Fertility Assisted Fertilization Center

São Paulo, Brazil

Fertility Assisted Fertilization Center

São Paulo, Brazil

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De Almeida Ferreira Braga D.P.,Fertility Assisted Fertilization Center | De Almeida Ferreira Braga D.P.,Sapientiae Institute | Setti A.S.,Sapientiae Institute | Figueira R.C.S.,Sapientiae Institute | And 6 more authors.
Urology | Year: 2011

Objective: To (1) analyze possible relationships between motile sperm organelle morphology examination (MSOME) and sperm chromatin status, aneuploidy incidence, and patient's age; (2) determine the effects of sperm morphologic abnormalities on intracytoplasmic sperm injection (ICSI) outcomes; and (3) identify the benefits of intracytoplasmic morphologically selected sperm injection (IMSI) in patients with high DNA fragmentation rate. Methods: The study was performed in 50 patients undergoing ICSI cycles. The MSOME, sperm DNA fragmentation, and sperm aneuploidy incidence were performed in 200 sperm cells of each patient. Regression models were used to assess the relationships among sperm morphology and sperm aneuploidy, sperm DNA fragmentation, patient's age, and ICSI outcomes. In cycles with patients showing a high incidence of DNA fragmentation, oocytes were split into 2 groups according to the sperm selection method: Standard-ICSI (n = 82) and IMSI (n = 79). Fertilization and high-quality embryo rates were compared between the groups. Results: A close relationship between sperm DNA fragmentation and the presence of vacuoles in the MSOME was noted. The patient's age was correlated to the presence of vacuoles. No correlation between sperm aneuploidy and IMSI was observed. Vacuolated cells were negatively correlated with fertilization, pregnancy, and implantation. In patients with a high incidence of sperm DNA fragmentation, fertilization and high-quality embryo rates were similar when comparing IMSI and Standard-ICSI. Conclusions: Our data demonstrate a correlation between paternal age and the incidence of nuclear vacuoles, as well as an effect of large and small vacuoles on late embryo development. © 2011 Elsevier Inc. All Rights Reserved.


Bonetti T.C.S.,University of Sao Paulo | Salomao R.,University of Sao Paulo | Brunialti M.,University of Sao Paulo | Braga D.P.A.F.,Fertility Assisted Fertilization Center | And 2 more authors.
Human Reproduction | Year: 2010

Background: Changes in the endometrium are not regulated exclusively by ovarian hormones; the immune system has also been implicated in normal endometrial function, similar to processes taking place during inflammatory and reparative path. Many cytokines are crucially important for reproductive processes, and the role of cytokines in the female reproductive system function has been broadly investigated during controlled ovarian stimulation (COS) for IVF attempts. The aim of this study was to evaluate the levels of serum cytokines and hormones, and the clinical outcomes of women who underwent COS and ICSI procedures. Methods: The study prospectively included 96 patients (aged 22-43 years, unexplained or male infertility, n = 61; female infertility factors, n = 35) who underwent ICSI cycles. Serum levels of interleukin (IL-8, IL-6, IL-1, IL-10, IL-12), tumour necrosis factor and leukaemia-inhibitory factor (LIF) and the hormones FSH, estradiol, progesterone, anti-Mullerian hormone and Inhibin-B were measured on the day of oocyte retrieval. Results: The ongoing pregnancy rate was 25.3. The presence of serum IL-1 positively affected the implantation rate (P = 0.004) and increased the chance of becoming pregnant by 15 fold. Furthermore, the percentage of patients with detectable serum IL-1 levels who conceived (62.5) was higher than those who failed to conceive (37.5; P = 0.019). The LIF was undetectable in all serum samples, and no other factors influenced the clinical outcomes of patients undergoing ICSI cycles. Conclusions: Our findings revealed that detectable serum levels of IL-1 on the day of oocyte retrieval in patients undergoing COS and ICSI are predictive of successful implantation and ongoing pregnancy. © 2010 The Author.


Maldonado L.G.L.,São Paulo State University | Franco Jr. J.G.,São Paulo State University | Franco Jr. J.G.,Prof Franco Jresearch Center For Human Reproduction | Setti A.S.,Sapientiae Institute Educational and Research Center in Assisted Reproduction | And 5 more authors.
Fertility and Sterility | Year: 2013

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.


Souza Setti A.,Sapientiae Institute | Ferreira R.C.,Fertility Assisted Fertilization Center | Paes De Almeida Ferreira Braga D.,Sapientiae Institute | Paes De Almeida Ferreira Braga D.,Fertility Assisted Fertilization Center | And 5 more authors.
Reproductive BioMedicine Online | Year: 2010

The development of a modified intracytoplasmic sperm injection (ICSI), called intracytoplasmic morphologically selected sperm injection (IMSI), demonstrated that a profound morphological investigation of the spermatozoon, under the magnification of 6600×, enables outcome improvement. The aim of this study was to compare ICSI outcome with IMSI outcome. The meta-analysis results demonstrated no significant difference in fertilization rate between ICSI and IMSI groups. However, a significantly improved implantation (odds ratio (OR) 2.72; 95% confidence interval (CI) 1.50-4.95) and pregnancy rate (OR 3.12; 95% CI 1.55-6.26) was observed in IMSI cycles. Moreover, the results showed a significantly decreased miscarriage rate (OR 0.42; 95% CI 0.23-0.78) in IMSI cycles as compared with ICSI cycles. This is the first meta-analysis of published data to evaluate the potential benefits of IMSI. The pooled data of IMSI cycles demonstrate a statistically significant improvement in implantation and pregnancy rates and a statistically significant reduction in miscarriage rates. However, more randomized controlled trials are needed to confirm these results. © 2010, Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.


Setti A.S.,Sapientiae Institute | Figueira R.D.C.S.,Fertility Assisted Fertilization Center | Braga D.P.A.F.,Sapientiae Institute | Braga D.P.A.F.,Fertility Assisted Fertilization Center | And 4 more authors.
Fertility and Sterility | Year: 2011

The comparison between the outcomes of intracytoplasmic morphologically selected sperm injection performed in couples with male factor infertility according to the World Health Organization guidelines from 1999 and 2010 was the objective of this study. Our results suggest that the sperm selection under high magnification results in improved treatment outcomes in patients with oligoasthenoteratozoospermia, according to the new World Health Organization guidelines. © 2011 by American Society for Reproductive Medicine.


Braga D.P.D.A.F.,Fertility Assisted Fertilization Center | Braga D.P.D.A.F.,Sapientiae Institute | Figueira R.D.C.S.,Fertility Assisted Fertilization Center | Queiroz P.,Fertility Assisted Fertilization Center | And 4 more authors.
Fertility and Sterility | Year: 2010

Objective: To evaluate zona pellucida birefringence (ZPB) in immature and mature oocytes collected after controlled ovarian stimulation and to assess the influence of ZPB on oocyte development. Design: Prospective study. Setting(s): Private assisted reproduction centre. Patient(s): Thirty patients undergoing intracytoplasmic sperm injection. Intervention(s): The ZPB of mature and immature oocytes was evaluated using a polarization imaging software module, and the oocytes were classified as high birefringence (HB) or low birefringence. Main Outcome Measure(s): The ZPB of in vivo and in vitro matured oocytes and its influence on spontaneous nuclear maturation in vitro, fertilization, and embryo quality. Result(s): The percentage of HB oocytes was higher in immature than in mature oocytes (40.1 vs. 23.6%). Among immature oocytes, an increased percentage of HB in prophase-I stage oocytes compared to metaphase I stage oocytes was also observed (50.7 vs. 25.0%). However, the percentage of HB oocytes did not change when comparing oocytes before and after in vitro maturation for both prophase I and metaphase I oocytes. No influence of ZPB was observed on the spontaneous in vitro maturation potential. Exclusively for metaphase II retrieved oocytes, a positive influence of ZPB on fertilization (odds ratio [OR], 1.78; 95% confidence interval [CI], 1.27-2.49) and embryo quality (OR, 2.28; 95% CI, 1.04-4.99) was noted. Conclusion(s): ZPB may be a useful tool to predict embryo quality for metaphase-II oocytes. Moreover, the completion of nuclear changes in the production of metaphase-II oocytes in vitro may not reflect their molecular maturity. Copyright © 2010 American Society for Reproductive Medicine, Published by Elsevier Inc.


Madaschi C.,Fertility Assisted Fertilization Center | Braga D.P.A.F.,Fertility Assisted Fertilization Center | De Figueira R.C.S.,Fertility Assisted Fertilization Center | Laconelli Jr. A.,Fertility Assisted Fertilization Center | Borges Jr. E.,Fertility Assisted Fertilization Center
Acupuncture in Medicine | Year: 2010

Background Acupuncture has recently been used as a complementary technique in the management of infertility. It has physiological and psychological effects and may be considered an alternative for stress reduction in women undergoing infertility treatments. Objective To examine the hypothesis that acupuncture treatment may increase the pregnancy rate in patients undergoing intracytoplasmic sperm injection cycles. Methods Patients enrolled in the study were stratified according to age and randomised to either a control group (n=208) or acupuncture group, (n=208). The pregnancy, implantation and abortion rates of the two groups were compared. Results No influence of acupuncture treatment on clinical outcomes was seen; however, when cycles in which the causes of infertility were exclusively tubaluterine or idiopathic were evaluated separately, a positive influence of acupuncture on pregnancy (OR=5.15, 95% Cl 1.03 to 34.5; p=0.048) was noted. Moreover, trends toward an increase in implantation were seen when acupuncture was performed (regression coefficient: 0.645; p=0.092). Conclusion The results suggest that acupuncture treatment had no influence when performed immediately before and immediately after embryo transfer, on clinical outcomes overall. In a subgroup analysis, when the embryo was not affected by an ovarian or seminal influence, a benefit was noted.


Braga D.P.D.A.F.,Fertility Assisted Fertilization Center | Braga D.P.D.A.F.,Sapientiae Institute Educational and Research Center in Assisted Reproduction | Halpern G.,Fertility Assisted Fertilization Center | Figueira R.D.C.S.,Fertility Assisted Fertilization Center | And 4 more authors.
Fertility and Sterility | Year: 2012

Objective: To investigate the influence of the male partner's lifestyle, including eating and social habits, on semen quality and intracytoplasmic sperm injection (ICSI) success. Design: Observational study. Setting: Private fertility clinic. Patient(s): Two hundred fifty male patients undergoing ICSI cycles. Intervention(s): We recorded dietary and social habits using a food frequency questionnaire adapted to meet specific study objectives. Evaluation of semen parameters and ICSI outcomes were performed. Main Outcome Measure(s): Frequency of intake of food items and social habits were registered on a scale with five categories ranging from no consumption to repeated daily consumption. Result(s): The sperm concentration was negatively influenced by body mass index (BMI) and alcohol consumption and was positively influenced by cereal consumption and the number of meals per day. The sperm motility was also negatively influenced by BMI, alcohol consumption, and smoking habit, whereas it was positively influenced by the consumption of fruits and cereals. The consumption of alcohol had a negative influence on the fertilization rate. The consumption of red meat as well as being on a weight loss diet had a negative impact on the implantation rate. In addition, the consumption of red meat and being on a weight loss diet had an effect on the pregnancy chance. Conclusion(s): Couples seeking assisted reproduction treatments must be advised about the drastic effect of both the male and female lifestyle on treatment success.


Figueira R.D.C.S.,Fertility Assisted Fertilization Center | De Almeida Ferreira Braga D.P.,Sapientiae Institute Educational | Semiao-Francisco L.,Fertility Assisted Fertilization Center | Madaschi C.,Fertility Assisted Fertilization Center | And 4 more authors.
Fertility and Sterility | Year: 2010

Morphologic abnormalities in the oocyte are relevant for determining its developmental fate and could be related to controlled ovarian stimulation protocols and ovarian response. The contributing factors of oocyte dysmorphism incidence and its effects on fertilization potential and embryo development are the object of discussion in this study. © 2010 by American Society for Reproductive Medicine.


Figueira R.D.C.S.,Fertility Assisted Fertilization Center | Braga D.P.A.F.,Fertility Assisted Fertilization Center | Braga D.P.A.F.,Sapientiae Institute Educational and Research Center in Assisted Reproduction | Setti A.S.,Sapientiae Institute Educational and Research Center in Assisted Reproduction | And 3 more authors.
Fertility and Sterility | Year: 2011

Objective: To examine the effect of sperm morphology on embryo development at the chromosomal level. Design: Prospective study. Setting: Assisted fertilization center. Patient(s): Couples who underwent IVF-PGS cycle, as a result of advanced maternal age, were randomly allocated into two groups: intracytoplasmic sperm injection (ICSI; n = 60) or intracytoplasmic morphologically selected sperm injection (IMSI; n = 60). Intervention(s): IVF in conjunction with preimplantation genetic screening (PGS). Main Outcome Measure(s): Sperm nuclear morphology at high-magnification ICSI and incidence of aneuploidy in derived embryo. Result(s): There was a significantly increased incidence for sex chromosome aneuploidy in ICSI embryos when compared with IMSI embryos (23.5% vs. 15.0%, respectively). High-magnification sperm selection was associated with a significantly lower risk of sex chromosome abnormalities (odds ratio [OR], 0.57; confidence interval [CI], 0.37-0.90). The incidence of chaotic embryos was also significantly higher with the ICSI procedure (27.5% vs. 18.8%), while the IMSI procedure was associated with a significantly lower risk of chaotic embryos (OR, 0.64; CI, 0.43-0.96). Moreover, the cycle cancellation rate was significantly higher in ICSI cycles (11.8% vs. 2.5%). High-magnification sperm selection was a significant predictor of the likelihood of cycle cancellation (OR, 0.26; CI, 0.11-0.62). Conclusion(s): Spermatozoa free of nuclear morphological malformations were found to be significantly associated with the lower incidence of aneuploidy in derived embryos, resulting in lower rates of cycle cancellation. ©2011 by American Society for Reproductive Medicine.

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