Instituto Sapientiae

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Instituto Sapientiae

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Braga D.P.A.F.,Instituto Sapientiae | Setti A.S.,Instituto Sapientiae | Borges Jr. E.,Instituto Sapientiae
Journal of Assisted Reproduction and Genetics | Year: 2013

Purpose: To (i) investigate a possible association between different features of pronuclear (PN) morphology and different features of blastocyst morphology, (ii) evaluate the combination of PN and blastocyst morphologies as a predictive factor for ICSI outcomes and (iii) identify possible contributing factors to poor PN morphology. Methods: This study included 908 normally fertilised zygotes reaching full blastocyst stage, obtained from 350 patients undergoing ICSI cycles, in which the implantations rates were 0 % or 100 %. The influence of PN morphology on blastocyst morphology and on the rates of pregnancy and miscarriage was investigated. Embryos were graded and split into three groups, taking into consideration both the PN and the blastocyst status. The pregnancy rate was compared among these groups. Results: Inner cell mass (ICM) alterations were correlated with the number of nucleolar precursor bodies (NPB), while trophectoderm alterations were correlated with the size of the pronuclei and the distribution of the NPB. The distribution of the NPB had an impact on the chances of pregnancy. A significant difference was observed among the groups regarding the pregnancy rate. The maternal age, number of aspirated follicles and number of retrieved oocytes influenced the incidence of PN defects. Conclusions: These findings suggest that a lower oocyte yield may lead to higher-quality PN zygotes. In addition, different PN features may influence further embryo development, especially the quality of the blastocyst. Moreover, the association between PN and blastocyst morphology may be used as a prognostic tool for implantation. © 2013 Springer Science+Business Media New York.


Setti A.S.,Instituto Sapientiae
Reproductive BioMedicine Online | Year: 2015

Abstract The aim of this study was to evaluate the influence of patients' lifestyle factors and eating habits on embryo development. A total of 2659 embryos recovered from 269 patients undergoing intracytoplasmic sperm injection cycles were included. The frequency of intake of food items and social habits were registered and its influences on embryo development evaluated. The consumption of cereals, vegetables and fruits positively influenced the embryo quality at the cleavage stage. The quality of the embryo at the cleavage stage was also negatively correlated with the consumption of alcoholic drinks and smoking habits. The consumption of fruits influenced the likelihood of blastocyst formation, which was also positively affected by the consumption of fish. Being on a weight-loss diet and consumption of red meat had a negative influence on the likelihood of blastocyst formation. The likelihood of blastocyst formation was also negatively influenced by the consumption of alcoholic drinks and by smoking habits. The consumption of red meat and body mass index had a negative effect on the implantation rate and the likelihood of pregnancy. In addition, being on a weight-loss diet had a negative influence on implantation rate. Our evidence suggests a possible relationship between environmental factors and ovary biology. © 2015 Reproductive Healthcare Ltd.


Braga D.P.A.F.,Instituto Sapientiae | Setti A.S.,Instituto Sapientiae | Borges Jr. E.,Instituto Sapientiae
Journal of Assisted Reproduction and Genetics | Year: 2012

Purpose: To identify the correlation between different cycles, patient factors and blastocyst characteristics. Methods: The study included 420 patients undergoing ICSI cycles and 2781 graded blastocysts, which took into account the blastocyst quality. The correlations between the blastocyst parameters and the patient and cycle characteristics were assessed. Results: The blastocyst development was negatively correlated with the maternal age, BMI and dose of FSH. The ICM was negatively correlated with the FSH dose, whereas the TE quality was influenced by the FSH dose, the maternal age and the number of retrieved oocytes. The embryo morphology on days two and three may predict the blastocyst developmental competence. Conclusions: Older patients and patients with high BMI should not be included in extended embryo culture programmes. The extended culture may not favour embryos with poor morphology on days two and three of development. Additionally, a lower ovarian stimulation and decreased oocyte yields may lead to the development of high-quality blastocysts. © 2012 Springer Science+Business Media New York.


Braga D.P.A.F.,Instituto Sapientiae | Setti A.S.,Instituto Sapientiae | Borges Jr. E.,Instituto Sapientiae
Fertility and Sterility | Year: 2013

Objective: To identify the association between oocyte dysmorphisms and blastocyst developmental competence. Design: Case-control study. Setting: Private assisted reproduction center. Patient(s): This study included 5,516 embryos, which were obtained from 605 patients undergoing intracytoplasmic sperm injection cycles in which ET was performed on day 5 of embryo development. Intervention(s): Intracytoplasmic sperm injection and ET. Main Outcome Measure(s): The morphologic characteristics of the blastocysts, namely the degree of blastocoel expansion and hatching status, the size and compactness of the inner cell mass (ICM), and the cohesiveness and number of trophectoderm cells, were correlated with oocyte dysmorphisms. Result(s): Of the 5,516 embryos evaluated, 2,920 (52.9%) reached the blastocyst stage. The blastocysts' degree of expansion and hatching status were decreased by the presence of aggregates of smooth endoplasmic reticulum clusters, large perivitelline space, and shape abnormalities. The presence of a large perivitelline space also decreased the ICM and trophectoderm cell quality. Aggregates of smooth endoplasmic reticulum clusters also decreased the ICM quality, pregnancy rate, and the miscarriage rate. Conclusion(s): The results presented here suggest that the individual identification of oocyte dymorphisms may be a prognostic tool for blastocyst development and quality. However, the results do not diminish the importance of cleavage-stage embryo morphology assessment to predict blastocyst development competence. © 2013 by American Society for Reproductive Medicine.


Koatz J.G.,Instituto Sapientiae
Jornal Brasileiro de Reproducao Assistida | Year: 2013

Objective: To evaluate the effect of female obesity on the results of In Vitro Fertilization (IVF) in six parameters: dose of gonadotropins required, number of oocytes retrieved and fertilization, pregnancy, miscarriage and live births rates. method: Literature search in PUBMED articles in English between 2008 and 2013 using the following keywords: female, obesity and In Vitro Fertilization. 15 articles were selected for this work. Results: From the total only two articles showed that female obesity does not alter the results of IVF. The remaining 13 came to the conclusion that obesity has a negative effect on some of the parameters evaluated. However, there was no consensus about its effect. Conclusion: Further studies are needed to clarify the real role of obesity in female patients undergoing IVF, but the weight loss prior to treatment should always be encouraged. © odos os direitos reservados a SBRA - Sociedade Brasileira de Reprodução Assistida.


Setti A.S.,Instituto Sapientiae | Braga D.P.A.F.,Instituto Sapientiae | Iaconelli Jr. A.,Instituto Sapientiae | Borges Jr. E.,Instituto Sapientiae
European Journal of Obstetrics Gynecology and Reproductive Biology | Year: 2013

Objective To evaluate advanced maternal age as a rationale for performing intracytoplasmic morphologically selected sperm injection (IMSI). Study design This study included couples undergoing intracytoplasmic sperm injection (ICSI) as a result of advanced maternal age (≥37 years old). Sample size calculations were based on the assumption that a 15% difference in implantation rate would mean a clinically significant difference. To achieve this difference, 33 cycles would be needed in each treatment arm (with a significance level of 5% and power of 85%). Couples were randomly allocated to one of two sperm selection procedures (ICSI, n = 33; or IMSI, n = 33). Sperm selection in the ICSI group was analyzed under a magnification of 400×. Sperm selection in the IMSI group was analyzed under high magnification of 6600×. The groups were compared with regard to the outcome of the cycles. Results IMSI cycles showed significantly higher implantation (4/33, 12.1% vs. 18/47, 38.3%, p = 0.026) and pregnancy (4/29, 13.8 vs. 18/30, 60.0%, p < 0.001) rates. The IMSI procedure positively influenced the blastocyst formation rate (RC: 15.00, R2: 49.9%, p = 0.001) and implantation rate (RC: 24.04, R 2: 9.6, p = 0.027), and was determinant to the increased odds of pregnancy (OR: 9.0, CI: 2.17-37.38, p = 0.001). Conclusion It seems that the injection of a morphologically normal spermatozoon overcomes the low oocyte quality in older women, resulting in improved embryo quality and in a 9-fold increase in the clinical pregnancy rate in couples with advanced maternal age. © 2013 Elsevier Ireland Ltd © 2013 Published by Elsevier Ireland Ltd. All rights reserved.


Borges Jr. E.,Instituto Sapientiae | Setti A.S.,Instituto Sapientiae | Braga D.P.D.A.F.,Instituto Sapientiae | Iaconelli Jr. A.,Instituto Sapientiae
Journal of Assisted Reproduction and Genetics | Year: 2013

Purpose: To compare the results of intracytoplasmic morphologically selected sperm injection (IMSI) between cycles in which the swim-up (SUP) or the density gradient centrifugation (DGC) techniques were used for sperm preparation. Methods: We evaluated 70 IMSI cycles performed in women with age ≤ 37 years, undergoing IMSI as result of male factor. The couples were divided into two groups: DGC group (n = 26) and SUP group (n = 44). The groups were compared with regard to IMSI outcomes. Results: There were no significant differences between SUP and DGC groups regarding the number of follicles, oocytes, mature oocytes, oocyte yield and mature oocyte rate. Fertilization rate and high-quality embryos rate on day 5 of development were similar between SUP and DGC groups. Implantation, pregnancy and miscarriage rates were not statistically different between SUP and DGC groups (28.8 vs 33.3 %, 46.2 vs 57.1 % and 8.3 vs 4.2 %, respectively). Conclusions: Both the SUP and the DGC techniques recover improved sperm fractions and result in similar IMSI outcomes. Further randomized trials analyzing both the quality of sperm through MSOME and the IMSI outcomes are needed to elucidate the role of sperm preparation techniques and morphology on IMSI outcomes. © 2013 Springer Science+Business Media New York.


Setti A.S.,Instituto Sapientiae | De Almeida Ferreira Braga D.P.,Instituto Sapientiae | Iaconelli Jr. A.,Instituto Sapientiae | Borges Jr. E.,Instituto Sapientiae
Journal of Assisted Reproduction and Genetics | Year: 2014

Purpose: To investigate if there is a correlation between the prevalence of sperm with large nuclear vacuoles (LNV) and intracytoplasmic sperm injection (ICSI) outcomes. Methods: Two hundred male patients undergoing ICSI had their sperm morphology evaluated through motile sperm organelle morphology examination (MSOME) and the percentage of LNV sperm was recorded and correlated to the ICSI outcomes. Results: The percentage of sperm with LNV negatively influenced the blastocyst formation (S: 16.9, R2: 20.5 %, p = 0.004) and implantation (S: 34.7, R2: 26.2 %, p = 0.001). There were significant differences in the percentage of sperm with LNV between patients in which pregnancy was achieved or not (22.2 % vs. 28.4 %, p < 0.001) and in patients with ongoing pregnancy or not (22.4 % vs. 28.5 %, p < 0.001). The incidence of sperm with LNV was determinant to the decreased odds of pregnancy (OR: 0.74, p < 0.001) and increased odds of miscarriage (OR: 1.46, p < 0.001). The area under the curve (AUC) was sufficient to distinguish between couples which did achieve pregnancy or not (AUC: 0.922, p < 0.001). Conclusions: The MSOME is a prognostic tool in the prediction of ICSI success and could be used to select patients that should have their sperm selected by MSOME for ICSI. © 2013 Springer Science+Business Media.


PubMed | Instituto Sapientiae
Type: Journal Article | Journal: Revista brasileira de ginecologia e obstetricia : revista da Federacao Brasileira das Sociedades de Ginecologia e Obstetricia | Year: 2015

In order to increase the success rate of in vitro fertilization cycles, several studies have focused on the identification of the embryo with higher implantation potential. Despite recent advances in the reproductive medicine, based on the OMICs technology, routinely applicable methodologies are still needed. Thus, in most fertilization centers embryo selection for transfer is still based on morphological parameters evaluated under light microscopy. Several morphological parameters may be evaluated, ranging from the pronuclear to blastocyst stage. In general, despite the day of transfer, some criteria are suggested to present a predictive value for embryo viability when analyzed independently or combined. However, the subjectivity of morphological evaluation, as well as the wide diversity of embryo classification systems used by different fertilization centers shows contrasting results, making the implementation of a consensus regarding different morphological criteria and their predictive value a difficult task. The optimization of embryo selection represents a large potential to increase treatment success rates, allowing the transfer of a reduced number of embryos and minimizing the risks of multiple pregnancy.


Braga D.P.A.F.,Fertility Assisted Fertilisation Center | Braga D.P.A.F.,Instituto Sapientiae | Setti A.S.,Fertility Assisted Fertilisation Center | Setti A.S.,Instituto Sapientiae | And 3 more authors.
Journal of Assisted Reproduction and Genetics | Year: 2014

Purpose: To evaluate: (i) the influence of morphology at cleavage stage on blastocyst formation and implantation, and (ii) whether the transfer of low-quality embryos on day-three would be a better approach than the transfer at blastocyst stage. Methods: This study included 8,444 embryos obtained from 1,125 patients undergoing ICSI cycles between January/2011 and September/2013. The influence of the quality of the embryo on days-two and -three on blastocyst formation and implantation success was evaluated. Moreover, the implantation potential of low-quality embryos, at cleavage stage, transferred on day-three was compared with the implantation potential of low-quality embryos, at cleavage stage, transferred on day-five. Results: Low-quality embryos on day-two had an approximate 20 % decreased chance of achieving the blastocyst stage, and blastocysts derived from low-quality embryos on day-two had a nearly 40 % decrease in the implantation chance. Low-quality embryos on day-three had a 30 % decreased chance of achieving the blastocyst stage, and blastocysts derived from low-quality embryos on day-three had an almost 40 % decreased implantation chance. The implantation rate didn't differ when low-quality embryos on the cleavage stage were transferred on day-three or left in culture and transferred on day-five. Conclusions: The transfer of low-quality embryos on day-three is a better approach than transfer at the blastocyst stage. In addition, the embryo morphology evaluation at the cleavage stage is still needed for the selection of the embryo with the best implantation potential in extended embryo culture programmes. © 2014 Springer Science+Business Media.

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