Huntington Medicina Reprodutiva

São Paulo, Brazil

Huntington Medicina Reprodutiva

São Paulo, Brazil

Time filter

Source Type

Zanatta A.,Huntington Medicina Reprodutiva | Zanatta A.,Hospital das Clinicas | Rocha A.M.,Huntington Medicina Reprodutiva | Pereira R.M.A.,Huntington Medicina Reprodutiva | And 6 more authors.
Journal of Assisted Reproduction and Genetics | Year: 2010

Purpose: Endometriosis and its associated infertility have been the object of continuous research for over a century. To understand the molecular mechanisms underlying the disease, it has become necessary to determine the aspects of its etiology that are not explained by the retrograde menstruation theory. This could in turn elucidate how various clinical and surgical treatments might affect the evolution and remission of the disease. Methods: This review is focused on the most recent clinical and laboratory findings regarding the association of HOXA10 with endometriosis and infertility. Result: The homebox (Hox/HOX) proteins are highly conserved transcription factors that determine segmental body identities in multiple species, including humans. Hoxa10/HOXA10 is directly involved in the embryogenesis of the uterus and embryo implantation via regulation of downstream genes. Cyclical endometrial expression of Hoxa10/HOXA10, with a peak of expression occurring during the window of implantation, is observed in the adult in response to estrogen and progesterone. Women with endometriosis do not demonstrate the expected mid-luteal rise of HOXA10 expression, which might partially explain the infertility observed in many of these patients. Recent studies also demonstrated HOXA10 expression in endometriotic foci outside the Müllerian tract. Conclusions: Multiple lines of evidence suggest that the actions of the homeobox A10 (Hoxa10/HOXA10) gene could account for some aspects of endometriosis. © 2010 Springer Science+Business Media, LLC.


De Mello Bianchi P.H.,Huntington Medicina Reprodutiva | De Mello Bianchi P.H.,University of Sao Paulo | Serafini P.,Huntington Medicina Reprodutiva | Serafini P.,University of Sao Paulo | And 6 more authors.
Reproductive Sciences | Year: 2010

Ovulation induction (OI) is a cornerstone of human assisted reproduction treatments (ART). Current OI protocols are based on the human follicular dynamics model known as propitious moment theory (PMT), by which follicles continuously grow from the primordial pool without any pattern, and follicular fate depend on the occurrence of a gonadotropin surge. Recently, a new paradigm of human follicular dynamics called follicular waves was revealed using sequential ultrasound examination of 1 interovulatory interval. Instead of random growth, follicles develop in coordinated groups or waves, occurring 2 to 3 times during an interovulatory interval. Follicular waves are common in several other mono-ovulatory species, like equines and bovines. In fact, this model was applied to the development of several OI protocols in veterinary medicine, especially in cows. It has been shown that synchronization of OI with the emergence of a follicular wave increases substantially success rates in animals, even with single embryo transfer. Veterinarians have already developed mechanisms to control wave emergence through mechanical or chemical ablation of the dominant follicle or corpus luteum. Considering the follicular dynamics similarities between humans and bovines regarding the follicular wave phenomenon, we hypothesize that synchronization of follicular wave emergence with ovarian stimulation produces more competent oocytes and embryos and will enhance ART efficiency in humans. At the end of this article, we propose 2 theoretical approaches to induce the emergence of a follicular wave in women: (1) a mechanical strategy by aspiration of the dominant follicle and (2) a pharmacological strategy by administering estradiol and progesterone. © The Author(s) 2010.


Smith G.D.,University of Michigan | Serafini P.C.,Huntington Medicina Reprodutiva | Serafini P.C.,University of Sao Paulo | Fioravanti J.,Huntington Medicina Reprodutiva | And 7 more authors.
Fertility and Sterility | Year: 2010

Objective: To compare cryopreservation of mature human oocytes with slow-rate freezing and vitrification and determine which is most efficient at establishing a pregnancy. Design: Prospective randomized. Setting: Academically affiliated, private fertility center. Patient(s): Consenting patients with concerns about embryo cryopreservation and more than nine mature oocytes at retrieval were randomized to slow-rate freezing or vitrification of supernumerary (more than nine) oocytes. Intervention(s): Oocytes were frozen or vitrified, and upon request oocytes were thawed or warmed, respectively. Main Outcome Measure(s): Oocyte survival, fertilization, embryo development, and clinical pregnancy. Result(s): Patient use has resulted in 30 thaws and 48 warmings. Women's age at time of cryopreservation was similar. Oocyte survival was significantly higher following vitrification/warming (81%) compared with freezing/thawing (67%). Fertilization was more successful in oocytes vitrified/warmed compared with frozen/thawed. Fertilized oocytes from vitrification/warming had significantly better cleavage rates (84%) compared with freezing/thawing (71%) and resulted in embryos with significantly better morphology. Although similar numbers of embryos were transferred, embryos resulting from vitrified oocytes had significantly enhanced clinical (38%) pregnancy rates compared with embryos resulting from frozen oocyte (13%). Miscarriage and/or spontaneous abortion rates were similar. Conclusion(s): Our results suggest that vitrification/warming is currently the most efficient means of oocyte cryopreservation in relation to subsequent success in establishing pregnancy. Copyright © 2010 American Society for Reproductive Medicine, Published by Elsevier Inc.


Losano J.D.A.,University of Sao Paulo | Angrimani D.S.R.,University of Sao Paulo | Pereira R.J.G.,University of Sao Paulo | Rocha A.M.,University of Michigan | And 6 more authors.
Andrologia | Year: 2015

Due to homologies between the chicken egg perivitelline membrane with mammalian zona pellucida proteins, spermatozoa of several species are able to bind to this membrane. However, adequate standardisation is required to attest possible applications of this technique for semen evaluation of a given species. Therefore, we thawed and divided cryopreserved semen samples into two aliquotes, one kept in water bath at 37 °C (thawed) and the other submitted to snap-freezing to damage sperm cells (dead spermatozoa). Aliquotes were mixed into different ratios of thawed:dead cells and analysed for motility, membrane and acrosomal integrity, and mitochondrial activity. In parallel, chicken egg perivitelline membranes were inseminated with these ratios, and the number of spermatozoa bound per mm2 of membrane was assessed by conventional microscopy (CM) and computer-assisted sperm analysis (CASA). Linear regression showed high correlation between thawed:dead sperm ratio and number of spermatozoa bound to the membrane (CM: r2 = 0.91 and CASA: r2 = 0.92 respectively). Additionally, positive correlations were found between the number of spermatozoa bound to the membrane and acrosomal integrity, membrane integrity, mitochondrial activity and motility. These findings indicate that sperm-egg-binding assay associated with CASA is a reliable, practical and inexpensive method for examining the fertilising capacity of cryopreserved bull semen. © 2014 Blackwell Verlag GmbH.


Domingues T.S.,Huntington Medicina Reprodutiva | Rocha A.M.,Huntington Medicina Reprodutiva | Serafini P.C.,Huntington Medicina Reprodutiva | Serafini P.C.,University of Sao Paulo
Current Opinion in Obstetrics and Gynecology | Year: 2010

Purpose of Review: This review discusses ovarian reserve tests for ovulation induction and their application in determining fertility capacity, and their current applications to assess risk of natural ovarian failure and to estimate ovarian function after cancer treatment. Recent Findings: The current arsenal of ovarian reserve tests comprises hormonal markers [basal follicle stimulating hormone, estradiol, inhibin-B, antimullerian hormone (AMH)] and ultrasonographic markers [ovarian volume, antral follicle counts (AFCs)]. These markers have limitations in terms of which test(s) should be used to reliably predict ovarian reserve with regard to accuracy, invasiveness, cost, convenience, and utility. Several studies have correlated sonographic AFCs with serum AMH levels for predicting the ovarian response to ovulation induction protocols during assisted reproduction treatments. Summary: Serum AMH levels and AFC are reliable tests for predicting the ovarian response to ovulation induction. However, none of the currently employed tests of ovarian reserve can reliably predict pregnancy after assisted conception. Further, ovarian reserve tests cannot predict the onset of reproductive and hormonal menopause; thus, they should be used with caution for reproductive life-programming counseling. Moreover, there is no evidence to support the use of ovarian reserve tests to estimate the risk of ovarian sufficiency after cancer treatments. © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins.


Criscuolo T.,Huntington Medicina Reprodutiva | Rocha A.M.,Huntington Medicina Reprodutiva | Semaco E.,Huntington Medicina Reprodutiva | Serzedelo T.,Huntington Medicina Reprodutiva | And 6 more authors.
Jornal Brasileiro de Reproducao Assistida | Year: 2010

Objective: Acrosomal integrity is a feature necessary to the correct interaction of the spermatozoon to the oocyte. The assessment of functional integrity of the acrosome is a useful tool for evaluation of male fertility before assisted reproduction treatments. We aimed to validate a perivitelinic binding test(PBT) for human sperm. Methods: Perivitelinic membranes were washed in PBS for yolk removal and squares of 1cm2 were obtained for the incubation of 1mL of Hepes diluted sperm (105sptz/mL) for 2 hours at 37°C. Membranes were washed in PBS for the removal of unbound sperm and they were mounted onto glass slides for count of motile sperm bound(MSB) to the membrane. Acrosome integrity was also assessed in spear smears stained with fast green/Bengal rose for computation of Pearson's correlation coefficient to MSB. Validation of PBT comprised linear regression of percent of MSB in fresh sperm samples diluted with dead sperm samples (semen plunged into N2L and thawed five times) at the dilution rate of 0:1; 1:4; 1:1; 3:4; 1:0. Pearson's correlation coefficient between MSB and intact acrosome of fresh samples was calculated. Significance was attained at 0.05. Results: Percent of MSB was correlated with acrosome integrity (r=0.65;p=0.04). Furthermore, MSB was also correlated to the dilution rate(r=0.927;p<0.001) and they featured a significant linear relationship (%MSB=0.09 + 0.7730 dilution rate; p-value <0.001).Conclusions: Motile sperm binding to egg yolk membrane is an easy and feasible test for the assessment of functional integrity of acrosome. This is a low cost tool for evaluation of semen before IUI and IVF. © Todos os direitos reservados a SBRA - Sociedade Brasileira de Reprodução Assistida.


Chamie L.P.,Diagnostic Imaging | Blasbalg R.,Diagnostic Imaging | Blasbalg R.,University of Sao Paulo | Ricar-do Mendes A.P.,Huntington Medicina Reprodutiva | And 4 more authors.
Radiographics | Year: 2011

Endometriosis is a common multifocal gynecologic disease that manifests during the reproductive years, often causing chronic pelvic pain and infer-tility. It may occur as invasive peritoneal fibrotic nodules and adhesions or as ovarian cysts with hemorrhagic content. Although findings at physical examination may be suggestive, imaging is necessary for definitive diagnosis, patient counseling, and treatment planning. The imaging techniques that are most useful for preoperative disease mapping are transvaginal ultrasonography (US) after bowel preparation, and magnetic resonance (MR) imaging. Initial transvaginal US is a reliable technique for detecting rectosigmoid endometriotic lesions. MR imaging is indicated as a comple-mentary examination in complex cases of endometriosis with extensive adhesions and ureteral involvement. Peritoneal endometriotic implants are typically hypoechoic on transvaginal US images and demonstrate low signal intensity on T2-weighted MR images. Endometriotic implants most commonly are found in retrocervical and rectosigmoid sites, followed by the vagina, bladder, and ureters. Cysts with low-level internal echoes and echogenic peripheral foci at transvaginal US are suggestive of endome-triomas. MR imaging has high specificity for identifying endometriomas, which are characterized by high signal intensity on T1-weighted images and low signal intensity on T2-weighted images. Correlation of the radiologic imaging features of endometriotic lesions with their laparoscopic appear-ances may help improve individual proficiency in the radiologic diagnosis of endometriosis. © RSNA, 2011.


Piccolomini M.M.,Huntington Medicina Reprodutiva | Nicolielo M.,Huntington Medicina Reprodutiva | Bonetti T.C.S.,Huntington Medicina Reprodutiva | Bonetti T.C.S.,Federal University of São Paulo | And 5 more authors.
Reproductive BioMedicine Online | Year: 2016

The aneuploidy rates in expanded blastocysts biopsied on days 5 and 6 development were assessed in women undergoing IVF followed by array comparative genomic hybridization. This study included 1171 expanded blastocysts from 465 patients. Among the 465 patients, 215 and 141 underwent embryo biopsy on day 5 and day 6 (46.2% and 30.3%, respectively), and 109 underwent biopsy on both days 5 and 6 (23.4%). The cycles of 206 women were cancelled because only aneuploidy embryos were present (44.3%). The aneuploid embryos were classified according to the type as single, double or complex aneuploidy. No differences were observed in the distributions of these three categories according to the day of the biopsy. The aneuploidy rate was also evaluated according to maternal age, and was found to be higher in older patients; however, no differences in this rate were detected between embryos biopsied on days 5 and 6 according to maternal age. Biopsy was carried out when blastocysts reached the expanded stage. The embryos biopsied on day 6 had a higher rate of aneuploidy (69.9%) than those biopsied on day 5 (61.4%); however, the euploid embryos transferred had similar chances for successful and healthy gestation. © 2016 Reproductive Healthcare Ltd.


Chamie L.P.,Fleury Medicina e Saude | Pereira R.M.A.,Huntington Medicina Reprodutiva | Zanatta A.,Huntington Medicina Reprodutiva | Serafini P.C.,Huntington Medicina Reprodutiva | Serafini P.C.,University of Sao Paulo
Radiographics | Year: 2010

Deeply infiltrating endometriosis (DIE) is a common gynecologic disease that is characterized by a difficult and delayed diagnosis. Radiologic mapping of the DIE lesion sites is crucial for case management, patient counseling, and surgical planning. Transvaginal ultrasonography (US) is the initial imaging modality for investigating DIE and has been the focus of several recent studies. DIE typically manifests at imaging as hypoechogenic nodules throughout the affected sites and thickening of the intestinal wall, with some lesions showing a mixed pattern due to cystic areas. Transvaginal US performed after bowel preparation improves the ability to diagnose intestinal lesions and provides invaluable details, including which layers of the intestine are affected and the distance between the lesion and the anal border. It is vital that radiologists be familiar with the technical aspects of this modality and with the US manifestations of DIE lesions. Transvaginal US performed after bowel preparation should be the first-line imaging modality for the evaluation of women with suspected endometriosis. © RSNA, 2010.


PubMed | Huntington Medicina Reprodutiva
Type: Journal Article | Journal: Journal of assisted reproduction and genetics | Year: 2010

endometriosis and its associated infertility have been the object of continuous research for over a century. To understand the molecular mechanisms underlying the disease, it has become necessary to determine the aspects of its etiology that are not explained by the retrograde menstruation theory. This could in turn elucidate how various clinical and surgical treatments might affect the evolution and remission of the disease.this review is focused on the most recent clinical and laboratory findings regarding the association of HOXA10 with endometriosis and infertility.the homebox (Hox/HOX) proteins are highly conserved transcription factors that determine segmental body identities in multiple species, including humans. Hoxa10/HOXA10 is directly involved in the embryogenesis of the uterus and embryo implantation via regulation of downstream genes. Cyclical endometrial expression of Hoxa10/HOXA10, with a peak of expression occurring during the window of implantation, is observed in the adult in response to estrogen and progesterone. Women with endometriosis do not demonstrate the expected mid-luteal rise of HOXA10 expression, which might partially explain the infertility observed in many of these patients. Recent studies also demonstrated HOXA10 expression in endometriotic foci outside the Mllerian tract.multiple lines of evidence suggest that the actions of the homeobox A10 (Hoxa10/HOXA10) gene could account for some aspects of endometriosis.

Loading Huntington Medicina Reprodutiva collaborators
Loading Huntington Medicina Reprodutiva collaborators