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 >34 days almost doubled the LBR compared with an MCL of <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 <6.7 U/l with LH >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.

Cette recherche clinique vise à explorer le retentissement de l'hypofertilité masculine et de la fécondation in vitro (FIV) sur le fonctionnement psychique des épouses dans le premier centre de consultation FIV en Egypte (1986), en contexte culturel égyptien. Près de 60% des couples qui consultent au Centre FIV présentent le diagnostic d'infertilité d'origine masculine. Nous nous intéressons à comprendre ce qui constitue la spécificité du fonctionnement psychique de ces femmes dans ce contexte culturel où l'infertilité masculine est une pathologie taboue, suscitant la honte familiale, et où seule la FIV homologue- utilisant les gamètes d'un couple marié- est autorisée par la loi. La première hypothèse renvoie à l'existence d'une souffrance psychique chez l'épouse liée au maintien du secret de l'hypofertilité masculine. La seconde hypothèse suppose que le diagnostic et les traitements médicaux sont accompagnés chez l'épouse d'une idéalisation oedipienne de ses propres parents. Notre échantillon est composé de dix femmes âgées de 20 à 40 ans inscrites dans un protocole FIV. Sur le plan méthodologique, nous nous sommes basés sur des entretiens de recherche semi-directifs et sur l'inventaire abrégé de dépression de Beck BDI-13. L'analyse des résultats met en évidence la présence chez les épouses d'un discours de plainte adressé envers leurs conjoints, en même temps que l'expression d'une idéalisation de leurs propres parents. La présence de symptômes de dépression variables est relevée dans l'échantillon. Enfin, la manière dont les femmes s'approprient subjectivement l'expérience de la FIV est un indicateur pertinent de leur équilibre psychique. Pour conclure, cette étude se veut être une recherche-action visant à mettre en place un dispositif clinique au service des femmes et des couples dans une institution médicale, et qui soit adapté à ce contexte culturel particulier. / This study aims at exploring the impact of male subfertility and In Vitro Fertilization (IVF) on the psychological functioning of a group of female spouses, in the first Egyptian IVF center in Egypt (1986), within the Egyptian cultural context. Approximately 60% of couples consulting at the Egyptian Center for IVF carry the diagnosis of male factor infertility. We are interested in understanding what constitutes the specificity of the psychological functioning of these women within this cultural context, where male infertility is a taboo pathology provoking family shame, and where only homologous IVF -using a married couple's gametes- is allowed by the law. The first hypothesis states that there is a specific female suffering related to the maintenance of the secret of male subfertility. The second hypothesis assumes that for the wife, the diagnosis disclosure and medical treatments are followed by an oedipal idealization of the her parents. Our sample is composed of ten women aged between 20 and 40 years old, and undergoing an IVF protocol. On the methodological aspect, we have used semi-structured interviews and the 13-Item Beck Depression Inventory. Results indicate the existence of a complain discourse among the wives, addressed towards their husbands, and at the same time an idealization of their own parents. Variable depression symptoms have been observed in our sample. Finally, the way women integrate psychologically the IVF experience is a relevant indicator of their psychological balance. As a conclusion, this study aims at being a research-action, which objective is to elaborate a clinical intervention at the service of women and couples, and suitable to this particular cultural context.

Des facteurs masculins sont identifiés dans près de la moitié des cas d’infertilité. À ce jour, les tests évaluant la fertilité masculine demeurent peu prédictifs de la survenue d’une grossesse. Dans le but de pallier cette lacune, nous avons mis au point deux nouveaux tests mesurant l’intégrité de l’ADN et le temps de survie des spermatozoïdes. Nous avons effectué une étude prospective portant sur 42 couples infertiles suivis en fécondation in vitro (FIV). Le spermogramme a été effectué selon les critères de l’Organisation Mondiale de la Santé (OMS) et le temps de survie des spermatozoïdes exposés à un détergent cationique a été mesuré en observant la mobilité sous microscope. L’intégrité de l’ADN des spermatozoïdes a été vérifiée par la nouvelle méthode de marquage radioenzymatique et par analyse de la structure de la chromatine (SCSA). Tous les tests ont été réalisés sur la partie des échantillons de sperme non utilisée par la clinique de fertilité. Le projet a été approuvé par le comité d’éthique du Centre Hospitalier Universitaire de Montréal (CHUM) et les patients ont préalablement signé un formulaire de consentement éclairé. L’analyse des paramètres du spermogramme et de l’intégrité de l’ADN n’a montré aucune différence statistiquement significative entre les données chez les couples avec ou sans grossesse. Cependant, le taux de grossesse biochimique était statistiquement plus élevé chez les couples dont le temps de survie des spermatozoïdes était long (>250 s) comparativement à ceux dont ce temps était court (≤250 s): 66% vs 27% respectivement (p<0,05). Les taux de grossesse clinique et d’implantation étaient aussi plus élevés, mais les différences n’atteignaient pas le seuil de signification statistique. Nos résultats confirment que le spermogramme et la mesure de la fragmentation de l’ADN des spermatozoïdes ne sont pas de bons facteurs prédictifs des résultats de la FIV. Par contre, le test de survie des spermatozoïdes serait un meilleur indicateur de la possibilité d’une grossesse en FIV. L’amélioration de sa spécificité et un plus grand nombre de sujets sont nécessaires avant de proposer son application en clinique de fertilité. / Male factors are known to be involved in almost half of the couples consulting for infertility. To date, the tests for evaluating male fertility are poor predictors of pregnancy. We developed two new tests to evaluate sperm function: a sperm survival test and a new method to measure sperm DNA integrity. This prospective study was conducted on 42 infertile couples undergoing in vitro fertilization (IVF). Assessment of sperm parameters was done according to the World Health Organization (WHO) criteria, and sperm survival upon exposure to a cationic detergent was measured by observing motility under the microscope. Sperm DNA integrity was verified by our new radioenzymatic method as well as by the sperm chromatin structure analysis (SCSA) method. All testing was performed on a remainder aliquot of the semen samples. The study was approved by the ethics committee of the Centre Hospitalier Universitaire de Montréal (CHUM), and informed consent was obtained before inclusion. Neither conventional semen analysis, nor sperm DNA fragmentation showed statistically significant difference between conception and non-conception cycles. However, the biochemical pregnancy rate was statistically higher in couples where the sperm survival time was long (>250 s) compared to short (≤250 s): 66% vs. 27% respectively, (p < 0.05). The clinical pregnancy rate and implantation rate were also higher but the differences did not reach statistical significance. Our study confirms that conventional semen analysis and the assay for sperm DNA integrity are not reliable indicators of IVF outcome. In contrast, our new sperm survival test seems to be a better predictor of the pregnancy rate after IVF. Improvement of its specificity and a larger cohort of patients are necessary before proposing its regular application in IVF clinics.

No description available.

Cette thèse de psychopathologie psychanalytique est une réflexion théorico-clinique sur l'expérience d'une assistance médicale à la procréation (AMP), et plus particulièrement sur l’état psychologique des femmes infertiles en parcours de fécondation in vitro (FIV) et de don d'ovocytes. Cette recherche a pour but d'évaluer la psychopathologie de ces femmes et les éventuels remaniements psychiques qu'impose ce mode de procréation. L’hypothèse générale de cette étude soutient l’idée qu’il existe des particularités dans le fonctionnement psychique des femmes infertiles qui diffèrent selon que les femmes ont recours à une FIV ou à un don d’ovocytes. La méthodologie repose sur la base d'entretiens semi-directifs, de questionnaires et de tests projectifs (Rorschach et TAT) et l'analyse du matériel recueilli s'appuie sur la théorie psychanalytique. Les résultats montrent que ces femmes souffrent d’une blessure psychique qui est à mettre en lien avec le vécu d’une castration réelle de leur féminité dans sa valence maternelle châtrée. Les femmes infertiles se trouvent sous l’emprise de l’objet primaire et leur fonctionnement mental se caractérise par une pensée opératoire défensive. De plus, le recours à une FIV ou à un don d’ovocytes suscite des aménagements psychiques, notamment en termes de représentations maternelles, qui apparaissent spécifiques au type d’AMP. Enfin, l’AMP amène les couples à érotiser les interventions médicales conduisant notamment à un remaniement des théories sexuelles infantiles et à une reconstruction des fantasmes originaires. / This thesis psychoanalytic psychopathology is a reflection on the theoretical and clinical experience of medical assistance to procreation (MAP), and more particularly on the psychological status of infertile women in course of in vitro fertilization (IVF) and oocyte donation. This research aims to assess the psychopathology of these women and the possible psychological changes imposed by this mode of procreation. The general hypothesis of this study is as follows: there are specific aspects in the psychic functioning of infertile women, these characteristics differ between women using IVF or oocyte donation. The methodology is based on semi-directive interviews, questionnaires and projective tests (Rorschach and TAT) and analysis of collected material is based on psychoanalytic theory. The results show that these women suffer psychological injury that is to be linked with the experience of a real castration of their femininity in its valence maternal castrated. Infertile women are under the mastery of the primary object and mental functioning is characterized by a defensive operational thought. In addition, the use of IVF or oocyte donation leads to psychic adjustments, particularly in terms of maternal representations that appear specific to the type of MAP. Finally, MAP brings couples to eroticize medical interventions leading a redesign of infantile sexual theories and a reconstruction of primal fantasies.

Introdução: Considerando a prevalência, a importância social dos tratamentos de alta complexidade de mulheres inférteis e o contexto atual da literatura que atribui relevância aos polimorfismos dos genes reguladores do desenvolvimento inicial e crescimento folicular, entre eles o FSHR, LH, LHR, AMH, AMHR, BMP15 e GDF9; torna-se imprescindível o melhor conhecimento e a quantificação desses fatores. Com isso poderemos individualizar e abordar de forma mais racional a investigação e o tratamento destas mulheres submetidas à fertilização in vitro (FIV). Objetivos: Avaliar se os polimorfismos dos genes do LH (Trp8Arg e Ile15Thr), AMH (Ile49Ser), BMP15 (673C/T, 9C/G, IVSI+905A/G), GDF9 (546G>A, 398C>G, 447C>T e 646G>A), e dos receptores do FSH (Ser680Asn), do LH (18isnILQ) e do AMH (Ile49Ser), estão relacionados a diferentes desfechos reprodutivos em pacientes submetidas à fertilização in vitro. Métodos: Realizamos dois estudos em mulheres submetidas à indução ovulatória para FIV: (1) um estudo caso-controle entre pacientes normo respondedoras e má respondedoras, (2) um estudo transversal em pacientes jovens submetidas à indução ovulatória para fertilização in vitro (FIV). Foi extraído DNA das pacientes submetidas à indução ovulatória para FIV a partir do sangue periférico para realização de polymerase chain reaction, com o objetivo de detectar os polimorfismos dos referidos genes e as respectivas relações com os resultados obtidos na estimulação ovariana, no Laboratório de Terapia Gênica do HCPA/UFRGS. Resultados: Foi evidenciado que a presença do polimorfismo 398C>G no gene GDF9 está associada à má resposta em pacientes inférteis submetidas à estimulação ovariana para fertilização in vitro (68% em má respondedoras versus 23% normo respondedoras, OR: 4.01, 95% IC:1.52-10.60). Além disso, o genótipo mutante para o polimorfismo G447C>T no gene do GDF9 foi encontrado em 50% nas pacientes má respondedoras versus 19% nas pacientes normo respondedoras (OR: 2.88, 95% IC:1.19-6.04), evidenciando uma forte associação destes polimorfismos com a má resposta ovariana à estimulação. Encontramos, também, que as mulheres portadoras do alelo mutante do gene 447C>T do GDF9 tiveram um número menor de folículos entre 12-14 mm no dia do hCG (1,62 versus 2,46, P = 0,007). As mulheres com o alelo mutante do gene do GDF9 398C>G tiveram um menor número de folículos maiores que 17 mm no dia do hCG (4,33 versus 6,49, P = 0,001), menor número de folículos entre 12 e 14 milímetros no dia do hCG (1,42 versus 2,25, P= 0,017), um menor número de folículos no dia do hCG (7,33 versus 10,11 versus, P = 0,007), e redução total de oócitos MII coletados (5,38 versus 8,84 P = 0,017). Conclusão: Concluímos que polimorfismos no gene do GDF9 têm uma influência significativa no desenvolvimento do oócito, uma vez que a presença dos alelos mutantes 447C>T e 398C>G diminui o número total de folículos maduros e o número total de oócitos coletados de tais pacientes, além deste último estar associado à má resposta ovariana em pacientes submetidas à indução da ovulação para fertilização in vitro. Isso mostra que este membro da família TGFβ além de atuar nas fases iniciais da foliculogênese também tem influência importante sobre a fase final do desenvolvimento do oócito. / Introduction: Given the prevalence, the social importance of high complexity treatments of infertile women and the current context of the literature assigns relevance to polymorphisms of genes regulating early follicle growth and development, including LH, AMH, BMP15, GDF9, FSHR, LHR and AMHR; become essential to better understanding and quantification of these factors. With this we can individualize and address more rationally research and treatment of these women undergoing IVF. Objectives: Evaluate the relationship of polymorphisms of LH (Trp8Arg andIle15Thr), AMH (Ile49Ser), BMP15 ( 673C/T, 9C/ G, IVSI+905A/ G) and GDF9 (546G>A, 398C>G, 447C>Tand646G>A) genes, and FSH (Ser680Asn), LH (18isnILQ) and AMH (Ile49Ser) receptors genes, related to different reproductive outcomes in patients undergoing IVF. Methods: Our study consisted of two phases: the first conducted a case-control study among patients with normal responders and poor responders, and the second a cross-sectional study in young patients undergoing ovulation induction for in vitro fertilization. DNA was extracted from peripheral blood for performing polymerase chain reaction (PCR) and analyzed at the Laboratory of Gene Therapy HCPA/UFRGS, with the objective of detecting polymorphisms of these genes and their relationships to the results obtained in ovarian stimulation. Results: It was shown that the presence of polymorphism 398C>G in GDF9 gene is associated with poor response in infertile patients undergoing controlled ovarian stimulation for in vitro fertilization (68% in poor responders versus 23% in normal responders). Furthermore, the genotype GDF9 447C>T mutant polymorphism was found in 50% and 19%, respectively, in poor and normal responders patients, showing a strong association with this polymorphism and a poor response in ovarian stimulation. Women carrying the GDF9 398C>G mutant allele had a smaller number of follicles between 12-14 mm on the day of r-hCG (1.62 vs. 2.46, respectively P=0.007). Women with GDF9 398C>G mutant allele had a smaller number of follicles larger than 17 mm on the r-hCG day (4.33 vs. 6.49, P=0.001), a smaller number of follicles between 12 and 14mm on the r-hCG day (1.42 vs. 2.25, P=0.017), a smaller number of follicles on the r-hCG day (7.33 vs. 10.11, P=0,007), and a reduced overall number of MII oocytes collected (5.38 vs. 8.84 ,P=0.017). Conclusion: We conclude that GDF9 polymorphisms in the gene have a significant influence on the development of the oocytes, since the presence of the mutant alleles 447C>T and 398C>G decreases the total number of mature follicles, total number of oocytes collected, and are associated a poor ovarian response in patients undergoing ovulation induction for in vitro fertilization. This shows that this member of the TGFβ family besides acting in the early stages of folliculogenesis also has important influence on the final stage of oocytes development.

Experimentos anteriores realizados em nosso laboratório indicam que o sucesso gestacional é afetado pela poluição atmosférica. O presente estudo teve como objetivo avaliar os efeitos biológicos associados a uma curva dose resposta das partículas de exaustão do diesel (PED) sobre o desenvolvimento embrionário inicial e o potencial de implantação, utilizando-se como modelo a fertilização in vitro e o cultivo embrionário de camundongos. No Experimento 1, encontrou-se um efeito negativo dose-dependente sobre o desenvolvimento embrionário inicial, o processo de eclosão, a alocação das células e a morfologia da massa celular interna (MCI) dos blastocistos. A análise post-hoc revelou que o desenvolvimento precoce do embrião não foi afetado pelas concentrações de 0,2 µg/cm2 ou 2 µg/cm2, mas foi significativamente afetado pela concentração de 20 µg/cm2 de PED. O processo de eclosão foi prejudicado pelas concentrações de 2 µg/cm2 e 20 µg/cm2. A alocação das células da MCI e a relação entre as células da MCI e do trofectoderma foram significativamente afetadas por todas as concentrações. Adicionalmente, observou-se um efeito negativo sobre a morfologia da MCI para as concentrações de 2 µg/cm2 e 20 µg/cm2. O Experimento 2, apesar de não mostrar efeito significativo sobre o potencial de implantação, evidenciado pela capacidade de adesão dos blastocistos e crescimento trofoblástico, revelou que a morfologia da MCI no dia 8 de cultivo, as taxas de viabilidade e de apoptose celular e a expressão de Oct4 e Cdx2 foram significativamente afetadas. O teste HSD-Tukey demonstrou que a presença de PED (0,2 µg/cm2 e 2 µg/cm2) durante o desenvolvimento embrionário aumentou significativamente a taxa de células em apoptose dos embriões tanto no dia 5 quanto no dia 8 de cultivo e, embora a proporção de células viáveis no dia 8 tenha sido prejudicada por ambas as concentrações, apenas a exposição a 2 µg/cm2 de PED diminuiu a viabilidade celular no dia 5. Por outro lado, tanto a concentração de 0,2 µg/cm2 como a de 2 µg/cm2 tiveram um efeito negativo significativo sobre a qualidade da MCI no dia 8 e a taxa de expressão de Oct4 nos blastocistos e aumentaram a porcentagem de células desses blastocistos expressando Cdx2, adicionalmente, a razão Oct4/Cdx2 dos embriões expostos a 0,2 µg/cm2 e 2 µg/cm2 foi significativamente menor. Frente a esses resultados, presumi-se que as PED poderiam estar envolvidas nos mecanismos que levariam à diminuição do sucesso reprodutivo observado em camundongos expostos à poluição atmosférica ambiental / Previous experiments conducted in our laboratory demonstrate that successful pregnancy is affected by air pollution. The aim of this study was to evaluate the biological effects associated with a dose-response curve of the diesel exhaust particles (DEP) on early embryonic development and implantation potential, using mice in vitro fertilization and culture embryo as model. In Experiment 1, we found a negative dose-dependent effect on the embryonic development, hatching process, cell allocation and morphology of inner cell mass (ICM) of blastocysts. A post-hoc analysis revealed that the early development of the embryo was not affected by concentrations of 0.2 g/cm2 or 2g/cm2, but was significantly affected by the concentration of 20 g/cm2 of DEP. The hatching process was impaired by concentrations of 2 g/cm2 and 20 g/cm2. Cell allocation of ICM and the ratio between cells of ICM and trophectoderm were significantly affected by all concentrations. Addicionaly, we observed a negative effect on ICM morphology was observed for the 2 µg/cm2 and the 20 µg/cm2 concentrations. Experiment 2, despite showing no significant effect on implantation potential, as evidenced by the adhesion ability and trophoblast outgrowth, revealed that ICM morphology on day 8 of culture, rates of cell viability and apoptosis, and expression of Oct4 and Cdx2 were significantly affected. The Tukey HSD test showed that presence of DEP (0.2 g/cm2 and 2 g/cm2) during embryonic development increased significantly the rate of apoptotic cells in embryos as on day 5 as on day 8 of culture, although the proportion of viable cells on day 8 was impaired by both concentrations, only exposure to 2 g/cm2 PED decreased cell viability on day 5. On the other hand, both the concentration of 0.2 g/cm2 such as 2 g/cm2 had a significant negative effect on the quality of ICM on the day 8 and the rate of expression of Oct4 on blastocysts, and increased the percentage of cells from these embryos expressing Cdx2, also, Oct4/Cdx2 ratio were significantly lower in the blastocysts derived from embryos exposed to 0.2 g/cm2 and 2 g/cm2¬ concentrations. Given these results, the suggestion is that DEP could be involved in the mechanisms that lead to decreased reproductive success observed in mice exposed to environmental pollution

Made available in DSpace on 2016-12-08T16:24:14Z (GMT). No. of bitstreams: 1 PGCA12MA106.pdf: 7444114 bytes, checksum: 2547058845886ef40cf92c5b6a4e6867 (MD5) Previous issue date: 2012-03-27 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Newborn calves derived from in vitro fertilization (IVF) procedures often have difficulties to adapt to life ex utero, with high birth weights usually associated with high plasma fructose levels in some in vitro-produced calves. We hypothesize that the fructose metabolic pathway is active at birth, with the fructosemia levels being either detrimental or beneficial to animal survival depending on the respiratory function in the neonate. To investigate this hypothesis, four and five newborn calves derived from in vitro- and in vivo-produced embryos were evaluated for morpho-physiological and clinical normality at birth, and for subsequent signs adaptation to life ex utero in the first 24 h of life. At birth, animals were subjected to gene expression analyses for key enzymes in the fructose metabolic pathway and to the collection of fetal fluids and urine for fructose analysis. In addition, during the period between birth and 24 h of life, animals were evaluated for clinical signs, plasma concentrations of metabolic substrates, blood chemistry, hemogasometry, and hematologic parameters. Neonatal physical, clinical, and behavioral traits were compared with physiological, biochemical, metabolic, and molecular findings observed at birth and in the first 24 h of life for the determination of physiological alterations and relationships of biological significance between the experimental groups. In vitro-derived newborn calves were heavier and larger at birth, having lower respiratory rate and thermoregulatory response than in vivo-derived controls, with no significant differences in fructose, glucose and lactate levels between groups. Nevertheless, physiological and metabolic findings at birth, in general, were widely similar and normal between groups. However, during the first 24 h of life, IVF-derived calves showed physiological, metabolic, biochemical, hemogasometric, and hematologic features indicative of a lower adaptation to life ex utero, particularly in the first 4 to 6 h of life. The main differences indicated that larger animals, mainly the IVF-derived calves, had more difficulties to maintain plasma oxygen levels, likely due to a less efficient hematosis, with evidence of a metabolic shift and elevation of metabolic substrates (mostly lactate), and a trend for acidosis followed by a compensatory normalization of the acid-base balance, predominantly in the first 6 h of life. The physiological and metabolic role of fructose was apparent, but not conclusive / Neonatos bovinos derivados de fecundação in vitro (FIV) frequentemente apresentam dificuldades de adaptação à vida ex utero, estando o excesso de peso ao nascer associado a elevadas concentrações plasmáticas de frutose em alguns bezerros de FIV. A hipótese deste trabalho é que a via metabólica da frutose é ativa ao nascimento, podendo ser benéfica ou prejudicial à sobrevivência neonatal, dependendo da função respiratória do neonato. Para investigar esta hipótese, quatro neonatos bovinos derivados de embriões produzidos in vitro e cinco de embriões in vivo foram avaliados quanto à normalidade morfo-fisiológica e clínica ao nascimento, e quanto a sinais de adaptação ao ambiente extrauterino nas primeiras 24 h de vida. Ao nascimento, os animais foram submetidos à análise de expressão gênica de enzimas da via metabólica da frutose e à coleta de fluídos fetais e de urina para mensuração da frutose. Durante o período do parto até as 24 h de vida, foram avaliados os sinais clínicos, as concentrações plasmáticas de substratos metabólicos, a bioquímica sanguínea, a hemogasometria e o hemograma. As características físicas, clínicas e comportamentais dos neonatos foram comparadas aos parâmetros fisiológicos, bioquímicos, metabólicos e moleculares avaliados ao parto e nas primeiras 24 h de vida para a determinação de alterações fisiológicas e inter-relações de significância biológica entre os grupos experimentais. Os neonatos bovinos derivados de FIV foram mais pesados e maiores ao nascimento, apresentando uma menor frequência respiratória e uma menor resposta termoregulatória que animais SOV, não havendo diferenças nos níveis de frutose, glicose e lactato entre os grupos. Não obstante, os parâmetros fisiológicos e metabólicos ao nascimento foram, em geral, amplamente similares e normais entre os grupos experimentais. Porém, ao longo das primeiras 24 h, os neonatos de FIV apresentaram características fisiológicas, metabólicas, bioquímicas, hemogasométricas, e hematológicas indicativas de uma maior dificuldade de adaptação à vida ex utero, em especial nas primeiras 4 a 6 h após de vida. As principais diferenças indicaram que animais maiores, em especial os de FIV, apresentaram maior dificuldade para a manutenção da normóxia, por uma hematose menos eficiente, mudanças metabólicas e uma elevação de substratos metabólicos (principalmente o lactato), e uma tendência à acidose com normalização compensatória do balanço ácido-base, principalmente nas primeiras 6 h de vida. O papel fisiológico e metabólico da frutose foi aparente, mas não conclusivo

O avanço da ciência, em especial na área da reprodução humana, permitiu a ocorrência de concepção humana de forma extracorpórea através do processo de fecundação in vitro a ser feita em laboratório especializado em reprodução humana assistida. Os embriões não implantados em útero materno são criopreservados. Este trabalho busca trazer os questionamentos da bioética, do biodireito, a cerca deste tema e das questões nele envolvidas. Também examina o enquadramento destes embriões sob a ótica da proteção Constitucional do patrimônio genético, da inviolabilidade da vida e da dignidade da pessoa humana. Trata também do Meio Ambiente quando aborda a Constituição Federal Brasileira de 1988, que em seu artigo 225 § 1º, inciso I, legisla sobre a preservação e restauração dos processos ecológicos e, no inciso II, determina que incumbe ao poder público preservar a diversidade e a integridade do patrimônio genético do País ficando demonstrado que tratar de embriões é tratar de patrimônio genético e de Meio Ambiente.Trata ainda da Nova Lei de Biossegurança/2005, a qual veio permitir pesquisas com célulastronco de embriões criopreservados, bem como a regulamentação desta Lei, tratando ainda sobre a Ação Direta de Inconstitucionalidade (ADIN) 3.510-0 que fora proposta junto ao Supremo Tribunal Federal (STF), questionando a constitucionalidade da permissão legal destas pesquisas. Dessa forma, é feita uma análise sobre a legislação existente com vistas a obter uma visão sobre eventuais direitos e proteção dos embriões criopreservados. / Submitted by Marcelo Teixeira (mvteixeira@ucs.br) on 2014-06-04T19:54:25Z No. of bitstreams: 1 Dissertacao Denise Kempf.pdf: 1443498 bytes, checksum: 1586cffbe1630fc158628d51f0cd295a (MD5) / Made available in DSpace on 2014-06-04T19:54:25Z (GMT). No. of bitstreams: 1 Dissertacao Denise Kempf.pdf: 1443498 bytes, checksum: 1586cffbe1630fc158628d51f0cd295a (MD5) / The advancement of science, particularly in the area of human reproduction, allowed the occurrence of human conception in a bypass through the process of in vitro fertilization to be made in a laboratory specializing in assisted human reproduction. The embryos not implanted in the uterus are cryopreserved. This work seeks to bring the questions of bioethics, the biolaw, about this issue and the issues involved. It also examines the framework of these embryos from the perspective of Constitutional protection of genetic heritage, the sanctity of life and human dignity. It also deals with the Environment when addresses the Brazilian Constitution of 1988, which in article 225 § 1, section I, legislation on the preservation and restoration of ecological processes and, in section II, provides that "it is for the government to preserve the diversity and integrity of the genetic heritage being shown that treating embryos is to address genetic heritage and also the Middle Ambiente.Trata Biossegurança/2005 New Law, which has allowed research on stem cells from cryopreserved embryos, as well as regulation this Act, still dealing with on the direct action of unconstitutionality (ADIN) 3510-0 which was proposed to the Supreme Court (STF), questioning the constitutionality of the legal permission of this research. Thus, an analysis is made on the existing legislation in order to get an insight into possible rights and protection of cryopreserved embryos.

Introdução: Considerando a prevalência, a importância social dos tratamentos de alta complexidade de mulheres inférteis e o contexto atual da literatura que atribui relevância aos polimorfismos dos genes reguladores do desenvolvimento inicial e crescimento folicular, entre eles o FSHR, LH, LHR, AMH, AMHR, BMP15 e GDF9; torna-se imprescindível o melhor conhecimento e a quantificação desses fatores. Com isso poderemos individualizar e abordar de forma mais racional a investigação e o tratamento destas mulheres submetidas à fertilização in vitro (FIV). Objetivos: Avaliar se os polimorfismos dos genes do LH (Trp8Arg e Ile15Thr), AMH (Ile49Ser), BMP15 (673C/T, 9C/G, IVSI+905A/G), GDF9 (546G>A, 398C>G, 447C>T e 646G>A), e dos receptores do FSH (Ser680Asn), do LH (18isnILQ) e do AMH (Ile49Ser), estão relacionados a diferentes desfechos reprodutivos em pacientes submetidas à fertilização in vitro. Métodos: Realizamos dois estudos em mulheres submetidas à indução ovulatória para FIV: (1) um estudo caso-controle entre pacientes normo respondedoras e má respondedoras, (2) um estudo transversal em pacientes jovens submetidas à indução ovulatória para fertilização in vitro (FIV). Foi extraído DNA das pacientes submetidas à indução ovulatória para FIV a partir do sangue periférico para realização de polymerase chain reaction, com o objetivo de detectar os polimorfismos dos referidos genes e as respectivas relações com os resultados obtidos na estimulação ovariana, no Laboratório de Terapia Gênica do HCPA/UFRGS. Resultados: Foi evidenciado que a presença do polimorfismo 398C>G no gene GDF9 está associada à má resposta em pacientes inférteis submetidas à estimulação ovariana para fertilização in vitro (68% em má respondedoras versus 23% normo respondedoras, OR: 4.01, 95% IC:1.52-10.60). Além disso, o genótipo mutante para o polimorfismo G447C>T no gene do GDF9 foi encontrado em 50% nas pacientes má respondedoras versus 19% nas pacientes normo respondedoras (OR: 2.88, 95% IC:1.19-6.04), evidenciando uma forte associação destes polimorfismos com a má resposta ovariana à estimulação. Encontramos, também, que as mulheres portadoras do alelo mutante do gene 447C>T do GDF9 tiveram um número menor de folículos entre 12-14 mm no dia do hCG (1,62 versus 2,46, P = 0,007). As mulheres com o alelo mutante do gene do GDF9 398C>G tiveram um menor número de folículos maiores que 17 mm no dia do hCG (4,33 versus 6,49, P = 0,001), menor número de folículos entre 12 e 14 milímetros no dia do hCG (1,42 versus 2,25, P= 0,017), um menor número de folículos no dia do hCG (7,33 versus 10,11 versus, P = 0,007), e redução total de oócitos MII coletados (5,38 versus 8,84 P = 0,017). Conclusão: Concluímos que polimorfismos no gene do GDF9 têm uma influência significativa no desenvolvimento do oócito, uma vez que a presença dos alelos mutantes 447C>T e 398C>G diminui o número total de folículos maduros e o número total de oócitos coletados de tais pacientes, além deste último estar associado à má resposta ovariana em pacientes submetidas à indução da ovulação para fertilização in vitro. Isso mostra que este membro da família TGFβ além de atuar nas fases iniciais da foliculogênese também tem influência importante sobre a fase final do desenvolvimento do oócito. / Introduction: Given the prevalence, the social importance of high complexity treatments of infertile women and the current context of the literature assigns relevance to polymorphisms of genes regulating early follicle growth and development, including LH, AMH, BMP15, GDF9, FSHR, LHR and AMHR; become essential to better understanding and quantification of these factors. With this we can individualize and address more rationally research and treatment of these women undergoing IVF. Objectives: Evaluate the relationship of polymorphisms of LH (Trp8Arg andIle15Thr), AMH (Ile49Ser), BMP15 ( 673C/T, 9C/ G, IVSI+905A/ G) and GDF9 (546G>A, 398C>G, 447C>Tand646G>A) genes, and FSH (Ser680Asn), LH (18isnILQ) and AMH (Ile49Ser) receptors genes, related to different reproductive outcomes in patients undergoing IVF. Methods: Our study consisted of two phases: the first conducted a case-control study among patients with normal responders and poor responders, and the second a cross-sectional study in young patients undergoing ovulation induction for in vitro fertilization. DNA was extracted from peripheral blood for performing polymerase chain reaction (PCR) and analyzed at the Laboratory of Gene Therapy HCPA/UFRGS, with the objective of detecting polymorphisms of these genes and their relationships to the results obtained in ovarian stimulation. Results: It was shown that the presence of polymorphism 398C>G in GDF9 gene is associated with poor response in infertile patients undergoing controlled ovarian stimulation for in vitro fertilization (68% in poor responders versus 23% in normal responders). Furthermore, the genotype GDF9 447C>T mutant polymorphism was found in 50% and 19%, respectively, in poor and normal responders patients, showing a strong association with this polymorphism and a poor response in ovarian stimulation. Women carrying the GDF9 398C>G mutant allele had a smaller number of follicles between 12-14 mm on the day of r-hCG (1.62 vs. 2.46, respectively P=0.007). Women with GDF9 398C>G mutant allele had a smaller number of follicles larger than 17 mm on the r-hCG day (4.33 vs. 6.49, P=0.001), a smaller number of follicles between 12 and 14mm on the r-hCG day (1.42 vs. 2.25, P=0.017), a smaller number of follicles on the r-hCG day (7.33 vs. 10.11, P=0,007), and a reduced overall number of MII oocytes collected (5.38 vs. 8.84 ,P=0.017). Conclusion: We conclude that GDF9 polymorphisms in the gene have a significant influence on the development of the oocytes, since the presence of the mutant alleles 447C>T and 398C>G decreases the total number of mature follicles, total number of oocytes collected, and are associated a poor ovarian response in patients undergoing ovulation induction for in vitro fertilization. This shows that this member of the TGFβ family besides acting in the early stages of folliculogenesis also has important influence on the final stage of oocytes development.