify, appraise and summarize the available evidence regarding the effectiveness and safety of time‐lapse embryo monitoring on the main outcomes of assisted reproductive techniques.

Oxidative stress and oocyte quality: ethiopathogenic mechanisms of minimal/mild endometriosis-related infertility

Endometriosis, a highly prevalent gynecological disease, is often associated with infertility, even in its milder forms (minimal and mild endometriosis). However, no consensus has been established with regard to this relationship and the possible mechanisms involved have not been completely elucidated. The oocyte is believed to have an important role in the infertility presented by these patients. Hence, oxidative stress events associated with alterations in the peritoneal, serum and/or follicular microenvironments might result in poor oocyte quality and compromise the reproductive potential of these women. Here, we review possible mechanisms involved in oocyte quality impairment that might lead to infertility in patients with early endometriosis.

Chemotherapy-induced damage to ovary: mechanisms and clinical impact

Cancer is a major public health problem around the world. Currently, about 5% of women diagnosed with cancer are of reproductive age. These young survivors may face compromised fertility. The effects of chemotherapeutic agents on ovarian reserve and its clinical consequences are generally inferred from a variety of surrogate markers of ovarian reserve, all aiming to provide prognostic information on fertility or the likelihood of success of infertility treatment. Until recently, the mechanisms that are responsible for chemotherapy-induced ovarian damage were not fully elucidated. The understanding of these mechanisms may lead to targeted treatments to preserve fertility. In this manuscript, we will review the current knowledge on the mechanism of ovarian damage and clinical impact of chemotherapy agents on fertility.

Relationship between first polar body morphology before intracytoplasmic sperm injection and fertilization rate, cleavage rate, and embryo quality

To evaluate the influence of the morphology of the first polar body (PB) on intracytoplasmic sperm injection (ICSI) outcomes.

N-Acetyl-Cysteine and l-Carnitine Prevent Meiotic Oocyte Damage Induced by Follicular Fluid From Infertile Women With Mild Endometriosis

This study evaluated the potential protective effect of the antioxidants, l-carnitine (LC) and N-acetyl-cysteine (NAC), in preventing meiotic oocyte damage induced by follicular fluid (FF) from infertile women with mild endometriosis (ME). We performed an experimental study. The FF samples were obtained from 22 infertile women undergoing stimulated cycles for intracytoplasmic sperm injection (11 with ME and 11 without endometriosis). Immature bovine oocytes were submitted to in vitro maturation (IVM) divided into 9 groups: no-FF (No-FF); with FF from control (CFF) or ME (EFF) groups; and with LC (C + LC and E + LC), NAC (C + NAC and E + NAC), or both antioxidants (C + 2Ao and E + 2Ao). After IVM, oocytes were immunostained for visualization of microtubules and chromatin by confocal microscopy. The percentage of meiotically normal metaphase II (MII) oocytes was significantly lower in the EFF group (51.35%) compared to No-FF (86.36%) and CFF (83.52%) groups. The E + NAC (62.22%), E + LC (80.61%), and E + 2Ao (61.40%) groups showed higher percentage of normal MII than EFF group. The E + LC group showed higher percentage of normal MII than E + NAC and E + 2Ao groups and a similar percentage to No-FF and CFF groups. Therefore, FF from infertile women with ME causes meiotic abnormalities in bovine oocytes, and, for the first time, we demonstrated that the use of NAC and LC prevents these damages. Our findings elucidate part of the pathogenic mechanisms involved in infertility associated with ME and open perspectives for further studies investigating whether the use of LC could improve the natural fertility and/or the results of in vitro fertilization of women with ME.