OBJECTIVES:To evaluate the presence of anti-ZIKV IgM and IgG antibodies in couples undergoing Assisted Reproduction Techniques (ART) and to examine reported ZIKV infections among women of reproductive age in São Paulo state. METHODS:A retrospective cohort analysis was performed using medical records of ART patients consecutively tested for ZIKV between March 2016 and June 2024 at a private ART center. Testing involved a rapid immunochromatographic assay, with positive results confirmed by PCR. According to ANVISA regulations, anti-ZIKV IgG testing was required from 2016 to 2022, while both IgG and IgM testing became mandatory from 2022 to 2024. Additionally, ZIKV notification data from DATASUS for metropolitan cities near the ART center were collected and compared with positivity rates observed in the cohort. RESULTS:Anti-ZIKV IgM positivity was 0.18% (1/569 female patients; 95% CI ≈ 0.00-0.98%), while anti-ZIKV IgG positivity was 2.1% (2/96 tested; 95% CI ≈ 0.25-7.32%), indicating limited prior exposure. DATASUS data showed a significant decline in ZIKV cases in São Paulo state, from 10,455 cases in 2016 to 228 in 2024. In cities surrounding the ART clinic, reported cases decreased from 73 to 1 during the same period. Among women of reproductive age, 42 cases were reported in 2016 and none in 2024. DISCUSSION:Conducting widespread population testing creates logistical and financial challenges. In this ART group, ZIKV positivity was rare (<1%), with about 2% showing signs of previous exposure, and most patients came from regions with low rates of ZIKV-related microcephaly. CONCLUSION:Positivity for anti-ZIKV was low among patients on ART.
OBJECTIVE:To evaluate clinical and laboratory parameters associated with the severity of ovarian hyperstimulation syndrome (OHSS) and to assess pregnancy outcomes in women hospitalized with moderate or severe OHSS. Several risk factors, including elevated antral follicle count (AFC), anti-Mullerian hormone (AMH), and serum estradiol (E2) levels, increase the risk of OHSS. METHODS:We studied 71 women with a median age of 32.7 years and a body mass index (BMI) of 22.8 kg/m2 with moderate (n=38) and severe (n=31) OHSS. We measured E2, hemoglobin (Hb), hematocrit (Hct), creatinine, albumin (Alb), total protein (TP), D-dimer (DD), and alanine aminotransferase (ALT) levels on the day of hospitalization and every second day until discharge. Data on the length of hospitalization, along with pregnancy outcomes, were recorded. RESULTS:There were no intergroup differences between women with moderate and severe OHSS in terms of age and BMI. The total pregnancy rate in both moderate (18/38) and severe (9/31) OHSS was 27/69; however, in women with severe OHSS, the positive pregnancy outcome was approximately half that observed in the moderate OHSS group and was accompanied by longer hospitalization (2.9-fold). All women with OHSS had elevated initial E2 levels (>6910pg/mL). Women with severe OHSS had higher initial E2 (p=0.001) and Hct (p=0.006) levels, together with lower Alb and TP concentrations (both p<0.001), compared with those with moderate OHSS. CONCLUSION:Elevated estradiol concentration is an associated factor for OHSS in women undergoing COH. Basal serum albumin concentration, together with total protein level and hematocrit, are predictive factors for OHSS severity.
OBJECTIVE:To evaluate the effects of fresh and frozen seminal plasma, at three different concentrations, on the migration and viability of periodontal ligament fibroblasts. METHODS:Semen samples from three healthy volunteers were processed to obtain seminal plasma, filtered (0.22 µm), and diluted to 2.5% and 5% (v/v) in DMEM. Aliquots were tested either fresh or after storage at -20°C for 8 days. Cell migration was evaluated by measuring wound closure in a wound-healing assay using photographs analyzed with ImageJ. Cell proliferation was assessed in triplicate at 6, 12, and 24 hours using the commercial CellTiter 96® AQueous Non-Radioactive Cell Proliferation Assay kit. RESULTS:Across donors, frozen seminal plasma showed a higher mean percentage of wound closure at 48 hours than fresh seminal plasma; however, differences versus controls were not consistently significant, and viability tended to decrease after exposure to seminal plasma, particularly after freezing. CONCLUSION:Fresh and frozen seminal plasma did not promote cell migration or proliferation at the concentrations tested. The apparent trend toward greater migration with frozen samples requires confirmation in adequately powered studies and should be interpreted cautiously.
Chemotherapy remains a cornerstone of cancer treatment, effectively targeting rapidly dividing cancer cells, yet its systemic effects often extend to healthy reproductive cells, resulting in temporary or permanent infertility. This review explores the mechanisms by which chemotherapy impairs fertility in both men and women, focusing on the damage to ovarian follicles and spermatogenesis. Key factors influencing fertility outcomes include the type and dosage of chemotherapy drugs, patient age, and pre-existing reproductive health. Alkylating agents, such as cyclophosphamide, and platinum-based drugs, like cisplatin, pose the highest risk of gonad-otoxicity, while other agents exhibit milder, often reversible effects. Fertility preservation options such as oocyte and embryo freezing for women, sperm banking for men, and emerging techniques like ovarian and testicular tissue cryopreservation offer hope for maintaining reproductive potential. The psychological burden of infertility and the promising yet complex role of nanoparticles in reproductive medicine are also discussed. By synthesizing current research, this review underscores the need for personalized fertility counseling and advanced preserva-tion strategies to balance cancer treatment efficacy with reproductive goals.
OBJECTIVE:To analyze the psychological and emotional experiences of women who donated oocytes in Spain. METHODS:A cross-sectional observational study was conducted between June 2024 and February 2025 at Instituto Bernabéu (Alicante) and Clínica Fertty (Barcelona). The sample consisted of women who met the inclusion criteria for oocyte donation programs. Participation was voluntary and anonymous, with informed consent obtained. The study was approved by the internal research committee of Instituto Bernabéu and registered under protocol MR48, in accordance with the Declaration of Helsinki. Data were collected using the EMODON questionnaire, developed ad hoc for this study, which assessed motivations, concerns, perceived professional support, and emotional state. Quantitative data were analyzed descriptively, and qualitative responses underwent thematic analysis. RESULTS:The mean age was 25 years (SD=3.88). Most donors reported altruistic motivations (95%), while 61% cited financial compensation. Concerns before treatment were expressed by 55%, primarily regarding future fertility (70%), hormonal side effects (50%), and surgical risks (45%). During stimulation, 54% felt emotionally stable, 24% more irritable, and 13% reported a negative emotional impact overall. After donation, 92% felt calm and satisfied. Foreign donors reported higher irritability (34%) than Spanish donors (19%). Nearly all participants (99%) valued the professional support received. Regarding anonymity, 71.3% stated it would not affect them or had never considered it, while a minority reported concern or refusal to donate again. CONCLUSIONS:Oocyte donation was generally well tolerated emotionally, with high satisfaction regarding clinical support. Nonetheless, a vulnerable subgroup highlighted the need for targeted psychological assistance.
OBJECTIVE:To evaluate if blastomere/trophectoderm biopsy for preimplantation genetic testing affects early HCG levels. METHODS:A single-center retrospective study, encompassing data of 196 women who underwent IVF treatments with intracytoplasmic sperm injection (ICSI) with either a transfer of a fresh or frozen-thawed day-5 blastocyst. All women tested positive for HCG (>25 IU/L) two weeks after the transfer. Of those, 97 women underwent preimplantation genetic testing ("PGT", the study group) while the control group ("non-PGT") of 99 women, had IVF treatment without PGT. RESULTS:No significant difference was found in HCG levels between the PGT and non-PGT groups. Similarly, there were no significant disparities in pregnancy outcomes, including miscarriage, live birth rate (LBR), extrauterine pregnancy, and intrauterine fetal death.Multivariate analysis revealed that HCG levels were significantly associated with Body Mass Index (BMI) and protocol type (fresh vs. frozen), but not with the biopsy day. Logistic regression analysis adjusted to the women's age, endometrial thickness, and HCG levels, found no significant correlation between the likelihood of live birth and PGT performance or the biopsy day. CONCLUSIONS:There is no apparent disparity in early HCG levels or pregnancy outcomes in IVF treatment with or without PGT. Notably, HCG levels are significantly higher in frozen-thawed cycles compared to fresh cycles, irrespective of PGT performed. Since HCG levels are associated with LBR, these findings enhance confidence of the non-detrimental effect of blastomere and trophectoderm biopsy.
OBJECTIVE:To assess whether the diagnosis and antibiotic treatment of chronic endometritis improve reproductive outcomes in patients with recurrent pregnancy loss or recurrent implantation failure. METHODS:This retrospective study included 67 women with recurrent pregnancy loss or recurrent implantation failure. Chronic endometritis was diagnosed in 30 patients (44.8%) based on hysteroscopic findings, CD138-positive histology, or a positive endometrial culture. All patients diagnosed with chronic endometritis received first-line antibiotic therapy, most commonly doxycycline 200 mg/day for 14 days. RESULTS:Following antibiotic therapy, 17 patients (56.7%) achieved a clinical pregnancy and 12 (40%) achieved a live birth. Clinical pregnancy and live birth rates were similar in women with recurrent pregnancy loss (60% and 40%, respectively) and those with recurrent implantation failure (55% and 40%, respectively), with no statistically significant differences between patients with resolved and persistent chronic endometritis (p>0.05). CONCLUSION:In this study, antibiotic treatment for chronic endometritis was not associated with a statistically significant improvement in reproductive outcomes. The heterogeneity of diagnostic and therapeutic approaches highlights the need for standardized criteria and well-designed prospective studies to clarify its clinical relevance.
OBJECTIVE:To evaluate the influence of three culture media on the good quality cleavage embryo and fertilization rates. METHODS:A three-arm, prospective, randomized, controlled clinical trial included patients undergoing IVF treatments at a single center from May to August 2023. Sibling oocytes were randomized in three culture media (A, B and C). Fertilization and day three good quality embryo rates were evaluated. RESULTS:Three hundred sixty-four retrieved oocytes from forty patients were randomized right after ovarian aspiration. From those, 309 metaphase II oocytes (mean per patient 7.72±2.87) were fertilized and cultured. Overall fertilization rate was 81.6%, with no statistical difference among media: 85.8% (73-100) vs. 77.2% (63-100) vs. 82.4% (67-100) for A, B and C, respectively (p=0.290). Although the percentage of D3 good quality embryos in each media was not statistically significant [A: 52.3% (0-76), B: 35.9% (0-67), C: 44.8% (0-100) (p=0.137)], the number of patients with at least one good quality embryo on D3 was statistically different [28 (70.0%) vs. 18 (45.0%) for A and B, respectively (p=0.020) OR 1.56; 95% CI (1.05-2.32, p=0.020)]. In a multivariable analysis, culture media and age have significantly affected D3 embryo quality OR 1.44; 95% CI (1.22-2.35, p=0.016). CONCLUSIONS:Although no difference was observed in fertilization and cleavage-stage embryo quality rate among brands, one culture medium had a significantly lower number of patients with good-quality cleavage embryos. Further trials with pregnancy outcomes are warranted to confirm clinical implications of these findings.
OBJECTIVE:The aim of this review was to evaluate the extent to which psychological stress may adversely affect seminal quality parameters in men. METHODS:A systematic review was conducted across databases including Embase, PubMed, Scopus, and Web of Science. Studies were subjected to data extraction, risk of bias, and narrative synthesis. RESULTS:A total of 34 studies were included in this review. Three (8.82%) studies were judged to be at a high risk of bias. Included studies were published between 1988 and 2023 and concerned a total of 11,141 participants, ranging from 20 to 1,362 participants per study. Psychological stress negatively impacted semen volume in 12.9% of studies, sperm concentration in 52.9%, total sperm count in 56.3%, sperm motility in 63.3%, and sperm morphology in 21.4%. Sources of psychological stress such as academic stress, daily life stress, infertility-related stress, stressful life events, and work-related stress were correlated to impairment of semen parameters in 70.6% of included studies. The ability to draw robust conclusions is severely restricted by significant heterogeneity across the reviewed literature. CONCLUSIONS:This systematic review found that psychological stress is frequently associated with impaired semen parameters, particularly sperm concentration and sperm motility. Nevertheless, these findings should be interpreted with caution. Most of the reported associations are observational and do not establish a definitive causal relationship between psychological stress and semen quality impairment.
OBJECTIVES:Chlamydia infection is a known risk factor for tubal occlusion and subsequent infertility. A significant proportion of Chlamydia infections are asymptomatic, which can delay diagnosis and allow silent progression of tubal damage. Therefore, identifying a history of Chlamydia infection-even in the absence of symptoms-may help recognize women at risk of tubal involvement. In such cases, it would be justified to perform tubal patency testing to assess potential tubal and pelvic sequelae. Our purpose was to evaluate the relationship of Chlamydia IgG serology with tubal patency as determined by Hysterosonosalpingo-Foam-Sonography (HyFoSy). Furthermore, the study examines whether this information could guide decision-making in the initial clinical evaluation of infertile patients. METHODS:A retrospective pilot study was performed including all patients referred for primary infertility to the Reproductive Medicine Unit of the Gynecology Service of the Hospital Arnau de Vilanova in Lleida between 2022 and 2024. Chlamydia infection history was assessed through serological IgG testing, and tubal patency was evaluated using HyFoSy. RESULTS:Seventy-nine patients were included in the study. A Chlamydia IgG seropositivity rate of 13.9% was observed, while tubal occlusion-assessed through HyFoSy-was detected in 25.3% of cases. Patients younger than 33 years with a positive Chlamydia IgG testing showed a higher rate of tubal occlusion compared to patients with negative serology (OR 8.00, 95% CI [1.08, 59.16]). No differences were observed in older patients. CONCLUSIONS:Chlamydia infection may be associated with a higher risk of tubal occlusion in younger patients, especially those under 33 years.
OBJECTIVE:Since cumulus cells (CCs) play an undeniable role in oocyte maturation by producing and transferring important molecules to the oocyte, examining these cells can provide a broad view of the factors affecting oocyte competence. Therefore, the aim of this study was to investigate the expression of genes and proteins ZNF83, ACY-1, andSMC5 in CCs of unfertilized oocytes and compare it with fertilized oocytes to gain new insights into the relationship between CCs function and oocyte competence. METHODS:Eighteen healthy female oocyte donors were included in this study. After obtaining the cumulus-oocyte complex and isolating the CCs, oocytes were injected and the embryos were followed and morphologically graded on day 3. Then the expression of genes and proteins ZNF83, ACY-1, andSMC5 in CCs of non-fertilized oocytes and CCs from fertilized oocytes was investigated and compared. RESULTS:The expression of ZNF83, ACY-1, and SMC5 at gene and protein levels was reduced in the non-fertilized group compared to the fertilized group (p<0.05). CONCLUSIONS:The results highlight CCs' critical role in supporting oocyte fertilization. These findings show the way for novel biomarkers and therapeutic strategies to improve IVF outcomes. More functional studies are needed to support the hypothesis of this study and explore the clinical applications of these markers in ART.
Menopause marks a crucial transition in a woman's life and is often accompanied by physical and psychological changes that can adversely affect mental health. Depression, anxiety, cognitive changes, and sleep disturbances are common during the menopausal transition, yet they are frequently underdiagnosed and undertreated, particularly in lowand middle-income countries. Emerging technologies, especially artificial intelligence (AI), offer new opportunities to narrow this care gap. Although AI has shown considerable promise in identifying menopause-related physical health conditions (e.g., osteoporosis and endometrial cancer), its use for mental health during this life stage remains limited. We discuss the potential of AI-driven tools-including machine learning algorithms, digital therapeutics, symptom trackers, and large language models-to improve the detection, monitoring, and personalized management of menopause-associated mental health disorders. By integrating genetic, clinical, lifestyle, and wearable data, AI systems may help predict risk, identify symptom patterns, and support tailored interventions. These approaches could enable scalable, accessible, and cost-effective mental healthcare, reduce stigma, and address service gaps. Harnessing AI in this area offers a significant opportunity to improve quality of life for millions of women worldwide.
OBJECTIVE:To assess the impact of the COVID-19 pandemic on symptoms of anxiety, depression, and stress among infertile and fertile women. METHODS:This prospective cohort study evaluated psychological distress using the 42-item Depression, Anxiety and Stress Scale (DASS-42) at two time points: during the early pandemic (Phase 1) and after six months (Phase 2). The study included infertile women whose embryo transfers were postponed (n=71) and fertile women who had given birth over six months earlier without fertility issues (n=117). Ethical approval was obtained (CAAE: 32964620.3.1001.5334). RESULTS:The mean age was higher in the infertile group (37.8 vs. 35.5 years; p=0.001). In Phase 1, infertile women reported significantly higher levels of stress (7.7 vs. 5.6; p=0.018) and depression (4.0 vs. 2.3; p=0.002), with no significant difference in anxiety (3.4 vs. 2.7; p=0.389). In Phase 2, stress (3.7 vs. 3.1; p=0.201), depression (4.0 vs. 3.5; p=0.446), and anxiety (5.8 vs. 5.4; p=0.666) scores were similar between groups. Longitudinal analysis in both infertile and fertile groups showed a significant reduction in stress and an increase in anxiety. Depressive symptoms worsened in the fertile group (p=0.018). CONCLUSION:Infertile women initially showed higher stress and depression than fertile controls. Over six months, stress declined and anxiety increased in both groups; depressive symptoms remained stable in infertile women but slightly worsened among fertile women. These findings support the inclusion of targeted and ongoing mental health support as part of fertility care.
OBJECTIVE:The aim of this study was to investigate whether there were differences in the number of good-quality blastocysts after 6 days of treatment with r-hFSH followed by late follicular phase treatment with r-hFSH:r-hLH in a 2:1 fixed ratio combination or HP-hMG in a PPOS protocol in a population of young women. METHODS:Healthy oocyte donors were randomized to Group 1 or Group 2 (40 women per group). All donors were treated with 200 mg/day oral progesterone from Day 1 and 225 IU/day r-hFSH for the first six days of ovarian stimulation. From Day 7 onwards, Group 1 received 225 IU/day r-hFHS:r-hLH 2:1 fixed ratio combination and Group 2 received 225 IU/day HP-hMG. Insemination was performed using intracytoplasmic sperm injection. Embryo quality was graded using the SART classification. The primary outcome was the number of blastocysts with good morphology (AA or AB). RESULTS:The mean (SD) number of good-quality blastocysts was significantly higher in Group 1 compared with Group 2 (3.4 [2.0] vs. 2.3 [2.0]; difference 0.9 (0.6 to 1.7); Kruskal-Wallis test p=0.0359). There was no difference in total gonadotropin dose, length of stimulation or number of oocytes retrieved between the groups. CONCLUSION:Treatment with r-hFSH:r-hLH in a 2:1 fixed ratio combination starting in the late follicular phase resulted in a significantly higher number of good-quality blastocysts compared with HP-hMG in oocyte donors receiving PPOS.
GLP-1 receptor agonists (GLP-1RAs) have gained attention as a potential adjunct in preconception care for women with polycystic ovary syndrome (PCOS) and infertility. This narrative literature review (June 2025) searched PubMed, SciELO, and LILACS using the descriptors "weight loss medication," "GLP-1 receptor agonists," "liraglutide," "semaglutide," "fertility," "PCOS," and "reproductive outcomes," including studies published between 2014 and 2025, yielding 47 relevant articles. Overall, GLP-1RAs show consistent metabolic benefits and emerging evidence of improved reproductive outcomes in PCOS, with clinical trials reporting increased menstrual regularity, ovulation, and pregnancy rates-particularly when combined with metformin. Liraglutide (1.2-3.0 mg/day) and exenatide (10 µg twice daily) have been associated with improved follicular development and endometrial receptivity. Mechanistically, GLP-1 receptors are expressed in reproductive tissues, and these agents may exert anti-inflammatory, antifibrotic, and androgen-lowering effects; liraglutide has also been reported to restore granulosa-oocyte communication via suppression of CXCL10. In one randomized trial, pregnancy rates were higher with liraglutide plus metformin (69.2%) than with metformin alone (35.4%; p<0.05). Ovulation rates up to 86% have been described with exenatide plus metformin, exceeding those observed with monotherapy. Despite these signals of benefit, GLP-1RAs remain contraindicated during pregnancy due to limited human data and fetal risks observed in animal studies; semaglutide and tirzepatide require an 8-10 week washout period prior to conception, and tirzepatide may reduce oral contraceptive effectiveness because of delayed gastric emptying. In summary, GLP-1RAs are a promising strategy for preconception management in women with PCOS and obesity-related infertility, especially in combination with metformin, but they should be avoided during pregnancy and lactation, and individualized counseling is essential to align therapy with reproductive goals.
OBJECTIVE:To evaluate whether endometrial thickness (EMT) is associated with pregnancy rates in frozen embryo transfer (FET) cycles. METHODS:This retrospective study analyzed medical records of patients who underwent FET between January 2021 and December 2024. All procedures were conducted by the same physician, using standardized endometrial preparation, with blastocyst-stage transfers. EMT was measured by transvaginal ultrasound on the day of transfer, and pregnancy was confirmed by β-hCG > 25 mIU/ml approximately two weeks later. Statistical analysis included Mann-Whitney U test, linear regression, ROC curve analysis, and chi-square tests, with significance defined as p≤0.05. RESULTS:A total of 522 FET cycles were performed, after exclusions, such as untreated uterine infertility factors and cryopreserved cleavage stage embryos, 478 patients were included with a chemical pregnancy rate of 70.29%. Participants' median age was 34.9 years (range 23-49). EMT ranged from 3.6 to 20mm (mean 8.82mm). ROC analysis identified 8.3 mm as the optimal cutoff (AUC=0.55; sensitivity 0.542; specificity 0.518). No significant differences were found in pregnancy rates between different EMT intervals (≤8.3mm vs. >8.3 mm, p=0.4944; <7 mm vs. ≥7mm, p=0.1036). Regression analysis showed no significant association between EMT and pregnancy (b=-1.205; p=0.3182; 95% CI: -3.914 to 1.504). CONCLUSION:In our study, EMT did not significantly predict pregnancy outcomes in FET cycles, indicating that the cancellation of embryo transfers should not be canceled solely on the basis of endometrial thickness.
OBJECTIVE:The etiopathogenesis of endometriosis-related infertility remains under investigation, including in women with endometriomas. Oocyte quality is believed to play an important role in the impairment of natural fertility in these patients, with systemic inflammation and oxidative stress acting as mediators of oocyte damage. Eicosanoids are bioactive lipids produced in response to inflammatory or oxidative conditions and are involved in various ovarian processes; their dysregulation may impair oocyte competence. This study aimed to compare the serum and follicular fluid eicosanoid profiles of women with and without endometriosis, including women with and without endometrioma. METHODS:In this prospective cohort study, blood and follicular fluid samples were collected on the day of oocyte retrieval from 18 infertile women with endometriosis (8 with endometrioma and 10 without endometrioma) and 20 patients with tubal and/or male-factor infertility. The eicosanoid profiles of the samples were analyzed by liquid chromatography-tandem mass spectrometry (LC-MS/MS). RESULTS:No differences were found in serum eicosanoids between the endometriosis and control groups. After subdividing the endometriosis group into women with and without endometrioma, we observed lower serum levels of 5-hydroxyeicosatetraenoic acid (5-HETE) in those with endometrioma (38.47pg/mL vs. 120.45pg/mL; p=0.01). Increased follicular levels of eicosapentaenoic acid (EPA) were found in women with endometriosis (4038.52pg/mL; p=0.03) and in those with endometrioma (5811.50pg/mL; p=0.005) compared with controls (1159.83 pg/mL). CONCLUSION:The findings suggest that pelvic disease promotes a systemic pro-inflammatory alteration, whereas endometrioma induces a local anti-inflammatory response. This may represent a mechanism to prevent oocyte damage, highlighting different mechanisms underlying endometriosis-related infertility according to lesion type. Further studies should confirm these findings using appropriate sample sizes and methodology.
OBJECTIVE:To assess whether sperm DNA fragmentation is affected differently by cryopreservation techniques using different cooling curves before immersion in liquid nitrogen (LN₂). METHODS:A paired case-control study was conducted with 21 semen samples from men undergoing fertility evaluation. Each sample (Fresh Group) was initially analyzed for sperm concentration, vitality, motility, and DNA fragmentation. The remaining semen was divided into two groups and subjected to different cryopreservation protocols: 1) preliminary refrigeration for 20 min at a cooling rate of -0.9°C/min, by exposure to liquid nitrogen vapor (Refrigerated Group), 2) direct exposure to liquid nitrogen vapor at a cooling rate of -20.5°C/min (Vapor Group). RESULTS:Both cooling protocols (Refrigerated and Vapor) caused a significant reduction compared with the Fresh Group in progressive motility (49.0% vs. 30.4% and 27.4%, p<0.001) and sperm vitality (85.1% vs. 64.9% and 64.1%, p<0.001). No significant differences were observed between the Refrigerated and Vapor Groups in terms of recovery of vitality and motility (p=0.361 and p=0.718, respectively). DNA fragmentation increased from 27.4% in the Fresh Group to 39.6% in the Refrigerated Group and to 36% in the vapor Group (p<0.001). However, the Vapor Group showed a lower mean DNA fragmentation rate than the Refrigerated Group (p=0.001). CONCLUSION:Cryopreservation using direct exposure to liquid nitrogen vapor was associated with lower sperm DNA damage compared with the protocol involving pre-refrigeration, suggesting that faster cooling may better preserve DNA integrity during freezing.
