RESUMO
COVID-19 has caused radical effects on the daily lives of millions of people. The causal agent of the current pandemic is SARS-CoV-2, a virus that causes symptoms related to the respiratory system, leading to severe complications. In the in vitro fertilization (IVF) universe, there are several protocols for infection control and laboratory safety. Some professional associations have issued guidelines recommending measures involving patient flow and IVF practices. This study presents a review and considerations for the resumption of activities in IVF laboratories and clinics in Brazil during the COVID-19 pandemic, according to the guidelines and statements from professional organizations and societies in reproductive medicine.
Assuntos
Instituições de Assistência Ambulatorial/organização & administração , COVID-19 , Fertilização in vitro , Controle de Infecções , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil , COVID-19/epidemiologia , COVID-19/prevenção & controle , Criança , Pré-Escolar , Fertilização in vitro/legislação & jurisprudência , Fertilização in vitro/métodos , Fertilização in vitro/normas , Humanos , Lactente , Controle de Infecções/legislação & jurisprudência , Controle de Infecções/métodos , Controle de Infecções/normas , Laboratórios/legislação & jurisprudência , Laboratórios/normas , Pessoa de Meia-Idade , Pandemias , SARS-CoV-2 , Adulto JovemRESUMO
Even the strictest laboratories and clinics are prone to the occurrence of microbial contamination. In the case of in vitro fertilization (IVF) research and practice facilities, the number of possible sources is particularly vast. In addition to ambient air, personnel, and non-sterilized materials, follicular fluid and semen from patients are a very common gateway for a diverse range of bacteria and fungi into embryo cultures. Even so, reports of contamination cases are rare, what leads many clinics to see the issue as a negligible risk. Microbiological contamination may result in the demise of the patient's embryos, leading to additional costs to both the patient and the clinics. Regardless of financial loss, emotional costs, and stress levels during IVF are highly distressing. Other worrisome consequences include DNA fragmentation, poor-quality embryos, early pregnancy loss or preterm birth, and possible long-term damages that need further investigation. In this review, we aimed to shed a light on the issue that we consider largely underestimated and to be the underlying cause of poor IVF outcomes in many cases. We also discuss the composition of the microbiome and how its interaction with the reproductive tract of IVF-seeking patients might influence their outcomes. In conclusion, we urge clinics to more rigorously identify, register, and report contamination occurrences, and highlight the role of the study of the microbiome to improve overall results and safety of assisted reproduction.
Assuntos
Bactérias/isolamento & purificação , Infecções Bacterianas/economia , Infecções Bacterianas/epidemiologia , Fertilização in vitro/economia , Fertilização in vitro/normas , Técnicas de Reprodução Assistida/economia , Infecções Bacterianas/microbiologia , Feminino , Humanos , Gravidez , Técnicas de Reprodução Assistida/normasRESUMO
Improving infrastructural conditions of the in vitro fertilization laboratory, such as the air quality, has profound positive effects on embryo culture. Poor environmental conditions reduce the rate of embryo formation and, therefore, of pregnancy. This review article presents important publications regarding the impact of air quality in human reproduction laboratories on embryo quality, pregnancy success, and live births. The studies demonstrate that the replacing the air filtration system improves significantly the environmental air quality, and, consequently, improves laboratory parameters, such as the fertilization rate, the number of blastocysts, the embryo implantation rate, and the number of live births. On the other hand, improving air quality decreases the number of abortions. Therefore, environmental parameters that improve embryo quality and increase healthy child birth rates must be the main targets for the assisted reproduction laboratory quality control.
Melhorar as condições de infraestrutura do laboratório de fertilização in vitro, com influência na qualidade do ar, tem efeitos positivos profundos na qualidade do embrião. As más condições ambientais do ar reduzem a taxa de sucesso na formação de embriões e a taxa de gravidez. Este artigo de revisão apresenta importantes publicações sobre o impacto da qualidade do ar dentro do laboratório de reprodução humana na qualidade do embrião, no sucesso de gravidez e no número de nascidos vivos. Os estudos demonstram que a troca do sistema de filtração de ar melhora significativamente a qualidade do ar ambiente, e consequentemente, melhora os parâmetros laboratoriais, tais como a taxa de fertilização, o número de blastocistos, a taxa de implantação e o número de nascidos vivos. Por outro lado, a melhora da qualidade do ar diminui o número de abortos. Portanto, os parâmetros ambientais que melhoram a qualidade do embrião e aumentam as taxas de nascimentos de crianças saudáveis devem ser os principais alvos para o controle de qualidade do laboratório de reprodução assistida.
Assuntos
Filtros de Ar , Técnicas de Cultura Embrionária/normas , Ambiente Controlado , Fertilização in vitro/normas , Filtração/normas , Humanos , Laboratórios , Controle de QualidadeRESUMO
Abstract Improving infrastructural conditions of the in vitro fertilization laboratory, such as the air quality, has profound positive effects on embryo culture. Poor environmental conditions reduce the rate of embryo formation and, therefore, of pregnancy. This review article presents important publications regarding the impact of air quality in human reproduction laboratories on embryo quality, pregnancy success, and live births. The studies demonstrate that the replacing the air filtration system improves significantly the environmental air quality, and, consequently, improves laboratory parameters, such as the fertilization rate, the number of blastocysts, the embryo implantation rate, and the number of live births. On the other hand, improving air quality decreases the number of abortions. Therefore, environmental parameters that improve embryo quality and increase healthy child birth ratesmust be themain targets for the assisted reproduction laboratory quality control.
Resumo Melhorar as condições de infraestrutura do laboratório de fertilização in vitro, com influência na qualidade do ar, tem efeitos positivos profundos na qualidade do embrião. As más condições ambientais do ar reduzem a taxa de sucesso na formação de embriões e a taxa de gravidez. Este artigo de revisão apresenta importantes publicações sobre o impacto da qualidade do ar dentro do laboratório de reprodução humana na qualidade do embrião, no sucesso de gravidez e no número de nascidos vivos. Os estudos demonstram que a troca do sistema de filtração de ar melhora significativamente a qualidade do ar ambiente, e consequentemente, melhora os parâmetros laboratoriais, tais como a taxa de fertilização, o número de blastocistos, a taxa de implantação e o número de nascidos vivos. Por outro lado,amelhora da qualidade do ar diminui o número de abortos. Portanto, os parâmetros ambientais que melhoram a qualidade do embrião e aumentam as taxas de nascimentos de crianças saudáveis devem ser os principais alvos para o controle de qualidade do laboratório de reprodução assistida.
Assuntos
Humanos , Fertilização in vitro/normas , Técnicas de Cultura Embrionária/normas , Ambiente Controlado , Filtros de Ar , Filtração/normas , Controle de Qualidade , LaboratóriosRESUMO
In Fertility Centers, quality should be measured by how well the organization complies with pre-defined requirements, and by how quality policies are implemented and quality objectives achieved. Having a quality management system (QMS) is a mandatory requirement for IVF centers established in most countries with regulatory guidelines, including Brazil. Nevertheless, none of the regulatory directives specify what a QMS must have in detail or how it should be implemented and/or maintained. ISO 9001 is the most important and widespread international requirement for quality management. ISO 9001 standards are generic and applicable to all organizations in any economic sector, including IVF centers. In this review, we discuss how we implemented QMS according to ISO 9001 and what we achieved 5 years later. In brief, with ISO we defined our structure, policies, procedures, processes and resources needed to implement quality management. In addition, we determined the quality orientation of our center and the quality objectives and indicators used to guarantee that a high-quality service is provided. Once measuring progress became part of our daily routine, quantifying and evaluating the organization's success and how much improvement has been achieved was an inevitable result of our well-established QMS. Several lessons were learned throughout our quality journey, but foremost among them was the creation of an internal environment with unity of purpose and direction; this has in fact been the key to achieving the organization's goals.
Na clínica de reprodução humana, a qualidade deve ser medida pela maneira como a organização cumpre os requisitos pré-definidos, e pela forma como as políticas de qualidade são implementadas e os objetivos de qualidade alcançados. Ter um sistema de gestão da qualidade (SGQ) é um requisito obrigatório para centros de fertilização in vitro estabelecidos na maioria dos países com diretrizes regulatórias, incluindo o Brasil. No entanto, nenhuma das diretivas regulamentares especifica o que um SGQ deve ter em detalhe ou como ele deve ser implementado e/ou mantido. A norma ISO 9001 é a exigência internacional mais importante e adotada mundialmente para a gestão da qualidade. Os conceitos da norma ISO 9001 são genéricos e aplicáveis a todas as organizações em qualquer setor económico, incluindo as clínicas de fertilização in vitro (ou bancos de células e tecidos germinativos tipo 2, como denominados no Brasil pela Agência Nacional de Vigilância Sanitária). Neste artigo, discutimos como implementamos um SGQ de acordo com a norma ISO 9001 e o que conseguimos 5 anos mais tarde. Em suma, com a norma ISO definimos nossa estrutura, políticas, procedimentos, processos e recursos necessários para implementar a gestão da qualidade. Além disso, determinamos a orientação da qualidade do nosso centro além dos objetivos de qualidade e indicadores utilizados para garantir que um serviço de alta qualidade seja fornecido para nossos clientes. A partir do momento que a mensuração do progresso tornou-se parte da nossa rotina diária, quantificar e avaliar o sucesso da organização e os resultados atingidos passou a ser uma consequência inevitável de um SGQ bem estabelecido. Várias lições foram aprendidas ao longo de nossa jornada de qualidade, mas o mais importante foi a criação de um ambiente interno com unidade de propósito e direção, que se tornou peça chave para alcançar os objetivos da organização.
Assuntos
Humanos , Técnicas Reprodutivas/normas , Gestão da Qualidade Total , Serviços de Saúde Reprodutiva/normas , Gestão da Qualidade Total , Fertilização in vitro/normasRESUMO
OBJECTIVE: To determine the influence of the concentration of oval spermatozoa according to the strict morphology criterion in men with normal sperm concentration following the World Health Organization criteria on the results of classic IVF. MATERIALS AND METHODS: Based on review of patient charts, this study included infertile couples presenting with female causes for infertility or unexplained infertility, in whom men presented with normal spermogram values for sperm concentration, sperm motility, volume of ejaculate and total sperm count after semen processing greater than 20 million. Based on the value obtained in strict sperm morphology, patients were divided into three groups: in Group A, patients with values between 0 % and 4 %; in group B, between 5 % and 14 %, and in group C, patients with sperm morphology greater than 14 %. The outcomes analyzed were oocyte fertilization rate, biochemical pregnancy rate, clinical pregnancy rate and rate of liveborns. RESULTS: A total of 244 cases met the inclusion criteria, 27 of them in group A, 165 in group B, and 52 in group C. The mean fertilization rate and the rate of liveborns were, respectively: 71.9 % and 33.3 % in group A; 80.9 % and 24.2 % in group B, and 78.8 % and 28.8 % in group C. There was no statistical difference among the groups in any of the outcomes analyzed. CONCLUSION: The values of strict sperm morphology, as proposed by Kruger and adopted by the World Health Organization, had no infl uence on the results of classic in vitro fertilization in the studied sample.
Assuntos
Fertilização in vitro/normas , Espermatozoides/citologia , Adulto , Fatores Etários , Distribuição de Qui-Quadrado , Feminino , Humanos , Masculino , Gravidez , Taxa de Gravidez , Valores de Referência , Contagem de Espermatozoides , Organização Mundial da SaúdeRESUMO
OBJECTIVE: To determine the influence of the concentration of oval spermatozoa according to the strict morphology criterion in men with normal sperm concentration following the World Health Organization criteria on the results of classic IVF. MATERIALS AND METHODS: Based on review of patient charts, this study included infertile couples presenting with female causes for infertility or unexplained infertility, in whom men presented with normal spermogram values for sperm concentration, sperm motility, volume of ejaculate and total sperm count after semen processing greater than 20 million. Based on the value obtained in strict sperm morphology, patients were divided into three groups: in Group A, patients with values between 0% and 4%; in group B, between 5% and 14%, and in group C, patients with sperm morphology greater than 14%. The outcomes analyzed were oocyte fertilization rate, biochemical pregnancy rate, clinical pregnancy rate and rate of liveborns. RESULTS: A total of 244 cases met the inclusion criteria, 27 of them in group A, 165 in group B, and 52 in group C. The mean fertilization rate and the rate of liveborns were, respectively: 71.9% and 33.3% in group A; 80.9% and 24.2% in group B, and 78.8% and 28.8% in group C. There was no statistical difference among the groups in any of the outcomes analyzed. CONCLUSION: The values of strict sperm morphology, as proposed by Kruger and adopted by the World Health Organization, had no influence on the results of classic in vitro fertilization in the studied sample.
Assuntos
Adulto , Feminino , Humanos , Masculino , Gravidez , Fertilização in vitro/normas , Espermatozoides/citologia , Fatores Etários , Distribuição de Qui-Quadrado , Taxa de Gravidez , Valores de Referência , Contagem de Espermatozoides , Organização Mundial da SaúdeRESUMO
This study established the first protocol for collection of gametes from live axolotl, Ambystoma mexicanum, by gentle abdominal massage and in vitro fertilization. To stimulate spermiation and ovulation, human chorionic gonadotrophin (hCG) and Ovopel pellets, which are commercially used to stimulate spawning in fish, were tested. The hCG was more effective than Ovopel pellets and yielded a higher semen volume in the injected males and a shorter response time in the females. Collected semen by this method was already motile and fertile. Fertile eggs could be collected in 3-4 successive collection times after the female has started the typical spawning behaviour. The fertilization condition that yielded the highest hatching rate was mixing semen with eggs before the addition of a fertilization saline solution (20 mmol/l NaCl, 1 mmol/l KCl, 1 mmol/l Mg(2)SO(4), 1 mmol Ca(2)Cl, 3 mmol NaHCO(3), 10 mmol/l Tris, pH 8.5 - Osmolality = 65 mosmol/kg). When the pH of the fertilization solution was increased to ≥ 10, the hatching rate was significantly increased. The use of fertilization solutions with osmolalities of ≥ 150 and ≥ 182 were accompanied with a significant decrease in hatching rates and the appearance of deformed larvae, respectively. In conclusion, a reliable protocol for gamete collection from live axolotl is established as a laboratory model of in vitro fertilization for urodele amphibians. This protocol may be transferable to endangered urodeles.
Assuntos
Ambystoma mexicanum , Fertilização in vitro/normas , Células Germinativas/citologia , Ambystoma mexicanum/fisiologia , Animais , Separação Celular , Feminino , Fertilização in vitro/métodos , Fertilização in vitro/veterinária , Manobra Psicológica , Masculino , Recuperação de Oócitos/métodos , Recuperação de Oócitos/normas , Recuperação de Oócitos/veterinária , Controle de Qualidade , Padrões de Referência , Recuperação Espermática/normas , Recuperação Espermática/veterináriaRESUMO
This study aims to compare the efficacy of recombinant LH (rLH) supplementation for ovarian stimulation in gonadotrophin-releasing hormone-antagonist protocol for IVF/intracytoplasmic sperm injection cycles. Search strategies included online surveys of databases. The fixed effects model was used for odds ratio (OR) and effect size (weighted mean difference, WMD). Five trials fulfilled the inclusion criteria. When the meta-analysis was carried out, advantages were observed for the LH supplementation protocol with respect to higher serum oestradiol concentrations on the day of human chorionic gonadotrophin administration P < 0.0001; WMD: 514, 95% CI 368, 660) and higher number of mature oocytes (P = 0.0098; WMD: 0.88, 95% CI 0.21, 1.54). However, these differences were not observed in the total amount of recombinant FSH (rFSH) administered, days of stimulation, number of oocyets retrieved, the clinical pregnancy rate per oocyte retrieval, the implantation rate and miscarriage rate. This result demonstrates that the association of rLH with rFSH may prevent any decrease in oestradiol after antagonist administration and that a significantly higher number of mature oocytes was available for laboratory work. Nevertheless, it failed to show any statistically significant difference in clinically significant end-points in IVF (implantation and pregnancy rates). Additional randomized controlled trials are needed to confirm these results further.