Av par i fertil ålder som aktivt försöker få barn är det 10-15 procent som inte lyckas inom ett år och räknas då till kategorin ofrivilligt barnlösa. Att drabbas av ofrivillig barnlöshet innebär stor sorg och prövning för det drabbade paret. Med hjälp av assisterad befruktning kan parets möjligheter till graviditet öka. En IVF-process innebär psykisk och fysisk påfrestning, vilket ställer stora krav på vårdens bemötande, kompetens och stöd. Denna studie syftar till att undersöka hur par som genomgår IVF-behandling upplever vårdens bemötande samt om och i så fall hur parets relation påverkats under och efter IVF-processen. Studien har en kvalitativ ansats och för att uppfylla syfte och besvara frågeställningar har semistrukturerade intervjuer använts som metod. Undersökningen består av fem intervjupar vilka genomgått eller genomgår en IVF-process. Resultatet visar att respondenterna från en början upplevde ett varmt och välkomnande bemötande, men att det efterhand förändrades. Respondenterna beskriver brister hos vårdpersonalen såsom kränkning, kompetens- och tidsbrist. Vidare framgår att flertalet upplever att de blivit bemötta som en i mängden, framförallt av läkare, då de inte fått den individanpassade vård som krävdes. Resultatet visar att paret under IVF-processen utsätts för flertalet påfrestningar, vilket kan vara krävande för parrelationen. Trots detta upplever paren att påfrestningarna medfört en stärkt parrelation. / Of couples of reproductive age who are actively trying to conceive, 10-15 percent fails within a year, and is then counted in the category of involuntary childlessness. Couples that suffer from infertility often experience great emotional distress. With the help of assisted reproduction, the couple's possibility of a pregnancy may increase. The IVF process involves mental and physical stress, which leads to heavy demands on health care treatment, expertise and support. This study aims to examine how couples undergoing IVF treatment experienced the response they received from health care system. This includes whether or not the couple's relationship was affected during and after the IVF treatment process and if so how it was affected. The study was made with a qualitative approach. Semi-structured interviews have been our method for obtaining data this study. The study is based on interviews of five couples who underwent, or are still undergoing an IVF treatment process. The results show that respondents initially experienced a warm and friendly welcome from the health care system, but it gradually changed for worse. The respondents describe what they see as inadequacies of healthcare providers such as offensiveness, lack of skills, and time constraints. Furthermore, it appears that the majority feels that they have been overlooked, especially by doctors, when they did not receive the personalized care they needed. The results show that during the IVF treatment process the couples are subjected to intense and varying forms of stress that can be hard on their relationships. Despite the strain it has put on them, the couple's feel that it has strengthened their relationships.

No description available.

The follicle and its enclosed oocyte share intimate and critical communication that regulates folliculogenesis and produces a mature oocyte. Protein and RNA accumulated in the oocyte during oogenesis control fertilization and direct embryonic development until the embryonic genome activates. Most knowledge of mammalian oocyte biology has been derived from eutherian species. Marsupials deserve more detailed studies because they have a distinct reproductive biology that offers a unique perspective from which to consider mammalian reproduction. The oocyte biology of the tammar wallaby, Macropus eugenii, is the focus of research in this thesis. Cold storage, a simple method for transporting ovarian tissue, was evaluated using histological techniques and follicle culture to assess the structure and function of tammar ovarian tissue. In vitro techniques were used to examine and compare: -folliculogenesis in prepubertal and adult animals, - fertilization of in vivo and in vitro matured oocytes, - and embryo development in follicular and tubal oocytes. / Tammar ovaries were placed in cold storage (PBS at 4?C) for 24 or 48 hours. Necrotic changes were minimal in ovarian follicles after cold storage and preantral follicles isolated from ovarian tissue after cold storage grew by similar amounts as non-stored follicles when cultured for 4 days in vitro. Although the general morphology and growth of follicles are unaffected after cold storage for up to 48 hours, the viability of the oocyte is of prime importance. The next important stages of this study were to develop in vitro techniques for follicle culture and for oocyte maturation and fertilization for future assessment of oocytes after cold storage. / A defined (serum-free) culture system was developed to grow isolated preantral follicles from prepubertal and adult tammars. FSH promoted follicle growth and antrum formation in follicles from prepubertal tammars. Although FSH promoted growth in follicles from adult tammars, other factors present in serum were required for antrum formation. Therefore, once the hypothalmo-pituitary-gonadal axis is mature, hormones and growth factors modify the mechanism of antrum formation. Only follicles that developed an antrum in the presence of serum had granulosa and theca layers that had appropriately differentiated. While FSH stimulates follicle growth in vitro, more complex conditions are required to promote granulosa and theca differentiation. / Intra-cytoplasmic sperm injection (ICSI) was successfully used to compare fertilization of in vivo and in vitro matured oocytes as well as the development of mature oocytes collected from the ovary (surrounded by zona pellucida) or from the oviduct (surrounded by zona pellucida and mucoid coat). In vitro matured oocytes proceeded though the early stages of fertilization (e.g. sperm nuclear decondensation, pronuclear formation), but not syngamy. After sperm injection, in vivo matured oocytes cleaved as far as the 8-cell stage. Oocytes do not lose their ability to fertilize after acquisition of the mucoid coat, since tubal oocytes cleaved as far as the 8-cell stage after sperm injection. Follicular oocytes develop as far as the 5-cell stage after sperm injection, but embryos had a large cleavage cavity that hindered cell-cell contact. While the mucoid coat is not required for cleavage, it is important for appropriate cell-cell interaction and normal early development of the embryo. / This, the most detailed in vitro study of marsupial oocyte biology, has shown that there are many similarities in the biology of marsupial and eutherian oocytes but that the unique biology of marsupials offers a significant perspective on mammalian reproduction. This work also lays the foundation for the effective use of assisted reproductive techniques for conservation of Australia’s unique mammalian fauna.

Inhibin A and B participate to regulation of gametogenesis. We investigated their applicability as a marker of gametogenesis of men fertility disorders. We monitored the levels of inhibins during the treatment. We interested in their paracrine activity, relationship in sera, follicular fluid and seminal plasma depending on cause of fertility failure. We studied the levels of inhibin B in serum and seminal plasma from 355 men treated for fertility failure, in the context of their andrological and immunological findings (quality of spermiogrammes and acrosome area). We monitored concentration of levels of inhibin A and B in serum and follicular fluids depending on cause of fertility failure, on course and treatment outcome. We took blood samples in the time of the oocytes collection, of the embryotransfer and early pregnancy. The follicular fluids were obtained during the oocytes collection. The levels of both of inhibins were measured by ELISA in all medium (serum, follicular fluid, seminal plasma). We confirm, that inhibin B is useful marker of spermatogenesis in men, but is necessary to examine patient in complex with determination of immunology profile or quality of acrosome. Seminal plasma is, in some indicated cases, more suitable diagnostics material. Similarly inhibin B in women seems to be...

Made available in DSpace on 2015-07-22T20:50:27Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-03-25. Added 1 bitstream(s) on 2015-08-11T03:25:26Z : No. of bitstreams: 1 Publico-00235.pdf: 311178 bytes, checksum: 4bdcda98426ffee2492755dd8ae27d33 (MD5) / Verificar a relacao entre as concentracoes de substancias reativas ao acido tiobarbiturico, a atividade das enzimas glutationa peroxidase e catalase com a ocorrencia de gravidez, com o estimulo hormonal administrado e com a presenca ou nao de um fator de infertilidade feminino. Metodo: Foi realizado um estudo prospectivo caso controle com o liquido folicular de 146 pacientes que foram submetidas ao programa de Reproducao Assistida da UNIFESP. Como criterios de inclusao foram considerados apenas as pacientes que realizaram o protocolo de fertilizacao in vitro (FIV) atraves de injecao intracitoplasmatica de espermatozoide (ICSI). Os grupos experimentais foram subdivididos de acordo com a presenca ou nao de gestacao, com hormonio administrado durante o estimulo (FSH ou FSH e hMG) e com a presenca ou nao de pelo menos um fator de infertilidade feminina. As aliquotas dos liquidos foliculares foram coletadas apos a retirada dos oocitos e analisadas por espectrofotometro para mensurar as concentracoes de substancias reativas ao acido tiobarbiturico (TBARS) . um marcador de peroxidacao lipidica, e das enzimas catalase e glutationa peroxidase presentes em cada amostra. Um modelo de regressao logistica foi construido utilizando numero de embrioes de alta qualidade no terceiro dia de cultivo transferidos, presenca de pelo menos um fator de infertilidade feminino e a atividade da glutationa peroxidase, maximizando a preditibilidade da ocorrencia de gravidez. Resultados: No grupo de mulheres nao gravidas foi observada uma maior atividade da enzima glutationa peroxidase (p=0,04). Nos outros grupos nao foi observada diferenca estatistica entre nenhum dos parametros avaliados. Na regressao logistica, o melhor modelo preditivo para gravidez incluiu os valores de fator de infertilidade, classificacao embrionaria no terceiro dia de cultivo e a atividade de glutationa peroxidase (73,68%, p=0.00001). O valor de odds-ratio para a atividade de glutationa peroxidase foi 0,98, indicando que valores crescentes de atividade glutationa levaram a diminuicao da chance de ocorrencia de gravidez. Conclusao: Nas condicoes deste estudo, (i) mulheres com ƒÀ-hCG negativo possuem uma maior atividade da glutationa peroxidase, (ii) diferentes estimulos ovarianos nao provocam alteracao nas concentracoes de TBARS e na atividade das enzimas antioxidantes e (iii) a presenca de pelo menos um fator de infertilidade feminino nao altera a concentracao de TBARS e a atividade da enzimas antioxidantes. / Objective: to verify the relation between thiobarbituric acid reactive substances concentrations, glutathione peroxidase and catalase activities, and occurrence of pregnancy, hormonal stimulation protocol utilized, and presence or not of a female infertility factor. Method: a prospective case-control study was carried with follicular fluid from 146 patients submitted to the Assisted Reproduction program at the Sao Paulo Federal University. Only patients submitted to in vitro fertilization (FIV) through intracytoplasmic sperm injection (ICSI) were included. The experimental groups were subdivided according to presence or absence of pregnancy, hormonal stimulation protocol used (FSH or FSH and hMG) and presence or absence of at least one female infertility factor. An aliquot of follicular fluid was collected after retrieval of the oocyte for analysis of thiobarbituric acid reactive substances concentrations, and glutathione peroxidase and catalase activities. All these analyses were carried out using a spectrophotometer. Groups were compared using Student’s T-test. A logistic regression model were calculated using embryo quality on day 3, presence or not of a female infertility factor, thiobarbituric acid reactive substances levels, and glutathione peroxidase (GPX) and catalase activities as independent variables, occurrence of pregnancy as a binary dependent variable. Results: Patients who did not achieve pregnancy presented higher glutathione peroxidase activity levels, when compared with patients who achieved pregnancy (p=0,04). In the other groups, no differences were observed. Logistic regression produced a model which best predicted pregnancy including presence of female infertility factor, embryo quality on day 3 and GPX activity (73.7% total predictive value, p=0.00001). Odds-ratio for GPX activity was 0.98, indicating that increasing values of GPX activity decreased the odds of occurrence of pregnancy. Conclusion: Based on our results, we may conclude that (i) higher GPX activity is associated to negative outcomes in ICSI cycles, (ii) different ovarian stimulation protocols does not alter concentrations of TBARS and activity of antioxidant enzymes, and (iii) the presence of at least one female infertility factor does not alter TBARS levels or antioxidant activity. / TEDE / BV UNIFESP: Teses e dissertações

Introdução: A resistência insulínica (RI) decorrente da obesidade está relacionada a distúrbios hormonais que afetam o sistema reprodutor. Leptina e grelina são hormônios que regulam o balanço energético; porém, informações acerca da relação destes hormônios com a infertilidade são escassas. A dieta de baixo índice glicêmico (BIG) parece exercer impacto positivo sobre as alterações metabólicas decorrentes da RI. Objetivo: Verificar o efeito de uma dieta hipocalórica de baixo índice/carga glicêmica sobre parâmetros antropométricos e metabólicos, níveis de grelina e leptina e desfechos reprodutivos em mulheres inférteis com excesso de peso candidatas à fertilização in vitro (FIV). Métodos: Ensaio clínico randomizado. Foram analisadas vinte e seis mulheres inférteis com obesidade Grau I ou II ou pré-obesidade associada à circunferência da cintura aumentada. As pacientes foram alocadas no grupo Dieta Hipocalórica de BIG, ou no grupo Controle (manutenção do hábito alimentar) e acompanhadas por 12 semanas. Parâmetros avaliados: peso corporal, índice de massa corporal (IMC), percentual de gordura (%G), glicose, insulina, HOMA-IR, lipídios séricos, hormônios reprodutivos, grelina acilada, leptina, dose de gonadotrofinas, número e qualidade oocitária e embrionária, taxa de fertilização e de gestação. Resultados: Houve redução de 5,5% do peso corporal e também do IMC (p < 0,001), do %G (p = 0,002), dos níveis de glicose (p = 0,034) e de leptina (p = 0,013) no grupo BIG quando comparado ao grupo controle. Houve um aumento de 18% nos níveis de grelina no grupo BIG quando comparado ao controle, mas esse aumento não foi significativo (p > 0,05). O grupo BIG obteve 85,4% mais oócitos coletados, quando comparado ao grupo controle (7,75 ± 1,44 vs. 4,18 ± 0,87, respectivamente, p = 0.039) no ciclo de FIV. Não houve diferença entre os grupos na dose de gonadotrofinas, na qualidade oocitária e embrionária, e na taxa de fertilização. Três (21,4%) pacientes do grupo BIG apresentaram gestação espontânea durante o acompanhamento, gerando três nascidos vivos. Conclusões: A perda de 5,5% do peso corporal através da dieta hipocalórica BIG foi capaz de melhorar parâmetros antropométricos, metabólicos, reprodutivos e os desfechos de FIV, quando comparado às mulheres que mantiveram o peso corporal. Estes resultados dão sustentação à recomendação clínica de aconselhar mulheres com sobrepeso ou obesas a perderem peso através de uma dieta balanceada, preferencialmente com baixo índice/carga glicêmica, antes de serem submetidas a procedimentos de reprodução assistida. / Introduction: Insulin resistance (IR) resulting from obesity is related to hormonal disorders that affect reproductive system. Leptin and ghrelin are hormones that regulate energy balance; however, the relationship of these hormones with infertility is not clear. The low glycemic index (LGI) diet seems to exert a positive impact on obesity and metabolic changes resulting from IR. Objective: To verify the effect of a hypocaloric diet with low glycemic index/load on anthropometric and metabolic parameters, ghrelin and leptin levels and reproductive outcomes in overweight and obese infertile women candidates to in vitro fertilization (IVF). Methods: Randomized clinical trial. Twenty six infertile women with grade I and II obesity, or pre-obesity with increased waist circumference were analysed. Patients were assigned to hypocaloric LGI diet group or control group (maintenance of usual diet), and followed the protocol for 12 weeks. Parameters evaluated: body weight, body mass índex (BMI), body fat percentage (%BF), glucose, insulin, HOMA-IR, serum lipids, reproductive hormones, leptin, acylated ghrelin, gonadotrophin doses, number and quality of oocytes and embryos, fertilization and pregnancy rates Results: There was a 5.5% weight loss and also a reduction in BMI (p < 0.001), BF% (p = 0.002), glucose (p = 0.034) and leptin levels (p = 0.013) in the LGI group compared to control. There was a 18% increase in ghrelin levels in the LGI group compared to control, but this increase was not significant (p > 0.05). The LGI diet group had 85.4% more oocytes retrieved compared to control group (7.75 ± 1.44 vs. 4.18 ± 0.87, respectively, p = 0.039) in the IVF cycle. The gonadotrophin dose, oocyte and embryo quality, and fertilization rate were similar between groups (p > 0.05). Three (21.4%) patients in the LGI group experienced spontaneous pregnancy during the follow-up, generating three live births. Conclusion: The 5.5% weight loss trough the hypocaloric LGI diet was able to improve antropometric, metabolic, reproductive and IVF outcomes when compared with women that not lose weight. These results support the clinical recommendation to advise overweight and obese women to lose weight through a balanced diet, preferably with low glycemic index/load, prior to be submitted to assisted reproduction technologies.

Made available in DSpace on 2015-03-26T13:47:10Z (GMT). No. of bitstreams: 1 texto completo.pdf: 568384 bytes, checksum: 3f28da52ad1ef87aa0545fb76b3263ef (MD5) Previous issue date: 2010-04-07 / Aiming to study the effect of different estrus synchronization protocols on the pregnancy rate in Bos taurus indicus x Bos taurus taurus recipient cattles, transferred with in vitro produced embryos, this study used 1,933 recipients (3,649 treatments) divided into 6 groups. In the first group, recipients received 2.0 mg of estradiol benzoate (EB) and 500 mg of cloprostenol, in addiction to an intravaginal device (1.9 g of progesterone) that remained for 8 days. Upon withdrawal of the intravaginal device each recipient received a single dose of 0.5 mg of estradiol cypionate (EC), 500 mg of cloprostenol and 400 IU of equine chorionic gonadotropin (eCG). In the second group, recipients received the same treatment as the first group, but without the 500 mg dose of cloprostenol at the placement of the progesterone intravaginal device. In the third group, recipients received at the time of intravaginal progesterone device placement a single dose of 500 mg cloprostenol and 2.0 mg of EB, and the device remained for 9 days. Two days before the intravaginal device removal (day 7) females received a single dose of 500 mg cloprostenol, and at the time of device removal, received a single dose of 0.5 mg of EC and 400 IU of eCG. In the fourth group, the recipients received the same treatment as the third group, but without cloprostenol in the intravaginal progesterone device placement. In the fifth group, recipients received 2.0 mg of EB, and an intravaginal progesterone device that remained for 8 days. Upon withdrawal of the intravaginal device, each recipient received 0.5 mg of EC, 500 mg of cloprostenol and 300 IU of eCG. In the sixth group, recipie nts received 2.0 mg of EB and an intravaginal progesterone device for 9 days. Two days before the withdrawal, (day 7), received 500 mg of cloprostenol and at the time of device removal received 0.5 mg of EC and 300 IU of eCG. All recipients that had corpus luteum were transferred on average 10 days after implant removal, in other words, about 8 days after estrus, and evaluated by ultrasonography 58 days after embryo transfer to pregnancy diagnosis. Data were subjected to descriptive statistics analysis (means, standard deviations and frequency distribution) and qualitative data were arranged in contingency tables and analyzed by chi-square at 5% of probability. Fourth group showed the best recovery rates (84.9%). However, the number of treatments performed (n=86) in group 4 was reduced in comparison with other protocols. Recipients who received Prostaglandin F2&#945; (PGF2&#945;) 48 hours before device removal showed better recovery rates than others and protocol 4 females had better pregnancy rates. The recipients that were in estrus longer than 91 days before device placing had worse recovery rates than recipients in estrus earlier (p<0.05), although did not influence pregnancy rate (p>0.05) . Despite some recipients peculiarities who presented estrus less than 16 days, the interval form estrus day to device placement did not influence positively these assessments (p>0.05). The uterus classified as normal in protocol 4 showed the best percentages of recovering and pregnancy rates (p<0.05) compared to the values of other protocols. However, comparing all protocols, the uterus classified as flaccid showed better recovery responses and classification did not influence uterine pregnancy rate. As the ovarian activity, the presence of corpus luteum influenced recipients recovery rates (p<0.05), whereas the follicles presence only interfered with the pregnancy rate of protocol 4 animals (p<0.05). The number of uses of the device did not influence the recipients recovery pregnancy rates (p>0.05). The reproductive status and protocol number in the history did not affect the recipients recovery rate (p>0.05). However, recipients who did not received PGF2&#945; before intravaginal device placing, had better results than those who received (p<0.05). The recipients which were transferred with expanded blastocyst had better pregnancy rates than they which were transferred with blastocyst (p<0.05). No differences were found in the cow and heifer categories in recipient donor estrus synchrony in relation to pregnancy rate (p>0.05). No influence of the time trial on the pregnancy rate (p>0.05). The protocols which employed PGF2&#945; 48 hours before the withdrawal had better recipients recovery rates than the protocols that applications were made on intravaginal device removal (p<0.05). Protocol 4 recipients had higher pregnancy rates, although it was a group of low numbers of animals. The used protocols interfered with the recipients recovery rate, and the applications of PGF2&#945; 48 hours before intravaginal device removal, resulted in improved estrus synchronization responses, so the answer was more pronounced when females were cyclical in occasion of the beginning of synchronization; intervals from the last estrus to intravaginal device placement over 90 days (anestrus) influence negatively the responses to estrus and ovulation synchronization protocols. However, the classes of interval from estrus to intravaginal device placement (CLAPROT), the covariates showed no marked effect on the recipients recovery response; The female categories (cows and heifers) did not influence the responses to estrus synchronization treatments, although heifers in the pre-puberty are less responsive to PGF2&#945; application in the beginning of the protocol. Regardless of the females category, the presence of the corpus luteum and flaccid uterine tone at the time of intravaginal device placement proved to be positively related to the recipients recovery response; Reusing intravaginal device has no influence on the recovery and pregnancy rates in embryo recipients; Females with histories of prior use of synchronization protocols with the use of PGF2&#945; become less responsive to new synchronization protocols, while not presenting the same behavior with respect to protocols with progesterone associated with PGF2&#945;. / Com o objetivo de estudar o efeito de diferentes protocolos de sincronização de estro (Uso de cloprostenol no momento da colocação do implante intravaginal e sua permanência por período de oito e nove dias) sobre a taxa de prenhez em receptoras bovinas Bos taurus indicus x Bos taurus taurus, inovuladas com embriões de PIV, o presente estudo utilizou 1933 receptoras (3.649 tratamentos) divididas em 6 protocolos. No protocolo 1, as receptoras receberam 2,0 mg de Benzoato de estradiol (BE) e 500 &#956;g de cloprostenol, e um dispositivo intravaginal (1,9 g de Progesterona) que permaneceu por 8 dias. No momento da retirada do dispositivo intravaginal cada receptora recebeu uma dose única de 0,5 mg de Cipionato de estradiol (CE), 500 &#956;g de Cloprostenol e 400 UI de gonadotrofina coriônica eqüina (eCG). No protocolo 2, as receptoras receberam o mesmo tratamento que o primeiro grupo, porém sem a dose de 500 &#956;g de Cloprostenol na colocação do dispositivo intravaginal de progesterona. No protocolo 3, as receptoras receberam no momento da colocação do dispositivo intravaginal de progesterona uma dose única de 500 &#956;g de Cloprostenol e 2,0 mg de BE, sendo que o dispositivo permaneceu por 9 dias. Dois dias antes da retirada do dispositivo intravaginal (dia 7) as fêmeas receberam uma dose única de 500 &#956;g de Cloprostenol, e no momento da retirada do implante, receberam uma dose única de 0,5 mg de CE e 400 UI de eCG. No protocolo 4, as receptoras receberam o mesmo tratamento que o protocolo 3, porém sem Cloprostenol na colocação do dispositivo intravaginal de progesterona. No protocolo 5, as receptoras receberam 2,0 mg de Benzoato de estradiol, e um dispositivo intravaginal de progesterona por 9 dias. Dois dias antes da retirada, no dia 7, receberam 500 &#956;g de Cloprostenol e no momento da retirada do implante 0,5mg de CE e 300 UI de eCG. No protocolo 6, as receptoras receberam 2,0 mg de BE, e um dispositivo intravaginal de progesterona que permaneceu por 8 dias. No momento da retirada do dispositivo intravaginal, cada receptora recebeu 0,5 mg de CE, 500 &#956;g de Cloprostenol e 300 UI de eCG. Todas as receptoras que apresentaram corpo lúteo foram inovuladas em média 10 dias após a retirada do dispositivo, ou seja, por volta de 8 dias após estro; e avaliadas por meio de ultrassonografia aos 58 dias após inovulação para o diagnóstico de gestação. Os dados foram submetidos a análises estatísticas descritivas (distribuição de freqüência) e os dados qualitativos foram arranjados em tabelas de contingência e analisados pelo teste de qui-quadrado a 5 % de probabilidade de erro. As receptoras do quarto protocolo apresentaram as melhores (p<0,05) taxas de aproveitamento (84,9%). No entanto, o número de tratamentos realizados (n=86) para o protocolo 4 foi reduzido em relação aos demais protocolos, mais estudos tornam-se necessários para confirmar a eficácia desse protocolo. Receptoras que receberam PGF2&#945; 48 horas antes da retirada do dispositivo apresentaram melhores índices de aproveitamento de receptoras (p<0,05) e as fêmeas do protocolo 4 apresentaram melhores índices de prenhez (p<0,05). As receptoras que apresentaram estro em período superior a 91 dias antes da colocação do dispositivo apresentaram piores taxas de aproveitamento que receptoras que apresentaram estro mais recente (p<0,05). Apesar de algumas particularidades das receptoras que apresentaram estro em período inferior a 16 dias, o intervalo dia do estro a colocação do implante não influenciou positivamente nessas avaliações (p>0,05). O útero classificado como normal no protocolo 4 foi o que apresentou melhores valores percentuais de taxa de aproveitamento e de prenhez em relação aos valores dos demais protocolos (p<0,05). Entretanto, comparando todos os protocolos, o útero classificado como flácido apresentou melhores respostas de aproveitamento de receptoras (p>0,05) e a classificação uterina não influenciou a taxa de prenhez (p>0,05). Quanto a atividade ovariana, a presença do CL influenciou na taxa de aproveitamento de receptoras (p<0,05), já a presença de folículos só interferiu na taxa de prenhez dos animais do protocolo 4 (p<0,05). O número de utilização do dispositivo não influenciou na taxa de aproveitamento de receptoras e na taxa de prenhez (p>0,05). O status reprodutivo e o número de protocolo no histórico não interferiram na taxa de aproveitamento de receptoras (p>0,05). No entanto, receptoras que não receberam PGF2&#945; antes da colocação do dispositivo intravaginal, apresentaram melhores resultados que as receptoras que receberam PGF2&#945; (p<0,05). As receptoras que foram inovuladas com blastocisto expandido apresentaram melhores taxas de prenhez do que as receptoras que foram inovuladas com blastocisto (p<0,05). Não houve diferença nas categorias vacas e novilhas na sincronia do estro receptora doadora, em relação à taxa de prenhez (P>0,05). Não houve influência da época experimental sobre a taxa de prenhez (p>0,05). Os protocolos que empregaram PGF2&#945; 48 horas antes da retirada apresentaram melhores taxas de aproveitamento de receptoras do que os protocolos em que as aplicações foram feitas no momento da retirada do dispositivo intravaginal (p<0,05). As receptoras do protocolo 4 apresentaram melhores taxas de prenhez, embora tenha sido um grupo de baixo número de animais. Os protocolos utilizados interferiram na taxa de aproveitamento de receptoras, sendo que, as aplicações de PGF2&#945; 48 horas antes da retirada do dispositivo intravaginal, resultaram em melhores respostas de sincronização de estro, sendo a resposta mais acentuada quando as fêmeas estavam cíclicas na ocasião do início das sincronizações; Os intervalos do ultimo estro à colocação do dispositivo intravaginal superiores a 90 dias (anestro) influenciam negativamente as respostas aos protocolos de sincronização de estro de ovulaç ão. No entanto, as classes de intervalo do estro à colocação do dispositivo intravaginal (CLAPROT), as co-variáveis estudadas não apresentaram efeito marcante sobre a resposta de aproveitamento de receptoras; As categorias de fêmeas (vacas e novilhas) não influenciam a respostas aos tratamentos de sincronização de estro (p>0,05), embora novilhas na fase pré-puberal são menos responsivas a aplicação de PGF2&#945; no início do protocolo. Independente da categoria de fêmeas, a presença do corpo lúteo e tonicidade uterina flácida no momento da colocação do dispositivo intravaginal mostraram-se positivamente relacionado à resposta de aproveitamento de receptoras; A reutilização de dispositivo intr avaginal não apresenta influencia sobre a taxa de aproveitamento e prenhez em receptoras de embriões; Fêmeas com históricos prévios de uso de protocolos de sincronização com uso de PGF2&#945; a apresentam-se menos responsíveis a novos protocolos de sincronização, embora não apresentam o mesmo comportamento com relação aos protocolos com progestagenos associado a PGF2&#945;.

Introdução: A resistência insulínica (RI) decorrente da obesidade está relacionada a distúrbios hormonais que afetam o sistema reprodutor. Leptina e grelina são hormônios que regulam o balanço energético; porém, informações acerca da relação destes hormônios com a infertilidade são escassas. A dieta de baixo índice glicêmico (BIG) parece exercer impacto positivo sobre as alterações metabólicas decorrentes da RI. Objetivo: Verificar o efeito de uma dieta hipocalórica de baixo índice/carga glicêmica sobre parâmetros antropométricos e metabólicos, níveis de grelina e leptina e desfechos reprodutivos em mulheres inférteis com excesso de peso candidatas à fertilização in vitro (FIV). Métodos: Ensaio clínico randomizado. Foram analisadas vinte e seis mulheres inférteis com obesidade Grau I ou II ou pré-obesidade associada à circunferência da cintura aumentada. As pacientes foram alocadas no grupo Dieta Hipocalórica de BIG, ou no grupo Controle (manutenção do hábito alimentar) e acompanhadas por 12 semanas. Parâmetros avaliados: peso corporal, índice de massa corporal (IMC), percentual de gordura (%G), glicose, insulina, HOMA-IR, lipídios séricos, hormônios reprodutivos, grelina acilada, leptina, dose de gonadotrofinas, número e qualidade oocitária e embrionária, taxa de fertilização e de gestação. Resultados: Houve redução de 5,5% do peso corporal e também do IMC (p < 0,001), do %G (p = 0,002), dos níveis de glicose (p = 0,034) e de leptina (p = 0,013) no grupo BIG quando comparado ao grupo controle. Houve um aumento de 18% nos níveis de grelina no grupo BIG quando comparado ao controle, mas esse aumento não foi significativo (p > 0,05). O grupo BIG obteve 85,4% mais oócitos coletados, quando comparado ao grupo controle (7,75 ± 1,44 vs. 4,18 ± 0,87, respectivamente, p = 0.039) no ciclo de FIV. Não houve diferença entre os grupos na dose de gonadotrofinas, na qualidade oocitária e embrionária, e na taxa de fertilização. Três (21,4%) pacientes do grupo BIG apresentaram gestação espontânea durante o acompanhamento, gerando três nascidos vivos. Conclusões: A perda de 5,5% do peso corporal através da dieta hipocalórica BIG foi capaz de melhorar parâmetros antropométricos, metabólicos, reprodutivos e os desfechos de FIV, quando comparado às mulheres que mantiveram o peso corporal. Estes resultados dão sustentação à recomendação clínica de aconselhar mulheres com sobrepeso ou obesas a perderem peso através de uma dieta balanceada, preferencialmente com baixo índice/carga glicêmica, antes de serem submetidas a procedimentos de reprodução assistida. / Introduction: Insulin resistance (IR) resulting from obesity is related to hormonal disorders that affect reproductive system. Leptin and ghrelin are hormones that regulate energy balance; however, the relationship of these hormones with infertility is not clear. The low glycemic index (LGI) diet seems to exert a positive impact on obesity and metabolic changes resulting from IR. Objective: To verify the effect of a hypocaloric diet with low glycemic index/load on anthropometric and metabolic parameters, ghrelin and leptin levels and reproductive outcomes in overweight and obese infertile women candidates to in vitro fertilization (IVF). Methods: Randomized clinical trial. Twenty six infertile women with grade I and II obesity, or pre-obesity with increased waist circumference were analysed. Patients were assigned to hypocaloric LGI diet group or control group (maintenance of usual diet), and followed the protocol for 12 weeks. Parameters evaluated: body weight, body mass índex (BMI), body fat percentage (%BF), glucose, insulin, HOMA-IR, serum lipids, reproductive hormones, leptin, acylated ghrelin, gonadotrophin doses, number and quality of oocytes and embryos, fertilization and pregnancy rates Results: There was a 5.5% weight loss and also a reduction in BMI (p < 0.001), BF% (p = 0.002), glucose (p = 0.034) and leptin levels (p = 0.013) in the LGI group compared to control. There was a 18% increase in ghrelin levels in the LGI group compared to control, but this increase was not significant (p > 0.05). The LGI diet group had 85.4% more oocytes retrieved compared to control group (7.75 ± 1.44 vs. 4.18 ± 0.87, respectively, p = 0.039) in the IVF cycle. The gonadotrophin dose, oocyte and embryo quality, and fertilization rate were similar between groups (p > 0.05). Three (21.4%) patients in the LGI group experienced spontaneous pregnancy during the follow-up, generating three live births. Conclusion: The 5.5% weight loss trough the hypocaloric LGI diet was able to improve antropometric, metabolic, reproductive and IVF outcomes when compared with women that not lose weight. These results support the clinical recommendation to advise overweight and obese women to lose weight through a balanced diet, preferably with low glycemic index/load, prior to be submitted to assisted reproduction technologies.

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / The Binder of Sperm Protein 1 (BSP1) is a protein produced by seminal vesicles of animals. It helps into the fertilization process of oocytes, promoting sperm capacitation, mediating the ligation from itself with the oviduct epithelium, and increasing the motility in the oviduct. When spermatozoa with purified BSP1 were incubated, acrosomal reaction rates were determined with and without the presence of heparin, as controls. The percentage of acrosomal reaction was higher (p <0.05) in control 1 (44.5%) compared with the other treatments (BSP1:10 Âg/mL: 24.5%; 20 Âg/mL: 25.5%; 40 Âg/mL: 26.0 %), and lower the rate (p> 0.05) when sperm were incubated only in Fert-TALP medium without heparin (14.5%). Cleavage and blastocyst rates were evaluated on days two and seven respectively, after fertilize oocytes in a medium containing BSP1. 1274 cumulus- oocyte complexes were recovered and incubated for 18 hours with frozen-thawed ejaculated semen in a Fert-TALP medium, containing: only heparin, 10, 20 or 40 &#956;g/mL of BSP1. Cleavage and blastocyst rates (34.1  4.4 vs 40.8  5.0%) were similar (p> 0.05) when incubation was made with 10 Âg/mL of BSP1 and heparin, respectively. However, the concentrations of 20 and 40 Âg/mL decreased the formation of blastocysts (22.4  2.9 and 19.3  4.1%) compared with heparin (40.8  5.1%, p <0.02). Subsequently, cumulus- oocyte complexes (n = 2239) were incubated with frozen-thawed ejaculated semen. Spermatozoa were selected by a gradient of 45% -90% Percoll containing: only heparin, 10, 20, 40 &#956;g/mL of BSP1 and there was a control 2 of Percoll without heparin or BSP1. Cleavage rate was similar (p> 0.05) for the incubation with concentrations of 10, 20 and 40 &#956;g/mL of BPS1 (67.7  3.0, 68.7  3.5, 75.2  3.8, respectively). However, these rates were similar when it was used just heparin and when oocytes were incubated with 40Âg/mL of BSP1 (78.9  1.7 vs 75.2  3.8%). For blastocyst rates was found that they were similar (p> 0.05) when the selection was made with heparin (44.1  4.3%) and 40 Âg/mL of BSP1 (30.0  3.3%). Finally, 1213 cumulus-oocyte complexes were recovered and incubated with freeze-thawed epididymal semen in Fert-TALP medium, which contained: only heparin, with heparin, and 10, 20 or 40 Âg/mL of BSP1. Cleavage and blastocyst rates were similar after incubation with and without heparin, but the concentration of 40Âg/mL of BSP1 produced higher cleavages rates (79.0  1.1%) than control 1 (68.5  1.3%, p <0.05). About blastocyst rates, there were rates significantly higher when concentrations of 20 and 40 Âg/mL of BSP1 were used (35.6  2.5 and 41.1  2.0%) than with (24.7  3.2; p <0.05) and without heparin (27.3  1.6%; p <0.0003). In conclusion, BSP1 allowed proper cleavage and development, when the protein was added to the fertilization medium and the Percoll gradient using ejaculated semen, and to the fertilization medium when used epididymal sperm, without requiring the use of heparin. / A âBinder of Sperm Protein 1â (BSP1) à uma proteÃna produzida pelas vesÃculas seminais dos animais, que ajuda no processo de fertilizaÃÃo do oÃcito promovendo a capacitaÃÃo espermÃtica, mediando a sua ligaÃÃo com o epitÃlio do oviduto e aumentando sua motilidade no oviduto. As taxas de reaÃÃo de acrossoma dos espermatozoides foram determinadas ao serem incubados com BSP1 purificado, e com e sem a presenÃa de heparina, como controles. A porcentagem de reaÃÃo de acrossoma foi maior (p<0.05) no controle 1 (44.5%) comparado com os tratamentos restantes (BSP1: 10 Âg/mL: 24.5%; 20 Âg/mL: 25.5%; 40 Âg/mL: 26.0%), sendo menor esta taxa (p>0.05) quando os espermatozoides sà foram incubados no meio Fert-TALP sem heparina (14.5%). As taxas de clivagem e de blastocistos foram avaliadas nos dias dois e sete respectivamente, depois de fertilizar oÃcitos em um meio que continha BSP1. Foram recuperados 1274 COCs e incubados durante 18 horas com sÃmen ejaculado congelado- descongelado em meio Fert-TALP, que continha: sà heparina, 10, 20 ou 40 Âg/mL de BSP1. As taxas de clivagem e de blastocistos (34.1  4.4 vs 40.8  5.0%) foram similares (p>0.05) quando se fez a incubaÃÃo com 10 Âg/mL de BSP1 e heparina, respectivamente. PorÃm, as concentraÃÃes de 20 e 40 Âg/mL diminuÃram a formaÃÃo de blastocistos (22.4  2.9 e 19.3  4.1%) em relaÃÃo com a heparina (40.8  5.1%; p < 0.02). Posteriormente foram incubados COCs (n= 2239), com sÃmen ejaculado congelado-descongelado que foi selecionado por um gradiente de Percoll 45%-90% que continha: sà heparina, 10, 20 ou 40 Âg/mL de BPS1 e foi realizado um controle 2 de Percoll sem heparina nem BSP1. A taxa de clivagem foi similar (p > 0.05) para a incubaÃÃo com as concentraÃÃes de 10, 20 e 40 Âg/mL de BSP1 (67.7Â3.0, 68.7Â3.5, 75.2Â3.8). PorÃm, estas taxas foram similares quando sà foi usada heparina e quando se incubou com 40 Âg/mL de BSP1 (78.9Â1.7 vs 75.2Â3.8%). Para as taxas de blastocistos encontrou-se que foram similares (p > 0.05) quando se fez a seleÃÃo com heparina (44.1Â4.3%) e com 40 Âg/mL de BSP1 (30.0Â3.3%). Finalmente, foram recuperados 1213 complexos cumulus-oÃcitos e incubados com espermatozoides epididimÃrios congelados-descongelados em meio Fert-TALP, que continham: sà heparina, sem heparina, e 10, 20 ou 40 Âg/mL de BSP1. As taxas de clivagem e de blastocistos foram similares apÃs as incubaÃÃes com e sem heparina, mas a concentraÃÃo de 40 Âg/mL de BSP1 produziu maiores taxas de clivagem (79.0  1.1%) que o controle 1 (68.5  1.3%; p < 0.05). Quanto Ãs taxas de blastocistos, encontraram-se maiores taxas quando foram usadas as concentraÃÃes de 20 e 40 Âg/mL de BSP1 (35.6  2.5 e 41.1  2.0%) que com (24.7  3.2; p < 0.05) e sem heparina (27.3  1.6%; p < 0.0003). Em conclusÃo, a BSP1 adicionada ao meio de fertilizaÃÃo e ao gradiente de Percoll quando usado o sÃmen ejaculado, e ao meio de fertilizaÃÃo quando usados espermatozoides epididimÃrios, permitiu clivagem e desenvolvimento prÃprio, sem a necessidade do uso de heparina.

Alterações morfogênicas do aparelho cardiorespiratório de bovinos provenientes de fecundação in vitro e transferência nuclear são um dos principais fatores responsáveis pela alta incidência de mortalidade embrionária, fetal e pós-natal. Utilizamos técnicas empregadas em microscopia de luz para estudar o desenvolvimento do coração e pulmão nestes animais. Verificamos que em embriões provenientes de fecundação in vitro, aos 28 dias de gestação, aparece o tubo laringotraqueal e sua septação através da prega traqueoesofágica. Neste mesmo período os embriões apresentaram cavidade pericárdica, átrio dividido em direito e esquerdo, cone cardíaco, seio venoso, camada de miocárdio e epicárdio. O brônquio traqueal foi observado em embriões com idade gestacional de 36 dias a partir de um brotamento na porção lateral direita da traquéia, cranial a sua bifurcação. Aos 44 dias de gestação os brotos pulmonares dos embriões apresentaram brônquios principais originando brotamentos de brônquios segmentares. O mesênquima de sustentação em diferenciação continha vasos sangüíneos dispersos, diferentemente de embriões provenientes de TN, que com 68 dias de gestação apresentou pulmão em fase pseudoglandular contendo brotos de bronquíolos e poucos vasos sangüíneos nos cortes obtidos e analisados. Com 70 dias, o coração do feto apresentava ventrículo significativamente grande, pequeno átrio e pulmão não desenvolvido. A partir dos nossos resultados, concluímos que alterações genéticas, incompletas informações e comunicações celulares e modificação no metabolismo celular são os prováveis responsáveis pelas anomalias presentes nas técnicas de manipulação de embrião, causando um desenvolvimento mais lento e falho quando comparados com embriões in vivo, explicando o alto índice de perda gestacional / Morphogenetic changes of cardio-respiratory system of bovine from in vitro fertilization and nuclear transfer is a major factor responsible for high incidence of both periods embryonic, fetal and postnatal mortality. We used techniques of light microscopy to study the development of heart and lung in these animals. We found that in embryos derived from in vitro fertilization, at 28 days of gestation, appears the laryngotracheal tube and its fold through tracheoesophageal septation. In the same period the embryos showed pericardial cavity, atrium divided into left and right, cardiac cone, venous sinus, layer of myocardium and epicardium. In embryos with 36 days of gestational age was observed the tracheal bronchus from a bud in the right lateral portion of the trachea, cranial to its bifurcation. At 44 days of gestation, the lung buds of the embryos showed main bronchi giving rise to budding of segmental bronchi. The sustentation mesenchyme in differentiation contained scattered blood vessels, unlike embryos from TN, which with 68 days of gestation showed lung in pseudoglandular stage, containing bronchioles buds and few blood vessels in histological sections obtained and analyzed. With 70 days, the fetal heart ventricle had significantly large, small atrium and lungs not developed. From our results we conclude that genetic alterations, incomplete information in cellular communications and change in cellular metabolism are likely responsible for the anomalies in the techniques of embryo manipulation, causing a slower and flawed development when compared to embryos in vivo, explaining the high rate of pregnancy loss