Fertilization rate and preimplantation development after intracytoplasmic sperm injection

Intracytoplasmic sperm injection (ICSI) is the treatment of choice in cases of male factor infertility. In the present review, all data from the literature regarding early fertlilization and preimplantation embryo development are analysed. ICSI seems to offer better fertilization rates than conventional IVF, even in the absence of a male factor and in prospective, randomized studies on sibling oocytes. Blastocyst formation is lower in ICSI than in IVF. This may be due to sublethal disturbances in oocyte architecture and function. Implantation and pregnancy rates, however, are similiar in ICSI and conventional IVF. Therefore, it can be concluded that ICSI offers a safe approach, as far as is known to date, for the treatment of male factor infertility. Embryo selection in cases of sublethal damage to oocytes seems to take place in the early preimplantation stages. Nor does the risk of monozygotic twinning, which was also proposed to be higher in ICSI compared with conventional IVF, seem to increase with this procedure.     

Pregnancy after immature oocyte donation and intracytoplasmic sperm injection

Objective: To report a case of pregnancy from in vitro-matured primary oocytes fertilized by ICSI. The pregnancy occured in a woman who was in an oocyte donation program; the woman's husband had normal sperm parameters.

Design: Case report.

Setting: Private general hospital affiliated with a university hospital.

Patient(s): A recipient with premature ovarian failure, a recipient's husband with normal sperm, and a pregnant woman who donated her oocytes.

Intervention(s): Aspiration of immature oocytes during cesarean section, in vitro culture for maturation, ICSI of matured oocytes, coculture of fertilized oocytes.

Main Outcome Measure(s): Fertilization of oocytes by ICSI, and cleavage of embryos by Vero cell coculture.

Result(s): Two of seven immature oocytes became metaphase II oocytes, and both were fertilized by ICSI. The two zygotes were cocultured on Vero cells to become grade 1 two-cell embryos. Pregnancy was obtained after transfer.

Conclusion(s): More studies are necessary to clarify whether ICSI can increase the fertilization rate of in vitro-matured primary oocytes, and to clarify the role of coculture in fertilization.     

Pregnancy rates after intracytoplasmic sperm injection in relation to sperm recovery techniques

Purpose/Methods: Clinical outcome after intracytoplasmic sperm injection (ICSI) was evaluated in relation to three techniques of sperm recovery, mini-Percoll, simple concentration, and centrifugation and washing. Results: Whereas fertilization and embryonic cleavage rates were similar in the three groups, the rates of implantation and clinical pregnancy were statistically significantly higher following sperm recovery by the techniques of mini-Percoll and centrifugation and washing.     

Pregnancy after preimplantation genetic diagnosis for Sanjad-Sakati syndrome

Sanjad-Sakati syndrome (SSS) is an autosomal recessive disorder characterized by congenital hypoparathyroidism, growth and mental retardation. In Saudi Arabia, the disease is caused by a deletion of 12 bp (155-166nt) in the tubulin-specific chaperone E gene. In a family with two affected siblings with SSS, preimplantation genetic diagnosis (PGD) was performed. Fluorescent PCR (F-PCR) was utilized to check the heterozygosity and the homozygosity status of the parents and the affected children, respectively. F-PCR was then optimized for single-cell analysis by using peripheral blood lymphocytes. The patient underwent a cycle with intra-cytoplasmic sperm injection. A total of 11 embryos were obtained and biopsied. There were five heterozygous, three homozygous affected and three normal embryos. One heterozygous and one normal embryo were transferred because of their very good quality (morula). A singleton pregnancy was obtained, and amniosynthesis confirmed the presence of the heterozygous fetus. These results show for the first time, the feasibility of PGD for SSS.     

Pregnancy and birth after intracytoplasmic sperm injection with totally immotile sperm recovered from the ejaculate

Objective: To report the birth of two healthy children after intracytoplasmic sperm injection (ICSI) with totally immotile spermatozoa recovered from the ejaculate.

Design: Retrospective case report.

Setting: University-based hospital.

Patient(s): Four couples in whom spermatozoa recovered from the ejaculate were totally immotile but presented normal vitality scores.

Intervention(s): Therapeutical IVF-ET attempts coupled with ICSI.

Main Outcome Measure(s): Fertilization and pregnancy results after ICSI.

Results: With random sperm injection, 19 of the 36 injected oocytes showed normal fertilization and cleavage. One of four patients had a twin pregnancy that resulted in birth of two healthy children.

Conclusion(s): In cases in which totally immotile ejaculated sperm present normal vitality scores, normal clinical outcomes can be achieved by using the usual random sperm selection during conventional ICSI.     

Pregnancy from intracytoplasmic sperm injection of a sperm head and detached tail

OBJECTIVE: To evaluate sperm ultrastructure and the efficacy of intracytoplasmic sperm injection (ICSI) with careful positioning of the sperm midpiece next to the sperm head in a patient with easily decapitated sperm syndrome. DESIGN: In vitro fertilization case report with retrospective sperm ultrastructure analysis. SETTING: In vitro fertilization clinic and andrology laboratory. PATIENT(S): A couple seeking treatment for diminished ovarian reserve and male factor infertility using donor oocyte IVF. INTERVENTION(S): Motile sperm inadvertently decapitated during micromanipulation were used for a modified ICSI procedure in which the midpiece was carefully positioned proximal to the sperm head. Sperm were also analyzed by transmission electron microscopy (TEM). MAIN OUTCOME MEASURE(S): Fertilization rate, embryo development, pregnancy, and the incidence of normal sperm ultrastructure. RESULT(S): The ICSI resulted in a fertilization rate of 63% and embryo development of good to moderate quality of 36% of the embryos. Transfer of two embryos resulted in a pregnancy and birth of a healthy child. Normal sperm centrosomes were identified retrospectively. CONCLUSION(S): Pregnancy can result in patients where the sperm are decapitated during immobilization before ICSI if normal centrosomes are present and the head and midpiece are positioned closely together.     

Efficacy of IVF following conservative management of endometrial cancer

Five cases of conservative management of early stage uterine carcinoma were reported. All patients successfully underwent in vitro fertilization (IVF). Role of conservative treatment, IVF and prophylactic surgery followed competition of parity was discussed.     

Pregnancy rates are higher with intracytoplasmic morphologically selected sperm injection than with conventional intracytoplasmic injection

OBJECTIVE: To verify whether microinjection into retrieved oocytes of motile spermatozoa with morphologically normal nuclei, strictly defined by high power light microscopy (x >6000), improves the IVF/intracytoplasmic sperm injection (ICSI) pregnancy rate in couples with repeated ICSI failures. DESIGN: Comparative prospective study testing routine IVF/ICSI outcome parameters against those of modified ICSI based on morphological selection of spermatozoa with normal nuclei. SETTING: Male factor fertility laboratory and IVF center. PATIENT(S): Sixty-two couples, with at least two previous consequent pregnancy failed ICSI cycles, underwent a single ICSI trial preceded by morphological selection of spermatozoa with normal nuclei. Fifty of these couples were matched with couples who underwent a routine ICSI procedure at the same IVF center and exhibited the same number of previous ICSI failures. INTERVENTION(S): Standard ICSI and modified ICSI. MAIN OUTCOME MEASURE(S): ICSI pregnancy rate. RESULT(S): The matching study revealed that pregnancy rate after modified ICSI was significantly higher than that of the routine ICSI procedure (66.0% vs. 30.0%). CONCLUSION(S): Microinjection into retrieved oocytes of selected spermatozoa with strictly defined morphologically normal nuclei improves significantly the incidence of pregnancy in couples with previous ICSI failures.     

Ovarian ectopic pregnancy after intracytoplasmic sperm injection

A ruptured primary ovarian pregnancy occurred following ovulation induction, intracytoplasmic sperm injection (ICSI) and embryo transfer (ET). The exact mechanism of ovarian pregnancy after intracytoplasmic sperm injection is unclear, but, it is possible that there may be an association between blastocyst transfer and ovarian pregnancy in infertile patients who underwent ICSI, prolonged in vitro culture and fifth day embryo transfer at blastocyst stage.     

Pregnancy course and outcome after intracytoplasmic sperm injection: a controlled, prospective cohort study

OBJECTIVE: To determine pregnancy course and major malformation rate after intracytoplasmic sperm injection (ICSI). DESIGN: Prospective, controlled, multicenter, nationwide German cohort study. SETTING: Tertiary infertility centers in Germany. PATIENT(S): Three thousand three hundred seventy-two children and fetuses and 8,016 children and fetuses after the 16th week of gestation in pregnancies after ICSI and natural conception, respectively. INTERVENTION(S): Standardized prospective follow-up. MAIN OUTCOME MEASURE(S): Major malformation rate. RESULT(S): The major malformation rate was 8.7% (295/3,372) for the ICSI cohort and 6.1% (488/8,016) for the population-based control cohort (relative risk, 1.44 [1.25-1.65]). After adjustment for risk factors, the risk declined (adjusted odds ratio, 1.24 [95% CI, 1.02-1.50]). Regarding singletons, there was a significant difference for birth weight and gestational age, with a higher number of preterm and low birth weight children in pregnancies achieved after ICSI. CONCLUSION(S): Children who are born after intracytoplasmic sperm injection have an increased risk of a major congenital malformation compared with those born after spontaneous conception. This risk is mainly due to paternal and maternal risk factors, which are more prevalent in couples who use ICSI for reproduction. An infertility-linked risk is highly probable for the observed findings. A technique-related risk, however, cannot be ruled out.     

Relationships between pregnancy rates following in vitro fertilization or intracytoplasmic sperm injection and endometrial thickness and pattern

OBJECTIVE: To investigate the role of endometrial thickness and pattern on the day of human chorionic gonadotropin (hCG) administration on in vitro fertilization (IVF)/intracytoplasmic injection (ICSI) outcome. STUDY DESIGN: A total of 150 infertile women undergoing embryo transfer after IVF/ICSI cycles were studied in a prospective survey. Sonographic features of the endometrium (thickness and pattern) on the day of hCG administration, hormonal profile (progesterone, estradiol, FSH, LH) and various other variables (maternal age, causes and duration of infertility, duration of treatment, number of human menopausal gonadotropin (hMG) ampoules administered, and number of oocytes retrieved) were evaluated. These variables in pregnant and nonpregnant patients were compared. RESULTS: There was no difference between pregnant and nonpregnant patients in mean endometrium thickness (10.1+/-1 versus 10.2+/-2, p=0.79). Pregnancies occurred only in patients with an endometrial thickness of 9-12 mm (p=0.036). Duration of treatment, number of hMG ampoules administered, number of oocytes retrieved, estradiol concentration, and estradiol/progesterone ratio on the day of hCG differed significantly between pregnant and nonpregnant patients. There was no correlation between endometrial pattern and pregnancy rate. The receiver-operating characteristic (ROC) curve and multiple logistic regression showed no significant effect of endometrial thickness in the outcome of IVF/ICSI. CONCLUSION: The sonographic features of the endometrium (thickness and pattern) on the day of hCG administration did not differ between pregnant and nonpregnant patients. The pregnancy rate declined beyond two limits of endometrial thickness.     

Pregnancy after intentional cryopreservation of percutaneous sperm aspiration specimens and intracytoplasmic sperm injection. A report of two cases

BACKGROUND: Microsurgical epididymal sperm aspiration (MESA) and percutaneous epididymal sperm aspiration (PESA) are two methods of obtaining spermatozoa from patients with irreparable obstructive azoospermia. Intentionally using frozen-thawed spermatozoa obtained from MESA had been reported to be successful. With minimal invasiveness, intentionally cryopreserved PESA specimens and intracytoplasmic sperm injection (ICSI) were carried out in two cases. CASES: Two cases of irreparable obstructive azoospermia received PESA, and the spermatozoa were cryopreserved intentionally. Successful ICSI was performed later, utilizing frozen-thawed spermatozoa. CONCLUSION: PESA and ICSI are promising methods for these patients. The major advantages are minimal invasiveness and flexibility for further treatment.     

Live births after intracytoplasmic sperm injection in the management of oligospermia and azoospermia in Nigeria

Intracytoplasmic sperm injection has revolutionised the management of male infertility. We report two cases that demonstrate the successful application of this technology in Nigeria in the management of both oligospermia and azoospermia. The first case relates to the treatment of a 31-year-old woman who required intracytoplasmic sperm injection of her husband's sperm for the treatment of both tubal fertility and male infertility. She had three embryos transferred on 9th June 1999 and was delivered of healthy male and female infants by caesarean section in January 2000 at 33 weeks gestation. The second case describes a 38-year-old woman who required intracytoplasmic sperm injection of the husband's surgically collected sperm for the management of azoospermia. She had two embryos transferred on 16th December 1999 and was delivered of a healthy male infant by caesarean section on 19th July 2001.