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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 | Bonetti T.C.S.,Fertility Assisted Fertilization Center | Bonetti T.C.S.,University of South Florida | Borges E.,University of Sao Paulo | And 7 more authors.
Reproductive BioMedicine Online | Year: 2013

The developmental potential of human embryos has important implications in assisted reproduction and depends, among other factors, on oocyte competency. The receptor for advanced glycation end products (RAGE) is a member of the superfamily of immunoglobulin cell-surface molecules that are constitutively expressed during embryonic development. RAGE is down-regulated in homeostasis in adult life. This study measured the concentration of soluble RAGE (sRAGE) in follicular fluid obtained from the leading follicle after ovarian stimulation of 54 women undergoing intracytoplasmic sperm injection. Corresponding embryos and sRAGE concentrations in follicular fluid were evaluated and correlations were investigated by multi-adjusted regression analysis. High intrafollicular sRAGE concentrations predicted poor-quality embryos (n = 45, OR = 0.986; P = 0.026), adjusted for patient age, body mass index and oocyte quality, showing an inverse association between intrafollicular sRAGE concentrations and embryo development. © 2012, Reproductive Healthcare Ltd.


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.


Cortezzi S.S.,Sapientiae Institute | Cabral E.C.,University of Campinas | Trevisan M.G.,Federal University of Alfenas | Trevisan M.G.,National Institute of Science and Technology of Bioanalytical INCTBio | And 11 more authors.
Reproduction | Year: 2013

This study has evaluated the performance of a multivariate statistical model to predict embryo implantation potential by processing data from the chemical fingerprinting of culture medium samples used for human embryo culture. The culture medium for 113 embryos from 55 patients undergoing ICSI was collected after embryo transfer. The samples were split into positive (n=29) and negative (n=84) implantation groups according their implantation outcomes (100% or 0% implantation). The samples were individually diluted and analyzed by electrospray ionization mass spectrometry (ESI-MS). The m/z ratios and relative abundances of the major ions in each spectrum were considered for partial least square discriminant analysis. Data were divided into two subsets (calibration and validation), and the models were evaluated and applied to the validation set. A total of 5987 ions were observed in the groups. The multivariate statistical model described more than 82% of the data variability. Samples of the positive group were correctly identified with 100% probability and negative samples with 70%. The culture media used for embryos that were positive or negative for successful implantation showed specific biochemical signatures that could be detected in a fast, simple, and noninvasive way by ESI-MS. To our knowledge, this is the first report that uses MS fingerprinting to predict human embryo implantation potential. This biochemical profile could help the selection of the most viable embryo, improving single-embryo transfer and thus eliminating the risk and undesirable outcomes of multiple pregnancies. © 2013 Society for Reproduction and Fertility.


Setti A.S.,Sapientiae Institute | Setti A.S.,Fertility Assisted Fertilization Center | Braga D.P.A.F.,Sapientiae Institute | Braga D.P.A.F.,Fertility Assisted Fertilization Center | And 5 more authors.
Journal of Assisted Reproduction and Genetics | Year: 2012

Purpose: To evaluate the relationship between oocyte dysmorphisms and IMSI outcomes Methods: Data of IMSI cycles performed in 332 patients were included in this study. Patients were included only if presented more than four and less than 30 oocytes upon oocyte retrieval. Patients who underwent IMSI were matched, concerning female age and sperm parameters, with patients who underwent ICSI in the same period (n = 332). The two groups (ICSI and IMSI) were compared with regard to treatment outcomes. The influence of IMSI on fertilization and embryo quality on D3 and D5, when oocyte dysmorphisms were present was analyzed. Results: A total of 6444 oocytes were morphologically evaluated and injected. Regardless of the oocyte quality, IMSI performance was a determinant of the increased odds of development to high quality embryo on D3 (OR: 1.98; CI: 1.54-2.56) and D5 (OR: 3.27; CI: 1.61-6.66). Conclusions: The selection of a morphologically normal spermatozoon under high-magnification is associated with increased embryo quality, regardless of the oocyte morphology. The injection of a spermatozoon, selected under high-magnification, into a morphologically normal oocyte leads to the highest probability of developing high quality embryos. © 2012 Springer Science+Business Media New York.


Setti A.S.,Sapientiae Institute | Figueira R.C.S.,Fertility Assisted Fertilisation Center | Braga D.P.A.F.,Fertility Assisted Fertilisation Center | Colturato S.S.,Fertility Assisted Fertilisation Center | And 4 more authors.
European Journal of Obstetrics Gynecology and Reproductive Biology | Year: 2011

The aim of this study was to perform a meta-analysis of the potential effects of oocyte morphological abnormalities on ICSI outcomes. Relevant original papers reporting on the relation between oocyte morphology and ICSI outcomes were identified by searching MEDLINE, EMBASE and the Cochrane Library. The main outcome measures were fertilisation rate and embryo quality. A meta-analysis was performed and Mantel-Haenszel pooled odd ratios (ORs) with 95% confidence intervals (CIs) were calculated to express the relation between the oocyte morphology and the ICSI outcomes. A total of 14 studies reporting 3688 ICSI cycles were included. Our meta-analysis demonstrates that the probability of an oocyte becoming fertilised is significantly reduced by the presence of large IPB (OR: 0.29, CI: 0.09-0.90), large PVS (OR: 0.86, CI: 0.74-0.99), refractile bodies (OR: 0.66, CI: 0.51-0.84) or vacuoles (OR: 0.59, CI: 0.42-0.83). No other investigated morphological abnormalities demonstrated significant relationships with ICSI outcomes. Our data demonstrate that the presence of large IPB, large PVS, refractile bodies or vacuoles is associated with decreased oocyte fertilisation. Our findings might be of importance for selecting embryos for replacement because the effects of oocyte abnormalities on implantation and pregnancy rates remain unclear. Copyright © 2011 Published by Elsevier Ireland Ltd. All rights reserved.


PubMed | Fertility Medical Group and Sapientiae Institute
Type: Journal Article | Journal: Fertility and sterility | Year: 2016

To study whether embryos derived from oocytes presenting a smooth endoplasmic reticulum cluster (SERC) are less likely to develop into blastocysts and implant.Transversal study.Private university-affiliated invitro fertilization (IVF) center.Total of 7,609 oocytes obtained from 743 intracytoplasmic sperm injection (ICSI) cycles.Oocytes split between the SERC-positive cycles (with at least one SERC-positive oocyte) and the SERC-negative cycles (only oocytes free of SERC).Embryo implantation.A statistically significantly higher mean number of follicles (24.0 10.5 vs. 19.6 10.5), retrieved oocytes (17.8 8.3 vs. 14.3 8.0), and mature oocytes (13.5 6.2 vs. 10.6 5.9) were observed in the SERC-positive cycles as compared with SERC-negative cycles. The implantation rate was statistically significantly lower in SERC-positive cycles as compared with SERC-negative cycles (14.8% vs. 25.6%; odds ratio 0.61; 95% confidence interval, 0.44-0.86). When only cycles with in which none (0) or all the blastocysts transferred had implanted (100%) were analyzed, the mean implantation rate per transferred blastocyst in the SERC-negative group was 20.5%; no blastocysts derived from SERC-positive oocytes implanted.The occurrence of SERC impairs embryo implantation. Careful oocyte observation that takes into account the presence of SERC should be part of embryo selection strategy before transfer.

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