PEDRO AUGUSTO ARAUJO MONTELEONE
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
LIM/58 - Laboratório de Ginecologia Estrutural e Molecular, Hospital das Clínicas, Faculdade de Medicina
LIM/58 - Laboratório de Ginecologia Estrutural e Molecular, Hospital das Clínicas, Faculdade de Medicina
6 resultados
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- The impact of balanced reciprocal translocation - 46,XX,t(7; 17) (p13;q24) probably involving the SOX9 gene in the in vitro fertilization with own oocytes evaluated by preimplantation genetic testing or donated oocytes(2019) PEREGRINO, Pedro F. M.; GOMES, Alecsandra; FUJII, Mariana; BONETTI, Tatiana C. S.; RIBOLDI, Marcia; MONTELEONE, Pedro A. A.Preimplantation genetic testing (PGT) for in vitro fertilization (IVF) - also known as PGT for Structural Rearrangements (PGT-SR) - has emerged as an option for at-risk couples carrying balanced translocations. The female in the couple featured in this case report is a carrier of a balanced reciprocal translocation who underwent IVF. PGT showed all her embryos were aneuploid. She subsequently had two cycles using donor oocytes, which ended in miscarriages.
conferenceObject The best choice for embryo transfer in good prognosis patients undergoing freeze-only police: one plus one is better than two(2020) MONTELEONE, P. A.; PEREGRINO, P.; MIORIN, J.; GOMES, A.; MARTIN, H.; BONETTI, T.- Should single embryo transfer be used in patients with any kind of infertility factor? Preliminary outcomes(2019) MONTELEONE, Pedro A. A.; PETERSEN, Paula G. M. F.; PEREGRINO, Pedro F. M.; MIORIN, Juliana; GOMES, Alecsandra P.; FUJII, Mariana G.; MARTIN, Hamilton de; BONETTI, Tatiana C. S.; GONCALVES, Sergio P.Objective: Multiple embryos have been transferred to compensate for low implantation rates, which in turn, increase the likelihood of multiple pregnancies. Despite the publication of clinical guidelines and a reduction in the number of embryos transferred, double embryo transfer still is the most common practice. There is no clear evidence of who should receive the single embryo transfer (SET), and it is more commonly indicated for patients of good prognosis. However, it is not clear how much the presence of other infertility factors can affect the SET prognosis. The aim of this study was to evaluate differences in clinical pregnancy rates (CPR) of frozen-thawed SET cycles for women presenting with different infertility factors. Methods: Retrospective cohort study evaluating 305 frozen-thawed SET cycles performed in the last 10 years in a private IVF center. We included patients undergoing ovarian stimulation cycles, using ejaculated sperm and a frozen-thawed ET. Embryos were routinely vitrified and warmed up, and the blastocysts were transferred after endometrium preparation. The cycles were categorized according to the infertility factor classified by the Society for Assisted Reproductive Technologies (SART) as anatomic female factor (n=55), endocrine female factor (n=26), endometriosis (n=37), male factor (n=60), ovarian insufficiency (n=26), unexplained (n=24), multiple factors (n=45) and other (n=32). CPR were compared between the groups and the multivariate analysis was performed to evaluate the association of each infertility factor and the CPR, adjusted for confounders. Results: The women varied in age from 18 to 44 years (35.9 +/- 3.8), presented Body Mass Index of 22.4 +/- 3.1kg/m(2), baseline serum FSH of 7.4 +/- 8.3 IU/ml, and had a mean of 11.0 +/- 8.4 MII oocytes recovered and 6.4 +/- 5.3 embryos cryopreserved. The CPR, according to infertility factors were: anatomic female factor (25.9%), endocrine female factor (30.8%), endometriosis (27.8%), male factor (20.7%), ovarian insufficiency (21.7%), unexplained (9.5%), multiple factors (17.1%) and other (20.7%). Multivariate analysis did not show significant association of infertility factors and CPR adjusted for confounders. Conclusions: Patients presenting different infertility factors seem to have a satisfactory CPR for a SET cycle, except those with unexplained infertility. This is a preliminary outcome and the number of patients by category is small; in addition, the retrospective characteristics of the study are its limitations. Overall, our findings suggest that patients presenting any infertility factor, except unexplained infertility, are suitable to receive a SET with satisfactory outcomes.
- One Plus One is Better than Two: An Approach Towards a Single Blastocyst Transfer Policy for All IVF Patients(2022) PEREGRINO, Pedro Felipe Magalhaes; BONETTI, Tatiana Carvalho de Souza; GOMES, Alecsandra Prado; MARTIN, Hamilton de; SOARES JUNIOR, Jose Maria; BARACAT, Edmund Chada; MONTELEONE, Pedro Augusto AraujoObjective It is known that the single embryo transfer (SET) is the best choice to reduce multiples and associated risks. The practice of cryopreserving all embryos for posterior transfer has been increasingly performed for in vitro fertilization (IVF) patients at the risk of ovarian hyperstimulation syndrome or preimplantation genetic testing for aneuploidy. However, its widespread practice is still controverse. The aim of this study was to evaluate how effective is the transfer of two sequential SET procedures compared with a double embryo transfer (DET) in freeze-only cycles. Methods This retrospective study reviewed 5,156 IVF cycles performed between 2011 and 2019, and 506 cycles using own oocytes and freeze-only policy with subsequent elective frozen-thawed embryo transfers (eFET) were selected for this study. Cycles having elective SET (eSET, n = 209) comprised our study group and as control group we included cycles performed with elective DET (eDET, n = 291). In the eSET group, 57 couples who had failed in the 1 (st) eSET had a 2 (nd) eFET, and the estimated cumulative ongoing pregnancy rate was calculated and compared with eDET. Results After the 1 (st) eFET, the ongoing pregnancy rates were similar between groups (eSET: 35.4% versus eDET: 38.5%; p = 0.497), but the estimated cumulative ongoing pregnancy rate after a 2 (nd) eFET in the eSET group (eSET + SET) was significantly higher (48.8%) than in the eDET group ( p < 0.001). Additionally, the eSET + SET group had a 2.7% rate of multiple gestations, which is significantly lower than the eDET group, with a 30.4% rate ( p < 0.001). Conclusion Our study showed the association of freeze-only strategy with until up to two consecutive frozen-thawed eSETs resulted in higher success rates than a frozen-thawed DET, while drastically reducing the rate of multiple pregnancies.
conferenceObject Is the application of elective single embryo transfer (e-SET) in freeze-all cycles a good strategy?(2019) MONTELEONE, P. A.; PETERSEN, P.; PEREGRINO, P.; GONCALVES, S.; MIORIN, J.; FUJII, M.; GOMES, A.; MARTIN, H.; BONETTI, T.- Transfer of 2 Embryos Using a Double-Embryo Transfer Protocol Versus 2 Sequential Single-Embryo Transfers: The Impact on Multiple Pregnancy(2018) MONTELEONE, Pedro A. A.; PEREGRINO, Pedro F. M.; BARACAT, Edmund C.; SERAFINI, Paulo C.Introduction: Assisted reproductive technologies (ARTs) are associated with potential risks, mainly related to multiple pregnancies, which are around 20% to 25%. Iatrogenic multiple pregnancies due to ovarian stimulation with multiples embryos transferred can be avoided by the elective single-embryo transfer (eSET), a growing practice worldwide. Adequately applied eSET, which impact on the incidence of complications without compromising treatment success, is still a challenge. The aim of this study was to compare the cumulative success rates of elective transfer of 2 embryos when transferred one by one (eSET), versus the success rates of elective double-embryo transfer (DET) in a single procedure, in a good prognosis population. Methods: This study evaluated 610 good prognosis infertile couples undergoing ART, split into 2 groups: eSET group which included those receiving first eSET (n = 237) and for those who did not become pregnant, they could receive a second frozen-thawed SET; and eDET group (n = 373) who received elective transfer of 2 good quality embryos in the first transfer. Results: Clinical pregnancy outcomes after a transfer of 2 embryos were similar between the groups (DET: 46.6% vs accumulated SET: 45.9%; P = .898). Multiple pregnancy rate was significantly lower in the group receiving transfer of 2 embryos, one by one, compared to DET (DET: 32.2% vs accumulated SET: 6.7%; P < .001). Conclusions: The eSET policy should be stimulated for good prognosis couples, as it maintains the accumulated clinical pregnancy rates, avoids multiples pregnancies, and consequently the maternal and neonate complication and indirect costs of treatment when considering spending on the obstetrics are reduced.