PAULO CESAR SERAFINI
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Obstetrícia e Ginecologia, Faculdade de Medicina - Docente
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
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- Human reproduction: current status(2015) IZZO, Carlos Roberto; MONTELEONE, Pedro Augusto Araujo; SERAFINI, Paulo C.The concern about the maintenance of the human species has existed since the earliest civilizations. Progress in the diagnosis and treatment of infertility has led to the development of assisted reproductive techniques (ART) which, along with the evolution of genetics and molecular biology studies, have contributed in a concrete way to the management of infertile couples. Classic in vitro fertilization was initially developed 35 years ago for the treatment of women with tubal blockage, however, it remains inaccessible to a significant proportion of infertile couples around the world. This can be explained by the lack of specialized clinics in some countries and by the high cost of the procedures. Efforts have been employed to increase the number of treatment cycles for assisted reproduction, as for example, the creation of low-cost programs. Even today, infertility remains a problem of global proportions, affecting millions of couples. The estimate of the incidence of infertility is uncertain, mainly because of the criteria used for its definition. This article aims to review the most important aspects, succinctly, regarding the incidence, etiology, and treatment options available to infertile couples.
conferenceObject FIRST REPORT OF A SUCCESSFUL SINGLETON LIVE BIRTH IN A FEMALE WITH 17-HYDROXYLASE DEFICIENCY THROUGH IVF FROZEN-THAWED EMBRYO TRANSFER AFTER ADEQUATE ENDOMETRIAL PREPARATION(2014) BIANCHI, P. H. M.; MONTELEONE, P. A. A.; DOMENICE, S.; COSTA, E. M. F.; MENDONCA, B. B.; BARACAT, E.; SERAFINI, P.bookPart Infertilidade Femina(2016) IZZO, Carlos Roberto; MONTELEONE, Pedro Augusto Araújo; SERAFINI, Paulo Cesar; BARACAT, Edmund Chada- Efficacy of MLPA for detection of Y-chromosome microdeletions in infertile Brazilian patients(2020) FRANCHIM, C. S.; SOARES-JUNIOR, J. M.; SERAFINI, P. C.; MONTELEONE, P. A. A.; COCCUZZA, M. S.; ZANARDO, E. A.; MONTENEGRO, M. M.; DIAS, A. T.; KULIKOWSKI, L. D.; BARACAT, E. C.Purpose Worldwide publications follow the gold standard method-the polymerase chain reaction (PCR)-for detecting Y-chromosome microdeletions; however, markers are frequently variable between the studies. Can we detect the deletions by another molecular method with more genomic coverage? The Y chromosome harbors several different genes responsible for testicular development and spermatogenesis, and its repetitive conformation predisposes it to complex rearrangements that have clinical impact. Our aim was to evaluate a molecular diagnostic method, the Multiplex Ligand Probe-dependent Amplification (MLPA), which is also a valuable ancillary method for the identification of deletions, duplications, and rearrangements in a single and faster reaction, leading to a better comprehension of patients' phenotypes, and should be considered a useful tool for detection of Y chromosome deletions. Methods This is a study of diagnostic accuracy (transversal prospective study) conducted to investigate Y-chromosome deletions in 84 individuals through PCR and MLPA methods. Forty-three infertile men (azoospermic and oligozoospermic) and 41 controls (40 fertile men and 1 normal karyotyped woman) were analyzed by PCR and MLPA techniques. Results We diagnosed seven (7) deletions (16.2%) by PCR and 9 with MLPA (21%). In addition, we found five (5) duplications and a suggestive mosaic. Conclusion Our results demonstrate that MLPA technique is valuable in the investigation of microdeletions and microduplications. Besides deletions, duplications can cause instability of chromosome genes, possibly leading to infertility. Both studied techniques provide an advantageous diagnostic strategy, thus enabling a better genetic counseling.
- Outcomes of elective cryopreserved single or double embryo transfers following failure to conceive after fresh single embryo transfer(2016) MONTELEONE, Pedro Augusto Araujo; MIRISOLA, R. J.; GONALVES, S. P.; BARACAT, Edmund C.; SERAFINI, Paulo C.The main adverse effect of IVF is the high multiple pregnancy rate resulting from the transfer of two or more embryos. The objective was to evaluate pregnancy rates in infertile women with a good prognosis who failed to conceive in a fresh elective single embryo transfer (eSET) and had a second cycle with elective double vitrified-warmed embryo transfer (eDFET) compared with elective single vitrified-warmed embryo transfer (eSFET). A total of 142 intracytoplasmic sperm injection cycles using a conventional protocol were evaluated. Good-prognosis patients underwent eSET in a fresh cycle, and those who failed to conceive underwent a second vitrified-warmed embryo transfer: eDFET (n = 102) or eSFET (n = 40). Embryos were transferred and vitrified on day 5 of development. Patients who received eDFET had fewer implantations (30.9%) than eSFET (52.5%; P = 0.004); pregnancy rates were similar (eDFET: 35.3%, eSFET: 42.5%). Patients with the eSFET had one monozygotic twin (5.9%), and 22.2% of eDFET patients had multiple pregnancies. Patients with a good prognosis who failed to conceive in the first fresh eSET did not have an advantage when receiving eDFET in the second cycle, as pregnancy rates were similar; 22.2% of patients in the eDFET group had multiple pregnancies.
- Prognostic factors for pregnancy after intrauterine insemination(2019) EJZENBERG, Dani; GOMES, Tiago J. O.; MONTELEONE, Pedro A. A.; SERAFINI, Paulo C.; SOARES- JR., Jose M.; BARACAT, Edmund C.Objective To evaluate prognostic factors for pregnancy after intrauterine insemination (IUI). Methods A retrospective study was conducted among couples who underwent IUI at Universidade de Sao Paulo, Brazil, between January 31, 2008, and April 30, 2016. The main outcome was a positive beta human chorionic gonadotropin (beta-hCG) test result after IUI. Univariate analyses were used to determine predictors of pregnancy. Selected numerical variables were categorized to maximize the area under the receiver operating characteristic (ROC) curve. Logistic regression was performed using the backward method. The quality of the model was evaluated using the R-2 (Nagelkerke) and Hosmer-Lemeshow tests. Results Of 355 insemination cycles, 56 (15.8%) resulted in a positive beta-hCG test result. The predictors and cutoff values that maximized the area under the ROC curve were as follows: follicle-stimulating hormone (mIU/mL; P<0.001); duration of infertility (P<0.001); number of follicles greater than or equal to 14 mm (>1 follicle; P<0.001); baseline spermatozoa concentration (>52.0 million/mL; P=0.007); total ejaculate (>123.7 million; P=0.003); and grade B motility (>35%; P=0.013). These factors were able to predict 50.4% of the positive test results (R-2). Conclusion Prognostic factors for pregnancy identified approximately half of all successful outcomes after IUI.
bookPart Técnica de reprodução assistida (TRA) de alta complexidade(2015) MONTELEONE, Pedro Augusto Araújo; IZZO, Carlos Roberto; SERAFINI, Paulo Cesar- Positive rheotaxis extended drop: a one-step procedure to select and recover sperm with mature chromatin for intracytoplasmic sperm injection(2017) MARTIN, Hamilton De; COCUZZA, Marcello S.; TISEO, Bruno C.; WOOD, Guilherme J. A.; MIRANDA, Eduardo P.; MONTELEONE, Pedro A. A.; SOARES JR., Jose Maria; SERAFINI, Paulo C.; SROUGI, Miguel; BARACAT, Edmund C.The purpose of this study was to develop a novel one-step ICSI approach to select sperm with better chromatin maturity than the conventional method. This was a pilot diagnostic study, which prospectively recruited men during a 6-month period in a University-affiliated infertility centre. Forty consecutive semen samples were provided for analysis. The positive rheotaxis extended drop (PRED) was set up creating a pressure and viscosity gradient. Each semen sample was divided into four aliquots: one aliquot for density gradient centrifugation (DGC), two aliquots for PRED (fresh semen (PRED-FS) and processed semen (PRED-DGC)), and one aliquot as the control (FS). In PRED, a mean of 200 spermatozoa were collected consecutively without selection from the outlet reservoir. The aniline blue assay was used to assess chromatin immaturity. The mean channel length, measured from inlet to outlet, was 32.55 +/- 0.86 mm, with a mean width of 1.04 +/- 0.21 mm. In 82.5% of cases (33/40), at least 50 spermatozoa were captured between 15 and 30 min. Improved chromatin maturity after the DGC preparation and the PRED approach was observed in all samples. This was reflected by a mean reduction from 28.65 +/- 8.97% uncondensed chromatin in the native ejaculates to 17.29 +/- 7.72% in DGC and 0.89 +/- 1.31% in the PRED approach (P < 0.01). The PRED method may improve the current ICSI technique by providing it with its own sperm selection process. ICSI would probably become an even more complete technique comprising selection, capture and injection of the male gamete.
bookPart Infertilidade por fator uterino(2016) KRöGER, Gustavo Burcovschi; EJZENBERG, Dani; MONTELEONE, Pedro Augusto Araujo; SERAFINI, Paulo CésarbookPart Endometriose e infertilidade(2016) BIANCHI, Paulo Homem de Mello; MONTELEONE, Pedro Augusto Araujo; SERAFINI, Paulo César