Evaluation of sperm morphology using Kruger's strict criteria.

Prospective and retrospective studies were conducted to evaluate sperm morphology using strict criteria for predicting fertilization capacity in males. Severely impaired male fertility potential was measured by a result of less than or equal to 4% (denotes percentage sperm having normal morphology) and scores of greater than 14% indicated normal fertilization potential. There were no statistically significant differences found in pregnancy rates in partners of men with normal morphology of less than or equal to 4% vs. those with 14% or greater (chi 2 analysis): the prospective study showed a 41% pregnancy rate in less than or equal to 4% group vs. 29% rate in greater than 14% group (p = 0.44 NS); the retrospective analysis showed a 50% pregnancy rate in the group with less than or equal to 4% morphology scores vs. 67% in greater than 14% group (p = 0.45 NS). When only the men with normal motile density (greater than 10 x 10(6)/ml) were evaluated, a statistical difference was found in the retrospective study between the group with morphology results greater than 14% (93%) vs. the group less than or equal to 4% (40%). However, the 56% success rate in the men with less than 10 x 10(6)/ml sperm and normal morphology less than or equal to 4% reduces the significance of the diagnosis of sperm morphology using the new strict criteria.     

Predictive parameters of successful varicocele repair

A total of 130 men presenting with oligospermia and clinically identifiable scrotal varicoceles was evaluated, treated surgically and followed for 1 year for pregnancy rate. The treatment outcome was compared to an age-matched cohort of 83 oligospermic men who had received empirical medical therapy with clomiphene citrate (25 mg. per day) for the same 1-year interval. This study was done to contrast treatment modalities in infertility and not as a strict control. Only eugonadotropic patients in both groups were used for comparison. In the varicocele group the over-all pregnancy rate was 38.5 per cent. Four variables (a lack of testicular atrophy, sperm density greater than 50 million per ejaculate, sperm motility 60 per cent or more and serum follicle-stimulating hormone values less than 300 ng. per ml.) proved to be accurate preoperative predictors of postoperative pregnancy success. Four other variables (varicocele size and laterality, sperm forward progression greater than 2 and normal sperm morphology 60 per cent or more) did not yield statistically significant rates of improvement in pregnancy postoperatively. The pregnancy rate of the eugonadotropic patients undergoing varicocele repair was 45.8 per cent. Despite statistical similarity in patient age, sperm density and mean gonadotropin levels the medically treated patients had a pregnancy rate of only 25.5 per cent, significantly lower than the surgically treated patients. In summary, patients with an identifiable varicocele had a greater chance of achieving a pregnancy following surgical correction than did those treated with empirical drug therapy. In addition, certain preoperative variables in the physical and laboratory analyses appeared to portend a greater surgical response.     

Abnormal sperm morphology and other semen parameters related to the outcome of the hamster oocyte human sperm penetration assay

A new method for evaluation of sperm morphology using strict criteria is currently used in the andrology laboratory at the Eastern Virginia Medical School. A prospective study was designed to evaluate the following semen parameters in samples of all patients over a set period of time: sperm concentration and motility, and normal sperm morphology. These factors were correlated with results of the hamster zona-free oocyte/human sperm penetration assay (SPA). One hundred patients with a sperm concentration ranging from 2 to 219 X 10(6)/ml, a motile sperm fraction ranging from 6.9 to 87%, and normal sperm morphology ranging from 1 to 39%, were evaluated. The statistical analysis system general linear model was used to judge the influence of the different variables. There was a statistically significant relationship between the per cent of sperm with normal morphology and penetration rate in the SPA (P = 0.001). Outcome of the SPA was also correlated with in vitro fertilization, retrospectively, in 84 patients. Thirty-eight patients had an SPA less than 10%, with no fertilization in vitro in 13 patients (33.3%) and fertilization in 25 (66.7%). Forty-five had an SPA greater than 10% with fertilization in 37 (82.2%) and no fertilization in eight (17.8%) patients.     

Morphology of seminal and swim-up spermatozoa and the outcome of in vitro fertilization and embryo transfer

Tubal infertility was treated by in vitro fertilization-embryo transfer (IVF-ET) in 112 couples. Twenty-eight pregnancies were obtained in 140 treatment cycles. Couples are accepted for treatment in our IVF-ET programme if previous semen samples fulfil the inclusion criteria: ejaculate volume greater than 1.5 ml, concentration of spermatozoa greater than 15 x 10(6) ml-1, greater than 40% motile spermatozoa, and greater than 25% spermatozoa with normal morphology. In order to determine to which extent IVF-ET treatment results are influenced by sperm morphology, within this selected group of patients, we have retrospectively analysed the data from both original semen samples and swim-up preparations. The sperm morphology was not related to the outcome of treatment in terms of fertilization (ovum cleavage rate), early embryo development, or pregnancy. Nor was any relationship detected between early embryo development or pregnancy and the degree of improvement in morphology resulting from the swim-up procedure. However, if improvement in morphology by swim-up was high, ovum cleavage rate was low. Sperm morphology within the limits set by our inclusion criteria could not predict the outcome of IVF-ET treatment. It is further concluded that the presence of abnormal spermatozoa at the site of fertilization may be without harm if only the number of normal sperms is high enough.     

精子畸形程度对常规体外受精-胚胎移植治疗的影响

目的 探讨精子畸形程度对常规体外受精(IVF)-胚胎移植治疗的影响. 方法 2007-2008年接受常规体外受精-胚胎移植105对夫妇男方精液进行分析,按精子正常形态百分率分为3组,正常精子形态组(精子正常形态≥15%)54例、轻度畸形精子组(精子正常形态10%～15%)26例、中度畸形精子组(精子正常形态5%～10%)25例,观察精子畸形程度对IVF受精率、卵裂率、优质胚胎率、着床率、妊娠率及流产率的影响. 结果①精子形态正常组与轻度畸形组受精率(79.4%与78.3%)、卵裂率(104.6%与98.6%)、优质胚胎率(58.1%与53.9%)、植入率(31.7%与30.8%)、妊娠率(48.1%与42.3%)及流产率(13.0%与18.2%)比较差异均无统计学意义(P>0.05).②精子形态正常组与中度畸形组受精率(63.9%)、优质胚胎率(48.2%)、植入率(16.7%)、妊娠率(24.0%)比较差异有统计学意义(P<0.05).而卵裂率(102.9%)、流产率(28.6%)比较差异无统计学意义(P>0.05).③轻度畸形组与中度畸形组受精率、优质胚胎率比较差异有统计学意义(P<0.05),植入率(30.8%与16.7%)、妊娠率(42.3%与24.0%)、卵裂率(98.6%与102.9%)、流产率(18.2%与28.6%)比较差异无统计学意义(P>0.05).结论 中度畸形精子患者常规IVF受精率、优质胚胎率、植入率和妊娠率有一定影响;轻度畸形精子对常规IVF影响不大.     

Influence of strict sperm morphology on the results of classic in vitro fertilization

Objective: To determine the influence of the concentration of oval spermatozoa according to the strict morphology criterion in men with normal sperm concentration following the World Health Organization criteria on the results of classic IVF. Materials and Methods: Based on review of patient charts, this study included infertile couples presenting with female causes for infertility or unexplained infertility, in whom men presented with normal spermogram values for sperm concentration, sperm motility, volume of ejaculate and total sperm count after semen processing greater than 20 million. Based on the value obtained in strict sperm morphology, patients were divided into three groups: in Group A, patients with values between 0 % and 4 %; in group B, between 5 % and 14 %, and in group C, patients with sperm morphology greater than 14 %. The outcomes analyzed were oocyte fertilization rate, biochemical pregnancy rate, clinical pregnancy rate and rate of liveborns. Results: A total of 244 cases met the inclusion criteria, 27 of them in group A, 165 in group B, and 52 in group C. The mean fertilization rate and the rate of liveborns were, respectively: 71.9 % and 33.3 % in group A; 80.9 % and 24.2 % in group B, and 78.8 % and 28.8 % in group C. There was no statistical difference among the groups in any of the outcomes analyzed. Conclusion: The values of strict sperm morphology, as proposed by Kruger and adopted by the World Health Organization, had no infl uence on the results of classic in vitro fertilization in the studied sample.     

精子形态对体外受精-胚胎移植治疗结局及新生儿的影响

目的:探讨正常形态精子百分率对体外受精-胚胎移植(IVF-ET)治疗结局及新生儿的影响。方法:采用WHO严格标准法将精液标本分为3组:中度畸形组:正常形态精子百分率5%～10%,轻度畸形组:10%<正常形态精子百分率<15%,正常组:正常形态精子百分率≥15%,比较各组间正常受精率、卵裂率、优质胚胎率、种植率、临床妊娠率及新生儿情况。结果:各组间患者年龄(男、女方)差异不显著(P>0.05);中度畸形组正常受精率显著低于轻度畸形组(63.70%vs73.74%,P<0.05),但与正常组差异无统计学意义(63.70%vs68.05%,P>0.05);正常组的优质胚胎率最高,显著高于中度畸形组(44.83%vs35.75%,P<0.05),其他各指标3组间差异无统计学意义(P>0.05);280个移植周期共分娩125个婴儿,其中单胎分娩73例,双胎分娩26例,出生婴儿未见先天异常,3组间流产率、异位妊娠率、孕周、早产率、出生体重差异无统计学意义(P>0.05)。结论:正常形态精子百分率为5%～10%对常规体外受精的受精率无影响,但显著降低优质胚胎率,而10%<正常形态精子百分率<15%对常规体外受精治疗结局的各项指标均无明显影响;正常形态精子百分率在预测IVF-ET的助孕结局及新生儿情况方面存在一定局限性。     

Correlation between sperm morphology, acrosin, and fertilization in an IVF program

Acrosin, a neutral proteinase, is located within the acrosome. The aim of this study was to evaluate acrosin concentrations in patients with severe damage of the sperm head and to determine whether acrosin concentration could predict the chances of fertilization in an IVF program. Sixty patients were accepted into this study, prospectively. The patients were divided into two groups, those with a normal morphology of less than 14% (group I, n = 33) and those with normal morphology less than 14% (group II, n = 27). All patients had a sperm concentration of less than 20 million sperm/ml and less than 30% progressively motile sperm. The acrosin assays were performed on the semen sample obtained on the day of IVF. Routine IVF insemination procedures were used, and only mature oocytes were considered. The only factor that showed a significant correlation of fertilization was normal morphology (p less that 0.01). The mean acrosin level was 73.4 /+- 38.6 mED/10 million sperm in group I and 70.9 /+- 42.7 mIU/10 million sperm in group II (no significant difference). The fertilization rate in group I was 45.4% and in group II, 77.7% p less than 0.002). Acrosin levels were not significantly different in patients with and without fertilization (72.0 /+- 42.1 and 73.6 /+- mIU/10 million sperm, respectively).     

Association between sperm cell chromatin condensation, morphology based on strict criteria, and fertilization, cleavage and pregnancy rates in an IVF program

Summary. In this study, a total of 95 ejaculates from infertile patients were investigated morphologically according to Kruger's strict criteria and 78 of the 95 ejaculates were stained for chromatin condensation with acidic aniline blue. Patients were divided into two groups based on the percentage of morphologically normal spermatozoa as follows: Men with normal sperm morphology <14% (Group I), and men with normal morphology >14% (Group 2). The relationship between percentage of normal sperm morphology and fertilization, cleavage and pregnancy rate was analysed. The rates were 33.7%, 57.1% and 0.0% respectively, in the first group. The corresponding values for the second group were 76.1%, 68.2% and 32.1%. The fertilization and pregnancy rates correlate significantly with morphologically normal spermatozoa.
In regard to the percentage of morphologically normal spermatozoa stained with aniline blue, patients were divided into two groups: patients with 0–20% stained spermatozoa (Group I) and those with >20% (Group 2). Fertilization and pregnancy rates were higher in the first group than in the second group (79.9%, 52.8% vs. 58.8%, 29.5%).
The results demonstrate that chromatin condensation visualized by aniline blue staining is a good predictor for IVF outcome and should be considered besides morphology by sperm assessment for patients undergoing IVF treatment.—     

附睾和睾丸精子活力对卵胞浆内单精子注射结局的影响

目的比较附睾或睾丸来源及其不同活力精子行卵胞浆内单精子注射（ICSI）的结局。方法回顾性分析2005年1月至2008年5月在本生殖中心经皮附睾精子抽吸术（PESA）、睾丸精子抽吸术（TESA）助孕的218例无精子症患者的资料,比较附睾和睾丸及其不同活力精子的正常受精率、卵裂率、优质胚胎率、临床妊娠率、种植率和早期流产率。结果附睾精子组与睾丸精子组比较,正常受精率、卵裂率、临床妊娠率、种植率和早期流产率无显著性差异（P〉0．05）;优质胚胎率附睾精子组显著高于睾丸精子组（P〈0．05）。附睾活动精子、睾丸活动精子和睾丸不活动精子的正常受精率显著高于附睾不活动精子（P〈0．01）;睾丸活动精子的正常受精率显著高于睾丸不活动精子组（P〈0．05）;以上各组间的优质胚胎率、临床妊娠率、种植率、流产率均无显著性差异（P〉0．05）。结论PESA操作简单且不影响妊娠率,无精子症患者行ICSI治疗时可首选附睾精子;附睾或睾丸不活动精子影响ICSI的受精率,应优先选择活力较好的精子,若无活动精子则选择睾丸不活动精子。     

异常形态精子对植入前胚胎发育和妊娠结局的影响

目的探讨异常形态精子(畸形率≥98%)对植入前胚胎发育及妊娠结局的影响。方法采用回顾性队列研究,分析2017年1~12月在唐都医院妇产科生殖医学中心行ART助孕的2419例患者临床资料,根据异常形态精子分为3组,即IVF对照组(畸形率≤96%,n=2129)、IVF实验组(畸形率≥98%,n=90)和ICSI实验组(畸形率≥98%,n=200)。比较3组间植入前受精失败率(受精率<30%)、正常受精率、可用胚胎率等胚胎发育参数和着床率、临床妊娠率、流产率及活产率等妊娠结局的差异。结果(1)胚胎发育结果:组间比较,IVF实验组受精失败率显著高于IVF对照组(P<0.05),ICSI实验组的受精失败率为0;ICSI实验组正常受精率显著高于IVF对照组和IVF实验组(P<0.05);IVF实验组可用胚胎率显著低于IVF对照组和ICSI实验组(P<0.05)。(2)妊娠结局:单因素分析结果显示,与IVF对照组、ICSI实验组相比,IVF实验组的着床率、临床妊娠率、流产发生率和活产率差异均有统计学意义(P<0.05);IVF对照组和ICSI实验组组间妊娠结局指标比较均无显著性差异(P>0.05)。(3)Logistic多因素分析显示:IVF实验组的受精失败风险显著高于IVF对照组(P=0.002),可用胚胎率、活产率显著低于IVF对照组(P=0.002);ICSI实验组的正常受精率显著高于IVF对照组(P=0.05)。结论对于活力正常、但异常形态精子率≥98%的患者,采用ICSI授精方式,能降低受精失败风险,提高正常受精率和可用胚胎率,同时提高妊娠率和活产率并降低流产发生率。     

Computer-assisted assessment of sperm morphology: comparison with conventional techniques

The aim of the present study was to compare conventional and computer-assisted morphology assessment of spermatozoa. Sixty-two semen samples from patients undergoing in vitro fertilization (IVF) and 40 samples from patients undergoing an intracytoplasmic sperm injection (ICSI) were studied using both techniques. The percentage of normal spermatozoa found was closely correlated between the techniques (r=0.788, p < 0.0001). The intra-operator variation was low for both techniques but the inter-operator variation was much higher with the conventional than with the computer-assisted method (coefficient of variation = 0.43 vs. 0.08, respectively, for conventional and computer-assisted assessments). The percentage of spermatozoa with normal morphology, as well as sperm motility, was significantly enhanced after PureSperm preparation, whatever the method used for assessment. In the IVF study, fertilization rate was poorly correlated with sperm morphology using both methods. However, combined with motility, morphology assessed with the computer allowed discrimination of two groups of patients with significantly different fertilization rates (30.5 +/- 5.4% vs. 63.1 +/- 5.4%, p < 0.0001). In contrast, the fertilization rate in ICSI was influenced neither by sperm morphology nor by motility. In conclusion, computer-assisted assessment of sperm morphology has a slightly better predictive value for ART than conventional assessment, but above all is much more reproducible, allowing standardization.     

Prediction of unexpectedly poor fertilization and pregnancy outcome using the strict criteria for sperm morphology before and after sperm separation in IVF-ET

This study was performed to investigate if unexpectedly poor fertilization and in-vitro fertilization (IVF) outcome could be predicted using sperm morphology as diagnosed by the strict criteria. Sperm morphology was assessed in 137 IVF-ET cycles with at least three oocytes collected. The lowest amount of normal forms was 5% in 137 samples, indicating there were no patients belonging to 'poor prognosis' (<5% normal forms). Treatment using intracytoplasmic sperm injection (ICSI) was also excluded. Before sperm separation by the swim-up method, sperm morphology demonstrated a significant correlation with the fertilization rate (p < 0.0001). The fertilization rate (80.5%) in 110 'normal' samples (>14% normal forms) was significantly higher (p < 0.01) than that (55.4%) in 27 samples with 'good prognosis' (those with 5--14% normal forms). No embryo was available for transfer (ET) in 4 (3.6%) of 110 'normal' cycles and in 3 (11.1%) of 27 'good prognosis' cycles (not significant). Fresh ET was intentionally cancelled to avoid severe ovarian hyperstimulation syndrome (OHSS) in six of 110 'normal' cycles as well as in one of 27 'good prognosis' cycles. The pregnancy rate per ET was 31.0% (31/100) in the former group, while it was 26.1% (6/23) in the latter group. There was no difference between the two groups. In the post swim-up evaluation of sperm characteristics, morphology was significantly correlated with the fertilization rate in IVF-ET (p < 0.05) while other sperm parameters were not. When the cut off level for the post swim-up sperm morphology was set at 25%, there was a significant difference in the fertilization rates between patients (78.6%) with post-swim-up >25% and those (55.0%) with post-swim-up < or =25% (p < 0.01). Taken together, a relative indication for ICSI using sperm morphology before and after swim-up was established. Category A includes < or =14% normal forms in the ejaculate and post-swim-up < or =25%, while Category B includes < or =14% in the ejaculate and post-swim-up >25%. There was a significant difference in the fertilization rates between patients (47.2%) in Category A and those (60.2%) in Category B (p < 0.05). The clinical pregnancy rate was 11.1% for patients in Category A compared with 35.7% for patients in Category B. However, there was no significant difference between the two categories. These results indicate that the strict criteria provide a reliable estimation of the fertilizing ability of human spermatozoa. ICSI might be considered in Category A patients to avoid poor fertilization and pregnancy outcome.     

Minimal requirements for ejaculates used for in vitro fertilization

Minimal requirements for ejaculates to be used for in vitro fertilization of human oocytes are defined. Experimental results obtained a total concentration of at least 5 X 10(6) spermatozoa per ml are required, with at least 30% of the sperm showing normal motility and normal morphology in the differential spermiocytogram. The total volume of ejaculate should not be less than 1 ml. A total of 140 ejaculates from patients taking part in the in vitro fertilization program were examined. In 60 ejaculates (42.9%) bacteria concentrations of greater than 10(5)/ml were found. Eighty (57.1%) of the probes were negative or had bacteria concentrations less than 10(4)/ml. Mycoplasma was found in 30 of the examined ejaculates (21.4%) and the second most frequent group of microorganisms were enterococci found in 15 patients (10.7%). Anaerobic organisms in concentrations of more than 10(5)/ml were not detected. After insemination of one or more pelviscopically obtained oocytes with sperm of the husband in 14 out of 22 cases (63.6%) with bacteria concentrations greater than 10(5)/ml the cleavage of at least one oocyte occurred leading to an embryo-transfer rate of 63.6%. In 14 of 31 ejaculates with negative bacteriological findings (45.2%) at least one of the inseminated oocytes was fertilized. Direct effect of microorganism contaminated sperm on the human in vitro fertilization system resulting in reduced fertilization rates cannot be demonstrated.(ABSTRACT TRUNCATED AT 250 WORDS)     

精子形态对体外受精的影响作用

目的　探讨精子形态在体外受精-胚胎移植（IVF-ET）中对受精率及胚胎卵裂速度、胚胎形态的影响作用。　方法　观察89个IVF-ET周期精子处理前后各项参数及成熟卵的受精率、卵裂胚胎的细胞数及形态,分析不同受精密度下精子形态对受精率及胚胎发育的影响。　结果　受精密度≤1.2×10     

Combination of hypoosmotic swelling/eosin Y test for sperm membrane integrity evaluation: correlations with other sperm parameters to predict ICSI cycles

The objective of our study was to evaluate the accuracy of the combination of hypoosmotic swelling (HOS) and eosin Y (Ey) exclusion tests to predict the ICSI cycles' outcome and its correlations with other sperm parameters. The functional and structural integrity of sperm membrane was evaluated with the combined HOS/Ey test in 95 ICSI cycles and the results were correlated with other sperm parameters, including concentration, motility, strict morphology, and total motile sperm count. The combined HOS/Ey test was evaluated for the prediction of the ICSI cycles' outcome parameters including fertilization, cleavage, and pregnancy rates. The HOS/Ey test presented significant relationships with concentration, motility, and strict morphology (p < 0,0001) but it couldn't predict the fertilization, cleavage, and pregnancy outcomes of ICSI cycles. The combined HOS/Ey test has strong correlations with motility and strict morphology parameters of sperm samples but is not sufficiently sensitive to estimate the outcome of ICSI cycles.     

按WHO《人类精液检查与处理实验室手册》第5版标准探讨精子形态对IVF-ET助孕结局的预测价值

目的:按WHO《人类精液检查与处理实验室手册》第5版(《WHO5》)标准探讨正常形态精子百分率对常规体外受精-胚胎移植的助孕结局及新生儿健康状况的预测价值。方法:采用《WHO5》标准把研究对象789例分为畸形精子症组(正常形态精子百分率<4%,35例)和正常组(正常形态精子百分率≥4%,754例),比较两组间正常受精率、卵裂率、优胚率、种植率、临床妊娠率、流产率及新生儿情况。结果:①两组间患者年龄(男、女方)、获卵数、女方平均身高及平均体重指数差异不显著(P>0.05);畸形精子症组的正常受精率、卵裂率、优胚率、周期冷冻率、种植率及移植周期妊娠率略低于正常组,而其流产率略高于正常组,但两组间各指标差异均无统计学意义(P>0.05);②除外继续妊娠(畸形精子症组1例,正常组140例),随访789个移植周期已分娩228个婴儿,畸形精子症组15个(9单胎+3双胎),正常组213个(141单胎+36双胎),出生婴儿无先天性缺陷,两组间孕周、早产率、低体重发生率差异均无统计学意义(P>0.05)。结论:按《WHO5》标准仅通过精子形态预测体外受精-胚胎移植的助孕结局及新生儿情况具有一定局限性。     

Intrauterine insemination in male factor subfertility: significance of sperm motility and morphology assessed by strict criteria

The study was conducted to evaluate the results of IUI treatment in a homogenous group with male factor infertility, and to assess the correlation of sperm variables, including sperm morphology by strict criteria, with pregnancy achievement after IUI. A total of 108 couples with no apparent female aetiology for infertility underwent 264 intrauterine insemination treatment cycles. A comparison was made between the sperm variables in two groups in which the achievement of pregnancy differed. The percentage of motile spermatozoa, degree of motility and normal morphology (by strict criteria) were significantly higher in the pregnant group compared with that of the nonpregnant group. A significant difference in pregnancy rates per couple after intrauterine insemination was demonstrated among three groups according to the percentage of sperm morphology, i.e. poor (< 4%), fair (4-14%) or good (> 14%) (11.1%; 36.1% and 50.0%, respectively). Intrauterine insemination is a valid mode of treatment in cases with male infertility, provided that normal morphology by strict criteria is higher than 4%.     

A retrospective comparison of pregnancy outcome following conventional oocyte insemination vs intracytoplasmic sperm injection for isolated abnormalities in sperm morphology using strict criteria

Initial in vitro fertilization (IVF)-embryo transfer studies found poor fertilization and pregnancy rates following conventional fertilization of oocytes when using sperm with <4% normal morphology using strict criteria. Some consider today that sperm with only < or =5% normal morphology using strict criteria are associated with infertility. However, other studies have disputed the diagnostic potential of low strict morphology in identifying subnormal male fertility. Based on the original studies most IVF centers perform intracytoplasmic sperm injection (ICSI) when the sperm shows low morphology using strict criteria to allow selection of normal sperm. However, ICSI adds extra time for the embryologist and extra expense for the infertile couple. The present study retrospectively compared fertilization, pregnancy, and implantation rates according to the 2 methods of oocyte fertilization with sperm having normal morphology using strict criteria of < or =5% in women < or =39 years. All fresh embryo transfers were performed on day 3. There was a significantly higher fertilization rate with ICSI. However, there were significantly higher clinical and delivered pregnancy and implantation rates following conventional insemination. The rate of canceled transfers due to no available embryo was 1.9% with conventional insemination vs 1.5% for ICSI in women with adequate egg reserve. Hopefully, this retrospective study will generate interest in a prospective study.     

Chronic scrotal hypothermia: results in 90 infertile couples

We studied the use of a testicular hypothermia device worn daily for at least 16 weeks in 64 men with subfertile semen and elevated testicular temperature, who had had an infertile marriage for 2 or more years in which the wife was judged fertile. Improvement in 1 or more semen parameters was seen in 42 patients (65.6 per cent). Semen analysis was converted into the motile oval index, a numerical value representing the count, motility and normal morphology. The motile oval index helps to predict pregnancy outcome. Of 21 patients with pre-treatment motile oval indexes greater than 4.8 million per ml. 11 (52.4 per cent) produced pregnancy. Patients with lower starting indexes did not fare as well. Of 20 patients who met the criteria, and who wore the device for less than 2 weeks or not at all and had no other treatment 1 (5.0 per cent) produced pregnancy. Mean hypothermia time to date of missed menses was 4.2 months. Six patients with nonobstructive azoospermia showed no semen change with the testicular hypothermia device.