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OBJECTIVE: Recently, it has been discussed whether or not mosaic embryo transfers should be performed since they might result in viable pregnancies, although they often end up being discarded. We report a case of successful pregnancy, after a mosaic embryo transfer from an in vitro matured egg and frozen PESA sperm. CASE DESCRIPTION: Tests performed on a female aged 40 years and a male aged 37 years seeking fertility treatment found she had an adequate ovarian reserve and patent fallopian tubes. He had a history of cryptorchidism and inguinal hernia repair. The spermogram showed azoospermia, and testicular ultrasound showed an atrophic left testicle and a normal right testis. The vas deferens was palpated during physical examination. Intracytoplasmic sperm injection with percutaneous epididymal sperm aspiration (PESA) was indicated. Two cycles of IVF after controlled ovarian stimulation with follitropin delta was performed. In the first cycle, seven mature eggs were inseminated, two fertilized normally, resulting in one blastocyst biopsied and analyzed by NGS with complex aneuploid results. In the second cycle, frozen sperm from PESA was used. Three eggs were inseminated on the day of the procedure (resulting in 2 blastocysts), and three in vitro matured eggs were inseminated after 24 hours (resulting in 1 blastocyst). NGS analysis showed two complex aneuploid embryos and one 40% low-level trisomy 20 aneuploid mosaicism (+20) for the post 24-hour embryo. A mosaic embryo transfer was performed, resulting in clinical pregnancy and birth of a healthy baby girl with a normal blood karyotype. DISCUSSION: Mosaic embryo transfer is a topic for discussion. Certain levels of mosaicism do not seem to pose risks to the development of the fetus.

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OBJECTIVE: To evaluate clinical and laboratory outcomes of oocyte donation cycles and compare the results from donors and recipients. METHODS: A retrospective cohort study was conducted at a reproductive medicine center. A 586 first fresh oocyte donation cycles, performed from 01/2002 to 12/2017 were included. The outcomes of 290 cycles from donors and 296 from recipients, resulting in 473 fresh embryo transfers, were analyzed. The oocyte division was equally made, whereas, at an odd amount, the donor always had a preference. The data were collected from an electronic database, and analyzed using Chi-square test, Fisher's exact test, Mann-Whitney U-test or Student t-test depending on the data distribution, and multivariate logistic regression, considering p<0.05. RESULTS: The main results comparing donor and recipient, were, respectively: fertilization rate (72.0±21.4 vs. 74.6±24.2, p<0.001), implantation rate (46.2% vs. 48.5%, p=0.67); clinical pregnancy rate (41.9% vs. 37.7%, p=0.39), live birth rates by transfer (33.3 vs. 37.7, p=0.54). CONCLUSIONS: Oocyte donation is often the way donors can access in vitro fertilization, and for recipients seems to be a good option for pregnancy. Demographic and clinical characteristics have a secondary role in oocyte donors under 35 years and patient without comorbidities under 50 years and were not associated with pregnancy outcomes, emphasizing the power of oocyte quality on the success of intracytoplasmic sperm injection treatment. An oocyte-sharing program that offers good and comparable results is fair and worth being encouraged.

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OBJECTIVE: Oocyte cryopreservation enables the storage of genetic material, especially in situations where the ovarian function is compromised, also for women desiring to postpone maternity. Before 2012, oocyte cryopreservation was still experimental, and the success of the procedure was uncertain; however, it was the only possibility that women had for fertility preservation. Thus, we aim to report a case of a birth after 13 years of elective oocyte cryopreservation. CASE DESCRIPTION: At 49 years of age, the patient returned to our reproductive center with the desire to get pregnant, using oocytes that had been frozen for 13 years. The endometrium was prepared, and the oocytes were thawed using the slow procedure method. Four of the six oocytes thawed survived (66%) and were inseminated; three fertilized and started their development. The transfer of two embryos on the third day of development was performed. Clinical pregnancy was confirmed via ultrasound and came to term with the birth of a healthy boy. DISCUSSION: Although the vitrification procedure has shown to be a better cryopreservation technique when compared to slow freezing, the latter represented an important role when patients wanted to cryopreserve oocytes in the early 2000s. Even many years later, this technique reveals its efficacy, preserving the viability and quality of oocytes stored in nitrogen tanks. After a literature review, this case seems to be the largest interval between oocyte cryopreservation and its use, with achieved pregnancy, in Brazil.

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BACKGROUND: The aim of this study was to evaluate the influence of the body mass index (BMI) on laboratory, clinical outcomes and treatment costs of assisted reproduction, as there are still controversial and inconclusive studies on this subject. METHODS: This research was retrospective cohort study, including women undergoing assisted reproduction in a Reproductive Medicine Center between 2013 and 2020. The participants were divided into groups according to BMI (kg/m2): Group 1 < 25; Group 2, 25-29.9 and Group 3, ≥ 30. A total of 1753 in vitro fertilization (IVF) fresh embryo transfer (ET) cycles were included for assisted reproduction outcomes analysis and 1869 IVF-ET plus frozen embryo transfer (FET) for cumulative pregnancy analysis. RESULTS: As higher the BMI, higher was the proportion of canceled IVF cycles (G1 (6.9%) vs. G2 (7.8%) vs. G3 (10.4%), p = 0.002) and gonadotropin's total dose (IU) and treatment costs (G1 (1685 ± 595, U$ 683,02) vs. G2 (1779 ± 610, U$ 721,13) vs. G3 (1805 ± 563, U$ 764,09), p = 0.001). A greater number of mature oocytes was observed in G1 and G2 (6 [6.4-7.0] vs. 6 [5.6-6.6] vs. 4 [4.6-6.7], p = 0.011), which was not found in oocyte maturity rate (p = 0.877). A significant linear tendency (p = 0.042) was found in cumulative pregnancy rates, pointing to worse clinical outcomes in overweight and obese patients. CONCLUSION: These findings highlight the importance of considering the higher treatment costs for these patients, beyond all the well-known risks regarding weight excess, fertility, and pregnancy, before starting IVF treatments.

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BACKGROUND: In spontaneous pregnancies, maternal weight and gestational diabetes are independent risk factors for macrosomia and large-for-gestational-age newborns. Furthermore, maternal body mass index (BMI) of ≥25 kg/m2 is associated with worse neonatal vitality, classified as an Apgar score of < 7 at the fifth minute of life. However, few studies have evaluated the influence of BMI on perinatal outcomes in pregnancies resulting from assisted reproduction. Therefore, this study aimed to analyze whether the perinatal outcomes of assisted reproduction are influenced by BMI. METHODS: This was a retrospective cohort study performed at a reproductive medicine center. Patients undergoing assisted reproduction (2013-2020) were divided into three groups according to their BMI (kg/m2): group 1, < 25; group 2, 25-29.9, and group 3, ≥30. In total, 1753 in vitro fertilization embryo transfer cycles were analyzed. Data were expressed as mean ± standard deviation or frequency (%). The analysis of variance and chi-square test were performed for comparison. To determine the participants and number of cycles for these analyses, generalized estimating equations were used, considering p < 0.05. RESULTS: In groups 1, 2, and 3, the rates of live birth were 33.5, 32.3, and 29.9% (p = 0.668); preeclampsia were 2.9, 6.1, and 6.3% (p = 0.268); small-for-gestational-age newborns were 23, 23.2, and 21.7% (p = 0.965); macrosomia were 1.9, 0.9, and 2.7% (p = 0.708); Apgar score > 7 at the fifth minute were 97.6, 98.2, and 100% (p = 0.616); and preterm birth were 29.6, 30.1, and 35.1% (p = 0.970), respectively. CONCLUSIONS: In conclusion, although the three groups had similar perinatal outcomes in this study, the study population was too small for conclusive results. The higher the BMI, the lower the chances of clinically relevant LBR and the higher the chances of premature labor and preeclampsia.

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OBJECTIVE: Ectopic pregnancy is a well-known complication following in vitro fertilization with embryo transfer; studies have questioned, however, whether there are risk factors that could be identified before the procedure. The objective of this study was to investigate the possible risk factors involved in ectopic pregnancy following in vitro fertilization. METHODS: Retrospective case-control study performed at an assisted reproduction clinic in Brazil. To select the control group, we used a 1:4 ratio. The study included 499 patients submitted to in vitro fertilization with clinical pregnancy. We collected the data from electronic records, between 2000-2019 and divided into: Group 1, ectopic pregnancy (n=90) and Group 2, intrauterine pregnancies (n=409). RESULTS: When comparing groups, the results observed were: Tubal factor infertility (35.6% vs. 21.1%, p=.005) (OR 2.0 [1.2-3.4], p=.004); Previous miscarriage history (15.1% vs. 7.1%, p<.05) (OR 2.0 [1.02-4.29], p=.044); Number of cleavage-stage embryo transfers (69.2% vs. 54.0 p=.028) (OR 1.9 [1.08-3.33], p=.025); Two or more embryos transferred (OR 2.5 [1.12-5.70], p=.025), all associated with greater ectopic pregnancy risk. Oocyte recipient patients were excluded from this analysis, but when included a difference was found when comparing the groups (9.4% (10/106) vs. 3.0% (13/434), p=.007), (OR 3.3 [1.41-7.98] p=.005); this result should be interpreted with caution because of the sample size. CONCLUSIONS: In high-risk patients, a single blastocyst transfer seems to be a reasonable approach to decrease the ectopic pregnancy risk.

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OBJECTIVE: Outcome data for oocyte vitrification for fertility preservation are still scarce despite the scientific and technological advances. Studies suggest that patients with cancer have worse outcomes regarding mature vitrified oocytes when compared to healthy patients. Thus, the objective of this study was to evaluate and compare the oocyte vitrification response in patients undergoing elective and oncofertility preservation. METHODS: The ovarian stimulation response was verified by a cross-sectional and observational study, analyzing data from 367 patients between 2009 and 2018, which were divided into elective group (EG; n=327) and oncofertility group (OFG; n=40). The number of follicles, oocytes, mature oocytes, and duration of the cycle was evaluated, which were compared with clinical and ovarian stimulus data between groups. RESULTS: A significant difference in women's age (31.3±5.8 vs. 37.0±2.9 years; p<0.01) and basal values of Follicle Stimulating Hormone (FSH), (4.0 [3.3 - 6.2] vs. 9.0 [5.4 - 9.9] mIU/mL; p<0.01) were observed. When adjusting data for age, FSH and Gonadotropin-releasing Hormone protocols, no significant difference in the number of vitrified mature oocytes between the two groups were observed (6.0 [3.0-11.0] vs. 7.0 [3.0-12.0]; p=0.11). CONCLUSIONS: Thus, patients undergoing elective and oncofertility preservation seem to respond similarly to controlled ovarian stimulation for fertility preservation. Breast cancer was the most frequent in the OFG (67%).

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With the growing understanding of in vitro fertilization and reproductive technology, the magnitude of studies related to embryonic evolution has also increased. The optimization of embryo selection is crucial to minimize the risk of multiple pregnancies and to guarantee successful implantation and pregnancy. On the second day of culture, the four-cell embryo can be shaped into different arrangements, such as tetrahedral and planar. Previous studies have shown that mammalian embryos have a tetrahedral shape and that any deviation from this ideal configuration can negatively affect blastocyst development. A few studies have also found that planar embryos would be linked to negative predictors of success for reaching the blastocyst stage and its good quality. Therefore, it seems that tetrahedral should be preferred over planar-shaped embryos for embryonic transfers, but there is still little understanding and evidence about this subject. Thus, the objective of the present paper was to review the available literature on study tendencies to compare tetrahedral and planar-shaped embryos considering their effect on implantation and pregnancy results.

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A síndrome de Turner decorre de uma anomalia dos cromossomos sexuais, afetando cerca de 1:2.500 nascidos vivos. A síndrome caracteriza-se principalmente por atraso do e denvolvimento dos caracteres sexuais e/ou amenorreia e baixa estatura. Entretanto, uma diversidade de estigmas também pode estar presente. O diagnóstico pode ser realizado com base nos estigmas da síndrome associados a um quadro de hipogonadismo hipergonadotrófico e confirmado por meio do cariótipo ­ sendo esse classicamente 45,X (monossomia do cromossomo X). Entretanto, os mosaicos (45,X/46,XY ou 45,X/46,XX) podem representar 34% a 75% dos casos, dependendo do método de análise utilizado. Trata-se de uma condição rara correspondendo a 5% das disgenesia gonadais e apresenta um amplo espectro fenotípico. A importância da identificação de mosaicos, especialmente a presença do cromossomo Y, reside no manejo adequado da gônada disgenética para a prevenção da ocorrência de tumor gonadal, principalmente o gonadoblastoma, com considerável potencial maligno.(AU)

Turner's syndrome results from a sex chromosomes anomaly, affecting about 1:2,500 live births. The syndrome is characterized mainly by delayed development of sexual characteristics and/or amenorrhea and short stature. However, a variety of stigmas may also be presented. The diagnosis can be made based on the stigmas of the syndrome associated with a hypergonadotrophic hypogonadism and confirmed by the karyotype ­ this being classically 45, X (monosomy of the X chromosome). However, mosaics (45,X/46,XY or 45,X/46, XX) may represent 34% to 75% of cases depending on the method of analysis used. It is a rare condition, corresponding to 5% of gonadal dysgenesis and presents a broad phenotypic spectrum. The importance of mosaic identification, especially the presence of the Y chromosome, lies in the proper management of the dysgenetic gonad for the prevention of the occurrence of gonadal tumor, especially gonadoblastoma, with considerable malignant potential.(AU)

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Bilateral ectopic pregnancy is a rare clinical condition with an estimated prevalence of 1/200 000 in spontaneous pregnancies. Studies have found that In Vitro Fertilization (IVF) is related to ectopic pregnancy independently, but the incidence of tubal disease in the donor egg recipient population is thought to be significantly lower than in the standard IVF population. We report the case of a patient participating in the egg-sharing program, who was diagnosed with ovarian ectopic pregnancy, treated with surgery. After one week, she was diagnosed with tubal ectopic pregnancy in the contralateral tube. The clinician should be aware that the treatment of one ectopic pregnancy does not preclude the occurrence of a second ectopic pregnancy in the same patient and should pay attention to the intra-operatory inspection of both side fallopian tubes in any ectopic pregnancy case. Routine ultrasound after ectopic pregnancy treatment may be reasonable, especially in high risk patients.

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