Search

Resumen Introduccion La incorporacion de tecnologias de testigo electronico como elemento de control de calidad en los procedimientos de reproduccion asistida puede aumentar la seguridad de los mismos, reduciendo el riesgo de error. No sabemos, sin embargo, como repercute la presencia de estos elementos de seguridad en la confianza y calidad percibida de los pacientes, y, en definitiva, si se traduce en una mejora en su experiencia al someterse a una fecundacion in vitro. Material y metodos Se condujo una encuesta a 200 pacientes que acudieron a una unidad privada de reproduccion asistida entre enero y julio de 2016. Se pidio que otorgasen un valor numerico a 6 afirmaciones, segun su grado de acuerdo con las mismas, de forma que quedase reflejada su percepcion sobre la seguridad de las tecnicas de reproduccion asistida y la tecnologia de testigo electronico. Resultados A pesar de que los pacientes tienen un nivel de confianza elevado en la calidad y seguridad de los procedimientos de reproduccion asistida, someterse a los mismos les genera ansiedad. Por tanto, los pacientes valoran positivamente la incorporacion de un sistema de testigo electronico, y consideran que aumenta su nivel de confianza. Estos resultados se acentuan en pacientes que se someten por primera vez a estos tratamientos, comparado con los pacientes que se estan sometiendo a un tratamiento en la actualidad o ya se han sometido a una o mas fecundaciones in vitro en el pasado. Discusion Dado el fuerte interes mostrado por los pacientes por los sistemas de testigo electronico, seria conveniente disponer de evidencia en nuestro contexto geografico relativa al coste, efectividad e impacto en la calidad de los procedimientos de reproduccion asistida de esta tecnologia.

Purpose: Hydroxypropyl cellulose (HPC), a polysaccharide that forms a viscous gel under low temperatures, is a promising substitute of the blood-derived macromolecules traditionally used in cryopreservation solutions. The performance of a protein-free, fully synthetic set of vitrification and warming solutions was assessed in a matched pair analysis with donor oocytes. Methods: A prospective study including 219 donor MII oocytes was carried out, comparing the laboratory outcomes of oocytes vitrified with HPC-based solutions and their fresh counterparts. The primary performance endpoint was the fertilization rate. Secondary parameters assessed were embryo quality on days 2 and 3. Results: 70/73 (95.9%) vitrified MII oocytes exhibited morphologic survival 2 h post-warming, with 49 (70.0%) presented normal fertilization, compared to 105 of 146 (71.9%) MII fresh oocytes. Similar embryo quality was observed in both groups. A total of 18 embryos implanted, out of 38 embryos transferred (47.3%), resulting in 13 newborns.

The objective of this study was to evaluate oral supplements with antioxidants in oocyte and embryonic quality in patients undergoing assisted reproductive treatments. A cohort of 120 patients was included in the study: 60 patients were included in the control group and 60 in the Seidivid group. The medication contained folic acid, myo-inositol, melatonin, and selenium (Seidivid) and was supplied for at least 2 months before the ovarian puncture. The results of the different cycles were compared, evaluating the number of follicles (9.67 vs 9.15, P = .584), the number of metaphase II (8.52 vs 8.53, P = .986), the number of embryos of A + B quality, the number of vitrified embryos (1.93 vs 2.26, P = .505), and biochemical (62.75% vs 66.00%, P = .83) and clinical pregnancy rates (52.94% vs 56.00%, P = .84). A significant fact in our study was that although the supplements with antioxidants were not statistically significant for some aspects, they were significant in terms of obtaining embryos of good quality (A + B).

Resumen Objetivo Medir como afecta a la calidad de vida de las parejas tanto la infertilidad como los tratamientos de reproduccion asistida (incluyendo la inseminacion artificial), y a la vez evaluar como la presencia y participacion de la enfermera puede ayudar en este proceso y paliar en parte la ansiedad y la disminucion de la calidad de vida de estos pacientes. Metodo Se ha realizado un estudio observacional analitico transversal en el que se han estudiado 48 pacientes (26 ciclos) de nuestra Unidad de Reproduccion Asistida desde el 2 de diciembre de 2013 hasta el 30 de abril de 2014 y hemos analizado los datos sociodemograficos, los resultados del test FertiQoL antes y despues del tratamiento, y las consultas realizadas telefonicamente y mediante correo electronico por estos pacientes. Resultados Los resultados obtenidos muestran una disminucion en la calidad de vida de estos pacientes, siendo en algunos aspectos mas acusado en los hombres y en las personas que no tienen hijos previos. Nuestros resultados tambien indican que un cuidado personalizado de los pacientes mejoro la calidad de vida y la tolerancia al tratamiento y que la mayoria de las pacientes recurrieron a la enfermera para resolver sus consultas. Conclusiones Nuestro estudio muestra que la enfermera puede desempenar un importante papel en la mejora de la calidad de vida de los pacientes sometidos a un tratamiento de reproduccion asistida.

OBJECTIVE To compare the results obtained with two different GnRH agonist dosages: 0.3mg versus 0.4mg to trigger ovulation in oocyte donor cycles. METHODS Experimental controlled randomized trial including 40 patients from a private practice center. The patients were randomized into two groups. Group A received a single dose of Triptorelin 0.3mg (Decapeptyl®) 36hours before pick-up. Group B patients received Triptorelin 0.4mg (Decapeptyl®) before pick-up to final oocyte maturation. We evaluated the total number of oocytes collected, the number of mature oocytes and total days of ovarian stimulation. RESULTS The average of total collected oocytes were 16 (Group A) versus 15 (Group B), and the mean number of mature oocytes were 13 versus 12 respectively. The only variable showing a difference was the percentage of mature oocytes, which was greater in Group A, resulting in 84.6%, in contrast with those treated with 0.4mg of Triptorelin (78.6%), although these differences were not statistical significant (p=0.35). Days of stimulation did not differ between groups. No cases of empty follicle syndrome were reported. CONCLUSIONS We found that an increase from 0.3 to 0.4mg of triptorelin in an oocyte donation program might not improve outcomes. Nevertheless, more studies might be necessary, not only in oocyte donors but in sterile women as well, to evaluate how GnRH agonist dosage could affect the results among other factors.

This case report describes a live birth after the fresh replacement of an embryo obtained from a spontaneously in vitro matured oocyte. The patient was subjected to controlled ovarian stimulation for IVF treatment, obtaining two oocytes. One was found to be immature at the time of denudation, at metaphase-I. This immature oocyte was kept in culture overnight in standard conditions along with the second oocyte - which was mature but failed to fertilize - spontaneously achieving metaphase-II, and was subjected to ICSI. The resulting embryo was replaced on the second day of development, producing a pregnancy that resulted in a healthy live birth. Post-denudation in vitro maturation could be considered as a tool to improve reproductive outcomes in selected patients, such as poor responders.

Sperm of poor quality may affect syngamy after fertilization, embryo development up to the blastocyst stage and reproductive outcome. Subsequently, sperm selection based on morphological characteristics and sperm DNA quality may help to partially avoid these problems. Today, highly efficient sperm selection based on morphological characteristics can be attained using the motile sperm organelle morphology (MSOME) examination, and the spermatozoa selected can be used for ICSI through a fertilization strategy known as intra-cytoplasmic morphologically selected sperm injection (IMSI). The aim of this investigation was to develop a simple methodology to assess sperm DNA fragmentation in single spermatozoa following MSOME/ IMSI, to test the hypothesis that morphologically normal spermatozoa, with an absence of vacuolization, is free of DNA damage. The results indicated that MSOME/IMSI-selected sperm, combined with the Sperm Chromatin Dispersion test (SCD; Oligo-Halosperm), can be reliably used to assess sperm DNA damage in selected single spermatozoa (75% average efficiency), thereby establishing a direct relationship between a good morphological pattern on the sperm and a good DNA quality. Furthermore, results showed spermatozoa presenting a normal morphology and no traces of vacuolization to be fully free of DNA damage. However, traces of vacuolization and more severe morphological alterations were accompanied by significant increases in the proportion of sperm containing a damaged DNA molecule. Interestingly, subtle morphological differences observed between normal and non-vacuolated and normal but vacuolated sperm exhibited significant differrences in the ability of the SCD-Oligo-Halosperm treated sperm to expand DNA fibers following protein depletion.

Although it was qualitatively pointed out by Fahy et al. (1984), the key role of the warming rates in non-equillibrium vitrification has only recently been quantitatively established for murine oocytes by Mazur and Seki (2011). In this work we study the performance of a closed vitrification device designed under the new paradigm, for the vitrification of human oocytes. The vitrification carrier consists of a main straw in which a specifically designed capillary is mounted and where the oocytes are loaded by aspiration. It can be hermetically sealed before immersion in liquid nitrogen for vitrification, and it is warmed in a sterile water bath at 37 °C. Measured warming rates achieved with this design were of 600.000 ºC/min for a standard DMEM solution and 200.000 ºC/min with the vitrification solution for human oocytes. A cohort of 143 donor MII sibling human oocytes was split into two groups: control (fresh) and vitrified with SafeSpeed device. Similar results were found in both groups: survival (97.1%), fertilization after ICSI (74.7% in control vs. 77.3% in vitrified) and good quality embryos at day three (54.3% in control vs. 58.1% in vitrified) were settled as performance indicators. The pregnancy rate was 3/6 (50%) for the control, 2/3 (66%) for vitrified and 4/5 (80%) for mixed transfers., The study received financial support from Fundación Ginemed, Junta de Andalucia (Excellence Project, 2008) and I.N.I.A. (RTA-2012).

Resumen Objetivos Los resultados de los ciclos de fecundacion in vitro (FIV)- inyeccion intracitoplasmatica de espermatozoides (ICSI) en las diferentes clinicas de reproduccion sufren altibajos mas o menos notables a los que no siempre encontramos una explicacion. La sensibilidad de la espermatogenesis a estres de distintos origenes da como resultado a diferentes poblaciones espermaticas. Si tenemos en cuenta que el peso del factor masculino en el ciclo de FIV-ICSI se cifra en torno al 50% (factor masculino puro o mixto), debemos pensar como podria afectar al eyaculado final una situacion de estres ambiental puntual. La periodicidad en las tasas de embarazo en nuestro centro nos hizo pensar que podria haber alguna relacion entre estas y la temperatura registrada en la ciudad. Material y metodos Se hizo un estudio restrospectivo y aleatorizado de las tasas de embarazo registradas en nuestro centro durante 3 anos consecutivos. Se incluyeron pacientes sometidas a ciclos de ICSI, menores de 38 anos, sin fallo ovarico y se excluyeron las pacientes cuyos ovulos fueron microinyectados con semen de donante. Resultados Una vez analizados los datos, se pudo relacionar la disminucion de los resultados de las tasas de embarazo en ciclos de ICSI con las elevadas temperaturas registradas en Sevilla en el periodo estival.

Objective To investigate the effectiveness of intracytoplasmic sperm injection (ICSI) using testicular sperm as a strategy to overcome infertility in men with high sperm DNA fragmentation (SDF). Design Prospective, observational, cohort study. Setting Private IVF centers. Patient(s) A total of 147 couples undergoing IVF-ICSI and day 3 fresh ETs whose male partner has oligozoospermia and high SDF. Intervention(s) Sperm injections were carried out with ejaculated sperm (EJA-ICSI) or testicular sperm (TESTI-ICSI) retrieved by either testicular sperm extraction (TESE) or testicular sperm aspiration (TESA). SDF levels were reassessed on the day of oocyte retrieval in both ejaculated and testicular specimens. Main Outcome Measure(s) Percentage of testicular and ejaculated spermatozoa containing fragmented DNA (%DFI) and clinical pregnancy, miscarriage, and live-birth rates. Result(s) The %DFI in testicular sperm was 8.3%, compared with 40.7% in ejaculated sperm. For the TESTI-ICSI group versus the EJA-ICSI group, respectively, the clinical pregnancy rate was 51.9% and 40.2%, the miscarriage rate was 10.0% and 34.3%, and the live-birth rate was 46.7% and 26.4%. Conclusion(s) ICSI outcomes were significantly better in the group of men who had testicular sperm used for ICSI compared with those with ejaculated sperm. SDF was significantly lower in testicular specimens compared with ejaculated counterparts. Our results suggest that TESTI-ICSI is an effective option to overcome infertility when applied to selected men with oligozoospermia and high ejaculated SDF levels.

The aim of this study was to measure how infertility and assisted reproduction treatments (including artificial insemination) could affect the quality of life, and to evaluate how nurses could be helpful in this process, by alleviating anxiety and increasing the quality of life.A cross-sectional observational study was conducted on 48 patients (26 cycles) in an Assisted Reproduction Unit from 2nd December 2013 to 30th April 2014. Socio-demographic data were obtained, with the quality of life being assessed using the FertiQoL questionnaire before and after the treatment, and the consultations with a nurse by telephone or e-mail of these patients were also analyzed.The study results show a decreased quality of life in these patients, which was worse in men and in couples who had no previous children. Patient-centered care improved quality of life and tolerability to the assisted reproduction treatment. Patients frequently telephoned the nurse to solve their doubts and problems.The present study suggests that nurses can play an important role in improving the quality of life of patients undergoing assisted reproduction treatment.

This study was conducted to test the hypothesis that continuous epididymal sperm depletion after recurrent ejaculations (REC) in contrast to a period of abstinence (ABS) results in a decreased level of sperm DNA fragmentation (SDF) and a consequent increased rate of pregnancy. Forty couples undergoing intra-cytoplasmic injection (ICSI) were asked to abstain from ejaculation for a period of 4 days and then ejaculate once per day for a period of 4 days, followed by a period of abstinence for 12 hours; sperm samples obtained after ABS and REC were assessed for volume, concentration, motility, and SDF and compared in 25 of the patients. Additionally, and in a different experiment, the pregnancy rate of this experimental group (40 couples) was compared to a control group of 150 couples in which the males had abstained from ejaculation for 4 days prior to ejaculation. Sperm selection was performed using density gradient centrifugation prior to ICSI. Semen quality in the REC group that was assessed over the course of the ejaculation schedule showed a decrease in semen volume (67%) and SDF (27%) following sperm selection; there was no difference for sperm motility or sperm concentration. When the pregnancy rate between the 40 couples in the REC group and 150 couples in the control ABS group were compared, the REC group had a pregnancy rate of 56.4% (25/40), whereas the ABS rate was only 43.3% (65/150) (p = 0.030). We conclude that recurrent ejaculation every 24 hours for four days with a final abstinence of 12 hours, combined with sperm selection using density gradient centrifugation, produces a significant increase in pregnancy rate when using ICSI. As ICSI was the strategy selected for fertilization, we propose that the observed reduction in SDF was the primary factor leading to improved reproductive outcome.

The first case of a rare mullerian anomaly characterized by the presence of a complete uterine septum with duplication of the cervix and a longitudinal vaginal septum has been reported very recently. We present here three new cases of such an anomaly in an attempt to alert gynaecologists to the possible occurrence of such a malformation. The cases challenge the classical views of unidirectional (caudad to cranial) mullerian development and support the alternative embryologic hypothesis of Muller et al. according to which fusion and resorption begins at the isthmus and proceeds simultaneously in both the cranial and caudal directions.