Objetivo: Avaliar as evidências disponíveis comparando a eficácia da estimulação ovariana (EO) com uso de citrato de clomifeno (CC) e/ ou letrozol (LTZ) para reduzir o consumo de FSH, em relação à estimulação ovariana padrão (EOP). Métodos: Realizamos uma revisão sistematizada e meta-análise de ensaios clínicos randomizados (ECRs) que compararam os desfechos reprodutivos na fertilização in vitro. As buscas foram realizadas em onze bancos de dados eletrônicos e avaliamos manualmente a lista de referência dos estudos incluídos e revisões similares. Nós estratificamos os resultados separando os estudos baseados no agente oral utilizado (CC ou LTZ) e nas características da mulher incluída (em que se espera e em que não se espera má resposta ovariana). Os desfechos avaliados foram risco relativo (RR) para nascimento vivo, gravidez clínica, aborto, e taxa de cancelamento de ciclo, Peto Odds Ratio (OR) para síndrome de hiperestímulo ovariano (SHO), e diferença média (MD) para número de óocitos captados e consumo de FSH (ampolas). Resultados: Foram incluídos 22 estudos nesta revisão. Considerando o grupo de mulheres em que se espera má resposta, a evidência sugere que o uso de CC durante a estimulação ovariana resulta em similares taxas de nascidos vivos (RR= 0,9, IC95% = 0,6 a 1,2, evidência de moderada qualidade) e de gravidez clínica (RR= 1,0, IC95% = 0,8 a 1,4, evidência de moderada qualidade); o uso de LTZ não causa alteração significativa no número de oócitos captados (MD= -0,4, IC95% = -0,9 a +0,1, evidência de alta qualidade). Considerando os estudos que avaliaram mulheres em que não se esperava má resposta, a evidência sugere que o uso de CC reduz o número de oócitos captados (MD= -4,6, IC95%= -6,1 a -3,0, evidência de alta qualidade) e o risco de SHO (Peto OR= 0,2, IC95%= 0,1 a 0,3, evidência de moderada qualidade), enquanto os resultados são semelhantes para taxas de nascidos vivos (RR= 0,9, IC 95% = 0,7 a 1,1, evidência de moderada qualidade) e de gravidez clínica (RR= 1,0, IC95% = 0,9 a 1,2, evidência de alta qualidade). Para os demais desfechos a qualidade das evidências foi baixa ou muito baixa. Conclusões: A utilização de CC em mulheres em que se espera má resposta tem a vantagem de alcançar resultados reprodutivos semelhantes com redução dos custos. Para as demais mulheres, o uso do CC tem a vantagem adicional de reduzir o risco de SHO, mas também reduz o número de oócitos captados. Mais estudos seriam necessários para avaliar o efeito do LTZ com o mesmo propósito. Estudos futuros devem ter como objetivo estudar a taxa de gravidez cumulativa por oócito captado, insatisfação da paciente e aceitação para repetir o ciclo se não engravidar, que são dados importantes para a tomada de decisões clínicas. / Objective: To assess the available evidence comparing effectiveness of ovarian stimulation (OS) using clomiphene citrate (CC) and/or letrozole (LTZ) for reducing FSH consumption compared with standard OS. Methods: We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) that compared the reproductive outcomes following in vitro fertilization. We searched eleven electronic databases and hand-searched the reference list of included studies and related reviews. We stratified the results separating the studies depending on the oral agent (CC or LTZ) and on the characteristics of the included women (expected poor ovarian response or other women). When combining the results of included studies, we assessed the relative risk (RR) for live birth, clinical pregnancy, miscarriage, and cycle cancelation, Peto Odds Ratio (OR) for OHSS, and mean difference (MD) for the number of oocytes retrieved and FSH consumption. Results: A total of 22 studies were included in this review. Considering women with expected poor ovarian response, the available evidence suggests that using CC for reducing FSH consumption during OS provide similar live birth (RR=0.9, 95%CI=0.6-1.2, moderate quality evidence) and clinical pregnancy rates (RR=1.0, 95%CI=0.8-1.4, moderate quality evidence); the use of LTZ doesn\'t cause a relevant change on the number of oocytes retrieved (MD=-0.4, 95%CI= -0.9 to +0.1, high quality evidence). Considering the studies evaluating other women, the available evidence suggests that using CC for reducing FSH consumption during OS reduces the number of oocytes retrieved (MD=-4.6, 95%CI=-6.1 to -3.0, high quality evidence) and the risk of OHSS (Peto OR=0.2, 95%CI=0.1-0.3, moderate quality evidence), while results in similar live birth (RR=0.9, 95%CI=0.7-1.1, moderate quality evidence) and clinical pregnancy rates (RR=1.0, 95%CI=0.9-1.2, high quality evidence). The quality of the evidence was low or very low for the other outcomes. Conclusion: The use of CC for reducing FSH consumption in women with expected poor ovarian response has the advantage of providing similar reproductive outcomes with reduced costs. For the other women, the use of CC for reducing FSH consumption has the additional advantage of reducing OHSS, but also reduces the total number of oocytes retrieved. More studies are necessary to evaluate the effect of LTZ for the same purpose. Future studies should aim on cumulative pregnancy per oocyte retrieval, patient dissatisfaction and agreement to repeat the cycle if not pregnant; which are important outcomes for clinical decisions.

Η ενδοκυττάρια έγχυση σπέρματος (ICSI) εισήχθη ως μέθοδος υποβοηθούμενης αναπαραγωγής (ΑRT) κυρίως για την αντιμετώπιση της ανδρικής στειρότητας. Όμως, λόγω των υψηλών ποσοστών επιτυχίας, και παρά τις αυξανόμενες ανησυχίες για τους κινδύνους από τη σημαντική ανθρώπινη παρεμβολή στο γονιδίωμα, το επιγονιδίωμα και την ανάπτυξη των παιδιών, προτιμάται ακόμα και σε περιπτώσεις όπου δεν απαιτείται ιατρικά. Από τις λίγες σήμερα συστηματικές μελέτες παιδιών από ART, καταγράφεται αυξημένο ποσοστό προδιάθεσης τους σε ασθένειες που σχετίζονται με κακό καρδιομεταβολικό πρότυπο στην ενήλικη ζωή. Στόχος της εργασίας ήταν η διερεύνηση της δυνατότητας χρήσης της μεταβολομικής ανάλυσης για τον πρώϊμο και έγκυρο προσδιορισμό σχετικών διαταραχών σε δείγματα πλάσματος προεφηβικών κοριτσιών και αγοριών από ΙCSI, που επιλέχτηκαν από ένα συστηματικά χαρακτηρισμένο σύνολο παιδιών μελέτης της Α’ Παιδιατρικής Κλινικής, Νοσοκομείου «Αγία Σοφία», Ιατρικής Σχολής, ΕΚΠΑ. ΥΛΙΚΑ ΚΑΙ ΜΕΘΟΔΟΙ: Τα μεταβολικά πρότυπα πλάσματος (α) 10 κοριτσιών από ΙCSI και 10 από φυσιολογική γονιμοποίηση (NC) και (β) 16 αγοριών από ΙCSI και 16 από NC ποσοτικοποιήθηκαν με χρωματογραφία αερίων – φασματομετρία μάζας (GC-MS). Μετά από την ταυτοποίηση κορυφών και την κατάλληλη κανονικοποίηση των προτύπων, 86 πρότυπα 70 μεταβολιτών στα κορίτσια και 92 πρότυπα 80 μεταβολιτών στα αγόρια αναλύθηκαν ξεχωριστά, και συγκριτικά με αλγορίθμους πολυπαραμετρικής στατιστικής ανάλυσης των λογισμικών TM4-MeV (v.4.9.0), και ΧLSTAT (v.2013.4.03). Οι διαφορές στο πρότυπο σύστασης του πλάσματος σε μικρού μεγέθους μεταβολίτες μεταξύ των ΙCSI και ΝC ομάδων σε κορίτσια και αγόρια και μεταξύ των δύο φύλων οπτικοποιήθηκαν σε κατάλληλα ανακατασκευασμένο από τη βιβλιογραφία και σχετικές βάσεις δεδομένων μεταβολικό δίκτυο πολλών ιστών. ΑΠΟΤΕΛΕΣΜΑΤΑ: Στα κορίτσια, ο αλγόριθμος μερικών ελαχίστων τετραγώνων-διακριτής ανάλυσης (PLS-DA) κατέδειξε σαφή διαχωρισμό των μεταβολικών πρoτύπων μεταξύ των ομάδων ΙCSI και NC. Ο διαχωρισμός αυξάνεται με το συνυπολογισμό των βιοχημικών μετρήσεων. Στα αγόρια, η PLS-DA των μεταβολικών ή και βιοχημικών προτύπων κατέδειξε επίσης διαχωρισμό, αν και μικρότερο, σε σχέση με κορίτσια. Η ανάλυση σημαντικότητας για μικροσυστοιχίες (SAM), που ενδείκνυται για την ανάλυση ομικών δεδομένων, ανέδειξε 37 από τους 70 μεταβολίτες που αναλύθηκαν στα κορίτσια με σημαντικά διαφορετική συγκέντρωση μεταξύ των ΙCSI και ΝC ομάδων, με 34 από αυτούς να αυξάνονται στην ICSI ομάδα. Οι 34 μεταβολίτες αφορούν κύρια σε σάκχαρα, αλκοόλες και οξέα σακχάρων, οργανικά οξέα και λιπίδια, που έχουν συνδεθεί με αντίσταση στην ινσουλίνη, μεταβολικό σύνδρομο, ή/και την παχυσαρκία. Η ίδια ανάλυση στα αγόρια ανέδειξε 25 από τους 80 μεταβολίτες που αναλύθηκαν με χαρακτηριστική διαφορά μεταξύ των ομάδων ICSI και NC, εκ των οποίων 9 με σημαντικά μικρότερη συγκέντρωση στην ομάδα ΙCSI. Χαρακτηριστικά αναφέρεται ότι στους 9 μεταβολίτες ανήκουν οι 4 με την πλέον διαφορετική συγκέντρωση μεταξύ των ICSI και NC ομάδων, που είναι η σορβιτόλη, και τα αρωματικά αμινοξέα τρυπτοφάνη, φαινυλαλανίνη και τυροσίνη. Συγκριτική ανάλυση του μεταβολικού προτύπου των δύο φύλων στην NC ομάδα κατέδειξε μια σαφή διαφοροποίηση, η οποία φαίνεται να αποτελεί κύρια αιτία της παρατηρούμενης φυλο-ειδικής μεταβολικής διαφοροποίησης μεταξύ των ομάδων ICSI και ΝC. ΣΥΜΠΕΡΑΣΜΑΤΑ: Η πολυπαραμετρική ανάλυση της σύστασης του πλάσματος σε μικρού μοριακού βάρους μεταβολίτες επέτρεψε τον προσδιορισμό μεταβολικών διαφορών μεταξύ των ομάδων ICSI και NC, που υποστηρίζουν την προδιάθεση των παιδιών από ICSI σε αντίσταση στην ινσουλίνη, με διακριτούς όμως μεταβολικούς και βιοχημικούς δείκτες μεταξύ των δύο φύλων. Τα ευρήματα αυτά πρέπει να επιβεβαιωθούν σε ένα ευρύτερο σύνολο παιδιών και των δύο φύλων. Καταδεικνύουν όμως την αξία της μεταβολομικής να παρέχει μία υψηλής ευκρίνειας προοπτική της μεταβολικής κατάστασης, οδηγώντας στον προσδιορισμό χαρακτηριστικών μεταβολικών προτύπων ακόμα και σε πολύπλοκες καταστάσεις φυσιολογίας. / The intracytoplasmic sperm injection (ICSI) method was introduced in artificial reproduction technology (ART) mainly to treat male infertility. However, due to its high success rates and despite the growing concerns concerning the risk that the significant human intervention associated with this method may have to the genome, epigenome and development of the offspring, the use of ICSI has gradually increased in the recent years, even when it is not medically required. Based on the few currently available systematic studies of ART conceived children, the latter are considered of higher risk for cardio-metabolic diseases as adults. The goal of the present study is to investigate whether metabolomic analysis of the blood plasma could contribute to the early and accurate determination of relevant predisposition in ICSI conceived prepubertal girls and boys, specifically selected from a systematically characterized group of children, participated in a study of the First Department of Pediatrics of the “Agia Sophia” Hospital, Medical School, University of Athens. MATERIALS AND METHODS: The blood plasma metabolic profiles of (a) 10 ICSI- and 10 naturally conceived (NC) girls and (b) 16 ICSI and 16 NC boys were acquired using gas chromatography-mass spectrometry. After peak identification and appropriate normalization, 86 profiles of 70 metabolites in girls and 92 profiles of 80 metabolites in boys were analyzed separately and comparatively using multivariate statistical analysis algorithms of TM4-MeV (v.4.9.0) and XLSTAT (v.2013.4.03) software. The differences in the plasma metabolite concentration profiles between the ICSI and NC groups in girls and boys were visualized in an inter-tissue metabolic network that was reconstructed based on relevant literature and metabolic databases. RESULTS: For the girls, the algorithm of partial least squares-discriminant analysis (PLS-DA) indicated a clear differentiation of the metabolic profiles between the ICSI and NC groups. The discrimination is more pronounced, when biochemical data are also considered. For the boys also, PLS-DA indicated separation between the metabolomic profiles of the two groups analyzed individually or in combination with the biochemical data, but not as explicit as in girls. Significance analysis for microarrays (SAM) determined 37 out of the 70 analyzed metabolites in the plasma profiles of the girls with significantly different concentration between the ICSI and the NC groups; 34 of these were of higher concentration in the ICSI group. The 34 metabolites include mainly sugars, sugar alcohols and acids, organic acids and lipids that have been associated with insulin resistance, metabolic syndrome and/or obesity. The same analysis in the plasma profiles of the boys determined 25 out of the 80 analyzed metabolites with significant difference between the ICSI and NC groups; nine of these were of significantly lower concentration in the ICSI group. It is underlined that the four most discriminatory metabolites between the ICSI and NC groups, i.e. sorbitol and the aromatic amino acids tryptophan, phenylalanine and tyrosine, are among the nine negatively significant. Comparative analysis of the metabolic profiles between the two sexes within the NC group indicated an unequivocal differentiation, which is considered to be the main cause of the observed sex-specific metabolic differences between the ICSI and NC groups. CONCLUSIONS: The multivariate statistical analysis of blood plasma metabolite profiles enabled the determination of sex-specific metabolic differences between the ICSI and NC groups; these differences support increased predisposition to insulin resistance for the ICSI offspring, with clearly different, however, metabolic and biochemical markers in the two sexes. These findings need to be confirmed in a wider group of children. They demonstrate, however, the value of metabolomics to provide a high-resolution perspective of the metabolic state, leading to the determination of characteristic metabolic profiles even in complex physiological conditions.

Introdução: A importância dos níveis pré-concepcionais de hormônio estimulante da tireoide (TSH) em pacientes inférteis submetidas à estimulação ovariana controlada (EOC) para técnicas de reprodução assistida (TRA) permanece controversa. O hipotireoidismo subclínico pode aumentar a morbidade obstétrica e neonatal. Ainda não existe consenso entre endocrinologistas e ginecologistas em relação ao rastreio de doença tireoidiana por meio da medida do TSH em pacientes inférteis, nem em relação aos valores de corte para o TSH no hipotireoidismo subclínico (se devem ser <2,5mIU/L ou <4,0/4,5mIU/L). Avaliar o potencial impacto das diferentes concentrações de TSH nos resultados reprodutivos de pacientes submetidas à EOC para tratamentos com TRA é um importante passo para se estabelecerem políticas de rastreio e abordagens terapêuticas adequadas. Objetivo: Comparar resultados reprodutivos de pacientes submetidas à EOC para fertilização in vitro (FIV)/injeção intracitoplasmática de espermatozoide (ICSI), de acordo com as diferentes concentrações de TSH (<2,5 mIU/L; 2,5 a 4,0 mIU/L; >4,0 e <10,0 mIU/L; pacientes em uso de levotiroxina, independente dos níveis de TSH). Pacientes e Métodos: Foi realizado um estudo de coorte retrospectiva avaliando mulheres submetidas à FIV/ICSI no Laboratório de Ginecologia e Obstetrícia do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, no período de janeiro de 2011 a dezembro de 2012, que apresentavam concentração sérica de TSH descrita em prontuário médico. Foi considerado hipotireoidismo subclínico quando as concentrações de TSH eram de 4,0 mIU/L e <10,0 mIU/L em pacientes assintomáticas, que foram separadas em quatro grupos (TSH <2,5mIU/L; TSH 2.5 e <4,0mIU/L; 4mIU/L e <10mIU/L; em uso levotiroxina). Os desfechos primários avaliados foram: taxa de gestação clínica, de nascidos vivos, de gravidez múltipla e de abortamento. Os desfechos secundários analisados foram: dose total de FSH utilizada e duração da EOC, número de oócitos captados e número de oócitos maduros. Resultados: Das 787 pacientes que realizaram ciclos de FIV/ICSI no período do estudo, 727 foram incluídas na análise. A prevalência de hipotireoidismo subclínico encontrada foi de 15,13%. Sessenta pacientes foram excluídas, pois não havia registro de concentrações de TSH em seus prontuários. Não houve diferença estatisticamente significativa em relação às taxas de gravidez de clínica, nascidos vivos, gestação múltipla e abortamento, entre os grupos estudados. Também não foi detectada diferença significativa na resposta à EOC nos grupos avaliados. Conclusão: A taxa de nascido vivo e de abortamento e a resposta à EOC das mulheres com hipotireoidismo subclínico após FIV/ICSI não foram prejudicadas. Estes achados reforçam as incertezas relacionadas ao impacto das concentrações de TSH nos resultados reprodutivos de mulheres submetidas à EOC para TRA, principalmente em pacientes com concentrações de TSH entre 2,5 e 4,0 mIU/L, e tabém a ausência de dados confiáveis que justifiquem diminuir o limite do TSH para 2,5 mIU/L para a definição de hipotireoidismo subclínico. / Background: The relevance of preconception TSH (thyroid-stimulating hormone) serum concentration in infertile patients undergoing controlled ovarian stimulation (COS) for assisted reproductive techniques (ART) treatments remains controversial. Subclinical hypothyroidism may increase pregnancy e neonatal morbidity. There is no consensus among endocrinologists and gynecologists regarding screening of thyroid disease neither by measurement of TSH in infertile patients nor about the cut-off values for TSH in subclinical hypothyroidism (whether <2.5mIU/L or <4.0/4.5mIU/L). Evaluating the potential impact of different TSH concentrations in reproductive outcomes of patients undergoing COS for assisted reproductive techniques is an important step to establish screening policies and adequate therapeutic approaches. The aim of this study is to compare reproductive outcomes of patients undergoing COS for in vitro fertilization (IVF)/ICSI according to TSH serum concentrations (<2.5 mIU/L, 2.5 to 4.0 mIU/L, and >4.0 e <10mIU/L and those patients using levothyroxine irrespective TSH concentrations. Patients and Methods: Retrospective cohort study evaluating all women who underwent in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) between January 2011 and December 2012 and who had TSH sérum concentration described at medical records. Subclinical hypothyroidism was considered when TSH concentrations 4,0mIU/L and <10.0 mIU/L in asymptomatic patients, but the patients were separated between 4 groups (TSH <2.5mIU/L; TSH 2.5 and <4.0mIU/L; 4m e <10IU/L; patients using levothyroxine irrespective TSH concentrations. The primary endpoints assessed were clinical pregnancy, miscarriage, live birth and multiple pregnancy. Secondary endpoints evaluated were total dose of FSH (follicle-stimulating hormone) and duration of COS, number of retrieved oocytes and number of mature oocytes. Results: 787 women underwent IVF/ICSI in within the period of the study. Sixty of these women were excluded because they didn´t had TSH concentrations available in medical records. The prevalence of hypothyroidism, in the present study was 15.13%. No significant difference was observed between the four groups according to clinical pregnancy, miscarriage, live birth and multiple pregnancy rates. There were no differences between the four groups in regard to the response to COS. Conclusion: The live birth rate, miscarriage rate, and response to COS of women with subclinical hypothyroidism following IVF/ICSI were not impaired. These findings reinforce the uncertainties related to the impact of TSH concentrations on reproductive outcomes of women undergoing COS for ART, mainly in patients with TSH ranging from 2.5-4.0 mIU/L, and the absence of reliable data that justify changing the threshold for the definition of subclinical hypothyroidism for 2,5 mIU/L in this population.

Infertility is the inability to achieve a pregnancy. WHO classify infertility into two groups. Primary infertility is the term used to describe a couple that has never been able to conceive a pregnancy, after at least 1 year of unprotected intercourse. Secondary infertility describes couples who have previously been pregnant at least once, but have not been able to achieve another pregnancy. Causes of infertility include a wide range of physical as well as emotional factors. Approximately 30 - 40% of all infertility is due to a "male" factor such as retrograde ejaculation, impotence hormone deficiency, environmental pollutants, scarring from sexually transmitted disease, or decreased sperm count. A "female" factor -- scarring from sexually transmitted disease or endometriosis, ovulation dysfunction, poor nutrition, hormone imbalance, ovarian cysts, pelvic infection, tumor or transport system abnormality from the cervix through the fallopian tubes -- is responsible for 40 - 50% of infertility in couples. The remaining 10 -30% of infertility cases may be caused by contributing factors from both partners, or no cause can be identified. This dissertation has two main goals. The first goal is to describe how a couple face up to their problems with infertility. The second goal is that this dissertation can be used as a study material for social and medical employees. This dessertation is based on a qualitative research. I used a method CAMI {--} communication through the use of computer. The observational goup were people disccusing at www.neplodnost.cz.

Introdução: A importância dos níveis pré-concepcionais de hormônio estimulante da tireoide (TSH) em pacientes inférteis submetidas à estimulação ovariana controlada (EOC) para técnicas de reprodução assistida (TRA) permanece controversa. O hipotireoidismo subclínico pode aumentar a morbidade obstétrica e neonatal. Ainda não existe consenso entre endocrinologistas e ginecologistas em relação ao rastreio de doença tireoidiana por meio da medida do TSH em pacientes inférteis, nem em relação aos valores de corte para o TSH no hipotireoidismo subclínico (se devem ser <2,5mIU/L ou <4,0/4,5mIU/L). Avaliar o potencial impacto das diferentes concentrações de TSH nos resultados reprodutivos de pacientes submetidas à EOC para tratamentos com TRA é um importante passo para se estabelecerem políticas de rastreio e abordagens terapêuticas adequadas. Objetivo: Comparar resultados reprodutivos de pacientes submetidas à EOC para fertilização in vitro (FIV)/injeção intracitoplasmática de espermatozoide (ICSI), de acordo com as diferentes concentrações de TSH (<2,5 mIU/L; 2,5 a 4,0 mIU/L; >4,0 e <10,0 mIU/L; pacientes em uso de levotiroxina, independente dos níveis de TSH). Pacientes e Métodos: Foi realizado um estudo de coorte retrospectiva avaliando mulheres submetidas à FIV/ICSI no Laboratório de Ginecologia e Obstetrícia do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, no período de janeiro de 2011 a dezembro de 2012, que apresentavam concentração sérica de TSH descrita em prontuário médico. Foi considerado hipotireoidismo subclínico quando as concentrações de TSH eram de 4,0 mIU/L e <10,0 mIU/L em pacientes assintomáticas, que foram separadas em quatro grupos (TSH <2,5mIU/L; TSH 2.5 e <4,0mIU/L; 4mIU/L e <10mIU/L; em uso levotiroxina). Os desfechos primários avaliados foram: taxa de gestação clínica, de nascidos vivos, de gravidez múltipla e de abortamento. Os desfechos secundários analisados foram: dose total de FSH utilizada e duração da EOC, número de oócitos captados e número de oócitos maduros. Resultados: Das 787 pacientes que realizaram ciclos de FIV/ICSI no período do estudo, 727 foram incluídas na análise. A prevalência de hipotireoidismo subclínico encontrada foi de 15,13%. Sessenta pacientes foram excluídas, pois não havia registro de concentrações de TSH em seus prontuários. Não houve diferença estatisticamente significativa em relação às taxas de gravidez de clínica, nascidos vivos, gestação múltipla e abortamento, entre os grupos estudados. Também não foi detectada diferença significativa na resposta à EOC nos grupos avaliados. Conclusão: A taxa de nascido vivo e de abortamento e a resposta à EOC das mulheres com hipotireoidismo subclínico após FIV/ICSI não foram prejudicadas. Estes achados reforçam as incertezas relacionadas ao impacto das concentrações de TSH nos resultados reprodutivos de mulheres submetidas à EOC para TRA, principalmente em pacientes com concentrações de TSH entre 2,5 e 4,0 mIU/L, e tabém a ausência de dados confiáveis que justifiquem diminuir o limite do TSH para 2,5 mIU/L para a definição de hipotireoidismo subclínico. / Background: The relevance of preconception TSH (thyroid-stimulating hormone) serum concentration in infertile patients undergoing controlled ovarian stimulation (COS) for assisted reproductive techniques (ART) treatments remains controversial. Subclinical hypothyroidism may increase pregnancy e neonatal morbidity. There is no consensus among endocrinologists and gynecologists regarding screening of thyroid disease neither by measurement of TSH in infertile patients nor about the cut-off values for TSH in subclinical hypothyroidism (whether <2.5mIU/L or <4.0/4.5mIU/L). Evaluating the potential impact of different TSH concentrations in reproductive outcomes of patients undergoing COS for assisted reproductive techniques is an important step to establish screening policies and adequate therapeutic approaches. The aim of this study is to compare reproductive outcomes of patients undergoing COS for in vitro fertilization (IVF)/ICSI according to TSH serum concentrations (<2.5 mIU/L, 2.5 to 4.0 mIU/L, and >4.0 e <10mIU/L and those patients using levothyroxine irrespective TSH concentrations. Patients and Methods: Retrospective cohort study evaluating all women who underwent in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) between January 2011 and December 2012 and who had TSH sérum concentration described at medical records. Subclinical hypothyroidism was considered when TSH concentrations 4,0mIU/L and <10.0 mIU/L in asymptomatic patients, but the patients were separated between 4 groups (TSH <2.5mIU/L; TSH 2.5 and <4.0mIU/L; 4m e <10IU/L; patients using levothyroxine irrespective TSH concentrations. The primary endpoints assessed were clinical pregnancy, miscarriage, live birth and multiple pregnancy. Secondary endpoints evaluated were total dose of FSH (follicle-stimulating hormone) and duration of COS, number of retrieved oocytes and number of mature oocytes. Results: 787 women underwent IVF/ICSI in within the period of the study. Sixty of these women were excluded because they didn´t had TSH concentrations available in medical records. The prevalence of hypothyroidism, in the present study was 15.13%. No significant difference was observed between the four groups according to clinical pregnancy, miscarriage, live birth and multiple pregnancy rates. There were no differences between the four groups in regard to the response to COS. Conclusion: The live birth rate, miscarriage rate, and response to COS of women with subclinical hypothyroidism following IVF/ICSI were not impaired. These findings reinforce the uncertainties related to the impact of TSH concentrations on reproductive outcomes of women undergoing COS for ART, mainly in patients with TSH ranging from 2.5-4.0 mIU/L, and the absence of reliable data that justify changing the threshold for the definition of subclinical hypothyroidism for 2,5 mIU/L in this population.

The intracellular sperm injection (ICSI) technique is a very effective tool for the fertilization research. In the newly established laboratory at the Faculty of Science of the Charles University it was necessary to introduce this method and define the early developmental potential of fertilized oocytes. After fertilization oocytes were incubated to the blastocyst stage with a success comparable with other laboratories (17%). The ubiquitin-proteasome system which plays a major role in a protein degradation within cells is involved in a regulatory mechanism of sperm maturation. It is also responsible for a penetration of a vitelline membrane. In these processes ubiquitin residues are localized extracellulary. High level of sperm ubiquitination correlates with their low quality. Hypotetically it can be expected that the ubiqutination of impaired sperm cells can be used as a negative marker for their recognition and degradation by 26S proteasome complex localized. Experiments in this diploma thesis were designed based on the hypothesis that the executive part of the selective mechanism is the 26S proteasome. Therefore the effect of MG132 peptide inhibition of the 20S proteasome on the pronuclei formation and subsequent early embryonic development after ICSI was studied. Inhibition of 20S proteasome...

Treatment success in IVF-ICSI is mainly limited by female age, but differences in ovarian reserve (OR; the remaining pool of oocytes and their quality) between individuals modify treatment prerequisites among women of similar age. OR may be assessed by OR tests (ORTs). The main aims of this work were to study menstrual cycle length (MCL), basal levels of circulating gonadotrophins, antral follicle count (AFC) and serum Anti-Müllerian hormone (AMH) levels and their associations with and prognostic capacities regarding IVF-ICSI outcome in large cohorts of unselected women. Age-adjusted MCL was positively and linearly associated with pregnancy rates (PRs), live-birth rates (LBRs) and ovarian response to controlled ovarian hyperstimulation. An MCL of &gt;34 days almost doubled the LBR compared with an MCL of &lt;26 days. The grouped variable ‘combined FSH and LH levels’ was superior to both individual gonadotrophin levels and the LH:FSH ratio. The highest mean PR was seen in connection with a combination of FSH &lt;6.7 U/l with LH &gt;4.9 U/l; PRs were lowest when FSH-LH levels were opposite to this (high-low) and intermediate when FSH-LH levels were low-low or high-high. Associations with LBR and ovarian response were similar as those for PR. AFCs and serum AMH levels were positively and log-linearly associated with PR, LBR and ovarian response. Success rates levelled out above AFC 30 or AMH 5 ng/ml. Treatment outcome was superior among women with polycystic ovaries. Among the studied ORTs, logAFC and logAMH concentration correlated most strongly. After multivariate testing, entering all studied ORTs, AMH and female age remained independently associated with LBR. AMH + AFC + age predicted both poor and excessive ovarian responses with high accuracy. Adjusting for age and oocyte yield, all ORTs remained significant for LBR, implying that ORTs also capture information on oocyte quality. In conclusion, measures of OR are strongly associated with PR, LBR and ovarian response in a log-linear fashion, and partly reflect oocyte quality. The OR spectrum is continuous, from small ‘oligofollicular’ ovaries (the low extreme) to polycystic ovaries (the high extreme). Among the studied ORTs, AMH together with age provide the most powerful basal estimate for IVF/ICSI outcome.

<p>Uvod: Vi&scaron;eplodne trudnoće se javljaju u 1,5% svih trudnoća nakon spontane koncepcije, dok nakon postupaka vantelesne oplodnje ovaj postotak u Evropi iznosi preko 20% uz velike varijacije među zemljama. U na&scaron;oj sredini, stopa vi&scaron;eplodnih trudnoća nakon postupaka vantelesne oplodnje iznosi daleko iznad 30%. Pojava hipertenzivnog sindroma u trudnoći, gestacijskog dijabetesa, operativnog zavr&scaron;avanja trudnoće, prevremenog porođaja, male porođajne telesne mase, neurolo&scaron;kih sekvela kod rođene dece i gotovo svih drugih komplikacija po majku i plod, kao i celokupno opterećenje zdravstvenog sistema vi&scaron;estruko su veći kod vi&scaron;eplodnih u odnosu na jednoplodne trudnoće i udeo navednih komplikacija raste sa brojem plodova. Sa druge strane deca iz postupaka vantelesne oplodnje čine i do 4,5% sve živorođene dece u pojedinim zemljama, &scaron;to uz činjenicu da infertilitet pogađa 16-18% parova u na&scaron;oj sredini daje ovoj pojavi posebnu dimenziju i činije i dru&scaron;tvenim problemom. Perinatalni ishodi trudnoća iz postupaka vantelesne oplodnje su u velikoj meri kompromitovani visokom stopom multiplih trudnoća, koje se danas smatraju komplikacijom, a ne uspehom postupaka vantelesne oplodnje. Jednoplodne trudnoće iz postupaka vantelesne oplodnje u većim studijama pokazuju diskretno slabije perinatalne ishode u odnosu na one spontano začete, dok kod vi&scaron;eplodnih trudnoća ova korelacija nije jasno izražena i dokumentovana, uz prisutnu dilemu da li je vi&scaron;eplodnost sama po sebi ili način koncepcije glavni problem u zapaženoj pojavi. Cilj rada: Uporediti perinatalne ishode vi&scaron;eplodnih trudnoća nastalih postupcima vantelesne oplodnje i spontano začetih kao i perinatalne ishode jednoplodnih i vi&scaron;eplodnih trudnoća iz postupaka vantelesne oplodnje. Pored navdenog cilj rada je i ukazati sveobuhvatnost navedenog problema i na moguća re&scaron;enja za smanjenje njihove učestalosti. Materijal i metode: Kombinacijom retrospektivne opservacione studije i prospektivne longitudinalne kohortne studije u periodu analizom perinatalnih ishoda pacijentkinja porođenih na Klinici za ginekologiju i aku&scaron;erstvo Kliničkog centra Vojvodine u periodu od od 01.01.2008. do 31.12.2010. godine, studija je analizirala i poredila perinatalne ishode kod 174 spontano začete vi&scaron;eplodne trudnoće, 163 vi&scaron;eplodne trudnoće nastale postupkom vantelesne oplodnje, kao i 155 jednoplodnih trudnoća začete postupkom vantelesne oplodnje. Analizirani parametric bili su telesna masa novorođenčeta, dostignuta gestacijska starost, vrednosti Apgar skora, učestalost hipertenzivnog sindroma kod majke i brojni drugi parametri perinatalnog ishoda. Uzeti od strane obučenih kliničara i uno&scaron;eni u posebno dizajniranu bazu podataka, rezultati su statistički analizirani u program JMP ver 9.0 (SAS publisher) uz kori&scaron;ćenje ANOVA analize za testiranje statističke značajnosti između srednjih vrednosti kontinuiranih varijabli, dok je statistička značajnost razlike učestalosti kategorijskih varijabli je određivana Pearsonovim &chi;2 testom. Rezultati: Jednoplodne ART trudnoće uz prosečnu starost od 33,5 godine, prosečnu gestacijsku starost na porođaju od 38,26 gn, udeo prevremenih porođaja od 12,9%, prosečnu telesnu masu od 3258 g, AS u prvom minutu od 8,35 i u petom minutu od 9,2, stopu carskog reza od 65,81%, udeo GDM-a od 7,1%, anemije od 41,94% i preeklampsije od 4,52%, ima sve relevantne parametre perinatalnog ishoda statistički značajno (p&lt;0.0001) superiornije od kako ART tako i non ART blizanačkih trudnoća. ART blizanačke trudnoće pokazale su prosečnu starost majke od 32,9 godina, prosečnu gestacijsku starost na porođaju od 35,6 gn, udeo prevremenih porođaja od 58,27%, prosečnu telesnu masu od 2374 g, AS u prvom minutu od 7,45 i u petom minutu od 8,65, stopu carskog reza od 83,7%, udeo GDM-a od 15,11%, anemije od 78,42% i preeklampsije od 12,23%, dok su non ART blizanačke trudnoće pokazale prosečnu starost majke od 28,8 godina, prosečnu gestacijsku starost na porođaju od 36,08 gn, udeo prevremenih porođaja od 49,71%, prosečnu telesnu masu od 2433 g, AS u prvom minutu od 7,75 i u petom minutu od 8,75, stopu carskog reza od 58,33%, udeo GDM-a od 7,02%, anemije od 67,84% i preeklampsije od 11,11%. Pored godina majke i udela carskog reza koji su bili vi&scaron;i u ART blizanačkim trudnoćama (&lt;0.0001), kao i blago veće pojavi poremećaja količine plodove vode (p=0,033), gotovo svi ostali pokazatelji toka i ishoda trudnoće bili su komparabilni u navedenim grupama. Diskusija i zaključak: Studija je pokazala da su tok i ishod vi&scaron;eplodnih trudnoća nastalih spontano i postupcima vantelesne oplodnje ekvivalentni u gotovo svim pokazateljima uz sličnu prosečnu telesnu masu i gestacijsku starost novorođenčadi, kao i da su svi navedeni parametri ovih vi&scaron;eplodnih trudnoća bez obzira na način koncepcije upadljivo i podjednako lo&scaron;iji u poređenju sa jednoplodnim trudnoćama iz postupka vantelesne oplodnje. Izuzimajući vi&scaron;eplodnost kao factor rizika deca iz postupaka vantelesne oplodnje su generalno zdrava. Sama vi&scaron;eplodnost, a ne način koncepcije predstavljaju problem, koje se sa pravom smatra najvećom komplikacijom vantelesne oplodnje. Dodatna analiza iskustava drugih zdravstvenih sistema ukazuje da jedino &scaron;iroka i sveobuhvatna implementacija strategije vraćanja samo jednog embriona (Single embryo transfer &ndash; SET) može da dovede do smanjivanje stope multiplih trudnoća nakon postupaka vantelesne oplodnje, i sledstvenih komplikacija, a bez ugrožavanja samog uspeha vantelesne oplodnje. Iskustva drugih zdravstvenih sistema ukazuju da je uspe&scaron;na implementacija SET-a jedino moguća uz angažovanje celog dru&scaron;tva, zajedno sa brojnim legislativnim merama iz domena nadzora, kontrole i finansiranja postupaka vantelesne oplodnje. Obim i način finansiranja postupaka vantelesne oplodnje od strane države (uz vi&scaron;e besplatnih poku&scaron;aja za infertilne parove) uz obaveznu upotrebu SET-a, i sistema krioprezervacije na osnovu primera iz prakse predstavlja ključ u borbi za smanjenje problema vi&scaron;eplodnih trudnoća nakon postupaka vantelesne oplodnje.</p> / <p>Introduction: Multiple pregnancies occur in 1.5% of all pregnancies after spontaneous conception and in more than 20 % of all pregnancies concieved after assisted reproductive technologies in Europe, with large variations between countries. In our setting, the rate of multiple pregnancies after the ART is well above 30%. The occurrence of hypertensive syndrome in pregnancy, gestational diabetes, operative delivery, premature birth, low birth weight, neurological and developmental impairment in children, and almost all the other complications for the mother and fetus, as well as the entire burden of the health system are several times higher in multiple pregnancies compared with singleton pregnancies. Incidence of&nbsp; forementioned complications rises with number of fetuses. On the other hand, children from in vitro fertilization procedures make up 4.5% of all live births in some countries, which together with the fact that infertility affects aproximately 16-18% of couples in our country gives an extra dimension to this phenomenon and makes it not just medical but wider social problem. Perinatal outcomes of pregnancies after assisted reproductive technologies (ART) are greatly compromised by the high rate of multiple pregnancies, which are now considered to be a complication rather than success of ART procedures. ART Singleton pregnancies have, in larger studies, show discretely lower perinatal outcomes compared with those conceived spontaneously, while for the multiple pregnancies, this correlation is not clearly expressed and documented. There remains dilemma whether multiplicity itself or the way of conception (ART vs. non ART) constitutes a major problem in the observed differences regarding perinatal outcome of ART pregnancies. Objective: To compare the perinatal outcomes of multiple pregnancies conceived by In vitro fertilization (IVF) and spontaneously and perinatal outcomes of IVF conceived singleton and multiple pregnancies. Additional aim of this thesis is to point out the complexity of this problem and offer possible solutions. Materials and Methods: Design of a study was a combination of retrospective and prospective observational longitudinal cohort study. Analysis included pregnancies which had delivery at the Department of Gynecology and Obstetrics, Clinical Center of Vojvodina in the period from 1.01.2008. to 31.12.2010. The study analyzed and compared the perinatal outcomes in 174 spontaneous conceived multiple pregnancies, 163 multiple pregnancies resulting from IVF procedures, and 155 singleton pregnancies conceived by IVF procedure. Analyzed parameters were newborns birth weight, gestational age at delivery, the value of the Apgar score, occurrence of hypertensive syndrome in pregnancy, gestational diabetes, as well as numerous parameters of perinatal outcome. Taken by trained clinicians and were entered into a specially designed database, the results were statistically analyzed in JMP ver 9.0 software (SAS publisher) using ANOVA analysis to test the statistical significance between the mean values of continuous variables, while the statistical significance of the difference in frequency of categorical variables was assessed by Pearsons &chi;2 test. Results: ART singleton pregnancies had an average mothers age of 33.5 years, the average gestational age at birth of 38.26 gestational weeks (gw), preterm delivery rate of 12.9%, average birth weight 3258 g, Apgar score (AS) in the first minute 8.35, and in the fifth minute 9.2, cesarean section rate 65.81%, Gestational diabetes (GDM) in 7.1% pregnancies, anemia occurred in 41.94% of pregnancies, while preeclampsia was observed in 4.52% of all pregnancies. All relevant parameters of perinatal outcome were significantly (p&lt;0.0001) superior to both ART and non-ART twin pregnancies. ART twin pregnancy showed the average mothers age of 32.9 years, the average gestational age at birth of 35.6 gw, the preterm delivery rate 58.27%, the average body weight newborns 2374 g, AS in the first minute of 7.45, and in the fifth minute of 8.65, the cesarean section rate of 83.7%, GDM in 15.11% of all pregnancies, anemia occurred in 78.42% and preeclampsia in 12.23% of pregnancies, while the non-ART twin pregnancy showed an average mothers age of 28.8 years, the average gestational age at birth of 36.08 gw, the preterm delivery rate of 49.71%, the average body weight of 2433 g, AS in the first minute of 7.75 in the fifth minute 8.75, the caesarian section rate of 58.33%, GDM-a occurred in 7.02%, anemia in 67.84% and preeclampsia in 11.11% of pregnancies. Except for maternal age and the caesarean section rate, which were significantly higher in ART twin pregnancies (p&lt;0.0001), as well as small increase in proportion of amniotic fluid volume disorders (p = 0.033), almost all other parameters of perinatal outcome of were comparable in these groups. Discussion and Conclusion: The study showed that the course and outcome of multiple pregnancies conceived spontaneous and after IVF procedures are equivalent in almost all parameters with similar average body weight and gestational age at birth, and that all these parameters of multiple pregnancies regardless of the conception mode are equally worse compared with singleton pregnancies from IVF procedures. With the exception of multiplicity as a risk factor children from in vitro fertilization procedures are generally healthy. Multiplicity itself and not the mode of conception presented a problem, which is rightly considered the major complication of IVF today. Additional analysis of the experiences of other health system indicates that only a broad and comprehensive implementation of strategy to return only one embryo (SET&ndash;single embryo transfer) can lead to a reduction of the rate of multiple pregnancies after IVF procedures, and the accompanying complications, without compromising IVF success. The experience of other health systems indicate that a successful implementation of SET is only possible with the involvement of the whole society, along with a number of legislative measures in the field of monitoring, control and reimbursement of assisted reproduction procedures. The scope and funding of an IVF procedures (with more free attempts for infertile couples, reimbursed by public health) with mandatory use of SET, and good cryopreservation programs are, based on examples in other countries who had successfully dealt with his problem, is the key in reducing the problem of multiple pregnancies after IVF procedures.</p>

Cette recherche a pour but d’étudier le rapport à l’école et à la scolarisation de parents d’élèves récemment immigrés au Québec. Plus précisément, elle étudie les représentations sociales (RS) de ces parents sur les systèmes scolaires de leurs sociétés d’accueil et d’origine ainsi que les stratégies qu’ils déploient pour soutenir l’expérience socioscolaire de leurs enfants dans le contexte scolaire québécois. L’originalité de notre étude réside à la fois dans le recours aux RS pour étudier le rapport à l’école des parents, dans la considération de leur situation prémigratoire et dans le croisement de deux points de vue sur la situation d’intérêt, soit celui de parents récemment immigrés ainsi que d’intervenants et d’intervenantes communautaires scolaires interculturels (ICSI). Ancrée dans une démarche qualitative interprétative exploratoire, notre collecte de données s’est faite auprès de six ICSI (6) et de vingt-cinq parents d’élèves québécois récemment immigrés (25). Les deux groupes de sujets ont été rencontrés dans le cadre d’entrevues semi-dirigées. La technique d’associations libres a aussi été mise à profit auprès des parents, afin de favoriser l’accès à la complexité de leurs RS (Carassus et Dosquet, 2010; Vidal, Rateau et Moliner, 2006). Selon nos résultats de recherche, les RS des parents récemment immigrés sur le système scolaire québécois s’ancrent plus largement dans leur expérience migratoire : motifs d’immigration et conditions d’établissement expérimentées dans la société d’accueil. Aussi, nos résultats ont montré la pertinence de structurer les RS des parents autour de quatre grands thèmes : l’intégration scolaire, sociale et professionnelle assurée par l’école; le développement intellectuel et la forme scolaire; divers enjeux de socialisation véhiculés à l’école et dans la société québécoises; les relations école-familles immigrantes. Dans ce sens, bien que les parents mettent en contraste divers éléments des systèmes scolaires de leurs sociétés d’accueil et d’origine, leurs RS du système scolaire québécois sont surtout ancrées dans des perspectives d’avenir pour leurs enfants, interpellant fortement la capacité de l’école à intégrer ces derniers dans les milieux scolaires et socioprofessionnels de la société d’accueil. Aussi, nos données convergent vers le désir de nombreux parents que le capital humain de leurs enfants soit actualisé à leur plein potentiel dans le contexte migratoire. Nos résultats montrent aussi l’ancrage de l’école à un moment et dans un espace donnés, alors que les RS des parents illustrent souvent des valeurs socioculturelles véhiculées à l’école québécoise et des modalités des relations école-familles pas toujours connues des parents récemment arrivés au Québec. Le croisement des regards des parents et des ICSI révèle aussi de nombreuses stratégies mobilisées par les parents récemment immigrés pour soutenir l’expérience socioscolaire de leurs enfants dans la société d’accueil que nous avons catégorisées ainsi : stratégies déployées «à la maison», stratégies déployées «à l’école» et stratégies déployées «en lien avec la communauté». Nos résultats tendent à montrer que l’actualisation du rôle de parent d’élève «à l’école» est soumise à des modalités plutôt instituées par le milieu scolaire. Aussi, les résultats de notre recherche mettent en lumière un décalage intéressant entre la mobilisation et la proactivité accrues de nombreux parents récemment immigrés ainsi que l’invisibilité de ces dernières pour le milieu scolaire, surtout lorsque les stratégies sont déployées dans l’intimité du milieu familial ou dans des contextes liés à la communauté. Le croisement des données recueillies auprès des parents et des ICSI permet aussi de préciser les besoins d’accompagnement des parents récemment immigrés pour une meilleure maîtrise des enjeux du milieu scolaire de la société d’accueil et permet de faire ressortir des pratiques des milieux scolaires et communautaires qui semblent soutenir cet accompagnement. De manière générale, nos résultats convergent vers la pertinence d’accorder une plus grande considération aux parents dans le processus d’intégration des enfants récemment immigrés à l’école du Québec et de favoriser l’établissement de relations école-familles ancrées dans une perspective de partenariat. Enfin, il semble que l’école ne puisse arriver à elle seule à soutenir l’intégration des familles récemment immigrées dans le milieu scolaire québécois ainsi que la réussite scolaire des enfants et que les ICSI représentent des ressources stratégiques à cet égard. / This research aims to study newcomer students’ immigrant parents’ relationship in regards to school and education in Quebec. Specifically, we examined these parents’ social representations (SR) with respect to the host and home societies’ school systems as well as the strategies they deploy to support their children’s educational experience in Quebec’s school context. The originality of our study lies in the use of the SR concept to explore the relationship between newcomer parents in Quebec and school, the consideration of their premigratory situation and, in crossing two views on the situation of interest: newcomer immigrant parents and community, education and cross-culture worker (CECW). In the context of a qualitative interpretative exploratory approach, our data collection was done with six CECW (6) and twenty-five newcomer students’ immigrant parents in Québec (25). In both cases, we have made semi-structured interviews. Also, to access the complexity of SR, we used the technique of free associations with the parents (Carassus & Dosquet, 2010; Vidal & al., 2006). According to our results, parents’ representations of school system in Quebec were mostly based on their migratory experience: reasons for migrating and conditions of establishment in the host society. Also, our results revealed the pertinence to structure parents' SR around four main themes: children’s school, social and professional integration into the host society; intellectual development and school structure; various socialization issues conveyed into school and into society; relationship between school and immigrant families. In this regard, although parents compare various elements between school in the host and home societies, their SR of school in Quebec are generally related to the future of their children, and these SR highly raise school’s ability to integrate their children in the school and socio-professional contexts. Also, our data converge to express many parents’ the desire to see their children’s human capital being at its full potential in the migratory context. Our results also shows that school is rooted in a specific context, while the parents’ SR often illustrate socio-cultural values conveyed in Quebec’s school, and while the terms of relationship between school and families are not always known by immigrant parents. These two points of view - those of parents and CECW -, when put into perspective, also reveals the several strategies mobilized by immigrant parents to support their children's educational experience in the host society. These strategies have been categorized as follows: strategies deployed "at home", "in school" and "with community". Our results suggest that the actualisation of the role of "in school" students’ parents is subject to some terms imposed by school. Also, our results highlight an interesting gap between parents mobilization and proactivity to support their children, and the fact that their actions are invisible for school, especially when strategies are deployed in the privacy of the family environment, or in collaboration with the community. Putting into perspective these two points of view also led us to clarify the support needed by newly immigrated parents to manage different issues related to school and schooling in the host society. Also, we have been able to identify practices deployed by school and community that are likely to support newly immigrated parents in the school context. Overall, our results converge to the pertinence of giving greater consideration to parents in their children’s integration process in Quebec’s school and on the necessity of encouraging greater partnerships between school and families. Finally, it seems that school cannot ensure on its own the integration of newcomer immigrant families and the academic achievement of newly immigrated students in Quebec's schools. In this regard, ICSI seem to be strategic resources.