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de Almeida Ferreira Braga D.P.,Fertility Assisted Fertilization Center | de Almeida Ferreira Braga D.P.,Sapientiae Institute Educational and Research Center in Assisted Reproduction | Borges E.,Fertility Assisted Fertilization Center | Borges E.,Sapientiae Institute Educational and Research Center in Assisted Reproduction
Handbook of Fertility: Nutrition, Diet, Lifestyle and Reproductive Health | Year: 2015

Intracytoplasmic sperm injection (ICSI) has become increasingly popular as a means of infertility therapy. Since its introduction in 1991, it has been a treatment option for couples with male infertility. However, in recent years, the success rate of ICSI has not substantially improved, despite the introduction of new procedures such as preimplantation genetic screening. Several studies have tried to identify the underlying causes of the limited success rate of ICSI. However, no good explanation has been found yet. In fact, the identification of factors that may influence the implantation of in vitro produced embryos is one of the most studied areas in assisted reproductive technology (ART). Special attention has been given to the effects of the patient's lifestyle on the outcomes of ART. In addition, there is a growing concern worldwide on male fertility, since the semen quality has declined in the latter half of the twentieth century. It has been suggested that the sperm quality decline over the past years is due to external agents, such as environmental factors, as well as eating habits and lifestyle. Recent studies have focused on the effect of external agents not only on male fertility but also on the ART treatment success. Many factors, such as weight, exercising, cigarette smoking, alcohol consumption, consumption of drugs of abuse, and other occupational and environmental factors, are reported to be correlated with male fertility. The consumption of caffeine and other eating habits have also been reported to correlate with fertility and ICSI success. The present chapter reviews and discusses the correlation between environmental factors, food intake, and social habits in male patients and its relationship to fertility health and ART outcomes. © 2015 Elsevier Inc. All rights reserved.

Setti A.S.,Sapientiae Institute Educational and Research Center in Assisted Reproduction | De Almeida Ferreira Braga D.P.,Sapientiae Institute Educational and Research Center in Assisted Reproduction | De Almeida Ferreira Braga D.P.,Fertility Assisted Fertilization Center | De Cassia Savio Figueira R.,Fertility Assisted Fertilization Center | And 3 more authors.
Archives of Medical Science | Year: 2012

Introduction: Despite the fact that ovarian stimulation is controlled, it is not always predictable. Because the day of human chorionic gonadotrophin (hCG) injection depends mainly on the patient's ovarian response to gonadotrophins, the day of oocyte retrieval cannot be determined in advance. As a result, oocyte retrievals are often scheduled to occur on weekends, a fact that entails at least one extra working day for the staff, and could lead to physical and psychological stress, especially in embryologists. The aim of this study was to evaluate whether intracytoplasmic sperm injection (ICSI) outcomes are influenced by the day of oocyte retrieval. Material and methods: A total of 327 ICSI cycles, whose retrievals were performed on Wednesdays and Sundays, were analysed in this retrospective study. Cycles were subdivided into two groups according to the day of oocyte retrieval: group W (n = 196), cycles in which oocyte retrieval was performed on Wednesday; and group S (n = 131), cycles in which oocyte retrieval was performed on Sunday. Groups were compared regarding fertilization, implantation, pregnancy and take-home baby rates. Results: No significant differences were observed between groups A and B regarding fertilization rate (68.9% and 72.5%; p = 0.1589), implantation rate (21.8% and 24.3%; p = 0.5714), pregnancy rate (29.9% and 31.6%; p = 0.7129) and take-home baby rate (23.6% and 28.1%; p = 0.4351). Conclusions: A well-trained embryologist's group adhering to staff scheduling allows large programmes to ensure a similar outcome independent of the workload or workday on which embryologists perform the manipulation of gametes. Copyright © 2012 Termedia & Banach.

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.

Cortezzi S.S.,Sapientiae Institute Educational and Research Center in Assisted Reproduction | Garcia J.S.,Federal University of Alfenas | Ferreira C.R.,University of Campinas | Braga D.P.A.F.,Sapientiae Institute Educational and Research Center in Assisted Reproduction | And 7 more authors.
Analytical and Bioanalytical Chemistry | Year: 2011

A bottom-up label-free mass spectrometric proteomic strategy was used to analyse the protein profiles of the human embryonic secretome. Culture media samples used for embryonic culture of patients undergoing intracytoplasmic sperm injection cycles were selected as a test case for this exploratory proof-of-principle study. The media were stored after embryo transfer and then pooled into positive (n∈=∈8) and negative (n∈=∈8) implantation groups. The absolute quantitative bottom-up technique employed a multidimensional protein identification technology based on separation by nano-ultra-high pressure chromatography and identification via tandem nano-electrospray ionization mass spectrometry with data-independent scanning in a hydrid QqTOF mass spectrometer. By applying quantitative bottom-up proteomics, unique proteins were found exclusively in both the positive- and negative-implantation groups, which suggest that competent embryos express and secrete unique biomarker proteins into the surrounding culture medium. The selective monitoring of these possible secretome biomarkers could make viable procedures using single-embryo transfer. [Figure not available: see fulltext.] © 2011 Springer-Verlag.

Setti A.S.,Sapientiae Institute Educational and Research Center in Assisted Reproduction | Cortezzi S.S.,Sapientiae Institute Educational and Research Center in Assisted Reproduction | Figueira R.D.C.S.,Fertility Assisted Fertilization Center | Martinhago C.D.,RDO Medical Diagnosis | And 5 more authors.
Journal of Assisted Reproduction and Genetics | Year: 2012

Purpose To evaluate if several genetic loci that are associ- ated with variation in normal menopause age and early menopause can account for a poor response to controlled ovarian stimulation. Methods A total of 71 patients age ≥35 years old who were undergoing intracytoplasmic sperm injection were genotyped for four genetic variants that are associated with normal variation in menopausal age and early menopause. The patients were divided into two groups based upon treatment response: a poor responder group (PR group, n = 21) and a normal responder group (NR group, n =n 50). The genetic variants rs244715, rs9379896,rs4806660 and rs16991615 were analyzed. Results There was no significant difference in the incidence of the genetic variants between the NR and PR group. The risk allele for the chromosome 19 variant (rs4806660) demonstrated a protective effect for a poor ovarian response. The presence of a risk allele was associated with an increased response to COS, which resulted in an elevated number of follicles (Coef: 2.54, P = 0.041) and retrieved oocytes (Coef: 1.41, P = 0.041). Conclusions The genetic variants rs244715, rs9379896, rs4806660 and rs16991615 are not risk factors for poor ovarian response in Brazilian women. In contrast, rs4806660 is associated with higher number of follicles and retrieved oocytes. rs4806660 may be associated with an increased response to gonadotrophin stimulation in this population. © 2012 The Author(s).

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