Eficacia del diagnóstico prenatal no invasivo por células fetales libres en sangre materna 1990-2014. Revisión sistemática

ANTECEDENTES: El aislamiento de células fetales libres o ADN fetal en sangre materna abre una ventana de posibilidades diagnósticas no invasivas para patologías monogénicas y cromosómicas, además de permitir la identificación del sexo y del RH fetal. Actualmente existen múltiples estudios que evalúan la eficacia de estos métodos, mostrando resultados costo-efectivos y de menor riesgo que el estándar de oro. Este trabajo describe la evidencia encontrada acerca del diagnóstico prenatal no invasivo luego de realizar una revisión sistemática de la literatura. OBJETIVOS: El objetivo de este estudio fue reunir la evidencia que cumpla con los criterios de búsqueda, en el tema del diagnóstico fetal no invasivo por células fetales libres en sangre materna para determinar su utilidad diagnóstica.  MÉTODOS: Se realizó una revisión sistemática de la literatura con el fin de determinar si el diagnóstico prenatal no invasivo por células fetales libres en sangre materna es efectivo como método de diagnóstico.  RESULTADOS: Se encontraron 5,893 artículos que cumplían con los criterios de búsqueda; 67 cumplieron los criterios de inclusión: 49.3% (33/67) correspondieron a estudios de corte transversal, 38,8% (26/67) a estudios de cohortes y el 11.9% (8/67) a estudios casos y controles. Se obtuvieron resultados de sensibilidad, especificidad y tipo de prueba. CONCLUSIÓN: En la presente revisión sistemática, se evidencia como el diagnóstico prenatal no invasivo es una técnica feasible, reproducible y sensible para el diagnóstico fetal, evitando el riesgo de un diagnóstico invasivo.

Equine conceptus development : a mini review

Many aspects of early embryonic development in the horse are unusual or unique; this is of scientific interest and, in some cases, considerable practical significance. During early development the number of different cell types increases rapidly and the organization of these increasingly differentiated cells becomes increasingly intricate as a result of various inter-related processes that occur step-wise or simultaneously in different parts of the conceptus (i.e., the embryo proper and its associated membranes and fluid). Equine conceptus development is of practical interest for many reasons. Most significantly, following a high rate of successful fertilization (71-96%) (Ball, 1988), as many as 30-40% of developing embryos fail to survive beyond the first two weeks of gestation (Ball, 1988), the time at which gastrulation begins. Indeed, despite considerable progress in the development of treatments for common causes of sub-fertility and of assisted reproductive techniques to enhance reproductive efficiency, the need to monitor and rebreed mares that lose a pregnancy or the failure to produce a foal, remain sources of considerable economic loss to the equine breeding industry. Of course, the potential causes of early embryonic death are numerous and varied (e.g. persistent mating induced endometritis, endometrial gland insufficiency, cervical incompetence, corpus luteum (CL) failure, chromosomal, genetic and other unknown factors (LeBlanc, 2004). However, the problem is especially acute in aged mares with a history of poor fertility in which the incidence of embryonic loss between days 2 and 14 after ovulation has been reported to reach 62-73%, and in which embryonic death is due primarily to embryonic defects rather than to uterine pathology (Ball et al., 1989; Carnevale & Ginther, 1995; Ball, 2000).

The case of pre-natal diagnosis

This chapter reconsiders critiques of pre-natal diagnosis in Disability Studies. Underlying assumptions about reproductive technologies are analysed to demonstrate that while many critiques of pre-natal diagnosis by Disability activists and theorists are concerned about children being the product of 'choice' through the selective effects of pre-natal diagnosis, the issue that reproductive technologies (such as IVF) themselves necessarily always already rely on 'choice' -- namely the choice for a 'biological' or 'own' child (different terms are used) -- is nowhere considered. The chapter considers several consequences of thinking through this issue and its implications.

Administration of beta(2)-adrenergic agonists during the peri-implantation period does not improve implantation or pregnancy rates in intracytoplasmic sperm injection (ICSI) cycles

Purpose: the objective of the present investigation was to determine implantation and pregnancy rates in patients undergoing ICSI and treated with beta(2)-adrenergic agonists, considering the uterine-relaxing action of these agents.Methods: A total of 225 women undergoing ICSI at the Center for Human Reproduction, Sinha Junqueira Maternity Foundation, entered the study. Patient participation in each group was random, by drawing lots, using a randomization table previously elaborated for the study (2:2:1). The group I (90 women) received 10 mg of terbutaline daily for 15 days starting on the day of oocyte retrieval; group II (90 women) received 20 mg of ritodrine daily during the same period of time as group I; group III (45 patients) received no treatment and was used as control. The evaluation was interrupted in 3 patients of group I and in 30 patients of group II because of a high incidence of side effects.Results: Pregnancy, implantation, and miscarriage rates were not significantly different (p>0.05) between the three groups: 29.88%, 13.25%, and 26.9% for group I; 33.33%, 17.5%, and 10.0% for group II; 28.88%, 15.07%, and 15.38% for group III, respectively.Conclusions: the results of this study do not support the routine use of beta(2)-adrenergic agonists during the peri-implantation period in assisted reproductive technology cycles.

Decreased fertility in poor responder women is not related to oocyte morphological status

Introduction: In women showing impaired fertility, a decreased response to ovarian stimulation is a major problem, limiting the number of oocytes to be used for assisted reproduction techniques (ART). Despite the several definitions of poor response, it is still a matter of debate whether young poor responder patients also show a decrease in oocyte quality. The objective in this study was to investigate whether poor ovarian response to the superstimulation protocol is accompanied by impaired oocyte quality.Material and methods: This study included 313 patients younger than 35 years old, undergoing intracytoplasmic sperm injection. Patients with four or fewer MII oocytes (poor-responder group, PR, n = 57) were age-matched with normoresponder patients (NR, n = 256).Results: A higher rate of oocyte retrieval and a trend towards an increase in MII oocyte rate were observed in the NR group when compared to the PR group (71.6 +/- 1.1% and 74.1 +/- 1.0% vs. 56.3 +/- 2.9% and 66.5 +/- 3.7%; p < 0.0001 and p = 0.056, respectively). A trend toward increased implantation rates was observed in the NR group when compared to the PR group (44 and 24.5 +/- 2.0% vs. 28.8 and 16.4 +/- 3.9%; p = 0.0305 and p = 0.0651, respectively).Conclusions: Low response to ovarian stimulation is apparently not related to impaired oocyte quality. However, embryos produced from poor responder oocytes show impaired capacity to implant and to carry a pregnancy to term.

Decrease of the DNA damage levels after sperm preparation by layering method

The aim of this prospective study was to determine the DNA fragmentation levels before and after sperm preparation by layering method. A total of 78 patients submitted to assisted reproduction technology (ART) for infertility treatment were evaluated. Ejaculated spermatozoa were obtained by masturbation on the day of ART procedure. The evaluation of DNA fragmentation was performed in the fresh semen and after preparation by a layering method, respectively. After washing with PBS, the sperm pellets were smears and then processed for the terminal deoxyribonucleotidyl transferase (TdT)-mediated dUTP nick-end labelling (TUNEL) assay that was performed using a Cell Death Detection Kit with tetramethylrhodamine-labelled dUTP. For quantitative evaluation, 200 spermatozoa in randomly selected areas on microscope slides were evaluated and the percentage of TUNEL positive spermatozoa was determined. If ≥20% of selected sperm were TUNEL positive, the exam was considered abnormal. The mean percentage of DNA sperm fragmentation before sperm preparation was 17±8.3% and after 7.8±6.5% (p<0.0001). The exam was considered normal in 49 patients before preparation and in 73 patients after (p<0.0001). The sperm preparation with a layering method for the ART procedure is effective to select sperm with a significant decrease of the DNA damage.

Agonistas do GnRH, antagonistas do GnRH e a reprodução assistida: Análogos do GnRH x fertilização in vitro

The agonists of gonadotropin-releasing hormone (GnRH) were introduced in ovarian stimulation for in vitro fertilization to avoid a premature surge of luteinizing hormone. Although they are accompanied by some disadvantages, GnRH agonists have become well accepted in clinical practice, and their use is associated with increased rates of pregnancy. The development of GnRH antagonists capable of blocking the pituitary immediately offered a therapeutic option. Comparative studies between the two analogs have suggested that the use of antagonists is associated with a shorter duration of ovulatory stimulus and a decreased incidence of ovarian hyperstimulation syndrome, while the type of GnRH analogues used show no significant effects on the rates of pregnancy and live birth. However, GnRH agonists have other applications in assisted reproductive technology cycles than the pituitary downregulation.

Abordagens dos Direitos Reprodutivos em Materiais Didáticos para a Formação Continuada de Educadoras(es): uma análise a partir dos editais da SECAD

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Avaliação de novos protocolos visando induzir e sincronizar a ovulação em éguas

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Avaliação de diluidores à base de gema de ovo e de lecitina de soja para a congelação de sêmen de Alouatta caraya

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Efeito do tratamento com extrato de pituitaria equina (EPE) e hCG no índice de recuperação de oócitos e maturação folicular em equinos

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Histerossonografia em mulheres inférteis candidatas às ténicas de reprodução assistida

Pós-graduação em Ginecologia, Obstetrícia e Mastologia - FMB

"Avaliação andrológica e criopreservação de sêmen de Ateles (macaco-aranha) mantidos em cativeiro"

A biotecnologia aplicada à reprodução é uma ferramenta também importante para conservação de espécies ameaçadas de extinção. Algumas espécies de primatas não-humanos neotropicais têm sido amplamente agredidas por ações antrópicas, ocasionando a inclusão de 26 espécies brasileiras na lista oficial de animais ameaçados de extinção do IBAMA. As espécies de primatas não humanos Ateles belzebuth e Ateles paniscus, participantes do gênero Ateles, popularmente chamados de macaco-aranha, encontram-se particularmente ameaçadas. Poucos estudos são realizados acerca do status populacional destas espécies e menos ainda sobre dados reprodutivos e reprodução assistida. O presente trabalho pretendeu avaliar as características andrológicas de exemplares de primatas não humanos do gênero Ateles em cativeiro e comparar a performance dos diluentes TES e CEBRAN II, este último à base de ringer lactato, como criopreservadores de sêmen destas espécies. O experimento foi realizado utilizando 06 exemplares machos de primatas não humanos do gênero Ateles (02 exemplares de Ateles marginatus e 04 exemplares de Ateles paniscus) mantidos sob as mesmas condições de cativeiro no Centro Nacional de Primatas (CENP-SVS/MS), em Ananindeua, Pará. Os animais utilizados foram submetidos a exame clínico-andrológico e biometria testicular, antes da colheita seminal realizada por eletroejaculação. Foram realizadas avaliações físicoquímicas e de patologias espermáticas, além de avaliação de motilidade e vigor no sêmen a fresco e pós-diluição com os diluentes TES e CEBRAN II. As alíquotas de sêmen diluídas com os dois diluentes, na proporção 2:1, foram envasadas em minitubos com capacidade para 0,25 ml e criopreservados em nitrogênio líquido. Após descongelação, as doses envasadas foram avaliadas em teste de termo-resistência (T.T.R.). As médias de volume e concentração espermáticas obtidas foram, respectivamente, 1,94 ml (± 0,83) e 3.020.000 sptz/ml (±275,97). O pH 8 foi observado em todas as amostras e todos os exemplares apresentaram coagulação seminal. O índice de patologias espermáticas encontrados foi alto (69,8% ± 9,05) indicando que pode haver influência da sazonalidade reprodutiva nas características seminais encontradas nos animais deste experimento. Os resultados de avaliação de motilidade e vigor do sêmen a fresco, diluído e no T.T.R. não puderam ser analisadas estatisticamente, pois somente o sêmen de 03 animais demonstrou espermatozóides viáveis pós-descongelação, com resultados que sugerem que o diluente TES apresenta melhor eficiência na preservação de sêmen de Ateles do que o diluente CEBRAN II.

Localização da proteína fosfolipase C zeta em extratos esppermáticos de gatos domésticos normospérmicos

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Evaluation of sperm quality in successive regular collections from captive black-and-gold howler monkeys (Alouatta caraya)

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)