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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. Source


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. Source


Maldonado L.G.L.,Sao Paulo State University | Franco Jr. J.G.,Sao 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. Source


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. Source


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. Source

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