Atualizações Científicas – 20 a 24 de fevereiro de 2012

Publicado em: 27 de Fevereiro de 2012

Artigos sobre Infertilidade Masculina e Feminina e Reprodução Humana foram publicados na última semana. A seguir, o resumo dos artigos para que você possa saber ainda mais sobre o assunto.

Effect of age on decisions about the numbers of embryos to transfer in assisted conception: a prospective study

Publicado em 11 de Fevereiro de 12 pela Lancet, disponível no Pub Med.

Resumo:

BACKGROUND: Elective single-embryo transfer has been proposed as a strategy to reduce the risk of multiple birth and adverse pregnancy outcomes after in-vitro fertilisation (IVF). Whether this approach should be restricted to young women is unclear.

METHODS: In a prospective study of UK Human Fertilisation and Embryology Authority data, we investigated whether perinatal livebirth outcomes varied by the number of embryos transferred in relation to maternal age. We compared rates of livebirth, multiple births, low birthweight (<2·5 kg), preterm birth (<37 weeks), and severe preterm birth (<33 weeks) in women younger than 40 years and those aged 40 years or older. We used logistic and binomial regression methods to assess, respectively, relative risk and absolute differences in risk.

FINDINGS: We assessed 124,148 IVF cycles overall, which yielded 33,514 livebirths. The odds ratios of livebirth were higher in women aged 40 years or older than in those younger than 40 years when two embryos were transferred compared with one embryo (3·12, 95% CI 2·56-3·77 vs 2·33, 2·20-2·46; p=0·0006 for interaction), but the absolute difference in risk of livebirth was smaller (0·090, 0·080-0·099 for women ≥40 years vs 0·156, 0·148-0·163 for those <40 years; p<0·0001). The odds ratios and absolute risk differences for multiple birth, preterm birth, and low birthweight were all smaller in older than in younger women (analyses were done in 32,732 cycles in which a livebirth had resulted and data on gestational age and birthweight were complete). Livebirth rates did not increase with transfer of three embryos, but the risk of adverse perinatal outcomes did increase.

INTERPRETATION: Transfer of three or more embryos at any age should be avoided. The decision to transfer one or two embryos should be based on prognostic indicators, such as age.

Evaluating the association between endometrial cancer and polycystic ovary syndrome

Publicado em 24 de Fevereiro de 12 pela Human Reproduction, disponível no Oxfor Journal.

Resumo:

BACKGROUND: Given the current lack of clarity in the published literature, we performed a systematic review of the literature to determine the exact strength of the association between polycystic ovary syndrome (PCOS) and endometrial cancer (EC).

METHODS: All published studies on the association between PCOS and EC identified through MEDLINE (1966–April 2011), EMBASE (1980–April 2011) and Cochrane (1998–April 2011). Original data were abstracted where available and summarized on a separate Microsoft Excel (2007) database for analysis. A total of 14 studies comparative and non-comparative were identified and included.

RESULTS: The non-comparative and comparative data suggested that women with PCOS were more likely to develop EC. A meta-analyses of five comparative studies showed an increased risk of EC in women with an odds ratio of 2.89 with a 95% confidence interval of 1.52– 5.48.

CONCLUSIONS: Women with PCOS are about three times more likely to develop EC compared with women without it. This translates into a 9% lifetime risk of EC in Caucasian women with PCOS compared with 3% in women without it. Although most women (91%) with PCOS will not develop endometrial cancer, our study has shown that they are more likely at increased risk. More studies are required to clarify the exact molecular mechanisms, determine the best way of screening and preventing disease progression.

Obstetric outcome in singletons after in vitro fertilization with cryopreserved/thawed embryos

Publicado em 22 de Fevereiro de 12 pela Human Reproduction, disponível no Oxfor Journal.

Resumo:

BACKGROUND: There is increasing use of cryopreservation in IVF. This study compared singletons born after cryopreservation with singletons born after fresh IVF cycles and singletons born to women in the general population.

METHODS: Data were collected for Swedish IVF treatments during the years 2002–2006. All singletons from single embryo transfer (SET) and double embryo transfer (DET) after cryopreserved (n ¼ 2348) and fresh cycles (n ¼ 8944) were included and cross-linked with the Swedish Medical Birth Registry and compared with all singletons born after spontaneous conception (n ¼ 571 914). Main outcomes were preterm and very preterm birth and low and very low birthweight (VLBW). Other outcomes were small for gestational age, large for gestational age (LGA), perinatal mortality and maternal outcomes.

RESULTS: Singletons from cryopreserved SET/DET or cryopreserved SET had increased rates of extreme preterm birth compared with singletons from the general population. A lower rate of LBW was found for cryopreserved SET/DET singletons compared with singletons from fresh cycles; however, a higher rate of perinatal mortality was detected. The rates of LGA and macrosomia were increased for cryopreserved SET/DET singletons when compared with those from fresh cycles and the general population. For maternal outcomes, a higher rate of pre-eclampsia was noted for pregnancies from cryopreserved cycles compared with those from fresh cycles or the general population, but the rate of placenta praevia was lower in pregnancies from cryopreserved cycles compared with those from fresh cycles.

CONCLUSIONS: The obstetric outcome of singletons after cryopreservation was slightly poorer when compared with the general population. In comparison with fresh cycles, the outcome varied. The finding of an increased rate of LGA after cryopreservation requires further study.

Periodontal disease: a potential modifiable risk factor limiting conception

Publicado em 22 de Fevereiro de 12 pela Human Reproduction, disponível no Oxfor Journal.

Resumo:

BACKGROUND: Periodontal disease (PD) is a common chronic infectious and inflammatory disease of the gums and its supporting tissues, associated with several adverse health outcomes including significant obstetric consequences. PD is treatable with good oral hygiene and dental care, and consequently is a modifiable variable that may lead to improvements in adult health. To date, there are no published studies describing the influence of PD on a woman’s time to conceive (TTC).

METHODS: This study formed part of the Smile study, which was a multi-centre randomized controlled trial of treatment for PD in midpregnancy. PD was defined as the presence of pockets ≥4-mm deep at ≥12 probing sites in fully erupted teeth. At the time of recruitment, women were asked about their TTC and whether they had required fertility treatment.

RESULTS: Of 3737 pregnant women recruited to the study, information was available from 3416 spontaneous conceptions, including 1014 cases with PD (29.7%). Planned pregnancies accounted for 1956 of the 3416 pregnancies available for study. For 146 women, the TTC was 12 months and PD was more prevalent in this group (34.9% versus 25.7%, P ¼ 0.015). The mean TTC in women with PD was 7.1 months [confidence interval (CI): 5.7–8.6] compared with 5.0 months (CI: 4.4–5.5, P ¼ 0.019) in those without PD. PD was present in 23.8% of Caucasian women and 41.4% of non-Caucasian women. Compared with Caucasian women without PD, non-Caucasian women with PD had an increased likelihood of TTC .12 months [13.9% versus 6.2%, odds ratio (OR): 2.88 (CI: 1.62–5.12), P , 0.001], but there was no difference for Caucasians with PD (8.6% versus 6.2%, OR: 1.15, CI: 0.74–1.79, P ¼ 0.534). Other simultaneous predictors of TTC .1 year included age, BMI .25 and smoking.

CONCLUSIONS: In the non-Caucasian population, PD was associated with an increased TTC, but whether this is related to PD, or some other factor also present within this population, should be further investigated.

Anti-Mullerian hormone as a predictor of follicular reserve in ovarian insufficiency: special emphasis on FSH-resistant ovaries

Publicado em 17 de Janeiro de 12 pela Human Reproduction, disponível no Oxfor Journal.

Resumo:

BACKGROUND: Anti-Mullerian hormone (AMH) is secreted by ovarian granulosa cells and its serum levels reflect ovarian follicle reserve. The main objective of this study was to test the use of AMH assay in identifying women with primary amenorrhea (PA) and existing follicles and to study follicle phase dependent AMH secretion.

METHODS: Serum levels of AMH were measured in subjects with FSH-resistant ovaries (FSHRO, n ¼ 12), primary ovarian insufficiency (POI) with PA (n ¼ 11) or secondary amenorrhea (SA n ¼ 20) of unknown etiology, and controls (n ¼ 23), and in Turner syndrome (TS) [45,X (n ¼ 18), mosaicism (n ¼ 7), structural X chromosome abnormalities (SCA, n ¼ 10)], and healthy controls (n ¼ 34).

RESULTS: Serumlevels ofAMHinwomen with FSHROwere comparable with those in controlwomen (2.76+2.37 versus 3.77+2.36 ng/ml) and significantly higher than in women with PA (0.05+0.04 ng/ml; P , 0.001) or SA of unknown origin (0.12+0.20 ng/ml; P , 0.001). TS girls/ women with 45,X or SCA had low serum AMH levels (0.13+0.09 and 0.27+0.19 ng/ml) compared with their controls (3.34+2.23 ng/ml) or subjects with mosaicism (2.33+2.81 ng/ml). AMH expression was detected in granulosa cells of women with FSHRO but not in any of the 45,X fetal ovarian specimens.

CONCLUSIONS: A serum AMH assay could be used to identify patients with decreasing ovarian reserves and POI. Moreover, our results support the notion that AMH is secreted mainly by small non-selected follicles, since follicular granulosa cells were AMH-positive and serum AMH levels were normal/low normal in women with FSHRO, who lack follicle development beyond the small antral stage.

Oocyte cryopreservation for age-related fertility loss

Publicado em 21 de Fevereiro de 12 pela Human Reproduction, disponível no Oxfor Journal.

Resumo:

The recent introduction of oocyte vitrification has significantly advanced the outcome of oocyte cryopreservation, leading to clinical results comparable to those achieved in IVF using fresh oocytes, as reported by experienced centres. This has lead to new debate, both in the professional community and in society at large, about the acceptability of offering this technology to reproductively healthy women who want to cryopreserve their oocytes against the threat of time. Given the many demands calling for simultaneous realization= in a relatively short period of their lives, many women who want to have children feel to be under considerable pressure. The option of oocyte cryopreservation may in fact give them more breathing space. In this document, it is concluded that the arguments against allowing this application of the technology are not convincing. The recommendations include the need for adequate information of women interested in oocyte cryopreservation, also in order to avoid raising false hopes. The message must remain that women’s best chances of having a healthy child are through natural reproduction at a relative early age. Centres offering this service must have the necessary expertise to employ oocyte cryopreservation efficiently with the so far non-standardized protocols. As data about long-term safety is still lacking, centres also have a responsibility to contribute to the collection of these data.

Congenital heart defects and parental exposure to chemicals

Publicado em 22 de Fevereiro de 12 pela Human Reproduction, disponível no Oxfor Journal.

Resumo:

BACKGROUND: Congenital heart defects (CHDs) are the most common major malformations in newborns. In this study we examined the associations between the occurrence of CHDs in children and periconceptional occupational parental exposures to chemicals.

METHODS: In an age-matched case–control study with standardized data collection at c. 15 months after birth, 424 mothers and 421 fathers of a child with CHD and 480 mothers and 477 fathers of a non-malformed child, filled out questionnaires on periconceptional general and job characteristics. A job exposure matrix, which links the information on job title and a description of work tasks to an expert judgement on exposure to chemicals in the workplace, was used.

RESULTS: The overall prevalence of occupational exposure to chemicals was 5.0 in cases and 6.2% in controls for mothers [odds ratio (OR) adjusted ¼ 0.92; 95% confidence interval (CI): 0.26–3.25], while 22.3 and 15.9% for fathers, respectively (OR adjusted ¼ 1.23; 95% CI: 0.39–3.91). No association of maternal occupational exposure to chemicals with risk of CHDs was found. Paternal exposure to phthalates was associated with a higher incidence of CHDs in general (OR adjusted ¼ 2.08; 95% CI: 1.27–3.40). Paternal exposure to phthalates was associated with perimembranous ventricular septal defect (OR adjusted ¼ 2.84; 95% CI: 1.37–5.92), to polychlorinated compounds with atrioventricular septal defect (OR adjusted ¼ 4.22; 95% CI: 1.23–14.42) and to alkylphenolic compounds with coarctation of the aorta (OR adjusted ¼ 3.85; 95% CI: 1.17–12.67).

CONCLUSIONS: Periconceptional paternal (but not maternal) occupational exposure to certain chemicals is associated with an increased risk of CHDs in children. The results, however, must be interpreted cautiously as exposure probabilities are a crude measure of exposure.

Conteúdo atualizado em: 17 de Abril de 2014

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