Publicado em 02/01/2012 - Atualizado 26/07/2019

Atualizações científicas da semana – 19 a 23 de dezembro de 2011


Neste final de ano, a comunidade científica publica mais artigos sobre Reprodução Humana e a Fecondare disponibiliza para você. Confira as atualizações:

Luteal phase support for assisted reproduction cycles.

Publicado em Outubro de 11 pela Cochrane Database Syst Rev, disponível no Pub Med.


BACKGROUND: Progesterone prepares the endometrium for pregnancy by stimulating proliferation in response to human chorionic gonadotropin (hCG),which is produced by the corpus luteum. This occurs in the luteal phase of the menstrual cycle. In assisted reproduction techniques (ART) the progesterone or hCG levels, or both, are low and the natural process is insufficient, so the luteal phase is supported with either progesterone, hCG or gonadotropin releasing hormone (GnRH) agonists. Luteal phase support improves implantation rate and thus pregnancy rates but the ideal method is still unclear. This is an update of a Cochrane Review published in 2004 (Daya 2004).

OBJECTIVES: To determine the relative effectiveness and safety of methods of luteal phase support in subfertile women undergoing assisted reproductive technology.

SEARCH STRATEGY: We searched the Cochrane Menstrual Disorders and Subfertility Group (MDSG) Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL),MEDLINE, EMBASE, PsycINFO, CINAHL, Database of Abstracts of Reviews of Effects (DARE),LILACS, conference abstracts on the ISI Web of Knowledge, OpenSigle for grey literature from Europe, and ongoing clinical trials registered online. The final search was in February 2011.

SELECTION CRITERIA: Randomised controlled trials of luteal phase support in ART investigating progesterone, hCG or GnRH agonist supplementation in in vitro fertilisation (IVF) or intracytoplasmic sperm injection (ICSI) cycles. Quasi-randomised trials and trials using frozen transfers or donor oocyte cycles  were excluded.

DATA COLLECTION AND ANALYSIS: We extracted data per women and three review authors independently assessed risk of bias. We contacted the original authors when data were missing or the risk of bias was unclear. We entered all data in six different comparisons. We calculated the Peto odds ratio (Peto OR) for each comparison.

MAIN RESULTS: Sixty-nine studies with a total of 16,327 women were included. We assessed most of the studies as having an unclear risk of bias, which we interpreted as a high risk of bias. Because of the great number of different comparisons, the average number of included studies in a single comparison was only 1.5 for live birth and 6.1 for clinical pregnancy.Five studies (746 women) compared hCG versus placebo or no treatment. There was no evidence of a difference between hCG and placebo or no treatment except for ongoing pregnancy: Peto OR 1.75 (95% CI 1.09 to 2.81),suggesting a benefit from hCG. There was a significantly higher risk of ovarian hyperstimulation syndrome (OHSS) when hCG was used (Peto OR 3.62, 95% CI 1.85 to 7.06).There were eight studies (875 women) in the second comparison, progesterone versus placebo or no treatment. The results suggested a significant effect in favour of progesterone for the live birth rate (Peto OR 2.95, 95% CI 1.02 to 8.56) based on one study. For clinical pregnancy (CPR) the results also suggested a significant result in favour of progesterone (Peto OR 1.83, 95% CI 1.29 to 2.61) based on seven studies. For the ther outcomes the results indicated no difference in effect.The third comparison (15 studies, 2117 women) investigated progesterone versus hCG regimens. The hCG regimens were subgrouped into comparisons of progesterone versus hCG and progesterone versus progesterone + hCG. The results did not indicate a difference of effect between the interventions, except for OHSS. Subgroup analysis of progesterone versus progesterone + hCG showed a significant benefit from progesterone (Peto OR 0.45, 95% CI 0.26 to 0.79).The fourth comparison (nine studies, 1571 women) compared progesterone versus progesterone + oestrogen. Outcomes were subgrouped by route of administration. The results for clinical pregnancy rate in the subgroup progesterone versus progesterone + transder ma oestrogen suggested a significant benefit from progesterone + oestrogen. There was no evidence of a difference in effect for other outcomes.Six studies (1646 women) investigated progesterone versus progesterone + GnRH agonist. We subgrouped the studies for single-dose GnRH agonist and multiple-dose GnRH agonist. For the live birth, clinical pregnancy and ongoing pregnancy rate the results suggested a significant effect in favour of progesterone + GnRH agonist. The Peto OR for the live birth rate was 2.44 (95% CI 1.62 to 3.67),for the clinical pregnancy rate was 1.36 (95% CI 1.11 to 1.66) and for the ongoing pregnancy rate was 1.31 (95% CI 1.03 to 1.67). The results for miscarriage and multiple pregnancy did not indicate a difference of effect.The last comparison (32 studies, 9839 women) investigated different progesterone regimens:intramuscular (IM) versus oral administration, IM versus vaginal or rectal administration, vaginal or rectal versus oral administration, low-dose vaginal versus high-dose vaginal progesterone administration, short protocol versus long protocol and micronized progesterone versus synthetic progesterone. The main results of this comparison did not indicate a difference of effect except in some subgroup analyses. For the outcome clinical pregnancy, subgroup analysis of micronized progesterone versus synthetic progesterone showed a significant benefit from synthetic progesterone (Peto OR 0.79, 95% CI 0.65 to 0.96). For the outcome multiple pregnancy, the subgroup analysis of IM progesterone versus oral progesterone suggested a significant benefit from oral progesterone (Peto OR 4.39, 95% CI 1.28 to 15.01).

AUTHORS’ CONCLUSIONS: This review showed a significant effect in favour of progesterone for luteal phase support, favouring synthetic progesterone over micronized progesterone. Overall, the addition of other substances such as estrogen or hCG did not seem to improve outcomes. We also found no evidence favouring a specific route or duration of administration of progesterone. We found that hCG, or hCG plus progesterone, was associated with a higher risk of OHSS. The use of hCG should therefore be avoided. There were significant results showing a benefit from addition of GnRH agonist to progesterone for the outcomes of live birth, clinical pregnancy and ongoing pregnancy. For now, progesterone seems to be the best option as luteal phase support, with better pregnancy results when synthetic progesterone is used.


Coasting (withholding gonadotrophins) for preventing ovarian hyperstimulation syndrome.

Publicado em Junho de 11 pela Cochrane Database Syst Rev, disponível no Pub Med.


BACKGROUND: Ovarian hyperstimulation syndrome (OHSS) is an iatrogenic and potentially life threatening condition resulting from excessive ovarian stimulation. Reported incidence varies from 1% to 10% of in vitro fertilization (IVF) cycles. The factors contributing to OHSS have not been completely explained. The release of vasoactive substances secreted by the ovaries under human chorionic gonadotrophin (hCG) stimulation may play a key role in triggering this syndrome. This condition is characterised by a massive shift of fluid from the intra-vascular compartment to the third space resulting in profound intra-vascular depletion and haemoconcentration.

OBJECTIVES: To assess the effect of withholding gonadotrophins (coasting) on the prevention of ovarian hyperstimulation syndrome in assisted reproduction cycles.

SEARCH STRATEGY: For the update of this review we searched the Cochrane Menstrual Disorders and Subfertility Review Group Trials Register (July 2010),CENTRAL(inception to July 2010),MEDLINE (PubMed) (inception to July 2010),and EMBASE (inception to July 2010) for randomised controlled trials (RCTs) in which coasting was used to prevent OHSS.

SELECTION CRITERIA: Only randomised controlled trials (RCTs) in which coasting was used to prevent OHSS were included.

DATA COLLECTION AND ANALYSIS: Two review authors independently selected trials and extracted data. Disagreements were resolved by discussion. Study authors were contacted to request additional information or missing data. The intervention comparisons were coasting versus early unilateral follicular aspiration (EUFA),no coasting or other interventions. Statistical analysis was performed in accordance with the Cochrane Menstrual Disorders and Subfertility Group guidelines.

MAIN RESULTS: This updated review identified 16 studies of which four met the inclusion criteria. There was no evidence of a difference in the incidence of moderate and severe OHSS (odds ratio (OR) 0.53, 95% CI 0.23 to 1.23),live birth (OR 0.48, 95% CI 0.14 to 1.62; P = 0.24) or in the clinical pregnancy rate (OR 0.69, 95% CI 0.44 to 1.08) between the groups. Significantly fewer oocytes were retrieved in coasting groups compared with GnRHa (OR -2.44, 95% CI -4.30 to -0.58; P = 0.01) or no coasting (OR -3.92, 95% CI -4.47 to -3.37; P < 0.0001). Data for coasting versus EUFA were not pooled for number of oocytes retrieved due to heterogeneity (I(2) = 87%).

AUTHORS’ CONCLUSIONS: There was no evidence to suggest a benefit of using coasting to prevent OHSS compared with no coasting or other interventions.


Interventions for trichomoniasis in pregnancy.

Publicado em Maio de 11 pela Cochrane Database Syst Rev, disponível no Pub Med.


BACKGROUND: Vaginitis due to Trichomonas vaginalis is one of the most common of sexually transmitted diseases. Trichomoniasis affects women during pregnancy as well but it is not clearly established whether it causes preterm birth and other  pregnancy complications.

OBJECTIVES: The objective of this review was to assess the effects of various treatments for trichomoniasis during pregnancy.

SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group’s Trials Register (14 January 2011).

SELECTION CRITERIA: Randomized trials comparing anti-trichomonas agents during pregnancy. Trials including symptomatic or asymptomatic women with trichomoniasis were eligible.

DATA COLLECTION AND ANALYSIS: Two review authors assessed eligibility and trial


MAIN RESULTS: We included two trials with 842 pregnant women. In both trials around 90% of women were cleared of trichomonas in the vagina after treatment. In the US trial, women with asymptomatic trichomoniasis between 16 and 23 weeks were treated with metronidazole on two occasions at least two weeks apart. The trial was stopped before reaching its target recruitment because metronidazole was not  effective in reducing preterm birth and there was a likelihood of harm (risk ratio 1.78; 95% confidence interval 1.19 to 2.66). The South African trial recruited women later in pregnancy and did not have the design and power to address adverse clinical outcomes. We excluded two recent studies, identified for the current update, because they did not address the primary question.

AUTHORS’ CONCLUSIONS: Metronidazole, given as a single dose, is likely to provide parasitological cure for trichomoniasis, but it is not known whether this treatment will have any effect on pregnancy outcomes. The cure rate could probably be higher if more partners used the treatment.


Gonadotrophin-releasing hormone antagonists for assisted reproductive technology.

Publicado em Dezembro de 11 pela Cochrane Database Syst Rev, disponível no Pub Med.


BACKGROUND: Gonadotrophin-releasing hormone (GnRH) antagonists can be used to prevent a luteinizing hormone (LH) surge during controlled ovarian hyperstimulation (COH) without the hypo-estrogenic side-effects, flare-up, or long down-regulation period associated with agonists. The antagonists directly and rapidly inhibit gonadotropin release within several hours through competitive binding to pituitary GnRH receptors. This property allows their use at any time during the follicular phase. Several different regimes have been described including multiple-dose fixed (0.25 mg daily from day six to seven of stimulation),multiple-dose flexible (0.25 mg daily when leading follicle is 14 to 15 mm),and single-dose (single administration of 3 mg on day 7 to 8 of stimulation) protocols, with or without the addition of an oral contraceptive pill. Further, women receiving antagonists have been shown to have a lower incidence of ovarian hyperstimulation syndrome (OHSS). Assuming comparable clinical outcomes for the antagonist and agonist protocols, these benefits would justify a change from the standard long agonist protocol to antagonist regimens. This is an update of a Cochrane review first published in 2001, and previously updated in 2006.

OBJECTIVES: To evaluate the effectiveness and safety of gonadotrophin-releasing hormone (GnRH) antagonists with the standard long protocol of GnRH agonists for controlled ovarian hyperstimulation in assisted conception cycle

SEARCH STRATEGY: We performed electronic searches of major databases, for example Cochrane Menstrual Disorders and Subfertility Group Specialised Register, CENTRAL, MEDLINE, EMBASE (from 1987 to April 2010); and handsearched bibliographies of relevant publications and reviews, and abstracts of major scientific meetings, for example the European Society of Human Reproduction and Embryology (ESHRE) and American Society for Reproductive Medicine (ASRM). A date limited search of Cochrane Menstrual Disorders and Subfertility Group Specialised Register, CENTRAL from April 2010 to April 2011 was run. Eighteen studies have been entered into the Classification pending references section of this update. These studies will be appraised for inclusion or exclusion in the next update of this review, due April 2012.

SELECTION CRITERIA: Two review authors independently screened the relevant citations for randomised controlled trials (RCTs) comparing different agonist versus antagonist protocols in women undergoing IVF or ICSI. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trial risk of bias and extracted data. If relevant data were missing or unclear, the authors were contacted for clarification.

MAIN RESULTS: Forty-five RCTs (n = 7511) comparing the antagonist to the long agonist protocols fulfilled the inclusion criteria. There was no evidence of a statistically significant difference in rates of live-births (9 RCTs; odds ratio (OR) 0.86, 95% CI 0.69 to 1.08) or ongoing pregnancy (28 RCTs; OR 0.87, 95% CI 0.77 to 1.00). There was a statistically significant lower incidence of OHSS in the GnRH antagonist group (29 RCTs; OR 0.43, 95% CI 0.33 to 0.57).

AUTHORS’ CONCLUSIONS: The use of antagonist compared with long GnRH agonist protocols was associated with a large reduction in OHSS and there was no evidence of a difference in live-birth rates.

Assisted hatching of human embryos: a systematic review and meta-analysis of randomized controlled trials

Publicado em Julho/Agosto de 2011 pela Hum Reprod Update, disponível no Pub Med.


BACKGROUND: Assisted hatching (AH) is a manipulation of zona pellucida aiming to facilitate embryo implantation.

METHODS: Systematic review and meta-analysis of medical literature was used to evaluate the effect of AH on assisted reproduction outcomes: clinical pregnancy, live birth, multiple pregnancy and miscarriage. Additional analysis was performed in these subgroups: (i) fresh embryos transferred to unselected or non-poor prognosis women; (ii) fresh embryos transferred to women with previous repeated failure; (iii) fresh embryos transferred to women of advanced age; (iv) frozen-thawed embryos transferred to unselected or non-poor prognosis women. Analyses were based on risk ratio and 95% confidence intervals (RR, 95% CIs) using Mantel-Haenszel random effects model.

RESULTS: There were 28 studies (5507 participants) included. AH was related to a trend toward increased clinical pregnancy for all participants (RR = 1.11, 95% CI= 1.00-1.24),with a significant increase in subgroups 2 (RR = 1.73; 95% CI =1.37-2.17) and 4 (RR = 1.36; 95% CI = 1.08-1.72, P< 0.01),but not for subgroups 1 and 3. For multiple pregnancy, a significant increase was observed for all participants (RR = 1.45; 95% CI = 1.11-1.90) and for subgroups 2 (RR = 2.53; 95% CI = 1.23-5.21) and 4 (RR = 3.40; 95% CI = 1.93-6.01). No significant heterogeneity was observed in subgroup analysis.

CONCLUSIONS: AH was related to increased clinical pregnancy and multiple pregnancy rates in women with previous repeated failure or frozen-thawed embryos. However, AH is unlikely to increase clinical pregnancy rates when performed in fresh embryos transferred to unselected or non-poor prognosis women or to women of advanced age. Due to the small sample evaluated by the pool of included studies, no proper conclusions could be drawn regarding miscarriage or live birth.

Antisperm antibodies are not associated with pregnancy rates after IVF and ICSI: systematic review and meta-analysis.

Publicado em Dezembro de 11pela Hum Reprod Update, disponível no Pub Med.


BACKGROUND: Several studies have examined the relationship between direct antisperm antibody (ASA) levels in semen and pregnancy rate after advanced assisted reproductive technologies (ARTs) but the results have been inconsistent. The aim of our study was to further evaluate the relationship between ASA and pregnancy after IVF or ICSI by systematic review and meta-analysis.

METHODS: We conducted a systematic Medline search of all relevant full papers on  direct semen ASA and pregnancy after IVF or ICSI. Three investigators independently reviewed the papers, followed by group discussion to choose the included papers. Meta-analysis was performed to get an odds ratio (OR) for the effect of ASA on pregnancy using IVF or ICSI.

RESULTS: The study identified and analyzed 16 valid studies (10 IVF and 6 ICSI). The study characteristics (including the ASA cutoff values) were heterogeneous. Our meta-analysis revealed that the combined OR for failure to achieve a pregnancy using IVF or ICSI in the presence of positive semen ASA was 1.22 (95% CI: 0.84, 1.77) and 1.00 (95% CI: 0.72, 1.38),respectively. The overall (IVF +ICSI) combined OR was 1.08 (95% CI: 0.85, 1.38).

CONCLUSION: This systematic review and meta-analysis indicate that semen antisperm antibodies are not related to pregnancy rates after IVF or ICSI, suggesting that both forms of ART remain viable options for infertile couples with semen ASA. However, additional, well-designed prospective studies using appropriate ASA cutoff levels are needed to further address this issue.


Corticotropin-releasing hormone, stress and human reproduction: an update Review

Publicado em Dezembro de 11Journal of Reproductive Immunology, disponível no Pub Med.


The stress system has suppressive effects on female and male reproductive function. Corticotrophin-releasing hormone (CRH),the principal regulator of stress, has been identi- fied in the female and male reproductive system. Reproductive CRH participates in various reproductive functions that have an inflammatory component, where it serves as an autocrine and paracrine modulator. These include ovarian and endometrial CRH, which may participate in the regulation of steroidogenesis and the inflammatory processes of the ovary (ovulation and luteolysis) and the endometrium (decidualization and blastocyst implantation) and placental CRH, which is secreted mostly during the latter half of preg- nancy and is responsible for the onset of labor. It has been suggested that there is a “CRH placental clock” which determines the length of gestation and the timing of parturition and delivery. The potential use of CRH-antagonists is presently under intense investiga- tion. CRH-R1 antagonists have been used in animal studies to elucidate the role of CRH in blastocyst implantation and invasion, early fetal immunotolerance and premature labor. The present review article focuses on the potential roles of CRH on the physiology and pathophysiology of reproduction and highlights its participation in crucial steps of preg- nancy, such as implantation, fetal immune tolerance, parturition and fetal programming of the hypothalamic–pituitary–adrenal (HPA) axis.

The influence of maternal and paternal factors on time to pregnancy—a Dutch population-based birth-cohort study: the GECKO Drenthe study

Publicado em 19 de Dezembro de 11Human Reproduction, disponível no Oxfor Journal.


BACKGROUND: Both maternal and paternal factors have been suggested to influence a couple’s fecundity. To investigate this, we exam- ined the role of several maternal and paternal lifestyle and socio-demographic factors as determinants of time to pregnancy (TTP) in a Dutch birth-cohort.

METHODS: Groningen Expert Center for Kids with Obesity (GECKO) Drenthe is a population-based birth-cohort study of children born between April 2006 and April 2007 in Drenthe, a province of The Netherlands. Both partners received extensive questionnaires during preg- nancy. Univariable and multivariable Cox regression analyses were used to determine the impact of the investigated factors on TTP.

RESULTS: A total of 4778 children were born, and the parents of 2997 children (63%) gave their consent to participate. After excluding unintended pregnancies and pregnancies as a result of fertility treatment, the data of 1924 couples were available for analysis. Hazards ratios and 95% confidence intervals of factors influencing TTP in multivariable Cox regression analysis were: maternal age 1.23 (0.98–1.54) for age ,25 years, 1.17 (1.03–1.32) for age 25–30 years and 0.72 (0.61–0.85) for age .35 years (reference category: 30–35 years); paternal age: 1.31 (0.94–1.82) for age ,25 years, 1.11 (0.97–1.28) for age 25–30 years and 0.91 (0.80–1.04 for age .35 years (reference category: 30–35 years); nulliparity: 0.76 (0.68–0.85) versus multiparity; menstrual cycle length: 1.12 (0.95–1.30) for 3 weeks, 0.72 (0.62–0.83) for 4– 6 weeks, 0.68 (0.40–1.16) for .6 weeks and 0.66 (0.54–0.81) for irregular cycle (reference category: 4 weeks); prior contraceptive use: 0.78 (0.67–0.91) for no contraception, 1.68 (1.45–1.95) for condom use, 1.08 (0.89–1.33) for condom use combined with oral contra- ception, 1.40 (1.16–1.70) for intrauterine device and 0.50 (0.25–1.01) for contraceptive injection (reference category: oral contraception); and maternal educational level 0.75 (0.62–0.92) for low education level and 0.81 (0.73–0.90) for medium educational level (reference cat- egory: high educational level).

CONCLUSIONS: This population-based birth-cohort study performed in fertile couples who had conceived revealed neither maternal nor paternal modifiable lifestyle factors were significantly associated with TTP after adjustment for confounding by socio-demographic factors. In contrast, several non-modifiable maternal socio-demographic factors are significant predictors of a couple’s fecundity.

Placental weight in singleton pregnancies with and without assisted reproductive technology: a population study of 536 567 pregnancies

Publicado em 19 de Dezembro de 11Human Reproduction update, disponível no Oxfor Journal.


BACKGROUND: Pregnancies conceived by assisted reproductive technology (ART) are at increased risk of adverse outcomes. Previous studies have suggested increased placental weight and increased placental weight/birthweight ratio in pregnancies associated with adverse outcomes. We therefore studied the association of ART with placental weight and placental weight/birthweight ratio.

METHODS: We included all singleton births in the Medical Birth Registry of Norway during the period 1999 – 2008 (n 1⁄4 536 567, including 8259 after ART). We divided placental weight and placental weight/birthweight ratio into quartiles, and calculated the proportions of ART and spontaneous pregnancies in the lowest and the highest quartile by length of gestation. Thereafter, we estimated crude and adjusted odds ratios (ORs) for being in each quartile of placental weight for ART pregnancies with spontaneous pregnancies as the reference. The analyses were repeated with ART pregnancies subgrouped into IVF or ICSI.

RESULTS: Mean placental weight was 678.9 g in pregnancies conceived by ART, and 673.0 g in pregnancies after spontaneous conception. ART pregnancies were overrepresented in the highest quartile of placental weight and underrepresented in the highest quartile of birth- weight, independent of length of gestation at delivery. Thus, placental weight/birthweight ratio was higher in ART pregnancies. For ART pregnancies, the OR for being in the highest quartile of placental weight was 1.37 (95% confidence interval 1.30–1.45) after adjustment for length of gestation, offspring birthweight, parity, fetal sex, maternal age, pre-eclampsia and diabetes. There was no difference in placental weight/birthweight ratio between IVF and ICSI pregnancies.

CONCLUSIONS: We found larger placentas and a higher placental weight/birthweight ratio among pregnancies conceived by ART com- pared with spontaneous pregnancies, and the difference was independent of length of gestation at delivery and ART method.

The poor responder in IVF: is the prognosis always poor? A systematic review

Publicado em Janeiro/Fevereiro de 2011 Human Reproduction update, disponível no Oxfor Journal.


BACKGROUND: In IVF treatment a considerable proportion of women are faced with a low number of oocytes retrieved. These poor responders have reduced pregnancy rates compared with normal responders. However, this may not be applicable to all poor responders. This review aims at identifying patient characteristics and ovarian reserve tests (ORT) that will determine prognosis for pregnancy in poor responders.

METHODS: A systematic search was conducted in PubMed, Embase, Cochrane and SCOPUS databases in April 2010. Studies regarding patient characteristics or ORT in poor responders and their pregnancy prospects were included. All included papers were summarized in descriptive tables.

RESULTS: Nineteen studies were included. Pooled data of six studies comparing poor and normal responders demonstrated clearly lower pregnancy rates in poor responders (14.8 versus 34.5%). Ten studies indicated that older poor responders have a lower range of pregnancy rates compared with younger (1.5–12.7 versus 13.0–35%, respectively). Four studies showed that pregnancy prospects become reduced when fewer oocytes are retrieved (0–7% with 1 oocyte versus 11.5–18.6% with 4 oocytes). Five studies concerning pregnancy rates in sub- sequent cycles suggested a more favourable outcome in unexpected poor responders, and if ≥2 oocytes were retrieved.

CONCLUSIONS: Poor responders are not a homogeneous group of women with regards to pregnancy prospects. Female age and number of oocytes retrieved in particular will modulate the chances for pregnancy in current and subsequent cycles. Applying these criteria will allow the identification of couples with a reasonable prognosis and balanced decision-making on the management of poor responders.

The fiscal outcome of artificial conception in Brazil—creating citizens in developing countries

Será publicado em Janeiro de 2012  Human Reproduction, disponível no Oxfor Journal.


BACKGROUND: Infertility is an important health issue, but only a small fraction of the affected population receives treatment in Brazil, because it is not covered by the government or private health insurance plans. We developed a generational accounting-based mathematical model to assess the direct economic result of creating a citizen through IVF in different economic scenarios, and the potential economic benefit generated by the individual and his/her future offspring.

METHODS: A mathematical model analyzes the revenues and expenses of an IVF-conceived individual over his lifetime. We calculated the net present value (NPV) of an IVF-conceived citizen, and this value corresponds to the fiscal contribution to the government by an individual, from birth through his predicted life expectancy. The calculation used discount rates of 4.0 and 7.0% to depreciate the money value by time.

RESULTS: A 4.0% discount rate represents the most favorable economic scenario in Brazil, and it results in an NPV of US$ 61 428. A 7.0% discount rate represents a less favorable economic reality, and it results in a debit of U$ 563, but this debt may be compensated by his/her future offspring.

CONCLUSIONS: The fiscal contribution generated by each IVF-conceived citizen can justify an initial government investment in infertility treatment. Poor economic times in Brazil can sometimes result in a fiscal debt from each new IVF-conceived child, but this initial expenditure may be compensated by the fiscal contribution in the next generation.

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