微刺激全部胚胎冷冻方案在常规体外受精-胚胎移植失败的卵巢低反应患者中的应用

目的探讨微刺激全部胚胎冷冻方案在常规体外受精/卵胞质内单精子显微注射-胚胎移植(IVF/ICSI-ET)方案失败的卵巢低反应(POR)患者中的应用价值。方法对196例IVF/ICSI-ET应用常规促排卵方案因POR放弃周期或移植失败后改用微刺激方案的402个周期进行回顾性分析,比较前、后2次不同促排卵方案的临床和实验室指标。结果 402个微刺激周期中32个周期取消,周期取消率为7.96%,370个周期获得卵母细胞,平均获卵数(2.2±1.5)个,共233个周期有胚胎冷冻,胚胎冷冻率为57.96%,共194个周期进行了ET,临床妊娠74例,早期自然流产6例,起始周期累积妊娠率为37.75%(74/196),冻融胚胎移植(FET)周期临床妊娠率为38.14%(74/194),其中≤37岁组FET周期的临床妊娠率(50.89%)明显高于37岁组(20.73%)(P0.05)。微刺激方案的临床和实验室指标均显著优于常规长方案。结论微刺激全部胚胎冷冻方案对常规方案IVF/ICSI-ET治疗失败的POR患者具有疗程短、刺激剂量小,获卵率高、可利用胚胎率高、周期取消率低等特点,对于该类患者再次助孕可考虑微刺激方案。     

体外受精-胚胎移植女性患者心理韧性及其影响因素研究

目的探讨接受体外受精/卵胞质内单精子注射-胚胎移植(in vitro fertilization/intracytoplasmic sperm injection-embryo transfer,IVF/ICSI-ET)女性患者影响心理韧性的因素。方法采用一般资料调查表、心理韧性量表、一般自我效能感量表、简易应对方式量表、领悟社会支持量表对进行IVF/ICSI-ET的189例女性患者进行问卷调查。结果 IVF/ICSI-ET女性患者的心理韧性总分为(61.4±11.7)分,显著低于国内普通人群[(65.4±13.9)分](P0.05),一般自我效能、积极应对方式、家庭内支持状况、文化程度、不孕类型、治疗周期数及不孕原因是心理韧性的主要影响因素,共同解释了IVF/ICSI-ET女性患者心理韧性63.00%的变异。结论 IVF/ICSI-ET女性患者心理韧性总体水平较差,医护人员应采取针对性的心理干预措施来提高其心理韧性,改善其心理健康状况,提高治疗效果。     

长方案卵泡中/后期添加含活性LH的不同促性腺激素制剂的临床结局比较

目的:探索经典长方案卵泡中/后期添加含活性黄体生成素(LH)的不同促性腺激素(Gn)制剂后行体外受精/卵胞质内单精子注射-胚胎移植(IVF/ICSI-ET)的最佳用药方案。方法:回顾性分析采用长方案行IVF/ICSI的1 441个周期患者的临床资料,根据中/后期所添加的Gn制剂不同,分为3组,A组为重组LH(r-LH)组,B组为人绝经期促性腺激素(h MG)组,C组为高纯h MG(HP-h MG)组。比较3组患者的Gn使用总量、Gn使用天数、获卵数、优质胚胎数、顶级优质胚胎数、临床妊娠率、活产率、早期流产率等。结果:C组Gn使用天数显著低于A组及B组,B组Gn使用总量显著高于A组及C组,A组和C组双原核(2PN)数、卵裂数、优质胚胎数、可利用胚胎数显著高于B组(P0.05),但A组与C组比较无统计学差异(P0.05);C组的顶级优质胚胎数高于A组及B组,差异有统计学意义(P0.05)。种植率A组为44.0%,B组为38.2%,C组为42.5%,各组间无统计学差异(P0.05)。临床妊娠率和活产率A组为62.5%和50.6%,B组为59.8%和44.0%,C组为65.3%和52.3%,A组和C组高于B组,但各组间比较无统计学差异(P0.05);早期流产率各组间相似。结论:长方案卵泡中后期添加LH制剂可获得较好的临床结局,但添加HP-h MG与r-LH可以减少Gn使用天数和总量,增加顶级优质胚胎数,临床妊娠率和活产率有增高的趋势,总体临床结局均优于国产h MG。     

长方案超促排卵过程中LH变化趋势对IVF/ICSI-ET结局的影响

目的:探讨控制性超促排卵(COH)周期中LH变化趋势对体外受精/卵胞质内单精子注射-胚胎移植(IVF/ICSI-ET)结局的影响。方法:回顾性分析228个IVF/ICSI长方案周期,1按h CG注射日与降调节后Gn启动前血清LH水平的变化趋势,分为降低趋势组和升高趋势组;2将升高趋势组及降低趋势组根据COH中期与降调节后LH水平变化趋势分为A组和B组(升高趋势中的降低组和升高组),C组和D组(降低趋势中的降低组和升高组);3按照LH降低幅度将A组和C组分为A1组(下降幅度50%)和A2组(下降幅度≥50%)、C1组(下降幅度50%)和C2组(下降幅度≥50%),比较各组IVF/ICS-ET结局的差异。结果:1降低趋势组与升高趋势组获卵数、胚胎数、总的受精率、卵裂率、可利用胚胎率、优质胚胎率比较,差异均无统计学意义(P0.05),而胚胎种植率(26.09%vs 35.22%,P0.05)、临床妊娠率(45.11%vs 58.67%,P0.05)显著较升高趋势组低,早期流产率较升高组略高(26.08%vs 15.91%),但差异无统计学意义(P0.05)。2A组与B组、C组与D组相比较IVF/ICSI结局均无统计学差异。3 A1组、A2组的受精率、临床妊娠率、胚胎种植率、可利用胚胎率组间比较,差异均无统计学意义,但优质胚胎率A1组较高(65.48%vs40.68%,P0.05);C1组、C2组IVF/ICSI结局相比无统计学差异。结论:IVF/ICSI-ET长方案,h CG注射日较Gn启动前血清LH升高,有助于提高胚胎种植率、临床妊娠率,且在COH中期LH下降幅度50%,能显著提高优质胚胎率。故在COH的过程中适时添加LH,选择合适的血清LH水平启动COH,有助于改善助孕结局。     

长方案降调节后高雌二醇水平获得双胎妊娠的病例分享

目的:探讨卵胞质内单精子显微注射-胚胎移植(ICSI-ET)长方案降调节后高雌二醇(E_2)水平的治疗方案。方法:对1例ICSI-ET长方案降调节后高E_2水平获得双胎妊娠的病例进行分析并总结经验。结果:通过适时启动超促排卵,患者获卵8枚,形成可用胚胎数3个,移植胚胎后成功获得双胎妊娠。结论:对于长方案降调节后E_2水平仍高的患者应根据其具体情况制定个体化的治疗方案。     

三种促排卵药物在体外受精/卵胞质内单精子注射-胚胎移植的临床疗效分析

目的:比较体外受精/卵胞质内单精子注射-胚胎移植(IVF/ICSI-ET)控制性超促排卵(COH)中3种不同促排卵药物的临床疗效。方法:回顾性分析行IVF/ICSI治疗的3种COH方案[短方案、长方案与克罗米芬(CC)+促性腺激素(Gn)方案]不孕症患者的3 347个移植周期的临床资料。3种COH方案内再各分为3个组,分别为高纯度尿促性素(HP-h MG)组、人尿促性素(h MG)组、重组卵泡刺激素(r FSH)组。比较3组患者给予Gn的时间、Gn用量、人绒毛膜促性腺激素(h CG)注射日雌二醇(E2)、孕酮(P)水平及子宫内膜厚度、获卵数、受精率、卵裂率、有效胚胎率、平均移植胚胎数、临床妊娠率和种植率。结果:h MG组无论在Gn使用的天数和剂量上,都显著高于HP-h MG组与r FSH组。在CC+Gn方案中,HP-h MG组在h CG注射日E2峰值最低。在长方案中,HP-h MG组h CG注射日的P水平最低(P0.05)。3种方案中各组的h CG注射日子宫内膜厚度、获卵数、受精率、卵裂率、有效胚胎率、平均移植胚胎数、临床妊娠率与种植率比较,均无统计学差异(P0.05)。结论:HP-h MG在h CG注射日具有较低P水平,使得内膜更利于胚胎着床,其COH临床效果上与其他促排卵药物一样有效、安全。     

二甲双胍对体外受精/卵胞质内单精子显微注射中多囊卵巢综合征患者妊娠结局有效性的系统评价

目的:系统性评价二甲双胍对常规体外受精/卵胞质内单精子显微注射(IVF/ICSI)中多囊卵巢综合征(PCOS)患者妊娠结局的有效性,旨在为助孕前的干预措施提供理论依据。方法:计算机检索中国学术期刊全文数据库(CNKI)、万方数据库、维普数据库、Pub Med、Medline、Embase有关二甲双胍对IVF/ICSI中PCOS患者妊娠结局的临床随机对照试验(RCT)。按Cochrane系统评价方法,首先对纳入的文献进行质量评价和资料提取后,采用Rev Man5.2软件进行Meta分析。结果:纳入11个RCT研究,共1 310例患者,其中二甲双胍组713例,对照组597例。Meta分析结果显示:与对照组相比较,二甲双胍组的临床妊娠率(OR=1.60,95%CI:1.26~2.04,P=0.000 2)较高,卵巢过度刺激综合征(OHSS)发生率较低(OR=0.45,95%CI:0.31~0.64,P=0.000 1)。而活产率(OR=1.38,95%CI:0.98~1.94,P=0.06)和流产率(OR=0.72,95%CI:0.51~1.02,P=0.07)组间无统计学差异。结论:二甲双胍可提高IVF/ICSI中PCOS患者的妊娠率、降低OHSS发生率,但不能提高活产率及降低流产率。     

长效促性腺激素释放激素激动剂降调后促性腺激素启动时间对IVF/ICSI-ET结局的影响

目的:探讨长效促性腺激素释放激素激动剂(GnRH-a)降调节后促性腺激素(Gn)的启动时机对体外受精/卵胞质内单精子注射-胚胎移植(IVF/ICSI-ET)结局的影响。方法:对接受IVF/ICSI-ET治疗的710个新鲜周期进行回顾性分析,根据GnRH-a降调节时间分组:14~15 d者为A组,16~17 d者为B组,≥18 d者为C组。分析和比较3组在年龄、不育年限、Gn使用天数、Gn使用剂量、启动日血清卵泡刺激素(FSH)、黄体生成素(LH)、雌激素(E2)水平、hCG注射日内膜厚度、获卵数、可移植胚胎数、种植率、临床妊娠率、流产率的差异。另根据月经周期Gn启动时间分组:在月经周期第3~7日者为Ⅰ组,月经第8日及以后者为Ⅱ组。分析和比较组间上述临床指标的差异。结果:A组的Gn用量为32.4±11.4支,Gn使用天数为12.5±1.9 d,显著大于B组(30.9±11.6支;10.8±2.5 d)、C组(30.5±11.5支;10.8±2.3 d),差异有统计学意义(P均0.05)。但Gn用量、Gn使用天数B组与C组间无统计学差异(P均0.05)。Gn不同启动时间的3组间在种植率、临床妊娠率及流产率方面无统计学差异(P均0.05);Ⅰ组、Ⅱ组的种植率、临床妊娠率、流产率相比较,差异亦无统计学意义(P均0.05)。结论:适当延长GnRH-a降调节天数有利于降低Gn用药剂量及用药时间,但是Gn启动时间对临床结局无显著影响。     

血清及卵泡液中抑制素B动态变化及其与促排卵结局的相关性研究

目的:探讨不同控制性超促排卵(controlled ovarian hyperstimulation,COH)方案中血清及卵泡液(follicular fluid,FF)中抑制素B(inhibin B,INHB)的动态变化及其与COH结局的相关性。方法:收集因输卵管因素和/或男方因素首次接受体外受精/卵细胞质内单精子注射-胚胎移植(IVF/ICSI-ET)助孕患者COH过程各时间节点的血清及取卵(ovum pick up,OPU)日不同大小卵泡的FF,按筛选要求选取长方案组(A组,n=38)及非降调节方案组(B组,n=38)患者,对其血清及FF中INHB水平进行检测并行相关性分析。结果:①降调节过程中,血清INHB水平显著下降(P0.01),且Gn启动日A组血清INHB水平较B组明显下降(P=0.000)。②A组和B组Gn启动后血清INHB水平呈上升趋势,至h CG注射日达高峰后下降,OPU后2 d显著下降(P0.01);A组和B组基础及Gn启动后的血清INHB水平无统计学差异(P0.05)。③ Gn第5日血清INHB水平与COH结局相关性最强,且Gn启动日血清INHB水平与Gn用量呈高度负相关(P0.01)。④A组和B组FF中血清INHB水平随卵泡直径增大而升高,大卵泡的FF中INHB水平无统计学差异(P0.05),但A组中小卵泡的FF中INHB水平显著高于B组(P0.01);且大卵泡的FF中INHB水平与COH结局相关性最好。结论:①降调节后血清INHB水平预示降调节对卵泡同步化作用较好;②COH过程中血清及大中卵泡的FF中INHB水平能很好地预测卵巢反应性及COH结局。     

博洛尼亚标准卵巢低反应者在促排卵体外受精/卵胞质内单精子注射周期中的卵巢反应性

目的了解博洛尼亚标准卵巢低反应者在促排卵体外受精/卵胞质内单精子注射(IVF/ICSI)周期中的卵巢反应性。方法本回顾性研究2011年1月—2016年12月期间于本院行常规促排卵IVF/ICSI,符合博洛尼亚标准的所有卵巢低反应(POR)患者,并分析这些患者在促排卵周期中出现POR的情况。结果年龄≥40岁且窦卵泡数(AFC)5的患者在首次促排卵IVF/ICSI周期中低反应的发生率为98.7%(75/76),这些患者在后续促排卵周期中低反应的发生率明显下降。首次促排卵周期低反应且年龄≥40岁的患者,第二周期促排卵出现低反应的几率为67.2%(45/67)。首次促排卵周期低反应且AFC5的患者,第二周期促排卵出现低反应的几率为69.5%(57/82)。两次大剂量促排卵周期(促性腺激素用量每日至少450 IU)均出现低反应的患者,再次促排卵发生低反应的几率为71.4%(10/14)。结论博洛尼亚标准中"预期的卵巢低反应者"在首次促排卵IVF/ICSI周期出现低反应的可能性极大,我们应该给予足够的重视,制定个性化的促排卵方案以改善患者的卵巢反应性。有过低反应史的博洛尼亚标准卵巢低反应者,也不应该放弃再次促排卵的机会,因为很大一部分患者在后续的促排卵周期中不再出现低反应。     

不同精子来源及授精方式对剩余胚胎继续囊胚培养结局的影响

目的:探讨不同精子来源及不同授精方式对胚胎继续发育能力的影响。方法:分析499例患者499个取卵周期剩余胚胎继续培养形成囊胚的情况,按精子来源不同分为供精IVF(D-IVF)组和夫精IVF(H-IVF)组,按授精方式不同分为IVF组和ICSI组,ICSI组按精子来源分为新鲜精液组、附睾精子和睾丸精子组,比较不同精子来源及授精方式获得剩余胚胎的囊胚形成率、胚胎利用率和无囊胚移植率。结果:① D-IVF组和H-IVF组受精率、卵裂率、优质胚胎率、第3日和第5日胚胎种植率、临床妊娠率和流产率均无统计学差异(P0.05),组间剩余胚胎囊胚形成率、胚胎利用率和无囊胚移植率亦无统计学差异(P0.05);②ICSI组与IVF组比较,其受精率较高(P0.05),但优质胚胎率显著下降,有统计学差异(55.11%vs 61.30%,P0.05),组间第3日卵裂期胚胎和剩余胚胎囊胚种植率、临床妊娠率无统计学差异(P0.05),但ICSI组与IVF组比较,其剩余胚胎囊胚形成率、胚胎利用率稍低,无囊胚移植率较IVF组稍高,差异有统计学意义(56.13%vs 65.32%,48.18%vs 55.39%,21.68%vs 13.20%,P0.05)。③新鲜精液组的优质胚胎率、胚胎利用率显著低于附睾精子和睾丸精子组(P0.05),各组囊胚移植的种植率和临床妊娠率无统计学差异(P0.05)。结论:D-IVF可获得H-IVF相似的结局,其剩余胚胎都有较高的发育潜能,ICSI获得的剩余胚胎发育潜能低于IVF组。附睾精子和睾丸精子ICSI后获得的胚胎比新鲜精液精子ICSI后胚胎发育潜能高。针对不同的授精方式可能需要制定相应的剩余胚胎囊胚培养标准。     

男性染色体多态性对精子质量及体外受精/卵胞质内单精子显微注射结局的影响

目的研究男方染色体多态性对精子质量及体外受精-胚胎移植(IVF-ET)结局的影响。方法回顾性比较IVF/卵胞质内单精子显微注射(ICSI)-ET助孕治疗的男方染色体多态(n=131)和正常对照夫妇(n=160)的妊娠结局,观察男方的精子质量和受精情况、临床妊娠率、早期流产率。结果男方染色体多态组中严重少/弱精子症(19.85%)比例显著高于染色体正常组(5.00%,P0.001),Yqh+在严重少/弱精子症(38.46%)中的比例最高;Yqh-也高达15.38%,1qh+在严重少/弱精子症组是最常见的常染色体多态类型(19.23%);染色体多态组的女方年龄、体质量指数(BMI)、基础性激素水平均无统计学差异(P0.05),男方前向精子率(PR%)、精子正常率以及获卵数、移植胚胎数均无统计学差异(P0.05)。染色体多态组行IVF-ET助孕治疗后,其着床率(17.42%)、临床妊娠率(28.17%)均显著低于正常对照组(32.26%,59.38%)(P0.05);并且早期流产率(11.11%)高于对照组(2.04%),但差异无统计学意义(P0.05)。染色体多态组行ICSI-ET助孕治疗后与正常对照组妊娠结局无统计学差异(P0.05),优质胚胎率(75.24%±23.68%)还高于正常对照组(49.97%±29.31%)(P0.05)。行ICSI-ET助孕的男方染色体多态患者其着床率(34.78%)以及临床妊娠率(52.00%)显著高于行IVF-ET助孕的男方染色体多态患者(17.42%,28.17%)(P0.05)。结论男性染色体多态性患者中严重少/弱精子的比例增加,男性染色体多态不利于IVF妊娠结局,对ICSI影响较小。     

Male partner screening before in vitro fertilization: preselecting patients who require intracytoplasmic sperm injection with the sperm penetration assay

Objectives: To determine the diagnostic accuracy of the sperm penetration assay (SPA) and standard semen parameters for subsequent fertilization in in vitro fertilization-embryo transfer (IVF-ET).

Design: Prospective study.

Setting: Andrology Laboratory, and university research laboratory.

Patients: Two hundred sixteen couples undergoing male-partner screening before IVF-ET (265 cycles).

Intervention(s): Male-partner screening (semen analyses [SA] and SPA), standard IVF-ET procedures, follow-up of fertilization in IVF-ET.

Main Outcome Measure(s): Diagnostic accuracy of SA and SPA for prediction of fertilization in IVF-ET.

Result(s): The SPA predicted IVF fertilization with high negative (84%) and positive (98%) predictive rates, and correct prediction in 88% of cycles. In contrast, sperm concentration, motility, morphology, and complete SA showed poor diagnostic accuracy, with correct prediction of IVF fertilization in 64%, 65%, 45%, and 68% of cycles, respectively.

Conclusion(s): Very low sperm concentration and/or motility were good predictors of poor IVF fertilization, however, low to normal semen parameters were not predictive of successful IVF fertilization. The SPA is a useful screening tool that predicts IVF fertilization with high diagnostic accuracy. The SPA may be useful to discriminate between those couples with a high probability of normal fertilization in IVF and those with a low probability of normal fertilization that may benefit from assisted fertilization by intracytoplasmic sperm injection (ICSI).     

Artificial oocyte activation after intracytoplasmic morphologically selected sperm injection: A prospective randomized sibling oocyte study

This study aimed to evaluate the effect of artificial oocyte activation (AOA) by calcium ionophore after intracytoplasmic morphologically selected sperm injection (IMSI) on fertilization, cleavage rate and embryo quality. A total of 194 oocytes from 21 cycles from women with a history of low fertilization rate accompanying teratozoospermia were enrolled over a 3-month period. Mature oocytes from each patient were randomly allocated into two groups after IMSI. In the study group, half of the patients’ oocytes (n?=?97) were exposed to AOA, and in the control group (n?=?97), AOA was not applied. The mean number of mature oocytes, fertilization and cleavage rates were similar between the study and control groups (p?>?0.05 for each). However, fertilized oocytes of the AOA group were less likely to produce top quality embryos when calculated per fertilized oocyte (28/80; 35.0% versus 38/71; 53.5%, respectively; p?=?0.024) and also per cycle (13/21; 61.9% versus 20/21; 95.24%, respectively; p?=?0.006). Our study indicates that AOA may not improve fertilization rates after IMSI and may even reduce the ability of a successfully fertilized oocyte to develop into a top quality embryo. AOA should, therefore, be applied to cases with a defined oocyte activating deficiency.     

Effect of incremental time experience on the results of in vitro fertilization with intracytoplasmic sperm injection (ICSI)

Purpose: Our objective was to determine the effect of experience on the results with intracytoplasmic sperm injection. Methods: The quarterly outcome with both ICSI and traditionalin vitro fertilization (IVF) in 1994 was analyzed in 475 patients under age 40 undergoing 595 oocyte retrievals. The data represent 307 patients undergoing 379 retrievals for IVF and 165 patients undergoing 216 retrievals for ICSI. Results: Fertilization rates with ICSI improved significantly each quarter (52.96, 62.17, 70.17, and 74.87% in Q-I, Q-II, Q-III, and Q-IV, respectively), while the rate with IVF improved significantly between Q-I (69.9%) and Q-II (80.10%) and slightly but significantly between Q-II and Q-IV (82.88%). The implantation rate per embryo after ICSI improved significantly after Q-I (6.17%) compared to Q-II (10.70%) and Q-IV (12.14%). The pregnancy rate per transfer with ICSI increased steadily after Q-I (13.79, 21.88, 23.53, and 25.00% in Q-I through Q-IV), reaching statistical significance between Q-I and Q-III and between Q-I and Q-IV. Conclusions: Although acceptable results can be obtained with ICSI after a relatively short period of time, optimum results require substantial experience.     

Comparison of embryo quality between intracytoplasmic sperm injection and in vitro fertilization in sibling oocytes

Background The aim of the present study was to compare the quality of embryos derived from sibling oocytes by in vitro fertilization (IVF) or ICSI. Methods Consecutive patients with a less than 40% fertilization rate in a previous standard IVF cycle or with relative male factor infertility were recruited for the study. The oocytes retrieved from each patient were divided into two groups for either conventional insemination (group A) or ICSI (group B). Power analysis showed that to detect a 25% difference in the rate of high-quality embryos between the groups with a power of 0.8, at least 1,200 oocytes were needed in each group. Results One hundred seventy-seven patients were included in the study. Group A was comprised of 1,526 oocytes and group B of 1,480 sibling oocytes. As expected, the fertilization rate was significantly higher in group B than group A (67.1 vs. 43.6%, p < 0.001). No significant between-group differences were observed in cleavage rate (92.7 and 89.7%, respectively) and the rate of either grade A embryos (22.6 and 23.9%, respectively) or grade A₁ embryos (37.3 and 33.5%, respectively). However, in the subgroup of patients with relative male-factor infertility (n = 36), the rate of grade A₁ embryos was significantly higher in the IVF than the ICSI group (46.4 vs. 29.0%, respectively, p = 0.02). Conclusions Embryo quality does not seem to be influenced by the mode of fertilization (IVF or ICSI). We assume that embryo quality depends on intrinsic factors of the gametes involved rather than on the fertilization process per se. Capsule Embryo quality does not seem to be influenced by the mode of fertilization but depends on intrinsic factors of the gametes involved.     

The association of different auto-antibodies against ovarian tissues and gonadotropins and poor ovarian response in intracytoplasmic sperm injection cycles

This study aimed to assess the possible association between ovarian auto-antibodies and poor ovarian response to controlled ovarian hyperstimulation (COH) in patients undergoing intracytoplasmic sperm injection (ICSI) cycles. In total, 42 poor responders and 43 male factor subjects were enrolled in the study and underwent either a standard long gonadotropin-releasing hormone (GnRH) agonist or antagonist protocol. Anti-ovarian, anti-oocyte, anti-zona pellucida (anti-ZP) and anti-gonadotropin antibodies in their sera and follicular fluid (FF) were measured by an enzyme-linked immunosorbent assay technique (ELISA). The mean follicular fluid anti-oocyte antibody [ratio of optical density (OD) _sample/OD _Control] was significantly higher in poor responders compared to the normal group (2.40?±?1.55 versus 1.72?±?0.71, p?=?0.012). The linear regression analysis showed an inverse correlation between FF anti-oocyte antibody concentrations and the number of: (i) retrieved oocytes (B = ?1.212, r = ?0.235, p?=?0.030); (ii) mature oocytes (B = ?1.042, r = ?0.234, p?=?0.031); (iii) embryos available (B =??0.713, r = ?0.228, p?=?0.036); and (iv) good quality embryos (B = ?0.369, r = ?0.229, p?=?0.035). However, there were no significant differences between two groups in terms of FF and serum anti-ovarian, anti-gonadotropins and anti-ZP antibodies. The Pearson correlation analysis on 85 infertile patients showed a positive correlation between age and the levels of FF anti-oocyte antibody (r?=?0.276, p?=?0.010). This study demonstrated that FF anti-oocyte antibody could be associated with poor response to COH in ICSI cycles.     

Cryopreserved sibling oocytes and intracytoplasmic sperm injection rescue unexpectedly poor fertilization in conventional in vitro fertilization

PURPOSE: To report a successful pregnancy from cryopreserved sibling oocytes and intracytoplasmic sperm injection (ICSI) for an infertile couple with an unexpectedly low fertilization rate in the fresh in vitro fertilization (IVF) cycle. METHODS: The woman had bilateral tubal obstruction and polycystic ovarian syndrome. The man had normal semen parameters. The couple underwent a cycle of controlled ovarian hyperstimulation in that 20 oocytes were retrieved. Twelve oocytes were conventionally inseminated and eight were cryopreserved using a slow freezing method. However, only one oocyte was fertilized, and no pregnancy was achieved. In the next cycle, the frozen oocytes were thawed and ICSI was performed. RESULTS: After thawing, seven oocytes (88%) survived and one was damaged. Six were at the metaphase II stage and were injected. Five (83%) achieved normal fertilization, and all of them cleaved (100%). After replacement of the embryos, a singleton pregnancy developed. A healthy female baby was delivered at term. Karyotyping revealed 46, XX. CONCLUSIONS: In addition to well-known indications, cryopreservation of excess sibling oocytes for patients receiving IVF has a possible advantage of preventing unexpectedly low fertilization rate or fertilization failures.