GnRH agonist versus GnRH antagonist in poor ovarian responders: A meta-analysis

The aim of this meta-analysis was to compare the efficacy of gonadotrophin antagonist (GnRH-ant) versus GnRH agonist (GnRHa) as coadjuvant therapy for ovarian stimulation in poor ovarian responders in IVF/intracytoplasmic sperm injection cycles. Search strategies included on-line surveys of databases such as MEDLINE, EMBASE and others. A fixed effects model was used for odds ratio (OR) and effect size (weighted mean difference, WMD). Six trials fulfilled the inclusion criteria (randomized controlled trials). There was no difference between GnRH-ant and GnRHa (long and flare-up protocols) with respect to cycle cancellation rate, number of mature oocytes and clinical pregnancy rate per cycle initiated, per oocyte retrieval and per embryo transfer. When the mete-analysis was applied to the two trials that had used GnRH-ant versus long protocols of GnRHa, a significantly higher number of retrieved oocytes was observed in the GnRH-ant protocols [P = 0.018; WMD: 1.12 (0.18, 2.05)]. However, when the meta-analysis was applied to the four trials that had used GnRH-ant versus flare-up protocols, a significantly higher number of retrieved oocytes (P = 0.032; WMD: -0.51, 95% CI -0.99, -0.04) was observed in the GnRHa protocols. Nevertheless, additional randomized controlled trials with better planning are needed to confirm these results.

Recombinant LH supplementation to recombinant FSH during induced ovarian stimulation in the GnRH-antagonist protocol: A meta-analysis

This study aims to compare the efficacy of recombinant LH (rLH) supplementation for ovarian stimulation in gonadotrophin-releasing hormone-antagonist protocol for IVF/intracytoplasmic sperm injection cycles. Search strategies included online surveys of databases. The fixed effects model was used for odds ratio (OR) and effect size (weighted mean difference, WMD). Five trials fulfilled the inclusion criteria. When the meta-analysis was carried out, advantages were observed for the LH supplementation protocol with respect to higher serum oestradiol concentrations on the day of human chorionic gonadotrophin administration (P < 0.0001; WMD: 514, 95% CI 368, 660) and higher number of mature oocytes (P = 0.0098; WMD: 0.88, 95% CI 0.21, 1.54). However, these differences were not observed in the total amount of recombinant FSH (rFSH) administered, days of stimulation, number of oocytes retrieved, the clinical pregnancy rate per oocyte retrieval, the implantation rate and miscarriage rate. This result demonstrates that the association of rLH with rFSH may prevent any decrease in oestradiol after antagonist administration and that a significantly higher number of mature oocytes was available for laboratory work. Nevertheless, it failed to show any statistically significant difference in clinically significant end-points in IVF (implantation and pregnancy rates). Additional randomized controlled trials are needed to confirm these results further. © 2007 Published by Reproductive Healthcare Ltd.

Revisando os efeitos da concentração de oxigênio sobre o desenvolvimento embrionário

Despite the fact that the processes of embryo development and implantation of mammals do not occur in atmospheric tension in vivo, it is common practice in laboratories for in vitro fertilization (IVF) the culture of embryos in an oxygen tension of 20%. The discrepancy between the tensions of oxygen leads to important discussions about their effects in vitro embryo development. It is believed that the culture of embryo in atmospheric oxygen tension can be detrimental to the quality of the data for predisposing them to the negative interference of reactive oxygen species (ROS), resulting in oxidative stress, leading to deleterious effects on metabolism embryo gene expression and blastocysts grown in those conditions. Faced with arguments for and against the culture of embryos in vitro oxygen tensions similar to those found in vivo, this revies article aims to condense and discuss the literature concerning the influence of oxygen tension on the quality of in vitro culture.

HDAC inhibition decreases XIST expression on female IVP bovine blastocysts

During initial development, both X chromosomes are active in females, and one of them must be silenced at the appropriate time in order to dosage compensate their gene expression levels to male counterparts. Silencing involves epigenetic mechanisms, including histone deacetylation. Major X chromosome inactivation (XCI) in bovine occurs between hatching and implantation, although in vitro culture conditions might disrupt the silencing process, increasing or decreasing X-linked gene expression. In this study, we aimed to address the roles of histone deacetylase inhibition by trichostatin A (TSA) on female preimplantation development.We tested the hypothesis that by enhancing histone acetylation, TSA would increase the percentage of embryos achieving 16-cell stage, reducing percentage of embryos blocked at 8-cell stage, and interfere with XCI in IVF embryos. We noticed that after TSA treatment, acetylation levels in individual blastomeres of 8-16 cell embryos were increased twofold on treated embryos, and the samewas detected for blastocysts. Changes among blastomere levels within the same embryo were diminished on TSA group, as low-acetylated blastomeres were no longer detected. The percentage of embryos that reached the 5th cleavage cycle 118 h after IVF, analyzed by Hoechst staining, remained unaltered after TSA treatment. Then, we assessed XIST and G6PD expression in individual female bovine blastocysts by quantitative real-time PCR. Even though G6PD expression remained unaltered after TSA exposure, XIST expression was eightfold decreased, and we also detected a major decrease in the percentage of blastocysts expressing detectable XIST levels after TSA treatment. Based on these results, we conclude that HDAC is involved on XCI process in bovine embryos, and its inhibition might delay X chromosome silencing and attenuate aberrant XIST expression described for IVF embryos. © 2013 Society for Reproduction and Fertility.

Cost-effectiveness comparison between pituitary down-regulation with a gonadotropin-releasing hormone agonist short regimen on alternate days and an antagonist protocol for assisted fertilization treatments

Objective: To compare cost-effectiveness between pituitary down-regulation with a GnRH agonist (GnRHa) short regimen on alternate days and GnRH antagonist (GnRHant) multidose protocol on in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) outcome. Design: Prospective, randomized. Setting: A private center. Patient(s): Patients were randomized into GnRHa (n = 48) and GnRHant (n = 48) groups. Intervention(s): GnRHa stimulation protocol: administration of triptorelin on alternate days starting on the first day of the cycle, recombinant FSH (rFSH), and recombinant hCG (rhCG) microdose. GnRHant protocol: administration of a daily dose of rFSH, cetrorelix, and rhCG microdose. Main Outcome Measure(s): ICSI outcomes and treatment costs. Result(s): A significantly lower number of patients underwent embryo transfer in the GnRHa group. Clinical pregnancy rate was significantly lower and miscarriage rate was significantly higher in the GnRHa group. It was observed a significant lower cost per cycle in the GnRHa group compared with the GnRHant group ($5,327.80 ± 387.30 vs. $5,900.40 ± 472.50). However, mean cost per pregnancy in the GnRHa was higher than in the GnRHant group ($19,671.80 ± 1,430.00 vs. $11,328.70 ± 907.20). Conclusion(s): Although the short controlled ovarian stimulation protocol with GnRHa on alternate days, rFSH, and rhCG microdose may lower the cost of an individual IVF cycle, it requires more cycles to achieve pregnancy. Clinical Trial Registration Number: NCT01468441. © 2013 by American Society for Reproductive Medicine.

Uma pesquisa sobre a opinião pública sobre incentivos financeiros para doação de óvulos no Brasil

Objective: The objective of this study was to assess the opinions of the Brazilian population about incentives for oocyte donation. Methods: A cross-sectional descriptive approach was used to consult the Brazilian public. The data collection involved the use of a structured questionnaire about legal and ethical issues surrounding oocyte donation. Individuals were randomly selected from the general population using different e-mail lists. Potential participants were contacted by e-mail and invited to participate in the study by completing an online web survey. Results: A total of 1,565 people completed the survey, including 1,284 women(82%) and 281 men(18%). Among the respondents, 1,309(83.6%) were university graduates, 1,033(66%) had a personal income ≥1,250 US dollars/month, 1,346(86%) considered themselves to be religious and 518 (33.1%) were health professionals. While many participants believed that women may donate their oocytes for altruistic reasons, the majority believed that a lack of oocyte donations is due to the prohibition of payments(64.3%) and that incentives would facilitate the decision to donate oocytes(84.7%). The majority of the participants(65.3%) agreed that a financial incentive(i.e., paying the donor) would be the most practical solution for increasing the number of oocyte donations. These results tended to be independent of gender, age, income, religion, education level and profession. Conclusion: While the Brazilian Federal Council of Medicine prohibits payments for oocyte donation, the majority of study participants had no objection to compensating oocyte donors. Moreover, most of the participants agreed that a financial incentive is the most practical solution to increasing the number of oocyte donations.

Heparin and penicillamine-hypotaurine-epinephrine (PHE) solution during bovine in vitro fertilization procedures impair the quality of spermatozoa but improve normal oocyte fecundation and early embryonic development

The presence of heparin and a mixture of penicillamine, hypotaurine, and epinephrine (PHE) solution in the in vitro fertilization (IVF) media seem to be a prerequisite when bovine spermatozoa are capacitated in vitro, in order to stimulate sperm motility and acrosome reaction. The present study was designed to determine the effect of the addition of heparin and PHE during IVF on the quality and penetrability of spermatozoa into bovine oocytes and on subsequent embryo development. Sperm quality, evaluated by the integrity of plasma and acrosomal membranes and mitochondrial function, was diminished (P < 0.05) in the presence of heparin and PHE. Oocyte penetration and normal pronuclear formation rates, as well as the percentage of zygotes presenting more than two pronuclei, was higher (P < 0.05) in the presence of heparin and PHE. No differences were observed in cleavage rates between treatment and control (P > 0.05). However, the developmental rate to the blastocyst stage was increased in the presence of heparin and PHE (P > 0.05). The quality of embryos that reached the blastocyst stage was evaluated by counting the inner cell mass (ICM) and trophectoderm (TE) cell numbers and total number of cells; the percentage of ICM and TE cells was unaffected (P > 0.05) in the presence of heparin and PHE (P < 0.05). In conclusion, this study demonstrated that while the supplementation of IVF media with heparin and PHE solution impairs spermatozoa quality, it plays an important role in sperm capacitation, improving pronuclear formation, and early embryonic development. © 2013 The Society for In Vitro Biology.

Influência do herpesvirus bovino tipo 5 no semen congelado de bovino sobre os parâmetros espermáticos e desenvolvimento embrionário in vitro

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Avaliação da integridade do acrossoma, membrana citoplasmática, potencial mitocondrial, cromática e produção de embriões in vitro de sêmen bovino com altos índices de gota citoplasmática proximal

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Efeitos de antioxidantes adicionados ao meio de fecundação in vitro sobre a capacitação espermática e desenvolvimento embrionário em bovinos

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Estímulo da síntese da glutationa na maturação in vitro de oócitos bovinos e sua influência no desenvolvimento embrionário

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

Identificação de espermatozóides portadores do cromossomo X em búfalos (Bubalus bubalis)

Pós-graduação em Medicina Veterinária - FMVZ

Resultados da FIV/ICSI após o desenvolvimento do embrião humano em baixa concentração de oxigênio: uma meta-análise

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Avaliação clínica, morbi-mortalidade e desenvolvimento de bezerros da raça Brahman produzidos por fertilização in vitro e inseminação artificial

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

Avaliação da técnica de aspiração ovocitária transvaginal (Ovum Pick Up) e produção in vitro de embriões da raça nelore (Bos taurus indicus) oriundos de doadoras com alterações da fertilidade

Este experimento teve como objetivo avaliar a possibilidade da utilização de fêmeas zebuínas de elevada qualidade genética, com problemas de fertilidade, adquiridos após um programa de transferência convencional de embriões, como doadoras de ovócitos em um programa de Ovum Pick Up e Produção In Vitro de embriões. Fêmeas da raça Nelore (n=16) (Bos taurus indicus), com idade média de 11 anos e 7 meses, foram submetidas às mesmas condições de ambiente, alimentação e manejo. Estes animais foram retirados do programa de T.E. por apresentarem problemas de fertilidade (cistos ovarianos, infecções genitais, mucometra e alguns casos de repetições de cio sem causa aparente). Os animais foram divididos em dois grupos conforme o tipo de patologia: GRUPO I (n=08) composto por animais que apresentaram patologias ovarianas (cistos) e GRUPO II (n=08) formado por animais com patologias extra ovarianas, ambos os grupos foram submetidos à aspiração folicular (OPU) utilizando dois tipos de agulhas (21G ; 19G ) e pressões (55 e 70mmHg) divididos em quatro tratamentos (T1 = 55/21G; T2 = 55/19G; T3 = 70/21G e T4 = 70/19G), posteriormente os ovócitos submeteramse a PIV. Foram realizadas 149 aspirações e colhidos 879 ovócitos (5,9 4,88) onde GRAU I = 16%; GRAU II = 43%; GRAU III = 21% e GRAU IV = 20%. As médias de ovócitos colhidos no GRUPO I foram (T1 = 7,06 5,10; T2= 7,00 3,64; T3 = 10,60 6,51 e T4 = 2,78 2,59) para os animais pertencentes ao GRUPO II obteve-se (T1= 4,90 4,47; T2= 2,93 3,05; T3 = 6,11 4,11 e T4 = 2,70 2,00). Para as médiasde ovócitos viáveis os resultados foram os seguintes: (T1 = 4,35 3,01; T2 = 4,88 2,96; T3 = 6,87 3,91 e T4 = 1,89 1,90) para o GRUPO I e (T1 = 2,70 2,22; T2 =1,92 1,98; T3 = 3,47 2,27 e T4 = 2,00 1,05) para o GRUPO II. Neste experimento foram levados à PIV 538 ovócitos dos quais 161 (32,85%) clivaram e 65 (13,26%) resultaram em Mórula ou Blastocistos. A análise estatística dos resultados não demonstrou diferença significativa entre os grupos quanto a colheita ovocitária. Quando analisada somente a pressão de sucção, foi observado que o tipo de agulha está diretamente relacionado a pressão da bomba de vácuo. Os melhores resultados foram obtidos com o tratamento T3 = 70/21G, além disso pode-se observar que as melhores médias de ovócitos colhidos foram as obtidas no grupo de animais que apresentaram cistos ovarianos (GRUPO I). Desta forma, concluímos neste experimento que a utilização da técnica de OPU/PIV é uma alternativa de grande utilidade no prolongamento da vida reprodutiva de animais zebuínos com alterações na fertilidade.