Fernando Zegers-hochschild - Academia.edu (original) (raw)

Papers by Fernando Zegers-hochschild

Reproductive Biomedicine Online, Sep 1, 2019

Human Reproduction at the University Diego Portales and member of the Division of Reproductive Me... more Human Reproduction at the University Diego Portales and member of the Division of Reproductive Medicine at Clinica las Condes. Recognized as Doctor Honoris Causa by the University of Antofagasta, Chile, he is founder and responsible of the Latin American Registry of ART and Vice-Chairman of the International Committee for Monitoring ART (ICMART). He is a member of the FIGO Committee for Reproductive Medicine, and fellow of the American College of Obstetrics and Gynecology. Dr. Zegers-Hochschild has authored over 120 scientific articles and book chapters.

JBRA assisted reproduction, 2023

Objective: To follow the impact of the SARS-CoV-2 pandemic on the practice of assisted reproducti... more Objective: To follow the impact of the SARS-CoV-2 pandemic on the practice of assisted reproductive technology in centers reporting to the Latin American Registry during 2020. Methods: An internally validated online survey designed on the Survey Monkey platform with a maximum of 20 closed questions was sent via e-mail or WhatsApp to the clinical director of each center reporting to the Latin American Registry of Assisted Reproduction between July and December 2020. Results: The number of centers responding to the survey varied during the six months. The relative contribution of Brazil to all responses was 41.4% to 45%, followed by México (16.2% to 23.8%), Argentina (8.1% to 12.6%), Colombia (7.1% to 8.2%), Chile (3.6% to 6.1%) and Peru (4.0% to 4.9%). Most centers reported stopping activities before July 2020 (81%). COVID-19 related symptoms were a criterion on their own to postpone ovarian stimulation (80.1% to 87.7% of centers). Although in July only 76 of 166 centers (45.8%) performed embryo transfers, by October 104 of 109 centers (95.4%) performed them. In survey 6 (December), 78 of 79 centers (98.7%) that had initially closed had already reopened, although 62.3% (61 of 98 centers) still performed 80% or less of their usual number of ART cycles. Conclusions: Most centers modified their clinical practice and applied specific protocols to screen their staff and patients. Suspicion of COVID-19 delayed treatments. Despite a peak of the pandemic, by December most centers were performing all ART treatments, although the number of cycles remained low compared to pre-pandemic numbers.

Reproductive Biomedicine Online, Mar 1, 2023

JBRA assisted reproduction, 2019

Research question: What was the utilization, effectiveness and perinatal outcome of assisted repr... more Research question: What was the utilization, effectiveness and perinatal outcome of assisted reproductive technologies (ART) performed in Latin America during 2016. Design: Retrospective collection of multinational data on ART performed in 178 institutions from 15 Latin American countries. Results: We are reporting 85,474 initiated cycles, 15,070 deliveries and 18,182 babies born in this period. Of all fresh autologous IVF/ICSI cycles, 40.9% were performed in women aged 35-39 years, and 31.1% in women aged ≥40 years. After removing freeze-all cycles, delivery rate per oocyte retrieval was 20.31% for ICSI and 21.85% for IVF. Fresh single embryo transfer including all age categories represented 22.96%, with a 15.35% delivery rate per transfer. Double embryo transfer represented 61.58% of transfers, with a 27.62% delivery rate per transfer. Multiple births included 18.12% twins and 0.55% triplets and higher. In oocyte donation, delivery rate per transfer was 32.89%, with a twin and triplet rate of 23.48% and 0.73%, respectively. Overall, preterm deliveries reached 17.11% in singletons, 65.69% in twins and 95.51% in triplets. Perinatal mortality was 8.0 ‰ in singletons, 19.0 ‰ in twins, and 62.3 ‰ in high-order multiples. Conclusions: The number of initiated cycles continues to increase. Compared with previous years, the number of embryos transferred decreased while the proportion of single embryo transfers increased with a drop in multiple births. It is mandatory to stimulate health care providers and consumers to continue in this trend.

JBRA assisted reproduction, 2012

Background. Reducing the rate in IVF of multiple births and associated perinatal complications ha... more Background. Reducing the rate in IVF of multiple births and associated perinatal complications has become the major challenge in Latin America, due to is association with a significant increase in the prematurity, and perinatal mortality. methods. We selected all procedures involving the transfer of IVF embryos, reported to the Latin America Registry of ART, initiated between January 1998 and December 2008. A Poisson regression analysis was performed, stratified by woman´s age to analyse the trend in the transfer of 2, 3 and ≥4-embryos and ≥triple-pregnancy rate. Results. A total of 164,874 IVF/ICSI transfers were considered. Overall, there was a decline in the proportion of procedures performed in women aged ≤34 years old from 51% to 43%; and an increase of ICSI procedures from 61% to 86%. All age groups experienced a reduction in the proportion of ≥4-embryos transfers and an increase in that of 2-embryo transfers. Overall, the clinical pregnancy rate improved from 29% to 35% (p=0.01); and the incidence of ≥triple-pregnancy decreased from 8% to 3% in 2008 (p<0.001), while twin pregnancy remained stable (~20%) Conclusions. Our data support the policy of transferring less embryos. It shows a decline in the mean number of embryos transferred and proportion ≥ 4-embryos transfers. Moreover, it reports a clinical pregnancy rate which instead of being reduced, has shown an increase over the 10-year period.

JBRA assisted reproduction, 2012

Multiple birth, due the transfer of more than one embryo, constitutes the most serious complicati... more Multiple birth, due the transfer of more than one embryo, constitutes the most serious complication for both mother and children after assisted reproductive technology. Embryo cryopreservation allows the sequential transfer of the whole cohort of embryos generated in one ART cycle, either by electively transferring one embryo (eSET) or two embryos (eDET). We reviewed the database of ART procedures reported to the Latin American n etwork of ART (REDLARA) by 140 institutions in 2010. We identify eSET, eDET, and 3ET and 4ET when three and four or more embryos were transferred, respectively, and none was cryopreserved. We analysed the outcome of 808 eSET, 5,978 eDET, 4,398 3ET and 968 4ET. Women that underwent eSET and 4ET were older than women that underwent eDET and 3ET (p<0.0001). The mean number of oocytes recovered was higher in women undergoing eDET (12.3) than in women undergoing eSET (6.7); 3ET (9.0); and 4ET (9.8) (p<0.0001). The clinical pregnancy rate reached 18% with eSET; 43% with eDET; 34% with 3ET; and 35% with 4ET. the proportion of twin delivery was 0.9% with eSET; when more than one embryo were transferred, the twin rate did not differ �������= 22% with eDET; 21% with 3ET and 23% with 4ET. However, high order multiple births (≥3newborns) increased ���ácantly with both 3ET (3.0%) and 4ET (4.4%). that neither the weight nor gestational age at delivery of singletons were associated to the number of embryos transferred. With the proper counselling regarding cumulative pregnancy rate and risks associated with twin pregnancy, and a � ed payment for all ET performed, we expect more couples-and physicians-would undergo eSET.

JBRA assisted reproduction, 2012

Copyright-Todos os direitos reservados a SBRA-Sociedade Brasileira de Reprodução Assistida Artigo... more Copyright-Todos os direitos reservados a SBRA-Sociedade Brasileira de Reprodução Assistida Artigo Original First polar body genetic diagnosis (PbGD) as a selection tool of euploid oocytes before insemination. Diagnóstico Genético del Primer Corpúsculo Polar (PbGD): herramienta de selección de ovocitos euploides antes de la fecundación. O diagnóstico do primeiro corpúsculo polar (PbGD) na seleção de oócitos haploides, antes da inseminação

JBRA assisted reproduction, 2011

Introduction: Since 1990, the Latin American Registry of Assisted Reproduction (RLA) has register... more Introduction: Since 1990, the Latin American Registry of Assisted Reproduction (RLA) has registered ART procedures performed in Latin America. The RLA has increased its regional coverage including to date more than 80% of ART cycles performed. 140 centers enter their data directly on line, and an administrative office collects and analyses the data. Material and methods: This paper analyses trends over the last twenty years, as well as biomedical data corresponding to ART procedures initiated between 1990 and 2009, and babies born up to 2010. Overall, the data include 275,883 embryo transfer-cycles, 71,875 deliveries and the birth of 95,436 babies. results: Some of the major changes include: an increase in the age of female partners undergoing fresh, autologous embryo transfers; and a marked shift towards the use of ICSI over IVF. As expected, there has been a steady increase over the last ten years in the delivery rates with at least one live born per embryo transfer, reaching 25.3% in IVF/ ICSI cycles, and 31.6% in OD cycles. Over the years, there has been a progressive but slight decrease in the mean number of ET, but still, almost one third of all births are either twins or triplets. In the last 15 years, the proportion of transfers of one or two embryos has increased from 11 and 17% in 1995, to 14%• and 43% respectively in 2009, conclusions: Access to ART has experienced a meager increase during the period covered in this report. Our region faces two main challenges: to facilitate access to ART and to decrease the rate of multiple births.

JBRA assisted reproduction, 2012

Human Reproduction, Jun 29, 2022

Abstract title International Committee for Monitoring Assisted Reproductive Technologies (ICMART)... more Abstract title International Committee for Monitoring Assisted Reproductive Technologies (ICMART) Preliminary World Report on ART, 2018 Study question In 2018 what was global utilization, effectiveness and safety of ART? Summary answer Globally, ART utilization and data collection continue to increase but with wide variations in utilization, effectiveness and safety. What is known already ICMART began ART global data collection in 1991. Utilization, effectiveness and safety have continuously improved with more cycles, higher pregnancy rates and lower multiple birth rates, the latter as a result of transfer of fewer embryos. Frozen embryo transfer (FET) and donor egg cycles continue to increase. However, wide variations in practice and outcomes exist globally. Approximately 9 million ART babies have been born. ICMART has helped develop registries internationally. A new electronic data collection platform has been developed in conjunction with the University of New South Wales in Sydney, Australia; nevertheless, data collection and quality remain challenging. Study design, size, duration Countries and regions annually collect ART data, some prospectively and others retrospectively. ICMART retrospectively requested these data from all known global sources for 2018 and reviewed them for missing or incorrect data. The dataset was corrected and then analyzed utilizing standardized definitions from The ICMART/WHO Revised Glossary on ART Terminology, 2009 which was current at the time but is now replaced by The International Glossary on Infertility and Fertility Care, 2017, and previously developed methods. Preliminary results are presented. Participants/materials, setting, methods The European IVF Monitoring Consortium (EIM), Latin American Network of Assisted Reproduction (REDLARA), Australian/ New Zealand Registry and African Network and Registry for ART (ANARA) submitted regional data, and other countries contributed national data, through standardized formats to ICMART. A few individual clinics with no registry access also contributed. Data were reviewed, corrected, validated to the extent possible, analyzed and summarized by ICMART using descriptive statistics. Main results and the role of chance Data collection and analysis are ongoing, so presented results are preliminary. The number of ART cycles continues to increase, but utilization is still highly variable among countries and regions. Regional and country differences persist in the age of women treated, number of embryos transferred, live birth rates, rate of multiple births, use of ICSI, cryopreservation cycles and other factors. The role of chance is minimal. Actual global ART results are limited to reporting countries and clinics representing approximately 3/4 of global cycles. However, this is a very large sample size from which imputation of total global results is performed. Limitations, reasons for caution Some countries have limited data and many countries have limited data validation. ICMART can perform only minimal verification of submitted data. Widespread adherence to consensus definitions provided in the Glossary takes time and requires translation into multiple languages. Wider implications of the findings ICMART World Reports standardize data, track trends, enable comparisons, stimulate questions and improve ART quality. Better understanding of ART increases societal acceptance and support for equitable access and ART research.

The reported success rates in terms of pregnancies after various forms of treatment of the infert... more The reported success rates in terms of pregnancies after various forms of treatment of the infertile male remain unsatisfactory; therefore, the idea of stimulating sperm motility, selecting, concentrating, and eventually preserving the motile spermatozoa, and pooling the “good” spermatozoa harvested from several ejaculates for artificial insemination, remains attractive. Here, we report our experience with different techniques of motility stimulation, cryopreservation of stimulated spermatozoa, and selection and concentration of motile spermatozoa.

JBRA assisted reproduction, 2017

Multinational data on assisted reproduction techniques undertaken in 2014 were collected from 159... more Multinational data on assisted reproduction techniques undertaken in 2014 were collected from 159 institutions in 15 countries in Latin America. Treatments included IVF/ ICSI, FET, OD, PGD and fertility preservation (FP). 41.34% of IVF/ICSI cycles were performed in women aged 35 to 39 years and 23.35% in women aged 40 and older. After removing cases with total freezing, delivery rate per oocyte retrieval was 25.05% for ICSI and 27.41% for IVF. Multiple births included 20.78% twins and 0.92 % triplets and over. In OD, twins reached 28.93% and triplets 1.07 %. Preterm deliveries reached 16.4% in singletons, 55.02% in twins and 76% in triplets. Perinatal mortality in 18,162 births was 23 per 1000 in singletons, 35 per 1000 in twins, and 36 per 1000 in high-order multiples. Elective single embryo transfer (eSET) represented only 2.63 % of fresh transfers, with a delivery rate of 32.15% per transfer. Elective double embryo transfer (eDET) represented 23.74% of transfers, with a delivery rate of 41.03% per transfer. Among babies born during this period 11,373 (62.6%) were singletons; 6,398 (35.2%) twins, and 391 (2.2%), triplets and more. Given the effect of multiple births on prematurity, morbidity and perinatal mortality, reinforcing the existing trend of reducing the number of embryos transferred is mandatory

Human Reproduction, May 20, 2016

Global utilization and effectiveness remained relatively constant despite marked variations among... more Global utilization and effectiveness remained relatively constant despite marked variations among countries, while the rate of single and frozen embryo transfers (FETs) increased with a concomitant slight reduction in multiple birth rates. what is known already: ART is widely practised in all regions of the world. Monitoring utilization, an approximation of availability and access, as well as effectiveness and safety is an important component of universal access to reproductive health. study design, size, duration: This is a retrospective, cross-sectional survey on utilization, effectiveness and safety of ART procedures performed globally from 2008 to 2010. participants, setting, methods: Between 58 and 61 countries submitted data from a total of nearly 2500 ART clinics each year. Aggregate country data were processed and analyzed based on forms and methods developed by the International Committee for Monitoring Assisted Reproductive Technologies (ICMART). Results are presented at country, regional and global level. main results and the role of chance: For the years 2008, 2009 and 2010, .4 461 309 ART cycles were initiated, resulting in an estimated 1 144 858 babies born. The number of aspirations increased by 6.4% between 2008 and 2010, while FET cycles increased by 27.6%. Globally, ART utilization remained relatively constant at 436 cycles/million in 2008 and 474 cycles/million population in 2010, but with a wide country range of 8-4775 cycles/million population. ICSI remained constant at around 66% of non-donor aspiration cycles. The IVF/ICSI combined delivery rate (DR) per fresh aspiration was 19.

Fertility and Sterility, 2023

Objective: the objective of this study is to evaluate markers of embryo quality, applied on day t... more Objective: the objective of this study is to evaluate markers of embryo quality, applied on day three of in vitro culture, in their capacity to predict whether embryos will reach blastocyst stage. Methods: a retrospective analysis of embryology database coming from 2772 zygotes obtained in 564 oocyte retrievals was performed; embryos were observed from day one to five: 23 to 26 hours after insemination all zygotes were evaluated to assess early cleavage, the number of blastomeres and embryo morphology were registered on day three and blastocyst formation was evaluated on day five; early first cleavage, number of blastomeres and embryo morphology at day three were correlated with embryo development until day five. Results: blastocyst formation rate was 36% in embryos with early cleavage and 19% in embryos without early the probability of a good quality embryo (grade 1 and 2a) at day three to reach the blastocyst stage was 48%, which was significantly higher than the chances of lower quality embryos. Conclusion: factors reported in this study-early cleavage, number of blastomeres and embryo morphology-are key words: blastocyst, expanded blastocyst, early cleavage, blastomere number, embryo morphology. que as probabilidades de embriões de menor qualidade. Conclusão: Os fatores relatados neste estudo-a clivagem precoce, número de blastômeros e morfologia do embriãosão úteis para decidir cultivo prolongado in vitro até cinco dias. Palavras-chave: blastocisto, blastocisto expandido, clivagem precoce, número de blastômeros, a morfologia do embrião.

Abstract The first in vitro fertilization baby was born in Chile in 1984. In 2016, with 6000 babi... more Abstract The first in vitro fertilization baby was born in Chile in 1984. In 2016, with 6000 babies born, the Ministry of Health officially recognized assisted reproduction techniques (ART) as an established clinical intervention. However, no reference was made to selecting embryos by genetic technologies. Fluorescence in situ hybridization of the first polar body was developed in Chile in 2000 and remained the only form of preimplantation genetic testing (PGT) for the following 10 years. In 2011, two centers reported PGT for aneuploidy in cleaving embryos, and in 2014, comparative genomic hybridization (CGH) was applied in Chile and reported to the Latin American Registry of ART. In the latest report of procedures performed in 2016, all PGT were performed by CGH in blastocysts. The mean age of women was 39.1 years. The clinical pregnancy rate per embryo transfer in women aged 35 years reached 70% (47% when no PGT was used) and 58% in women aged 40 years (29% when no PGT was used). Furthermore, the spontaneous miscarriage rate was 8.3% in women aged 35 years (16.0% in women without PGT) and 16.7% in women aged 40 years (28.6% in women without PGT). There has been a corresponding tendency to transfer only one embryo, lowering multiple gestation and its perinatal complications. Despite the absence of a law, the fate of abnormal embryos is a matter of great public and legal concern. A survey conducted among directors of Chilean centers offering PGT showed that chromosomic or genetically defective embryos are not deleted; they are cryopreserved and costs involved are handled by the center itself. However, some patients autonomously decide to take their embryos to transportation tanks, but there is no follow-up to such decisions. The availability and use of PGT is increasing. Today, 9 of 12 centers offer this technology.

International Encyclopedia of Public Health, 2008

Human Reproduction, 1992

A group of 24 couples with unexplained infertility was scheduled for in-vitro fertilization and t... more A group of 24 couples with unexplained infertility was scheduled for in-vitro fertilization and tubal embryo transfer between May 1989 and September 1990. In the same period, in-vitro fertilization and intrauterine transfer of embryos was planned in a control group of 44 women with tubal infertility. The mean age and duration of infertility were similar in both groups and the same scheme of ovarian stimulation was used. No statistically significant difference was obtained comparing oestradiol levels and numbers of mature oocytes retrieved between the group of patients with unexplained infertility and those with tubal infertility. The fertilization rate of the oocytes obtained from women with unexplained infertility (60.4%) was significantly lower (P less than 0.001) than that of the oocytes obtained from patients with tubal infertility (87.3%). There was no statistically significant difference in the cleavage rates between patients with unexplained infertility and those with tubal infertility. It is concluded that lack of fertilization is an unexplored cause of infertility in couples with unexplained infertility.

Human Reproduction Open, 2020

What factors are associated with monozygotic twins (MZT) after autologous IVF/ICSI with fresh and... more What factors are associated with monozygotic twins (MZT) after autologous IVF/ICSI with fresh and frozen/thawed single embryo transfer (SET) and what is the outcome of MZT? Factors associated with increased MZT were blastocyst transfer and elective single embryo transfer (eSET), with MZT showing a lower gestational age at birth and neonatal weight but higher perinatal mortality only after fresh transfer. ART is associated with an increased incidence of MZT, which carries higher perinatal mortality. However, risk factors associated with MZT are still controversial. A population-based retrospective analysis of data extracted from ART cycles reported to the Latin American Registry of ART between January 2012 and December 2016 was used in order to study the frequency and outcome of MZT after SET. In total, 2925 clinical pregnancies obtained after autologous IVF/ICSI with fresh SET were used to study biomedical factors possibly associated with MZT, such as maternal age, type of inseminat...

Revista Médica Clínica Las Condes, 2001

Reproductive Biomedicine Online, Sep 1, 2019

Human Reproduction at the University Diego Portales and member of the Division of Reproductive Me... more Human Reproduction at the University Diego Portales and member of the Division of Reproductive Medicine at Clinica las Condes. Recognized as Doctor Honoris Causa by the University of Antofagasta, Chile, he is founder and responsible of the Latin American Registry of ART and Vice-Chairman of the International Committee for Monitoring ART (ICMART). He is a member of the FIGO Committee for Reproductive Medicine, and fellow of the American College of Obstetrics and Gynecology. Dr. Zegers-Hochschild has authored over 120 scientific articles and book chapters.

JBRA assisted reproduction, 2023

Objective: To follow the impact of the SARS-CoV-2 pandemic on the practice of assisted reproducti... more Objective: To follow the impact of the SARS-CoV-2 pandemic on the practice of assisted reproductive technology in centers reporting to the Latin American Registry during 2020. Methods: An internally validated online survey designed on the Survey Monkey platform with a maximum of 20 closed questions was sent via e-mail or WhatsApp to the clinical director of each center reporting to the Latin American Registry of Assisted Reproduction between July and December 2020. Results: The number of centers responding to the survey varied during the six months. The relative contribution of Brazil to all responses was 41.4% to 45%, followed by México (16.2% to 23.8%), Argentina (8.1% to 12.6%), Colombia (7.1% to 8.2%), Chile (3.6% to 6.1%) and Peru (4.0% to 4.9%). Most centers reported stopping activities before July 2020 (81%). COVID-19 related symptoms were a criterion on their own to postpone ovarian stimulation (80.1% to 87.7% of centers). Although in July only 76 of 166 centers (45.8%) performed embryo transfers, by October 104 of 109 centers (95.4%) performed them. In survey 6 (December), 78 of 79 centers (98.7%) that had initially closed had already reopened, although 62.3% (61 of 98 centers) still performed 80% or less of their usual number of ART cycles. Conclusions: Most centers modified their clinical practice and applied specific protocols to screen their staff and patients. Suspicion of COVID-19 delayed treatments. Despite a peak of the pandemic, by December most centers were performing all ART treatments, although the number of cycles remained low compared to pre-pandemic numbers.

Reproductive Biomedicine Online, Mar 1, 2023

JBRA assisted reproduction, 2019

Research question: What was the utilization, effectiveness and perinatal outcome of assisted repr... more Research question: What was the utilization, effectiveness and perinatal outcome of assisted reproductive technologies (ART) performed in Latin America during 2016. Design: Retrospective collection of multinational data on ART performed in 178 institutions from 15 Latin American countries. Results: We are reporting 85,474 initiated cycles, 15,070 deliveries and 18,182 babies born in this period. Of all fresh autologous IVF/ICSI cycles, 40.9% were performed in women aged 35-39 years, and 31.1% in women aged ≥40 years. After removing freeze-all cycles, delivery rate per oocyte retrieval was 20.31% for ICSI and 21.85% for IVF. Fresh single embryo transfer including all age categories represented 22.96%, with a 15.35% delivery rate per transfer. Double embryo transfer represented 61.58% of transfers, with a 27.62% delivery rate per transfer. Multiple births included 18.12% twins and 0.55% triplets and higher. In oocyte donation, delivery rate per transfer was 32.89%, with a twin and triplet rate of 23.48% and 0.73%, respectively. Overall, preterm deliveries reached 17.11% in singletons, 65.69% in twins and 95.51% in triplets. Perinatal mortality was 8.0 ‰ in singletons, 19.0 ‰ in twins, and 62.3 ‰ in high-order multiples. Conclusions: The number of initiated cycles continues to increase. Compared with previous years, the number of embryos transferred decreased while the proportion of single embryo transfers increased with a drop in multiple births. It is mandatory to stimulate health care providers and consumers to continue in this trend.

JBRA assisted reproduction, 2012

Background. Reducing the rate in IVF of multiple births and associated perinatal complications ha... more Background. Reducing the rate in IVF of multiple births and associated perinatal complications has become the major challenge in Latin America, due to is association with a significant increase in the prematurity, and perinatal mortality. methods. We selected all procedures involving the transfer of IVF embryos, reported to the Latin America Registry of ART, initiated between January 1998 and December 2008. A Poisson regression analysis was performed, stratified by woman´s age to analyse the trend in the transfer of 2, 3 and ≥4-embryos and ≥triple-pregnancy rate. Results. A total of 164,874 IVF/ICSI transfers were considered. Overall, there was a decline in the proportion of procedures performed in women aged ≤34 years old from 51% to 43%; and an increase of ICSI procedures from 61% to 86%. All age groups experienced a reduction in the proportion of ≥4-embryos transfers and an increase in that of 2-embryo transfers. Overall, the clinical pregnancy rate improved from 29% to 35% (p=0.01); and the incidence of ≥triple-pregnancy decreased from 8% to 3% in 2008 (p<0.001), while twin pregnancy remained stable (~20%) Conclusions. Our data support the policy of transferring less embryos. It shows a decline in the mean number of embryos transferred and proportion ≥ 4-embryos transfers. Moreover, it reports a clinical pregnancy rate which instead of being reduced, has shown an increase over the 10-year period.

JBRA assisted reproduction, 2012

Multiple birth, due the transfer of more than one embryo, constitutes the most serious complicati... more Multiple birth, due the transfer of more than one embryo, constitutes the most serious complication for both mother and children after assisted reproductive technology. Embryo cryopreservation allows the sequential transfer of the whole cohort of embryos generated in one ART cycle, either by electively transferring one embryo (eSET) or two embryos (eDET). We reviewed the database of ART procedures reported to the Latin American n etwork of ART (REDLARA) by 140 institutions in 2010. We identify eSET, eDET, and 3ET and 4ET when three and four or more embryos were transferred, respectively, and none was cryopreserved. We analysed the outcome of 808 eSET, 5,978 eDET, 4,398 3ET and 968 4ET. Women that underwent eSET and 4ET were older than women that underwent eDET and 3ET (p<0.0001). The mean number of oocytes recovered was higher in women undergoing eDET (12.3) than in women undergoing eSET (6.7); 3ET (9.0); and 4ET (9.8) (p<0.0001). The clinical pregnancy rate reached 18% with eSET; 43% with eDET; 34% with 3ET; and 35% with 4ET. the proportion of twin delivery was 0.9% with eSET; when more than one embryo were transferred, the twin rate did not differ �������= 22% with eDET; 21% with 3ET and 23% with 4ET. However, high order multiple births (≥3newborns) increased ���ácantly with both 3ET (3.0%) and 4ET (4.4%). that neither the weight nor gestational age at delivery of singletons were associated to the number of embryos transferred. With the proper counselling regarding cumulative pregnancy rate and risks associated with twin pregnancy, and a � ed payment for all ET performed, we expect more couples-and physicians-would undergo eSET.

JBRA assisted reproduction, 2012

Copyright-Todos os direitos reservados a SBRA-Sociedade Brasileira de Reprodução Assistida Artigo... more Copyright-Todos os direitos reservados a SBRA-Sociedade Brasileira de Reprodução Assistida Artigo Original First polar body genetic diagnosis (PbGD) as a selection tool of euploid oocytes before insemination. Diagnóstico Genético del Primer Corpúsculo Polar (PbGD): herramienta de selección de ovocitos euploides antes de la fecundación. O diagnóstico do primeiro corpúsculo polar (PbGD) na seleção de oócitos haploides, antes da inseminação

JBRA assisted reproduction, 2011

Introduction: Since 1990, the Latin American Registry of Assisted Reproduction (RLA) has register... more Introduction: Since 1990, the Latin American Registry of Assisted Reproduction (RLA) has registered ART procedures performed in Latin America. The RLA has increased its regional coverage including to date more than 80% of ART cycles performed. 140 centers enter their data directly on line, and an administrative office collects and analyses the data. Material and methods: This paper analyses trends over the last twenty years, as well as biomedical data corresponding to ART procedures initiated between 1990 and 2009, and babies born up to 2010. Overall, the data include 275,883 embryo transfer-cycles, 71,875 deliveries and the birth of 95,436 babies. results: Some of the major changes include: an increase in the age of female partners undergoing fresh, autologous embryo transfers; and a marked shift towards the use of ICSI over IVF. As expected, there has been a steady increase over the last ten years in the delivery rates with at least one live born per embryo transfer, reaching 25.3% in IVF/ ICSI cycles, and 31.6% in OD cycles. Over the years, there has been a progressive but slight decrease in the mean number of ET, but still, almost one third of all births are either twins or triplets. In the last 15 years, the proportion of transfers of one or two embryos has increased from 11 and 17% in 1995, to 14%• and 43% respectively in 2009, conclusions: Access to ART has experienced a meager increase during the period covered in this report. Our region faces two main challenges: to facilitate access to ART and to decrease the rate of multiple births.

JBRA assisted reproduction, 2012

Human Reproduction, Jun 29, 2022

Abstract title International Committee for Monitoring Assisted Reproductive Technologies (ICMART)... more Abstract title International Committee for Monitoring Assisted Reproductive Technologies (ICMART) Preliminary World Report on ART, 2018 Study question In 2018 what was global utilization, effectiveness and safety of ART? Summary answer Globally, ART utilization and data collection continue to increase but with wide variations in utilization, effectiveness and safety. What is known already ICMART began ART global data collection in 1991. Utilization, effectiveness and safety have continuously improved with more cycles, higher pregnancy rates and lower multiple birth rates, the latter as a result of transfer of fewer embryos. Frozen embryo transfer (FET) and donor egg cycles continue to increase. However, wide variations in practice and outcomes exist globally. Approximately 9 million ART babies have been born. ICMART has helped develop registries internationally. A new electronic data collection platform has been developed in conjunction with the University of New South Wales in Sydney, Australia; nevertheless, data collection and quality remain challenging. Study design, size, duration Countries and regions annually collect ART data, some prospectively and others retrospectively. ICMART retrospectively requested these data from all known global sources for 2018 and reviewed them for missing or incorrect data. The dataset was corrected and then analyzed utilizing standardized definitions from The ICMART/WHO Revised Glossary on ART Terminology, 2009 which was current at the time but is now replaced by The International Glossary on Infertility and Fertility Care, 2017, and previously developed methods. Preliminary results are presented. Participants/materials, setting, methods The European IVF Monitoring Consortium (EIM), Latin American Network of Assisted Reproduction (REDLARA), Australian/ New Zealand Registry and African Network and Registry for ART (ANARA) submitted regional data, and other countries contributed national data, through standardized formats to ICMART. A few individual clinics with no registry access also contributed. Data were reviewed, corrected, validated to the extent possible, analyzed and summarized by ICMART using descriptive statistics. Main results and the role of chance Data collection and analysis are ongoing, so presented results are preliminary. The number of ART cycles continues to increase, but utilization is still highly variable among countries and regions. Regional and country differences persist in the age of women treated, number of embryos transferred, live birth rates, rate of multiple births, use of ICSI, cryopreservation cycles and other factors. The role of chance is minimal. Actual global ART results are limited to reporting countries and clinics representing approximately 3/4 of global cycles. However, this is a very large sample size from which imputation of total global results is performed. Limitations, reasons for caution Some countries have limited data and many countries have limited data validation. ICMART can perform only minimal verification of submitted data. Widespread adherence to consensus definitions provided in the Glossary takes time and requires translation into multiple languages. Wider implications of the findings ICMART World Reports standardize data, track trends, enable comparisons, stimulate questions and improve ART quality. Better understanding of ART increases societal acceptance and support for equitable access and ART research.

The reported success rates in terms of pregnancies after various forms of treatment of the infert... more The reported success rates in terms of pregnancies after various forms of treatment of the infertile male remain unsatisfactory; therefore, the idea of stimulating sperm motility, selecting, concentrating, and eventually preserving the motile spermatozoa, and pooling the “good” spermatozoa harvested from several ejaculates for artificial insemination, remains attractive. Here, we report our experience with different techniques of motility stimulation, cryopreservation of stimulated spermatozoa, and selection and concentration of motile spermatozoa.

JBRA assisted reproduction, 2017

Multinational data on assisted reproduction techniques undertaken in 2014 were collected from 159... more Multinational data on assisted reproduction techniques undertaken in 2014 were collected from 159 institutions in 15 countries in Latin America. Treatments included IVF/ ICSI, FET, OD, PGD and fertility preservation (FP). 41.34% of IVF/ICSI cycles were performed in women aged 35 to 39 years and 23.35% in women aged 40 and older. After removing cases with total freezing, delivery rate per oocyte retrieval was 25.05% for ICSI and 27.41% for IVF. Multiple births included 20.78% twins and 0.92 % triplets and over. In OD, twins reached 28.93% and triplets 1.07 %. Preterm deliveries reached 16.4% in singletons, 55.02% in twins and 76% in triplets. Perinatal mortality in 18,162 births was 23 per 1000 in singletons, 35 per 1000 in twins, and 36 per 1000 in high-order multiples. Elective single embryo transfer (eSET) represented only 2.63 % of fresh transfers, with a delivery rate of 32.15% per transfer. Elective double embryo transfer (eDET) represented 23.74% of transfers, with a delivery rate of 41.03% per transfer. Among babies born during this period 11,373 (62.6%) were singletons; 6,398 (35.2%) twins, and 391 (2.2%), triplets and more. Given the effect of multiple births on prematurity, morbidity and perinatal mortality, reinforcing the existing trend of reducing the number of embryos transferred is mandatory

Human Reproduction, May 20, 2016

Global utilization and effectiveness remained relatively constant despite marked variations among... more Global utilization and effectiveness remained relatively constant despite marked variations among countries, while the rate of single and frozen embryo transfers (FETs) increased with a concomitant slight reduction in multiple birth rates. what is known already: ART is widely practised in all regions of the world. Monitoring utilization, an approximation of availability and access, as well as effectiveness and safety is an important component of universal access to reproductive health. study design, size, duration: This is a retrospective, cross-sectional survey on utilization, effectiveness and safety of ART procedures performed globally from 2008 to 2010. participants, setting, methods: Between 58 and 61 countries submitted data from a total of nearly 2500 ART clinics each year. Aggregate country data were processed and analyzed based on forms and methods developed by the International Committee for Monitoring Assisted Reproductive Technologies (ICMART). Results are presented at country, regional and global level. main results and the role of chance: For the years 2008, 2009 and 2010, .4 461 309 ART cycles were initiated, resulting in an estimated 1 144 858 babies born. The number of aspirations increased by 6.4% between 2008 and 2010, while FET cycles increased by 27.6%. Globally, ART utilization remained relatively constant at 436 cycles/million in 2008 and 474 cycles/million population in 2010, but with a wide country range of 8-4775 cycles/million population. ICSI remained constant at around 66% of non-donor aspiration cycles. The IVF/ICSI combined delivery rate (DR) per fresh aspiration was 19.

Fertility and Sterility, 2023

Objective: the objective of this study is to evaluate markers of embryo quality, applied on day t... more Objective: the objective of this study is to evaluate markers of embryo quality, applied on day three of in vitro culture, in their capacity to predict whether embryos will reach blastocyst stage. Methods: a retrospective analysis of embryology database coming from 2772 zygotes obtained in 564 oocyte retrievals was performed; embryos were observed from day one to five: 23 to 26 hours after insemination all zygotes were evaluated to assess early cleavage, the number of blastomeres and embryo morphology were registered on day three and blastocyst formation was evaluated on day five; early first cleavage, number of blastomeres and embryo morphology at day three were correlated with embryo development until day five. Results: blastocyst formation rate was 36% in embryos with early cleavage and 19% in embryos without early the probability of a good quality embryo (grade 1 and 2a) at day three to reach the blastocyst stage was 48%, which was significantly higher than the chances of lower quality embryos. Conclusion: factors reported in this study-early cleavage, number of blastomeres and embryo morphology-are key words: blastocyst, expanded blastocyst, early cleavage, blastomere number, embryo morphology. que as probabilidades de embriões de menor qualidade. Conclusão: Os fatores relatados neste estudo-a clivagem precoce, número de blastômeros e morfologia do embriãosão úteis para decidir cultivo prolongado in vitro até cinco dias. Palavras-chave: blastocisto, blastocisto expandido, clivagem precoce, número de blastômeros, a morfologia do embrião.

Abstract The first in vitro fertilization baby was born in Chile in 1984. In 2016, with 6000 babi... more Abstract The first in vitro fertilization baby was born in Chile in 1984. In 2016, with 6000 babies born, the Ministry of Health officially recognized assisted reproduction techniques (ART) as an established clinical intervention. However, no reference was made to selecting embryos by genetic technologies. Fluorescence in situ hybridization of the first polar body was developed in Chile in 2000 and remained the only form of preimplantation genetic testing (PGT) for the following 10 years. In 2011, two centers reported PGT for aneuploidy in cleaving embryos, and in 2014, comparative genomic hybridization (CGH) was applied in Chile and reported to the Latin American Registry of ART. In the latest report of procedures performed in 2016, all PGT were performed by CGH in blastocysts. The mean age of women was 39.1 years. The clinical pregnancy rate per embryo transfer in women aged 35 years reached 70% (47% when no PGT was used) and 58% in women aged 40 years (29% when no PGT was used). Furthermore, the spontaneous miscarriage rate was 8.3% in women aged 35 years (16.0% in women without PGT) and 16.7% in women aged 40 years (28.6% in women without PGT). There has been a corresponding tendency to transfer only one embryo, lowering multiple gestation and its perinatal complications. Despite the absence of a law, the fate of abnormal embryos is a matter of great public and legal concern. A survey conducted among directors of Chilean centers offering PGT showed that chromosomic or genetically defective embryos are not deleted; they are cryopreserved and costs involved are handled by the center itself. However, some patients autonomously decide to take their embryos to transportation tanks, but there is no follow-up to such decisions. The availability and use of PGT is increasing. Today, 9 of 12 centers offer this technology.

International Encyclopedia of Public Health, 2008

Human Reproduction, 1992

A group of 24 couples with unexplained infertility was scheduled for in-vitro fertilization and t... more A group of 24 couples with unexplained infertility was scheduled for in-vitro fertilization and tubal embryo transfer between May 1989 and September 1990. In the same period, in-vitro fertilization and intrauterine transfer of embryos was planned in a control group of 44 women with tubal infertility. The mean age and duration of infertility were similar in both groups and the same scheme of ovarian stimulation was used. No statistically significant difference was obtained comparing oestradiol levels and numbers of mature oocytes retrieved between the group of patients with unexplained infertility and those with tubal infertility. The fertilization rate of the oocytes obtained from women with unexplained infertility (60.4%) was significantly lower (P less than 0.001) than that of the oocytes obtained from patients with tubal infertility (87.3%). There was no statistically significant difference in the cleavage rates between patients with unexplained infertility and those with tubal infertility. It is concluded that lack of fertilization is an unexplored cause of infertility in couples with unexplained infertility.

Human Reproduction Open, 2020

What factors are associated with monozygotic twins (MZT) after autologous IVF/ICSI with fresh and... more What factors are associated with monozygotic twins (MZT) after autologous IVF/ICSI with fresh and frozen/thawed single embryo transfer (SET) and what is the outcome of MZT? Factors associated with increased MZT were blastocyst transfer and elective single embryo transfer (eSET), with MZT showing a lower gestational age at birth and neonatal weight but higher perinatal mortality only after fresh transfer. ART is associated with an increased incidence of MZT, which carries higher perinatal mortality. However, risk factors associated with MZT are still controversial. A population-based retrospective analysis of data extracted from ART cycles reported to the Latin American Registry of ART between January 2012 and December 2016 was used in order to study the frequency and outcome of MZT after SET. In total, 2925 clinical pregnancies obtained after autologous IVF/ICSI with fresh SET were used to study biomedical factors possibly associated with MZT, such as maternal age, type of inseminat...

Revista Médica Clínica Las Condes, 2001