Daniela Braga de Souza | Trinity Laban (original) (raw)

Papers by Daniela Braga de Souza

Research paper thumbnail of The Developmental Competence of Oocytes Retrieved from The Leading Follicle in Controlled Ovarian Stimulated Cycles

International Journal of Fertility Sterility, 2013

Background: This study compares the developmental capacity of gametes retrieved from the largest ... more Background: This study compares the developmental capacity of gametes retrieved from the largest follicle with small follicles of a cohort in controlled ovarian stimulated cycles.

Research paper thumbnail of Are poor responders patients at higher risk for producing aneuploid embryos in vitro?

Journal of Assisted Reproduction and Genetics, May 1, 2011

Purpose To test the hypothesis that aged women with poor ovarian response express an increase on ... more Purpose To test the hypothesis that aged women with poor ovarian response express an increase on embryo chromosomal alterations when compared to aged women who presented normal response. Methods Couples undergoing intracytoplasmic sperm injection cycles with preimplantation genetic screening, were subdivided into two groups: Poor Responder group (n=34), patients who produced ≤4 oocytes; and Normoresponder group (n=50), patients who produced ≥5 oocytes. Groups were compared regarding cycles' outcomes and aneuploidy frequency. Results There were no significant differences between and groups regarding the fertilization rate (p=0.6861), clinical pregnancy (p=0.9208), implantation (p=0.6863), miscarriage (p=0.6788) and the percentage of aneuploid embryos (p=0.270). Embryo transfer rate was significantly lower on poor responder group (p=0.0128) and logistic regression confirmed the influence of poor response on the chance of embryo transfer (p=0.016).

Research paper thumbnail of Decline in semen quality among infertile men in Brazil during the past 10 years

International braz j urol : official journal of the Brazilian Society of Urology

To investigate whether the semen quality of men undergoing conventional semen analysis is deterio... more To investigate whether the semen quality of men undergoing conventional semen analysis is deteriorating over time. We analyzed and compared the sperm count, motility and morphology of 2300 semen samples provided by males undergoing conventional seminal analysis, from years 2000 to 2002 and 2010 to 2012. The incidences of severe oligozoospermia and azoospermia over time were also compared. A total of 764 sperm samples were analyzed in 2000-2002 and 1536 in 2010-2012. Over time, the mean sperm concentration/ml decreased significantly from 61.7 million in 2000-2002 to 26.7 million in 2010-2012 (R2=11.4%, p< 0.001), the total sperm concentration decreased significantly from 183.0 million to 82.8 million (R2=11.3%, p< 0.001), and the percentage of normal forms decreased significantly from 4.6% to 2.7% (R2=9.8%, p< 0.001). The incidence of severe oligozoospermia significantly increased from 15.7% to 30.3% (OR: 1.09, p< 0.001) and the incidence of azoospermia increased from 4.9...

Research paper thumbnail of Non-Invasive Prediction of Blastocyst Formation by Day Three Embryo Culture Medium Mass Spectrometry Lipid Fingerprinting

JBRA Assisted Reproduction, 2015

To identify lipid markers of blastocyst formation by day three culture medium mass spectrometry (... more To identify lipid markers of blastocyst formation by day three culture medium mass spectrometry (MS) fingerprinting. For this study, 50 embryo samples from culture media were harvested on day three, from patients undergoing embryo transfers on day five. Samples were split into groups based on their degree of expansion and hatching status on day five (Complete-Blastocyst, n=25 and No-Blastocyst, n=25) and its secretomes were analysed by MS. Mass spectra fingerprinting was acquired using a Q-Tof spectrometer (LC-MS, Agilent 6550 iFunnel Q-TOF) equipped with an automated injector. The data was analysed using the principal component analysis (PCA) followed by a partial least square discrimination analysis (PLS-DA), combined with variable influence in the projection (VIP) scores. In total, there were 1,657 ions found, in which 165 ions were differently expressed between groups, with a fold chance ≥ 4x and P&amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001, in the t-test. PLS-DA showed a clear separation between the groups and among 15 VIPs selected by the program, 13 of them were highly expressed in the Complete-Blastocyst Group and two were expressed in the No-Blastocyts Group. Besides embryo status on day five, the PLS-DA was also able to classify samples according to patients&amp;amp;amp;amp;amp;amp;amp;amp;#39; age. Lipids supposedly highly expressed in the Complete-Blastocyst Group included: isoprenoids, diacylglycerols, sterols, fatty esters, secosteroids, phosphosphingolipids, glycerophosphates and diacylglycerophosphates, while fatty amides were suggested to be highly expressed in the No-Blastocysts Group. Day three culture medium MS is a promising approach for the identification of embryos that should be cultured until day five.

Research paper thumbnail of Environmental Factors, Food Intake, and Social Habits in Male Patients and its Relationship to Intracytoplasmic Sperm Injection Outcomes

Handbook of Fertility, 2015

Research paper thumbnail of The impact of food intake and social habits on embryo quality and the likelihood of blastocyst formation

Reproductive BioMedicine Online, 2015

The aim of this study was to evaluate the influence of patients&amp;amp;amp;amp;amp;amp;amp;a... more The aim of this study was to evaluate the influence of patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; lifestyle factors and eating habits on embryo development. A total of 2659 embryos recovered from 269 patients undergoing intracytoplasmic sperm injection cycles were included. The frequency of intake of food items and social habits were registered and its influences on embryo development evaluated. The consumption of cereals, vegetables and fruits positively influenced the embryo quality at the cleavage stage. The quality of the embryo at the cleavage stage was also negatively correlated with the consumption of alcoholic drinks and smoking habits. The consumption of fruits influenced the likelihood of blastocyst formation, which was also positively affected by the consumption of fish. Being on a weight-loss diet and consumption of red meat had a negative influence on the likelihood of blastocyst formation. The likelihood of blastocyst formation was also negatively influenced by the consumption of alcoholic drinks and by smoking habits. The consumption of red meat and body mass index had a negative effect on the implantation rate and the likelihood of pregnancy. In addition, being on a weight-loss diet had a negative influence on implantation rate. Our evidence suggests a possible relationship between environmental factors and ovary biology.

Research paper thumbnail of Decreasing sperm quality: findings from a 10 year gap longitudinal analysis of 2300 sperm samples from Brazil

JBRA Assisted Reproduction, 2013

Research paper thumbnail of The Developmental Competence of Oocytes Retrieved from The Leading Follicle in Controlled Ovarian Stimulated Cycles

International journal of fertility & sterility, 2013

This study compares the developmental capacity of gametes retrieved from the largest follicle wit... more This study compares the developmental capacity of gametes retrieved from the largest follicle with small follicles of a cohort in controlled ovarian stimulated cycles. This prospective study performed in a private assisted fertilization center included 1016 follicles collected from 96 patients who underwent intra cytoplasmic sperm injection (ICSI). After follicular aspiration, oocytes were assigned to two groups according to the diameter of the derived follicle. The large follicle group (n=96) comprised oocytes derived from the leading follicle of the cohort and the small follicle group (n=920) consisted oocytes derived from the smaller follicles of the cohort. The fertilization and percentage of topquality embryos were compared between groups by Chi-square or Fisher's exact test, where appropriate. The effect of the follicular diameter on oocyte dimorphism was assessed by binary logistic regression. A significantly higher percentage of oocytes derived from the leading follicle ...

Research paper thumbnail of Sperm morphological normality under high magnification predicts laboratory and clinical outcomes in couples undergoing ICSI

Human Fertility, 2014

The objective of this study was to evaluate whether &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;... more The objective of this study was to evaluate whether &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;motile sperm organelle morphology examination&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; (MSOME) is correlated with the outcome of ICSI. A total of 14400 spermatozoa from 72 couples undergoing ICSI were analysed by MSOME (x6600) and graded into four groups: grade I, normal form and no vacuoles; grade II, normal form and lesser than or equal to 2 small vacuoles; grade III, normal form greater than 2 small vacuoles or at least one large vacuole and grade IV, large vacuole and abnormal head shapes or other abnormalities. The correlations between the proportion of morphologically normal spermatozoa (grade I + II) and ICSI outcomes were assessed. The proportion of grade I+ II spermatozoa was lower in patients with oligoasthenoteratozoospermia (OAT) compared to patients with other types of semen alterations (10.6% vs. 17.0%, p = 0.001). The proportion of grade I+ II spermatozoa was positively correlated with blastocyst formation (S = 8.31, R(2):13.5%, p = 0.014) and implantation rates (S = 8.32, R(2): 7.9%, p = 0.030). The proportion of grade I + II spermatozoa was higher in patients with ongoing pregnancy in comparison with those who had a miscarriage (23.2% vs. 10.8%, p = 0.007). Sperm morphological normality was lower in oligoasthenoteratozoospermia patients but correlated with blastocyst formation, implantation and miscarriage rates in couples undergoing ICSI. MSOME may be valuable in predicting ICSI outcomes.

Research paper thumbnail of Sperm morphological abnormalities visualised at high magnification predict embryonic development, from fertilisation to the blastocyst stage, in couples undergoing ICSI

Journal of Assisted Reproduction and Genetics, 2014

To investigate the predictive value of the motile sperm organelle morphology examination (MSOME) ... more To investigate the predictive value of the motile sperm organelle morphology examination (MSOME) on embryo morphology. The morphologies of 540 embryos obtained from 60 couples undergoing ICSI were evaluated from days 1 to 5 of development and were examined for associations with the percentages of morphologically normal paternal sperm and of the paternal sperm with large nuclear vacuoles (LNVs) as determined by MSOME. An increased percentage of LNV sperm was associated with increased odds of a zygote presenting with pronuclear abnormalities. It was also associated with decreased odds of (i) normal cleavage on days 2 and 3 of development, (ii) the presence of a high-quality embryo on day 3, (iii) the development of an embryo to the blastocyst stage, and (iv) an embryo possessing a normal trophectoderm and inner cell mass. The calculated areas under the curves differed for the embryos that did and did not develop to the blastocyst stage and for the high- and low-quality blastocysts. The optimal cut-off value for the percentage of LNV sperm that maximised proper blastocyst formation was ≤24.5 %, and the cut-off value that maximised blastocyst quality was ≤19.5 %. These results suggest a very early onset of paternal influences on embryo development. The evaluation of the incidence of vacuoles by MSOME may significantly improve upon the prognostic information provided by conventional semen analyses.

Research paper thumbnail of Parameters for embryo development in vitro : The role of the WHO guidelines (2010) in the characterization of abnormal sperm

JBRA Assisted Reproduction, 2013

Research paper thumbnail of The impact of the embryo quality on the risk of multiple pregnancies

JBRA Assisted Reproduction, 2013

ABSTRACT Summary The aim of the present study was to determine the chance of pregnancy and the ri... more ABSTRACT Summary The aim of the present study was to determine the chance of pregnancy and the risk of multiple pregnancies taking into account the number and quality of transferred embryos in patients &gt;36 years old or ≤36 years old. For this study, 1497 patients undergoing intra-cytoplasmic sperm injection (ICSI) cycles in a private assisted reproduction centre were split into groups according to the number and quality of the transferred embryos on the third or fifth day of development. The pregnancy rate and multiple pregnancy rate were compared between the embryo quality groups in patients &lt;36 years old or ≥36 years old. In patients &lt;36 years old, for the day 3 embryo transfer, no significant difference was noted in the pregnancy rate when the groups were compared. However the multiple pregnancy rate was increased by the transfer of an extra low-quality embryo (17.1 versus 28.2%, P = 0.020). For day 5 embryo transfer, the transfer of an extra blastocyst significantly increased the pregnancy rate (36.0 versus 42.4%, P &lt; 0.001) and the multiple pregnancy rate (4.4 versus 16.9%, P &lt; 0.001). In older patients, no significant difference was noted in the pregnancy rate when the groups were compared. However, when an extra low-quality embryo was transferred, a significantly increased rate of multiple pregnancies was observed for day 3 (18.2 versus 26.4%, P = 0.049) and day 5 embryo transfers (5.2 versus 16.1%, P &lt; 0.001). In conclusion, the transfer of an extra low-quality embryo may increase the risk of a multiple pregnancy. In younger patients, the transfer of an extra low-quality blastocyst may also increase the chance of pregnancy.

Research paper thumbnail of Contribution of in-vitro maturation in ovarian stimulation cycles of poor-responder patients

Reproductive BioMedicine Online, 2010

This cohort study evaluated whether rescue spontaneous maturation (RSM) could be a valid method t... more This cohort study evaluated whether rescue spontaneous maturation (RSM) could be a valid method to increase the number of embryos available for transfer and whether transfers with RSM-derived embryos would contribute to clinical outcomes of poor-responder patients in ovarian stimulation cycles. The study included 440 patients undergoing intracytoplasmic sperm injection cycles in which fewer than five metaphase II (MII) oocytes and at least one immature oocyte were retrieved after follicle aspiration. Patients were allocated into two groups based on the injected oocytes' nuclear maturation status: MII group (n = 330), in which only embryos derived from MII oocytes were transferred, and RSM group (n = 110), in which at least one embryo derived from an RSM oocyte was transferred. No differences between the MII and RSM groups were observed for pregnancy (16.7% versus 16.5%) or miscarriage (25.5% versus 29.4%) rates, respectively. The RSM group had a higher number of transferred embryos (1.87 ± 1.24 versus 2.35 ± 1.22; P < 0.001), a lower embryo transfer cancellation rate (14.5% versus 6.36%; P = 0.025) and lower implantation rate (15.4 ± 31.5% versus 10.5 ± 22.3%; not significant). These findings suggest that RSM did not contribute to the outcomes in poorresponder cycles. RBMOnline Reproductive BioMedicine Online (2010) 20, 335-340 w w w . s c i e n c e d i r e c t . c o m w w w . r b m o n l i n e . c o m

Research paper thumbnail of Physical activity, obesity and eating habits can influence assisted reproduction outcomes

Women's Health, 2010

Objective: to determine if eating habits, physical activity and BMI can influence assisted reprod... more Objective: to determine if eating habits, physical activity and BMI can influence assisted reproduction outcomes. Material and Methods: this study analyzed 436 patients undergoing intracytoplasmic sperm injection cycles. Patients answered a questionnaire and regression analysis examined the relationship between lifestyle and BMI with the intracytoplasmic sperm injection cycles outcomes. Results: no influence of lifestyle and obesity was observed on the number of oocytes recovered. Obesity reduced the normal fertilization rate (coefficient [Coef.]: -16.0; p = 0.01) and increased the risk of miscarriage (OR: 14.3; p = 0.03). Physical activity positively affected implantation (Coef.: 9.4; p = 0.009), increased the chance of pregnancy (OR: 1.83; p = 0.013) and tended to decrease the risk of miscarriage (OR: 0.30; p = 0.068). In addition, an inverse correlation was found between physical activity and BMI, and a direct correlation was found between soft-drink consumption and BMI. Conclusions: eating habits, physical activity and obesity could affect clinical outcomes of assisted reproduction.

Research paper thumbnail of Predictive Factors of Repeat Sperm Aspiration Success

Urology, 2010

To evaluate the outcomes of repeated testicular sperm aspirations (TESAs) and to investigate whet... more To evaluate the outcomes of repeated testicular sperm aspirations (TESAs) and to investigate whether the interval between TESA procedures, success in the first attempt, and patient age might influence the results.

Research paper thumbnail of Outcome of ICSI using zona pellucida-bound spermatozoa and conventionally selected spermatozoa

Reproductive BioMedicine Online, 2009

This study aimed to investigate whether the spermatozoa-zona pellucida binding test is able to se... more This study aimed to investigate whether the spermatozoa-zona pellucida binding test is able to select spermatozoa with higher fertilization potential and higher rate of successful embryo development. This prospective study was performed with metaphase II (MII) oocytes retrieved from couples undergoing intracytoplasmic sperm injection (ICSI) cycles. For each patient, half of the MII oocytes were injected using a routine ICSI method (control group, n = 194) while the other half were injected with previously zona pellucida-bound spermatozoa (ZP-binding group, n = 194). Fertilization rate, high-quality embryo rate, and embryo transfer rate were compared between the groups. No significant difference was observed among the groups in the fertilization rate (76.8% versus 77.3% for control and ZP-binding groups, respectively). However, an increased percentage of high-quality embryos was observed when zona pellucida-bound spermatozoa were injected (70.0% versus 83.3% for control and ZP-binding groups, respectively, P = 0.003). Moreover, when embryo selection was performed while ignoring experimental group origin, embryos from the ZP-binding group were more commonly selected for transfer (43.6% versus 54.6% for control and ZP-binding groups, respectively, P = 0.004). These findings suggest that the spermatozoa-zona pellucida binding test may be an efficient method to identify the most competent spermatozoa for ICSI.

Research paper thumbnail of Twelve years of MSOME and IMSI: a review

Reproductive BioMedicine Online, 2013

A promising method for observing spermatozoa, motile sperm organelle morphology examination (MSOM... more A promising method for observing spermatozoa, motile sperm organelle morphology examination (MSOME) enables the evaluation of the nuclear morphology of motile spermatozoa in real time at high magnification and has allowed the introduction of a modified microinjection procedure, intracytoplasmic morphologically selected sperm injection (IMSI). Since its development, several studies have intensively investigated the efficacy of MSOME and IMSI. The objective of the present study is to review the current literature on the MSOME and IMSI techniques. A promising method for observing spermatozoa, motile sperm organelle morphology examination (MSOME), enables the evaluation of the nuclear morphology of motile spermatozoa in real time at high magnification and has allowed the introduction of a modified microinjection procedure, intracytoplasmic morphologically selected sperm injection (IMSI). Since its development, several studies have intensively investigated the efficacy of MSOME and IMSI. The objective of the present study is to review the current literature on the MSOME and IMSI techniques.

Research paper thumbnail of WITHDRAWN: IMSI is beneficial in cases of advanced maternal age: a prospective randomized study

Reproductive BioMedicine Online, 2012

Research paper thumbnail of Artificial oocyte activation using calcium ionophore in ICSI cycles with spermatozoa from different sources

Reproductive BioMedicine Online, 2009

The present study evaluated the effect of artificial oocyte activation (AOA) with calcium ionopho... more The present study evaluated the effect of artificial oocyte activation (AOA) with calcium ionophore A23187 on intracytoplasmic sperm injection (ICSI) cycles using spermatozoa from different sources. The 314 cycles evaluated were divided into three groups according to sperm origin; the ejaculated group (n = 92), the epididymal group (n = 82), and the testicular group (n = 140). Each group was further split into experimental subgroups, depending on whether or not AOA was performed. In addition, the cycles of women younger than 36 years were evaluated separately. For each experimental group, ICSI outcomes were compared between subgroups. No significant difference was observed between subgroups for all sperm origin groups. When evaluating only the cycles of women younger than 36 years of age, AOA increased the percentage of high-quality embryos (74.5 versus 53.0%, P = 0.011) and the implantation rate (19.3 versus 10.5%, P = 0.0025) when it was used with ejaculated spermatozoa, and the percentage of high-quality embryos (64.4 versus 50.3%, P = 0.006) when epididymal spermatozoa were used. These results may suggest that both sperm maturity and oocyte quality play a role in oocyte activation. However, this study is to be continued to confirm these findings.

Research paper thumbnail of Zona pellucida birefringence score and meiotic spindle visualization in relation to embryo development and ICSI outcomes

Reproductive BioMedicine Online, 2009

The meiotic spindle and the zona pellucida exhibit molecular order when imaged with polarized opt... more The meiotic spindle and the zona pellucida exhibit molecular order when imaged with polarized optics. This study aimed to investigate possible factors contributing to the zona pellucida birefringence score and meiotic spindle visualization, and to evaluate whether these structures may predict intracytoplasmic sperm injection outcomes. Oocytes were divided into groups according to zona pellucida birefringence and meiotic spindle visualization. In addition, the cycles were split into three groups based on the zona birefringence of transferred embryos. A positive correlation was observed between zona birefringence and meiotic spindle visualization. In addition, when the meiotic spindle was observed, the fertilization rate among oocytes with high or low zona pellucida birefringence was similar. Implantation and pregnancy rates were significantly higher when embryos derived from high birefringence oocytes were exclusively transferred (P = 0.041 and P = 0.004 respectively). Furthermore, the miscarriage rate was higher when embryos derived from low birefringence oocytes were exclusively transferred. On the other hand, the total dose of FSH negatively affected meiotic spindle visualization. Results show that selection of embryos based on zona pellucida and meiotic spindle imaging can significantly improve implantation and pregnancy rates. Moreover, the dose of FSH used for ovarian stimulation may affect the organization of the oocyte meiotic spindle.

Research paper thumbnail of The Developmental Competence of Oocytes Retrieved from The Leading Follicle in Controlled Ovarian Stimulated Cycles

International Journal of Fertility Sterility, 2013

Background: This study compares the developmental capacity of gametes retrieved from the largest ... more Background: This study compares the developmental capacity of gametes retrieved from the largest follicle with small follicles of a cohort in controlled ovarian stimulated cycles.

Research paper thumbnail of Are poor responders patients at higher risk for producing aneuploid embryos in vitro?

Journal of Assisted Reproduction and Genetics, May 1, 2011

Purpose To test the hypothesis that aged women with poor ovarian response express an increase on ... more Purpose To test the hypothesis that aged women with poor ovarian response express an increase on embryo chromosomal alterations when compared to aged women who presented normal response. Methods Couples undergoing intracytoplasmic sperm injection cycles with preimplantation genetic screening, were subdivided into two groups: Poor Responder group (n=34), patients who produced ≤4 oocytes; and Normoresponder group (n=50), patients who produced ≥5 oocytes. Groups were compared regarding cycles' outcomes and aneuploidy frequency. Results There were no significant differences between and groups regarding the fertilization rate (p=0.6861), clinical pregnancy (p=0.9208), implantation (p=0.6863), miscarriage (p=0.6788) and the percentage of aneuploid embryos (p=0.270). Embryo transfer rate was significantly lower on poor responder group (p=0.0128) and logistic regression confirmed the influence of poor response on the chance of embryo transfer (p=0.016).

Research paper thumbnail of Decline in semen quality among infertile men in Brazil during the past 10 years

International braz j urol : official journal of the Brazilian Society of Urology

To investigate whether the semen quality of men undergoing conventional semen analysis is deterio... more To investigate whether the semen quality of men undergoing conventional semen analysis is deteriorating over time. We analyzed and compared the sperm count, motility and morphology of 2300 semen samples provided by males undergoing conventional seminal analysis, from years 2000 to 2002 and 2010 to 2012. The incidences of severe oligozoospermia and azoospermia over time were also compared. A total of 764 sperm samples were analyzed in 2000-2002 and 1536 in 2010-2012. Over time, the mean sperm concentration/ml decreased significantly from 61.7 million in 2000-2002 to 26.7 million in 2010-2012 (R2=11.4%, p< 0.001), the total sperm concentration decreased significantly from 183.0 million to 82.8 million (R2=11.3%, p< 0.001), and the percentage of normal forms decreased significantly from 4.6% to 2.7% (R2=9.8%, p< 0.001). The incidence of severe oligozoospermia significantly increased from 15.7% to 30.3% (OR: 1.09, p< 0.001) and the incidence of azoospermia increased from 4.9...

Research paper thumbnail of Non-Invasive Prediction of Blastocyst Formation by Day Three Embryo Culture Medium Mass Spectrometry Lipid Fingerprinting

JBRA Assisted Reproduction, 2015

To identify lipid markers of blastocyst formation by day three culture medium mass spectrometry (... more To identify lipid markers of blastocyst formation by day three culture medium mass spectrometry (MS) fingerprinting. For this study, 50 embryo samples from culture media were harvested on day three, from patients undergoing embryo transfers on day five. Samples were split into groups based on their degree of expansion and hatching status on day five (Complete-Blastocyst, n=25 and No-Blastocyst, n=25) and its secretomes were analysed by MS. Mass spectra fingerprinting was acquired using a Q-Tof spectrometer (LC-MS, Agilent 6550 iFunnel Q-TOF) equipped with an automated injector. The data was analysed using the principal component analysis (PCA) followed by a partial least square discrimination analysis (PLS-DA), combined with variable influence in the projection (VIP) scores. In total, there were 1,657 ions found, in which 165 ions were differently expressed between groups, with a fold chance ≥ 4x and P&amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001, in the t-test. PLS-DA showed a clear separation between the groups and among 15 VIPs selected by the program, 13 of them were highly expressed in the Complete-Blastocyst Group and two were expressed in the No-Blastocyts Group. Besides embryo status on day five, the PLS-DA was also able to classify samples according to patients&amp;amp;amp;amp;amp;amp;amp;amp;#39; age. Lipids supposedly highly expressed in the Complete-Blastocyst Group included: isoprenoids, diacylglycerols, sterols, fatty esters, secosteroids, phosphosphingolipids, glycerophosphates and diacylglycerophosphates, while fatty amides were suggested to be highly expressed in the No-Blastocysts Group. Day three culture medium MS is a promising approach for the identification of embryos that should be cultured until day five.

Research paper thumbnail of Environmental Factors, Food Intake, and Social Habits in Male Patients and its Relationship to Intracytoplasmic Sperm Injection Outcomes

Handbook of Fertility, 2015

Research paper thumbnail of The impact of food intake and social habits on embryo quality and the likelihood of blastocyst formation

Reproductive BioMedicine Online, 2015

The aim of this study was to evaluate the influence of patients&amp;amp;amp;amp;amp;amp;amp;a... more The aim of this study was to evaluate the influence of patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; lifestyle factors and eating habits on embryo development. A total of 2659 embryos recovered from 269 patients undergoing intracytoplasmic sperm injection cycles were included. The frequency of intake of food items and social habits were registered and its influences on embryo development evaluated. The consumption of cereals, vegetables and fruits positively influenced the embryo quality at the cleavage stage. The quality of the embryo at the cleavage stage was also negatively correlated with the consumption of alcoholic drinks and smoking habits. The consumption of fruits influenced the likelihood of blastocyst formation, which was also positively affected by the consumption of fish. Being on a weight-loss diet and consumption of red meat had a negative influence on the likelihood of blastocyst formation. The likelihood of blastocyst formation was also negatively influenced by the consumption of alcoholic drinks and by smoking habits. The consumption of red meat and body mass index had a negative effect on the implantation rate and the likelihood of pregnancy. In addition, being on a weight-loss diet had a negative influence on implantation rate. Our evidence suggests a possible relationship between environmental factors and ovary biology.

Research paper thumbnail of Decreasing sperm quality: findings from a 10 year gap longitudinal analysis of 2300 sperm samples from Brazil

JBRA Assisted Reproduction, 2013

Research paper thumbnail of The Developmental Competence of Oocytes Retrieved from The Leading Follicle in Controlled Ovarian Stimulated Cycles

International journal of fertility & sterility, 2013

This study compares the developmental capacity of gametes retrieved from the largest follicle wit... more This study compares the developmental capacity of gametes retrieved from the largest follicle with small follicles of a cohort in controlled ovarian stimulated cycles. This prospective study performed in a private assisted fertilization center included 1016 follicles collected from 96 patients who underwent intra cytoplasmic sperm injection (ICSI). After follicular aspiration, oocytes were assigned to two groups according to the diameter of the derived follicle. The large follicle group (n=96) comprised oocytes derived from the leading follicle of the cohort and the small follicle group (n=920) consisted oocytes derived from the smaller follicles of the cohort. The fertilization and percentage of topquality embryos were compared between groups by Chi-square or Fisher's exact test, where appropriate. The effect of the follicular diameter on oocyte dimorphism was assessed by binary logistic regression. A significantly higher percentage of oocytes derived from the leading follicle ...

Research paper thumbnail of Sperm morphological normality under high magnification predicts laboratory and clinical outcomes in couples undergoing ICSI

Human Fertility, 2014

The objective of this study was to evaluate whether &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;... more The objective of this study was to evaluate whether &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;motile sperm organelle morphology examination&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; (MSOME) is correlated with the outcome of ICSI. A total of 14400 spermatozoa from 72 couples undergoing ICSI were analysed by MSOME (x6600) and graded into four groups: grade I, normal form and no vacuoles; grade II, normal form and lesser than or equal to 2 small vacuoles; grade III, normal form greater than 2 small vacuoles or at least one large vacuole and grade IV, large vacuole and abnormal head shapes or other abnormalities. The correlations between the proportion of morphologically normal spermatozoa (grade I + II) and ICSI outcomes were assessed. The proportion of grade I+ II spermatozoa was lower in patients with oligoasthenoteratozoospermia (OAT) compared to patients with other types of semen alterations (10.6% vs. 17.0%, p = 0.001). The proportion of grade I+ II spermatozoa was positively correlated with blastocyst formation (S = 8.31, R(2):13.5%, p = 0.014) and implantation rates (S = 8.32, R(2): 7.9%, p = 0.030). The proportion of grade I + II spermatozoa was higher in patients with ongoing pregnancy in comparison with those who had a miscarriage (23.2% vs. 10.8%, p = 0.007). Sperm morphological normality was lower in oligoasthenoteratozoospermia patients but correlated with blastocyst formation, implantation and miscarriage rates in couples undergoing ICSI. MSOME may be valuable in predicting ICSI outcomes.

Research paper thumbnail of Sperm morphological abnormalities visualised at high magnification predict embryonic development, from fertilisation to the blastocyst stage, in couples undergoing ICSI

Journal of Assisted Reproduction and Genetics, 2014

To investigate the predictive value of the motile sperm organelle morphology examination (MSOME) ... more To investigate the predictive value of the motile sperm organelle morphology examination (MSOME) on embryo morphology. The morphologies of 540 embryos obtained from 60 couples undergoing ICSI were evaluated from days 1 to 5 of development and were examined for associations with the percentages of morphologically normal paternal sperm and of the paternal sperm with large nuclear vacuoles (LNVs) as determined by MSOME. An increased percentage of LNV sperm was associated with increased odds of a zygote presenting with pronuclear abnormalities. It was also associated with decreased odds of (i) normal cleavage on days 2 and 3 of development, (ii) the presence of a high-quality embryo on day 3, (iii) the development of an embryo to the blastocyst stage, and (iv) an embryo possessing a normal trophectoderm and inner cell mass. The calculated areas under the curves differed for the embryos that did and did not develop to the blastocyst stage and for the high- and low-quality blastocysts. The optimal cut-off value for the percentage of LNV sperm that maximised proper blastocyst formation was ≤24.5 %, and the cut-off value that maximised blastocyst quality was ≤19.5 %. These results suggest a very early onset of paternal influences on embryo development. The evaluation of the incidence of vacuoles by MSOME may significantly improve upon the prognostic information provided by conventional semen analyses.

Research paper thumbnail of Parameters for embryo development in vitro : The role of the WHO guidelines (2010) in the characterization of abnormal sperm

JBRA Assisted Reproduction, 2013

Research paper thumbnail of The impact of the embryo quality on the risk of multiple pregnancies

JBRA Assisted Reproduction, 2013

ABSTRACT Summary The aim of the present study was to determine the chance of pregnancy and the ri... more ABSTRACT Summary The aim of the present study was to determine the chance of pregnancy and the risk of multiple pregnancies taking into account the number and quality of transferred embryos in patients &gt;36 years old or ≤36 years old. For this study, 1497 patients undergoing intra-cytoplasmic sperm injection (ICSI) cycles in a private assisted reproduction centre were split into groups according to the number and quality of the transferred embryos on the third or fifth day of development. The pregnancy rate and multiple pregnancy rate were compared between the embryo quality groups in patients &lt;36 years old or ≥36 years old. In patients &lt;36 years old, for the day 3 embryo transfer, no significant difference was noted in the pregnancy rate when the groups were compared. However the multiple pregnancy rate was increased by the transfer of an extra low-quality embryo (17.1 versus 28.2%, P = 0.020). For day 5 embryo transfer, the transfer of an extra blastocyst significantly increased the pregnancy rate (36.0 versus 42.4%, P &lt; 0.001) and the multiple pregnancy rate (4.4 versus 16.9%, P &lt; 0.001). In older patients, no significant difference was noted in the pregnancy rate when the groups were compared. However, when an extra low-quality embryo was transferred, a significantly increased rate of multiple pregnancies was observed for day 3 (18.2 versus 26.4%, P = 0.049) and day 5 embryo transfers (5.2 versus 16.1%, P &lt; 0.001). In conclusion, the transfer of an extra low-quality embryo may increase the risk of a multiple pregnancy. In younger patients, the transfer of an extra low-quality blastocyst may also increase the chance of pregnancy.

Research paper thumbnail of Contribution of in-vitro maturation in ovarian stimulation cycles of poor-responder patients

Reproductive BioMedicine Online, 2010

This cohort study evaluated whether rescue spontaneous maturation (RSM) could be a valid method t... more This cohort study evaluated whether rescue spontaneous maturation (RSM) could be a valid method to increase the number of embryos available for transfer and whether transfers with RSM-derived embryos would contribute to clinical outcomes of poor-responder patients in ovarian stimulation cycles. The study included 440 patients undergoing intracytoplasmic sperm injection cycles in which fewer than five metaphase II (MII) oocytes and at least one immature oocyte were retrieved after follicle aspiration. Patients were allocated into two groups based on the injected oocytes' nuclear maturation status: MII group (n = 330), in which only embryos derived from MII oocytes were transferred, and RSM group (n = 110), in which at least one embryo derived from an RSM oocyte was transferred. No differences between the MII and RSM groups were observed for pregnancy (16.7% versus 16.5%) or miscarriage (25.5% versus 29.4%) rates, respectively. The RSM group had a higher number of transferred embryos (1.87 ± 1.24 versus 2.35 ± 1.22; P < 0.001), a lower embryo transfer cancellation rate (14.5% versus 6.36%; P = 0.025) and lower implantation rate (15.4 ± 31.5% versus 10.5 ± 22.3%; not significant). These findings suggest that RSM did not contribute to the outcomes in poorresponder cycles. RBMOnline Reproductive BioMedicine Online (2010) 20, 335-340 w w w . s c i e n c e d i r e c t . c o m w w w . r b m o n l i n e . c o m

Research paper thumbnail of Physical activity, obesity and eating habits can influence assisted reproduction outcomes

Women's Health, 2010

Objective: to determine if eating habits, physical activity and BMI can influence assisted reprod... more Objective: to determine if eating habits, physical activity and BMI can influence assisted reproduction outcomes. Material and Methods: this study analyzed 436 patients undergoing intracytoplasmic sperm injection cycles. Patients answered a questionnaire and regression analysis examined the relationship between lifestyle and BMI with the intracytoplasmic sperm injection cycles outcomes. Results: no influence of lifestyle and obesity was observed on the number of oocytes recovered. Obesity reduced the normal fertilization rate (coefficient [Coef.]: -16.0; p = 0.01) and increased the risk of miscarriage (OR: 14.3; p = 0.03). Physical activity positively affected implantation (Coef.: 9.4; p = 0.009), increased the chance of pregnancy (OR: 1.83; p = 0.013) and tended to decrease the risk of miscarriage (OR: 0.30; p = 0.068). In addition, an inverse correlation was found between physical activity and BMI, and a direct correlation was found between soft-drink consumption and BMI. Conclusions: eating habits, physical activity and obesity could affect clinical outcomes of assisted reproduction.

Research paper thumbnail of Predictive Factors of Repeat Sperm Aspiration Success

Urology, 2010

To evaluate the outcomes of repeated testicular sperm aspirations (TESAs) and to investigate whet... more To evaluate the outcomes of repeated testicular sperm aspirations (TESAs) and to investigate whether the interval between TESA procedures, success in the first attempt, and patient age might influence the results.

Research paper thumbnail of Outcome of ICSI using zona pellucida-bound spermatozoa and conventionally selected spermatozoa

Reproductive BioMedicine Online, 2009

This study aimed to investigate whether the spermatozoa-zona pellucida binding test is able to se... more This study aimed to investigate whether the spermatozoa-zona pellucida binding test is able to select spermatozoa with higher fertilization potential and higher rate of successful embryo development. This prospective study was performed with metaphase II (MII) oocytes retrieved from couples undergoing intracytoplasmic sperm injection (ICSI) cycles. For each patient, half of the MII oocytes were injected using a routine ICSI method (control group, n = 194) while the other half were injected with previously zona pellucida-bound spermatozoa (ZP-binding group, n = 194). Fertilization rate, high-quality embryo rate, and embryo transfer rate were compared between the groups. No significant difference was observed among the groups in the fertilization rate (76.8% versus 77.3% for control and ZP-binding groups, respectively). However, an increased percentage of high-quality embryos was observed when zona pellucida-bound spermatozoa were injected (70.0% versus 83.3% for control and ZP-binding groups, respectively, P = 0.003). Moreover, when embryo selection was performed while ignoring experimental group origin, embryos from the ZP-binding group were more commonly selected for transfer (43.6% versus 54.6% for control and ZP-binding groups, respectively, P = 0.004). These findings suggest that the spermatozoa-zona pellucida binding test may be an efficient method to identify the most competent spermatozoa for ICSI.

Research paper thumbnail of Twelve years of MSOME and IMSI: a review

Reproductive BioMedicine Online, 2013

A promising method for observing spermatozoa, motile sperm organelle morphology examination (MSOM... more A promising method for observing spermatozoa, motile sperm organelle morphology examination (MSOME) enables the evaluation of the nuclear morphology of motile spermatozoa in real time at high magnification and has allowed the introduction of a modified microinjection procedure, intracytoplasmic morphologically selected sperm injection (IMSI). Since its development, several studies have intensively investigated the efficacy of MSOME and IMSI. The objective of the present study is to review the current literature on the MSOME and IMSI techniques. A promising method for observing spermatozoa, motile sperm organelle morphology examination (MSOME), enables the evaluation of the nuclear morphology of motile spermatozoa in real time at high magnification and has allowed the introduction of a modified microinjection procedure, intracytoplasmic morphologically selected sperm injection (IMSI). Since its development, several studies have intensively investigated the efficacy of MSOME and IMSI. The objective of the present study is to review the current literature on the MSOME and IMSI techniques.

Research paper thumbnail of WITHDRAWN: IMSI is beneficial in cases of advanced maternal age: a prospective randomized study

Reproductive BioMedicine Online, 2012

Research paper thumbnail of Artificial oocyte activation using calcium ionophore in ICSI cycles with spermatozoa from different sources

Reproductive BioMedicine Online, 2009

The present study evaluated the effect of artificial oocyte activation (AOA) with calcium ionopho... more The present study evaluated the effect of artificial oocyte activation (AOA) with calcium ionophore A23187 on intracytoplasmic sperm injection (ICSI) cycles using spermatozoa from different sources. The 314 cycles evaluated were divided into three groups according to sperm origin; the ejaculated group (n = 92), the epididymal group (n = 82), and the testicular group (n = 140). Each group was further split into experimental subgroups, depending on whether or not AOA was performed. In addition, the cycles of women younger than 36 years were evaluated separately. For each experimental group, ICSI outcomes were compared between subgroups. No significant difference was observed between subgroups for all sperm origin groups. When evaluating only the cycles of women younger than 36 years of age, AOA increased the percentage of high-quality embryos (74.5 versus 53.0%, P = 0.011) and the implantation rate (19.3 versus 10.5%, P = 0.0025) when it was used with ejaculated spermatozoa, and the percentage of high-quality embryos (64.4 versus 50.3%, P = 0.006) when epididymal spermatozoa were used. These results may suggest that both sperm maturity and oocyte quality play a role in oocyte activation. However, this study is to be continued to confirm these findings.

Research paper thumbnail of Zona pellucida birefringence score and meiotic spindle visualization in relation to embryo development and ICSI outcomes

Reproductive BioMedicine Online, 2009

The meiotic spindle and the zona pellucida exhibit molecular order when imaged with polarized opt... more The meiotic spindle and the zona pellucida exhibit molecular order when imaged with polarized optics. This study aimed to investigate possible factors contributing to the zona pellucida birefringence score and meiotic spindle visualization, and to evaluate whether these structures may predict intracytoplasmic sperm injection outcomes. Oocytes were divided into groups according to zona pellucida birefringence and meiotic spindle visualization. In addition, the cycles were split into three groups based on the zona birefringence of transferred embryos. A positive correlation was observed between zona birefringence and meiotic spindle visualization. In addition, when the meiotic spindle was observed, the fertilization rate among oocytes with high or low zona pellucida birefringence was similar. Implantation and pregnancy rates were significantly higher when embryos derived from high birefringence oocytes were exclusively transferred (P = 0.041 and P = 0.004 respectively). Furthermore, the miscarriage rate was higher when embryos derived from low birefringence oocytes were exclusively transferred. On the other hand, the total dose of FSH negatively affected meiotic spindle visualization. Results show that selection of embryos based on zona pellucida and meiotic spindle imaging can significantly improve implantation and pregnancy rates. Moreover, the dose of FSH used for ovarian stimulation may affect the organization of the oocyte meiotic spindle.