Unit of Reproductive Medicine

Santiago, Chile

Unit of Reproductive Medicine

Santiago, Chile
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Courbiere B.,Unit of Reproductive Medicine | Courbiere B.,Aix - Marseille University | Oborski V.,Aix - Marseille University | Braunstein D.,Aix - Marseille University | And 5 more authors.
Fertility and Sterility | Year: 2011

Objective: To evaluate the obstetric outcome of women with IVF pregnancies hospitalized for ovarian hyperstimulation syndrome (OHSS). Design: A case-control study. Setting: Department of Obstetrics - Gynecology and Reproductive Medicine. Patient(s): All IVF patients hospitalized for OHSS with a positive pregnancy test matched to an IVF pregnancy control group who did not develop OHSS. Intervention(s): Retrospective study of all clinical and laboratory data. Main Outcome Measure(s): OHSS morbidity, early pregnancy outcome, and obstetric complications. Result(s): The incidence of OHSS requiring hospitalization was 1.14% among 3,504 IVF cycles. Forty patients (31 singletons, 8 twins, and 1 triplet) hospitalized for severe OHSS with a mean duration of hospitalization of 10.2 ± 7.2 days were compared with a control group of 80 IVF pregnancies (48 singletons, 15 twins, and 2 triplets). Early OHSS occurred in 22.5% of patients, and late OHSS in the remaining 77.5% patients. In the OHSS group, 10% had thromboembolic complications. The miscarriage rate was similar for the OHSS group and the control IVF group (17.5% vs. 16%). Concerning ongoing clinical pregnancies, pregnancy-induced hypertension (PIH) and preterm labor were significantly higher in the OHSS group (respectively, 21.2% vs. 9.2% and 36% vs. 10.7%). In the subgroup of singletons, PIH was significantly higher for OHSS pregnancies than for controls. Conclusion(s): Pregnancies after IVF and OHSS are associated with a greater risk of adverse obstetric outcome. Copyright © 2011 American Society for Reproductive Medicine, Published by Elsevier Inc.


Zegers-Hochschild F.,Unit of Reproductive Medicine | Zegers-Hochschild F.,Diego Portales University | Schwarze J.E.,Clinica Monteblanco | Crosby J.A.,Unit of Reproductive Medicine | Musri C.,Unit of Reproductive Medicine
Reproductive BioMedicine Online | Year: 2015

Multinational data on assisted reproduction technologies were collected from 155 institutions in 14 Latin Amerian countries during 2012. Case-by-case data included 47,326 assisted reproduction technology cycles covering over 80% of cycles carried out in Latin America. Treatments included IVF, intracytoplasmic sperm injection (ICSI), frozen embryo transfers, oocyte donations and fertility preservation. Embryo transfer and IVF-ICSI was carried out in 39% of women aged 35-39 years and 31% of women aged 40 years or over. Delivery rate per oocyte retrieval was 20.9% for ICSI and 26.5% for IVF. Multiple births comprised 20.6% twins and 1.2% triplets and over. In oocyte donations, twins reached 27.8% and triplets and over 2.4%. Pre-term births in singletons were 14%. The relative risk of prematurity increased by 4.30 (95% CI 4.1 to 4.6) in twins and 43.8 (95% CI 28.5 to 67.4) in triplets and higher. Perinatal mortality increased from 25.2 per thousand in singletons to 44.4 in twins and 80.7 in triplets and over. Elective single embryo transfer was carried out in only 1.4%, of cycles, with a delivery rate of 30% in women 34 years or younger, and should be considered the way forward provided access is facilitated with public funding. © 2014 Reproductive Healthcare Ltd. Published by Elsevier Inc. All rights reserved.


PubMed | Clinica Monteblanco, Unit of Reproductive Medicine and Diego Portales University
Type: Journal Article | Journal: Reproductive biomedicine online | Year: 2015

Multinational data on assisted reproduction technologies were collected from 155 institutions in 14 Latin American countries during 2012. Case-by-case data included 47,326 assisted reproduction technology cycles covering over 80% of cycles carried out in Latin America. Treatments included IVF, intracytoplasmic sperm injection (ICSI), frozen embryo transfers, oocyte donations and fertility preservation. Embryo transfer and IVF-ICSI was carried out in 39% of women aged 35-39 years and 31% of women aged 40 years or over. Delivery rate per oocyte retrieval was 20.9% for ICSI and 26.5% for IVF. Multiple births comprised 20.6% twins and 1.2% triplets and over. In oocyte donations, twins reached 27.8% and triplets and over 2.4%. Pre-term births in singletons were 14%. The relative risk of prematurity increased by 4.30 (95% CI 4.1 to 4.6) in twins and 43.8 (95% CI 28.5 to 67.4) in triplets and higher. Perinatal mortality increased from 25.2 per thousand in singletons to 44.4 in twins and 80.7 in triplets and over. Elective single embryo transfer was carried out in only 1.4%, of cycles, with a delivery rate of 30% in women 34 years or younger, and should be considered the way forward provided access is facilitated with public funding.


Nygren K.G.,Queen Sophia Hospital | Sullivan E.,University of New South Wales | Zegers-Hochschild F.,Unit of Reproductive Medicine | Mansour R.,Egyptian Center | And 3 more authors.
Fertility and Sterility | Year: 2011

Objective: To analyze information on assisted reproductive technologies (ART) performed globally. Design: Data on access, efficacy, and safety of ART were collected for the year 2003 from 54 countries. Setting: National and regional ART registries globally. Patient(s): Patients undergoing ART globally. Intervention(s): Collection and analysis of international ART registry data. Main Outcome Measure(s): Number of cycles performed in reporting countries and regions globally for different ART procedures with resulting pregnancy, live birth and multiple birth rates. Result(s): A total of 433,427 initiated cycles reported in this registry resulted in 173,424 babies born. This corresponded to a delivery rate per aspiration of 22.4% for in vitro fertilization (IVF), 23.3% for intracytoplasmic sperm injection (ICSI), and a delivery rate per transfer of 17.1% for frozen embryo transfer. Although there is wide variation among countries and regions, the overall proportion of deliveries with twins and triplets from IVF and ICSI was 24.8% and 2.0%, respectively. There were wide variations in access, and compared with the previous report (year 2002), there was a 3.9% increase in the number of reported cycles and a minor increase in the delivery rate per aspiration. There was also a marginal decline in the mean number of embryos transfered and in the rate of multiple births. Conclusion(s): ART access, efficacy, and safety varies greatly globally. Collection and analysis of data over time will benefit ART patients, providers, and policy makers. © 2011 by American Society for Reproductive Medicine.


Zegers-Hochschild F.,Unit of Reproductive Medicine | Schwarze J.-E.,Unit of Reproductive Medicine | Crosby J.A.,Unit of Reproductive Medicine | de Souza M.C.B.,Unit of Reproductive Medicine
Jornal Brasileiro de Reproducao Assistida | Year: 2011

Introduction: Since 1990, the Latin American Registry of Assisted Reproduction (RLA) has registered ART procedures performed in Latin America. The RLA has increased its regional coverage including to date more than 80% of ART cycles performed. 140 centers enter their data directly on line, and an administrative office collects and analyses the data. Material and methods: This paper analyses trends over the last twenty years, as well as biomedical data corresponding to ART procedures initiated between 1990 and 2009, and babies born up to 2010. Overall, the data include 275,883 embryo transfer-cycles, 71,875 deliveries and the birth of 95,436 babies. Results: Some of the major changes include: an increase in the age of female partners undergoing fresh, autologous embryo transfers; and a marked shift towards the use of ICSI over IVF. As expected, there has been a steady increase over the last ten years in the delivery rates with at least one live born per embryo transfer, reaching 25.3% in IVF/ ICSI cycles, and 31.6% in OD cycles. Over the years, there has been a progressive but slight decrease in the mean number of ET, but still, almost one third of all births are either twins or triplets. In the last 15 years, the proportion of transfers of one or two embryos has increased from 11 and 17% in 1995, to 14%· and 43% respectively in 2009, Conclusions: Access to ART has experienced a meager increase during the period covered in this report. Our region faces two main challenges: to facilitate access to ART and to decrease the rate of multiple births. © Todos os direitos reservados a SBRA.


MacKenna A.,Unit of Reproductive Medicine | Crosby J.,Unit of Reproductive Medicine | Zegers-Hochschild F.,Unit of Reproductive Medicine | Zegers-Hochschild F.,Diego Portales University
Reproductive BioMedicine Online | Year: 2013

This study assessed the development of sibling embryos to blastocyst as a prognostic factor for patients undergoing embryo transfer at day 3. A retrospective analysis of a clinical and embryology database including 353 patients who underwent 393 cycles of intracytoplasmic sperm injection with day-3 embryo transfer and excess embryos, maintained in culture until day 5, was performed. Cycles were divided into group A and group B (with and without blastocyst formation, respectively). Age and basal FSH were similar in both groups. Statistically significant differences in clinical pregnancy rates (55.8% versus 40.6%; P = 0.0031), live birth rates (50.0% versus 37.2%; P = 0.012) and implantation rates (34.2% versus 23.7%; P = 0.0035) were observed in groups A and B, respectively. Odds ratios showed women from group A had 1.85- and 1.68-times the odds of patients from group B of achieving clinical pregnancy and a live birth, respectively. Cumulative live birth rate for group A, after one cycle of vitrified-warmed blastocyst transfer, was 66.4%. The development of sibling embryos to blastocyst is a prognostic factor for the outcome of the cycle in which transfer is performed at day 3 and provides valuable information about the prognosis of subsequent cycles. © 2013, Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.


Zegers-Hochschild F.,Unit of Reproductive Medicine
Fertility and Sterility | Year: 2011

Societies in Latin America are not scientifically driven and therefore, the allocation of human and economic resources to research is meager, as a reflection of this as well as other cultural and economic realities. © 2011 American Society for Reproductive Medicine, Published by Elsevier Inc.


Palomba S.,Unit of Reproductive Medicine
Journal of Clinical Endocrinology and Metabolism | Year: 2015

Normogonadotropic anovulation, including polycystic ovary syndrome (PCOS), is one of the main causes of infertility. Recent meta-analysis and randomized controlled trial suggest the use of aromatase inhibitors (ie, letrozole) as effective drug and first-line treatment to restore fertility in these patients. The current manuscript will give a critical, provocative, and personal point of view on the topic. Copyright © 2015 by the Endocrine Society.


Schwarze J.-E.,Unit of Reproductive Medicine | Crosby J.A.,Unit of Reproductive Medicina Unit | Zegers-Hochschild F.,Unit of Reproductive Medicina Unit | Zegers-Hochschild F.,Diego Portales University
Reproductive BioMedicine Online | Year: 2015

Abstract Embryo cryopreservation is an integral part of assisted reproduction techniques; it allows the sequential transfer of all embryos, thus diminishing the risk of multiple pregnancies and associated perinatal complications. To address concerns about the safety of this procedure, neonatal outcome after 43,070 fresh embryo transfers was compared with 12,068 frozen-thawed embryo transfers (FET). After adjusting for maternal age, gestational age, embryo development at time of transfer, number of babies born and gestational order, FET was not found to be associated with an increase in perinatal mortality (odds ratio [OR] 1.72, 95% confidence interval [CI] 0.81 to 3.62); preterm birth (OR 1.05, 95% CI 0.93 to 1.18); or extreme preterm birth (OR 0.82, 95% CI 0.64 to 1.06). Furthermore, after correcting for known confounding factors, FET was found to be associated with an increase in neonatal weight of 39.7 g (95% CI 1.54 to 64.10; P < 0.0001). Embryo cryopreservation was, therefore, not associated with an increase in the risk of poor perinatal outcome. © 2015 Reproductive Healthcare Ltd.


PubMed | Unit of Reproductive Medicine
Type: Journal Article | Journal: The Journal of clinical endocrinology and metabolism | Year: 2015

Normogonadotropic anovulation, including polycystic ovary syndrome (PCOS), is one of the main causes of infertility. Recent meta-analysis and randomized controlled trial suggest the use of aromatase inhibitors (ie, letrozole) as effective drug and first-line treatment to restore fertility in these patients. The current manuscript will give a critical, provocative, and personal point of view on the topic.

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