Sandro Esteves

Androfert Centro de Referência para Reprodução Masculina

In recent years, the management of male factor infertility has undergone important changes with the introduction of novel concepts, advanced testing, and therapeutic interventions. This review highlights some of these changes and discusses their impact to routine clinical practice. First, we discuss the recent changes in the World Health Organizati...

In Fertility Centers, quality should be measured by how well the organization complies with pre-defined requirements , and by how quality policies are implemented and quality objectives achieved. Having a quality management system (QMS) is a mandatory requirement for IVF centers established in most countries with regulatory guidelines, including Br...

Objective: To investigate the effectiveness of intracytoplasmic sperm injection (ICSI) using testicular sperm as a strategy to overcome infertility in men with high sperm DNA fragmentation (SDF). Design: Prospective, observational, cohort study. Setting: Private IVF centers. Patient(s): A total of 147 couples undergoing IVF-ICSI and day 3 fr...

Purpose To provide an agreed upon definition of hyper-response for women undergoing ovarian stimulation (OS)? Methods A literature search was performed regarding hyper-response to ovarian stimulation for assisted reproductive technology. A scientific committee consisting of 5 experts discussed, amended, and selected the final statements in the que...

Human papillomavirus (HPV) is a common sexually transmitted disease that has been linked to both cancer and reproductive health issues. While its impact on fertility and pregnancy success has been studied, there is still too little evidence about the influence of HPV on assisted reproductive technology (ART). Therefore, there exists a need for HPV...

STUDY QUESTION Do early- and mid-luteal serum progesterone (P4) levels impact ongoing pregnancy rates (OPRs) in fresh blastocyst transfer cycles using standard luteal phase support (LPS)? SUMMARY ANSWER A drop in serum P4 level from oocyte pick-up (OPU) + 3 days to OPU + 5 days (negative ΔP4) is associated with a ∼2-fold decrease in OPRs. WHAT IS...

A high ovarian response to conventional ovarian stimulation (OS) is characterized by an increased number of follicles and/or oocytes compared with a normal response (10-15 oocytes retrieved). According to current definitions, a high response can be diagnosed before oocyte pick-up when >18-20 follicles ≥11-12 mm are observed on the day of ovulation...

Gonadotropin therapy to treat specific male infertility disorders associated with hypogonadotropic hypogonadism is evidence-based and effective in restoring spermatogenesis and fertility. In contrast, its use to improve fertility in men with idiopathic oligozoospermia or nonobstructive azoospermia remains controversial, despite being widely practic...

The aim of this study was to assess mitochondrial DNA analysis as a predictor of the pregnancy potential of biopsied preimplantation embryos. The study included 78 blastomeres biopsied from day 4 cleavage stage euploid embryos. The embryo karyotype was confirmed by 24-chromosome preimplantation genetic testing for aneuploidies using the Illumina Ne...

Biomedical science is rapidly developing in terms of more transparency, openness and reproducibility of scientific publications. This is even more important for all studies that are based on results from basic semen examination. Recently two concordant documents have been published: the 6th edition of the WHO Laboratory Manual for the Examination a...

Study question Does timing of WBT in t-NC differ according to six different commonly definitions for LH surge, and if so, do differences in timing impact OPRs? Summary answer Performing WBT on follicular collapse+5 days is equivalent to LH surge +7/+8 /+9 days in terms of OPRs, using six different definitions of LH surge. What is known already Pi...

Study question Does the ongoing pregnancy rate (OPR) of HRT with or without GnRH-agonist suppression and t-NC protocols differ in patients undergoing warmed blastocyst transfer? Summary answer HRT, with or without GnRH-agonist suppression, and t-NC protocols are associated with comparable OPRs in patients undergoing warmed blastocyst transfer. Wh...

Purpose Nonobstructive azoospermia (NOA) associated with primary spermatogenic failure is a common cause of male infertility usually considered untreatable; however, some reports have suggested that hormonal stimulation to boost the intra-testicular testosterone level and spermatogenesis might increase the chance of achieving pregnancy using homolo...

Research Question Does the timing of warmed blastocyst transfer in true natural cycle (t-NC) differ according to six different commonly used definitions of luteinizing hormone (LH) surge, and do differences in timing have any impact on ongoing pregnancy rate (OPR)? Design Prospective monitoring, including repeated blood sampling and ultrasound ana...

The Patient-Oriented Strategies Encompassing IndividualizeD Oocyte Number (POSEIDON) criteria identify and classify the so-called ‘low-prognosis’ patients undergoing assisted reproductive technology (ART). Recent large-scale studies using real-world data (RWD) have shown that patients classified under this system have distinct reproductive outcomes...

Since the birth of Louise Brown in 1978 via IVF, reproductive specialists have acquired enormous knowledge and refined several procedures, which are nowadays applied in assisted reproductive technology (ART). One of the most critical steps in this practice is the fertilization process. In the early days of IVF, a remarkable concern was the unpleasa...

Purpose Microdeletion on Y-chromosome is a well-known genetic cause of infertility in azoospermic and oligozoospermic men. RNA transcripts possess microRNA (miRNA) response elements (MRE) that may interact with competing endogenous RNAs (ceRNA), thus repressing their activity. MiRNAs originally targeting transcripts of genes deleted in the Y-chromo...

Increasing evidence has demonstrated that obesity impairs female fertility and negatively affects human reproductive outcome following medically assisted reproduction (MAR) treatment. In the United States, 36.5% of women of reproductive age are obese. Obesity results not only in metabolic disorders including type II diabetes and cardiovascular dise...

Background: Efficient and safe embryo vitrification techniques have contributed to a marked worldwide increase in the use of elective frozen embryo transfer (FET). Pinpointing the day of ovulation, more commonly by documentation of the LH surge and less commonly by ultrasonography, is crucial for timing of FET in a true natural cycle (t-NC) to max...

Purpose: Nonobstructive azoospermia (NOA) associated with primary spermatogenic failure is a common cause of male infertility usually considered untreatable; however, some reports have suggested that hormonal stimulation to boost the intra-testicular testosterone level and spermatogenesis might increase the chance of achieving pregnancy using homo...

Infections may act with variable impact on the physiopathology of the reproductive organs, determining infertility or reducing the outcomes of assisted reproduction technology. The aim of this narrative review is to describe the existing evidence regarding the pathogens with a supposed or recognized role in reproductive medicine. Viral hepatitis, a...

Purpose: Sperm DNA fragmentation (SDF) and seminal oxidative stress are emerging measurable factors in male factor infertility, which interventions could potentially reduce. We evaluated (i) the impact of lifestyle changes combined with oral antioxidant intake on sperm DNA fragmentation index (DFI) and static oxidation-reduction potential (sORP),...

Objective: To investigate the intraindividual agreement of the sperm chromatin dispersion (SCD) assay results to assess sperm DNA fragmentation (SDF) in men with infertility. Design: Diagnostic test reliability study. Setting: Andrology laboratories. Patient(s): A total of 219 men with infertility. Intervention(s): Sperm DNA fragmentation...

PurposeNonobstructive azoospermia (NOA) is associated with intrinsic testicular defects that severely impair sperm production. Although NOA invariably leads to infertility, focal sperm production may exist in the testicles of affected patients, which can be retrieved and used for intracytoplasmic sperm injection (ICSI) to generate healthy offspring...

In the last decades, the universal use of mobile phones has contributed to radiofrequency electromagnetic radiation environmental pollution. The steady growth in mobile phone usage has raised concerns about the effects of phone radiation on male reproductive health. Epidemiological studies report a sharp decline in sperm counts in developing countr...

Study question Is mitochondrial DNA viability ratio of day–4 biopsied embryos associated with embryo implantation potential? Summary answer The mitochondrial DNA viability ratio is significantly higher in embryos that implant. The score might help to select euploid embryos for single embryo transfer. What is known already Embryo euploidy is a cri...

Purpose: The use of antioxidants is common practice in the management of infertile patients. However, there are no established guidelines by professional societies on antioxidant use for male infertility. Materials and methods: Using an online survey, this study aimed to evaluate the practice pattern of reproductive specialists to determine the...

Despite the worldwide increase in frozen embryo transfer, the search for the best protocol to prime endometrium continues. Well-designed trials comparing various frozen embryo transfer protocols in terms of live birth rates, maternal, obstetric and neonatal outcome are urgently required. Currently, low-quality evidence indicates that, natural cycle...

Mitochondoiral vlaues as a tool to monitor embryo implantation power

Abstract Introduction Several studies suggest that luteinizing hormone (LH) could improve IVF outcome in women of advanced reproductive age by optimizing androgen production. In this review, we assessed the role of recombinant-human LH (r-hLH) and recombinant human follicle stimulating hormone (r-hFSH) co-treatment in ovarian stimulation for assist...

The development of surgical sperm retrieval procedures can be considered as the single most important breakthrough in the field of male infertility. Various testicular sperm retrieval procedures exist and are indicated in patients with obstructive and nonobstructive azoospermia, as well as patients with high levels of sperm DNA fragmentation and se...

Background A Delphi consensus was conducted to evaluate global expert opinions on key aspects of assisted reproductive technology (ART) treatment. Methods Ten experts plus the Scientific Coordinator discussed and amended statements plus supporting references proposed by the Scientific Coordinator. The statements were distributed via an online surv...

Objective To evaluate the effect of varicocelectomy on sperm deoxyribonucleic acid fragmentation (SDF) rates in infertile men with clinical varicocele. Design Systematic review and meta-analysis. Setting Not applicable. Patient(s) Infertile men with clinical varicocele subjected to varicocelectomy. Intervention(s) Systematic search using PubMed...

Obtaining good quality sperm for in-vitro fertilization, ICSI, or for cryopreservation can be a major problem if a man suffers from medical conditions that preclude normal collection. Major advances in sperm retrieval and preparation techniques have been witnessed in recent years, allowing a better understanding of the contribution of the sperm to...

Obtaining good quality sperm for in-vitro fertilization, ICSI, or for cryopreservation can be a major problem if a man suffers from medical conditions that preclude normal collection. Major advances in sperm retrieval and preparation techniques have been witnessed in recent years, allowing a better understanding of the contribution of the sperm to...

The aim of this paper was to estimate the effect of dexamethasone during ovarian stimulation in women of different reproductive age with elevated early follicular phase progesterone level undergoing fresh IVF cycle. This study is a prospective longitudinal analysis of consecutive women who underwent fresh IVF cycles at a single center, between Janu...

Study question: What is the agreement between antral follicle count (AFC) and anti-Müllerian hormone (AMH) levels when used to patient classification according to the Patient-Oriented Strategies Encompassing IndividualizeD Oocyte Number (POSEIDON) criteria? Summary answer: Our study indicates a strong agreement between the AFC and the AMH levels...

The POSEIDON ( P atient- O riented S trategies E ncompassing I ndividualize D O ocyte N umber) criteria were developed to help clinicians identify and classify low-prognosis patients undergoing assisted reproductive technology (ART) and provide guidance for possible therapeutic strategies to overcome infertility. Since its introduction, the number...

Objective To estimate the prevalence of low-prognosis patients according to the POSEIDON criteria using real-world data. Design Multicenter population-based cohort study. Settings Fertility clinics in Brazil, Turkey, and Vietnam. Patients Infertile women undergoing assisted reproductive technology using standard ovarian stimulation with exogenou...

The scope of the clinical embryology laboratory has expanded over recent years. It now includes conventional in vitro fertilization (IVF) techniques and complex and timedemanding procedures like blastocyst culture, processing of surgically retrieved sperm, and trophectoderm biopsy for preimplantation genetic testing. These procedures require a stab...

The scope of the clinical embryology laboratory has expanded over recent years. It now includes conventional in vitro fertilization (IVF) techniques and complex and time-demanding procedures like blastocyst culture, processing of surgically retrieved sperm, and trophectoderm biopsy for preimplantation genetic testing. These procedures require a sta...

The prolonged lockdown of health facilities providing non‐urgent gamete cryopreservation –as currently recommended by many reproductive medicine entities and regulatory authorities due to the SARS‐CoV‐2 pandemic will be detrimental for subgroups of male infertility patients. We believe the existing recommendations should be promptly modified and pr...

Abstract The prolonged lockdown of health services providing high-complexity fertility treatments –as currently recommended by many reproductive medicine entities– is detrimental for society as a whole, and infertility patients in particular. Globally, approximately 0.3% of all infants born every year are conceived using assisted reproductive techn...

COVID-19 is the world's most massive epidemic known to date. In order to prevent hospital burdens, governments around the world have adopted restrictive containment measures. Such measures have led to a temporary suspension of all non-urgent clinical procedures. With the reduction of con-tagions, in some country there is a slow and gradual restorat...

Poor ovarian response remains one of the most challenging tasks for an IVF clinician. In this review, we aim to highlight the ongoing research for optimizing the prognosis in poor ovarian response patients. The newly introduced POSEIDON criteria argue that the first step is to move from a poor response to a poor prognosis concept, while improving i...

Intracytoplasmic sperm injection (ICSI), combined with surgical sperm retrieval (SR) techniques, is the sole option for patients with non-obstructive azoospermia to achieve fertility; however, with suboptimal results. Given the variability in clinical presentation, the potential role of factors that can predict the likelihood of successful testicul...

The pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), responsible for the disease so-called COVID-19, represents the most exceptional health, social, economic, and humanitarian crisis known to humankind since the H1N1 flu of 1918. So far, it affected 213 countries, infecting over 100,000 people daily worldwide, wi...

We herein summarise the evidence concerning the impact of sperm DNA fragmentation in various clinical infertility scenarios and the advances on sperm DNA fragmentation tests. The collected evidence was used to formulate 41 recommendations. Of these, 13 recommendations concern technical aspects of sperm DNA fragmentation testing, including pre-analy...

Clinical implications of sperm DNA frgmentation tetsing

Objective To explore predictors of successful sperm retrieval (SR) and to identify potentially suitable candidates for testicular sperm aspiration (TESA), a more straightforward, less traumatic, and less costly procedure than open surgical SR methods. Design Retrospective chart review. Setting Academic tertiary medical center. Patients A total o...

Background: The current outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, named coronavirus disease 19 (COVID-19), is not the first well-known spillover of an animal originated virus to infect humans. However, one of the few to make such a fast jump in a powerful evolutionary shortcut. The incredible pattern of ag...

Purpose: To report the utilization of diagnostic intracytoplasmic sperm injection (D-ICSI), an ICSI cycle performed in the natural cycle, to obtain information about embryo development potential after sperm injection into zona pellucida (ZP)-free oocytes. Materials and Methods: We report the case of a couple with primary unexplained infertility wi...

Despite the considerate progress to which assisted reproduction technology (ART) has been subject since 1978, some issues remain unresolved. Notably, the clinical management of patients with a poor ovarian response is still a challenge in everyday practice, frustrating to both the patient and the fertility expert. Poor ovarian responders (PORs) emb...

Background: The three-parent assisted reproductive technique may increase oocyte competence. Objective: In this case-control study, the suitability of germinal vesicle transfer (GVT), synchronous ooplasmic transfer (sOT), asynchronous ooplasmic transfer using cryopreserved MII oocyte (caOT), and asynchronous ooplasmic transfer using waste MII oo...

Objective To study the global DNA methylation pattern in spermatozoa of patients with varicocele as well as investigate their semen quality. Design Prospective observational case-control study. Setting University-affiliated hospital. Patient(s) A total of 26 men with varicocele and 26 fertile men without the disorder. Interventions Analysis of...

In this report we present an unusual case of a couple who achieved a twin pregnancy by intracytoplasmic sperm injection (ICSI) with a single immature oocyte retrieved. The oocyte was at metaphase I at 39 h post human chorionic gonadotrophin (hCG) administration, which is our standard ICSI time. Extended culture allowed the extrusion of the polar bo...

Background: Treatment of palpable varicocele in infertile men with abnormal semen parameters is widely accepted, and physical examination (PE) remains a cornerstone for recommending varicocele repair. However, identification of clinical varicocele during PE can be challenging for both urology residents and consultants. Objective: To compare the...

Male infertility is a complex condition with a strong genetic and epigenetic background. This review discusses the importance of genetic and epigenetic factors in the pathophysiology of male infertility. The interplay between thousands of genes, the epigenetic control of gene expression, and environmental and lifestyle factors, which influence gene...

Spermatogenic failure (SF) denotes a severe intrinsic testicular dysfunction invariably resulting in infertility. The condition affects approximately 10% of infertile men and it is usually associated with nonobstructive azoospermia (NOA). Half the men with NOA-SF have sparse foci of sperm production within their dysfunctional testes, which may be e...

Sperm retrieval techniques have been developed to allow sperm acquisition directly from the epididymis or seminiferous tubules to treat azoospermia-related infertility with the aid of intracytoplasmic sperm injection (ICSI). Nowadays, testicular sperm retrieval has also been used to overcome infertility in non-azoospermic men with high levels of ej...

Adult men produce millions of spermatozoa daily, dependent on adequate testicular environment and hormonal control. Spermatogenesis and steroidogenesis are regulated by a master switch (gonadotropin-releasing hormone [GnRH] pulse generator) that controls two separate and independent feedback systems, namely, the androgen production (luteinizing hor...

In this chapter, we present an update on current surgical treatment in the context of male infertility. Specifically, we focused on varicocele repair, vasovasostomy, vasoepididymostomy, and treatment of ejaculatory duct obstruction, including the perioperative planning and prognostic aspects, with an emphasis on the role of microsurgery.

The field of male infertility has witnessed many advancements in the past few decades that have refined our understanding of the sperm contribution to conception. The extent of sperm DNA fragmentation is currently believed to play a key role on fertilization and embryogenesis making it an important test of sperm function. This belief has triggered...