Objective: This study aimed to compare the use of semi-rigid and flexible catheters in terms of pregnancy rate and level of difficulty of the embryo transfer (ET) procedure. Methods: Seven hundred and thirty-nine consecutive follicular aspirations for IVF or ICSI performed in our private fertility clinic within a 30-month period were randomly divided into two groups. Patients were allocated to either of the groups at the time of follicular retrieval with the aid of a random number generator according to the catheter used in ET: Group 1 (n = 370) -Frydman Classic Catheter 4.5 catheters; and Group 2 (n = 369) -Frydman Ultrasoft 4.5 catheters. Only patients offered ET in the randomized cycle were included (Group 1 = 363 and Group 2 = 340). Patients did not change groups after catheter allocation. Statistical analysis was carried out using an unpaired t-test or a chi square test as appropriate. Differences with P<0.05 were considered. Results: A statistically significant difference in favor of the use of the Ultrasoft catheter was evident for parameters use of a tenaculum (19.8% vs. 5.9%) or a hysterometer (5.0% vs. 1.2%), presence of blood during post-ET inspection of the catheter (9.9% vs. 3.8%), and implantation rate (13.0% vs. 16.4%). Clinical pregnancy and delivery rates were comparable in both groups. Conclusions: Our results suggest that a softer catheter may help with difficult ETs. Softer catheters, as also reported by other authors, resulted in better implantation rates.
Objective: This study aimed to assess the effects of sperm DNA fragmentation in parents belonging to different age groups. The couples included in the study comprised normozoospermic men and infertile women undergoing conventional IVF.Methods: The results obtained from 163 conventional IVF cycles were analyzed retrospectively. The couples enrolled in the study included women aged between 30 and 37 years. Sperm DNA fragmentation was studied using the TUNEL assay. The patients were split into four groups based on male age and sperm DNA fragmentation, as follows: Group 1: ≤39 years and TUNEL assay ≤20%; Group 2: ≤39 years and TUNEL assay >20%; Group 3: ≥40 years and TUNEL assay ≤20%; and Group 4: ≥40 years and TUNEL assay >20%.Results: No significant differences were found in semen parameters or fertilization rates between groups. Groups with <20% sperm DNA fragmentation showed significant differences in other parameters, including higher blastocyst formation rate (Group 1: 63% and Group 3: 60% vs. Group 2: 43% and Group 4: 41%, p<0.05) and higher expanded blastocyst formation rate (Group 1: 42% and Group 3: 40% vs. Group 2: 21% and Group 4: 18%, p<0.05). Miscarriage rate was significantly higher in Group 4 (42% and 46% vs. 5%, 25% and 5% in Groups 1, 2 and 3, respectively, p<0.05).Conclusions: Our results showed lower blastocyst formation rates from IVF when males had high levels of sperm DNA fragmentation. Higher miscarriage rates were also observed in couples with males aged 40+ years. These results reinforce the need to inform couples with male partners aged 40+ years about the potential risks inherent to fertility treatment.
ObjectiveTo define the appropriate number of embryos to be transferred at day 5.MethodsRetrospective analysis of 784 consecutive fresh day-5 embryo transfers performed between 2007 and 2015, divided in three groups: Group A (N = 219): received the only 2 embryos that reached a transferable stage; Group B (N = 357): received 2 selected embryos among several that reached a transferable stage; Group C (N = 208): received the only 3 developing embryos. Clinical pregnancy, implantation, multiple pregnancy and delivery rates were registered. Kruskal-Wallis and Fisher Exact tests were applied as appropriate.ResultsAge and previous attempts were comparable in the 3 groups. Compared with Group A, Groups B and C had a higher oocyte recovery (10.7 ± 5.6 vs. 14.7 ± 8.0 vs. 13.8 ± 6.6), fertilization rate (75.97% vs. 81.60% vs. 83.29%) and percentage of embryos reaching a transferable stage on day 5 (39.98% vs. 63.99% vs. 60.97%), as well as a significantly higher clinical pregnancy (42.92% vs. 61.06% vs. 58.17%) and implantation rates (21.09% vs. 40.98% vs. 36.97%). The multiple pregnancy rate was higher in Groups B and C than in Group A (11.70% vs. 31.19% vs. 37.19%). The high order multiple pregnancy rate (> 2) was significantly increased in group C (1.06% vs. 0.92% vs. 14.05%).ConclusionsIn patients with 3 or more day 5 developing embryos, delivery rates are similar if 2 or 3 embryos are transferred. The transfer of 3 embryos carries an unacceptable increase in the risk of high order multiple pregnancy, with its known consequences. According to our data, we should not exceed the number of 2 day-5 fresh embryos transferred.
Objetivo: Comparar as taxas de fertilização em FIV e ICSI em pacientes normozoospérmicos e teratospérmicos leves. métodos: Foram estudados 81 casos de pacientes que fizeram o primeiro tratamento de fertilização in vitro. Se incluiram mulheres ≤43 anos com ≥4 oocitos maduros e homens <51 anos. As amostras de semen foram avaliadas segundo a OMS 1999. Estas deviam apresentar uma concentração >20 x 10 6 spz/ml, mobilidade A≥25% e mobilidade A+B≥40%. Foi considerado teratospermia leve os valores de Kruger entre 10 e 13 e normal Kruger ≥14, os casos foram separados em dois grupos: Grupo 1: K=10-13 e Grupo 2: K≥14. Para evitar possíveis falhas de fertilização por FIV, os oocitos foram divididos em dois grupos, um deles foi inseminado por FIV e o outro por ICSI. Resultados: nenhuma diferença na taxa de fertilização entre G1 e G2 foi encontrada (66,1±38,4 vs 71,6±33,3) na FIV convencional. Também não foram encontradas diferenças nos casos em que houve falha total de fertilização (17,2% vs 7,7%) e em que houve fecundação ≥67% (69.0% vs 67.3%). Avaliando-se G1 e G2 juntos, se comparou FIV vs ICSI, observando-se que a ICSI obteve uma diferença maior para taxa de fertilização (69,6±35,1 vs 84,5±18,5) e nos casos em que havia mais de 67% fertilização (67,9% vs 88,9%). A FIV apresentou um número maior de casos com falha total de fertilização (FIV 11,1% vs ICSI 0%). Conclusão: nosso trabalho mostra a vantagem de realizar FIV+ICSI naqueles pacientes com indicação de FIV convencional que realizam tratamento de alta complexidade pela primeira vez. Palavras chaves: Taxa de fertilização, desenvolvimento embrionário, Kruger. RESUmENObjetivo: Comparar las tasas de fecundación de FIV e ICSI en pacientes normozoospérmicos o teratozoospérmicos leves. métodos: Se estudiaron 81 casos con indicación de FIV, que realizaban el primer tratamiento. Se incluyeron mujeres ≤43 años con ≥4 oocitos maduros y hombres <51 años. Las muestras de semen fueron evaluadas según OMS1999. Se incluyeron muestras con concentración ≥20 x 10 6 espermatozoides/ ml, movilidad Grado A ≥25% y movilidad Grado A+B ≥40%.Se consideró teratozoospermia leve, a valores de Kruger entre 10 y 13 y normal Kruger ≥14, se separaron dos grupos: G1: K=10-13 y G2: K≥14. Para prevenir posibles fallas de FIV, los oocitos fueron divididos en dos grupos, uno de ellos fue inseminado por FIV y el otro por ICSI. Resultados: no se observaron diferencias entre G1 y G2 en la tasa de fecundación por FIV convencional (66,1±38,4 vs 71,6±33,3). Tampoco se encontraron diferencias en los casos en que hubo falla total de fecundación (17,2% vs 7,7%) ni en los que hubo fecundación ≥67% (69.0% vs 67.3%). Sumando G1 y G2 se comparó FIV vs ICSI, se observó que el ICSI tuvo una diferencia mayor en la tasa de fecundación (69,6±35,1 vs 84,5±18,5) y en aquellos casos donde hubo fecundación ≥67% (67,9% vs 88,9%). El FIV presentó un número mayor de casos con falla total de fecundación (FIV 11,1% vs ICSI 0%). Conclusión: nuestros resultados muestran la ventaja de realizar FIV+ICSI en aquellos pacientes con indic...
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