Sperm chromatin structure assay (SCSA) parameters are related to fertilization, blastocyst development, and ongoing pregnancy in in vitro fertilization and intracytoplasmic sperm injection cycles

OBJECTIVE: To determine the relationship between sperm chromatin structure assay (SCSA) parameters (DNA fragmentation index [DFI] and high DNA stainability [HDS]), and conventional IVF and IVF/intracytoplasmic sperm injection (ICSI) outcomes. DESIGN: Retrospective review and prospective study. SETTING: Private IVF clinic. PATIENT(S): Two hundred forty-nine couples undergoing first IVF and/or ICSI cycle. INTERVENTION(S): IVF, ICSI, blastocyst culture. MAIN OUTCOME MEASURE(S): DFI, HDS, conventional semen parameters, IVF, ICSI. RESULT(S): IVF and ICSI fertilization rates were not statistically different between high- and low-DFI groups. More men with > or =15% HDS had lower (<25% and <50%) IVF fertilization rates. High DNA stainability was not related to ICSI fertilization rates. High DNA stainability did not affect blastocyst rates or pregnancy outcomes. Men with > or =30% DFI were at risk for low blastocyst rates (<30%) and no ongoing pregnancies. Men with > or =30% DFI had more male factors. World Health Organization thresholds were not predictive of ongoing pregnancy. CONCLUSION(S): The relationship between HDS and poor IVF fertilization rates provides preliminary evidence that ICSI may be indicated in men with > or =15% HDS. Men with high levels of DNA fragmentation (> or =30% DFI) were at greater risk for low blastocyst rates and failure to initiate an ongoing pregnancy. The SCSA provides valuable prognostic information to physicians counseling couples before IVF and/or ICSI cycles.     

Age and pregnancy rates in in vitro fertilization

The influence of women[s age on the results of in vitro fertilization (IVF) was analyzed in 1801 women undergoing the procedure. Advancing age was found to be related to significant reduced success rates from an average of 30.1% per transfer below the age of 36 years to 15.9% per transfer at 37 years or more (P<0.001). The decrease was related to a reduction in oocyte production (five at 25 years or less, four below the age of 40 years, three at 40 years or more, and two in the 43 to 47-year group) and probably-due to reduced implantation. It is concluded that a woman's age must be considered an important prognostic factor when IVF is suggested.     

Numerical dose-compensated in vitro fertilization inseminations yield high fertilization and pregnancy rates

Objective: To evaluate in cases with morphologically abnormal sperm whether fertilization and pregnancy rates are increased by normalizing the number of sperm inseminated and whether biomarkers can identify cases of reduced or failed fertilization.

Design: Prospective studies of sperm morphology and function.

Setting: University hospital assisted human reproduction program.

Patient(s): Partners of 308 women undergoing IVF.

Intervention(s): Motile sperm populations were assessed for sperm head morphology, for surface receptors for mannose and progesterone binding, and the ability to undergo a free mannose-induced acrosome reaction. Zinc in seminal plasma was determined by atomic absorption spectroscopy.

Main Outcome Measure(s): Sperm morphology was associated with fertilization and clinical pregnancy rates. Biomarker analyses were correlated with fertilization rates using Kruskal-Wallis tests, χ² tests, and Spearman rank order correlations.

Result(s): Fertilization and pregnancy rates after numerical dose compensation inseminations were indistinguishable between men with differing percentages of normal sperm. Biomarker deficits were identified irrespective of sperm head morphology in 96% of cases of reduced or failed fertilization.

Conclusion(s): Fertilization and pregnancy rates in cases of abnormal morphology are optimized by inseminating at least 25,000 sperm/mL with normal acrosomes. Reduced or failed fertilization can be predicted by testing for molecular deficits in mannose receptor expression and mannose-stimulated acrosome loss.     

精子DNA碎片与体外受精结局的关系

目的:探讨精子DNA碎片与体外受精(in vitro fertilization,IVF)结局的关系。方法:采用染色质扩散实验(sperm chromatin dispersion,SCD)对242例接受IVF的男方进行精子DNA碎片率(DNAfragmentation index,DFI)检测,按照WHO标准进行精液常规分析,将精子DFI、精液常规参数和IVF受精率、卵裂率、可移植胚胎率、优质胚胎率进行Spearman相关分析,将精子DFI、精液常规参数对生化妊娠、临床妊娠的影响进行Logistic回归分析。结果:精子DFI与精子前向活动率呈负相关(r=-0.355,P<0.001);密度梯度法处理前、后精子DFI均与IVF受精率呈负相关(r=-0.223,P<0.001)(r=-0.136,P<0.05);精子DFI、精液常规参数与卵裂率、可移植胚胎率、优质胚胎率无相关性;精子DFI与生化妊娠、临床妊娠结局无相关性。结论:精子DFI影响精子活力与IVF受精率,精子DFI检测对预测IVF受精率有一定的临床意义。     

The relationship of semen parameters to fertilization in patients participating in a program of in vitro fertilization

Approximately 80% of the patients in a program of in vitro fertilization (IVF) will fertilize an oocyte. The purpose of this study was to determine which parameters of the semen analysis influence fertilization in vitro. Of 120 patients participating in an in vitro fertilization program, 98 achieved fertilization of at least one mature oocyte and 22 did not. Ovulation induction was standardized and patients whose sperm was exposed to at least one mature oocyte (by light microscopy) were included in the study. Semen washing was accomplished using a swim-up technique. Semen parameters were assessed both before (raw) and after washing. Following insemination with 100,000 motile sperm, fertilization was determined by the presence of pronuclei or cleavage. Mean sperm count and motility were higher in patients who fertilized. However, morphology was similar. Fertilization was more likely to occur with a raw density>104 million/ml and a motility>64%, as well as with a density>18 million/ml and a motilkity>86% following washing. Furthermore, washing lowered sperm counts by 75% and increased motility by 25% but had no effect on morphology. This study demonstrates that sperm count and motility, but not morphology, influence fertilization in a program of in vitro fertilization and that patients with higher counts and motility have and greater probability of fertilization.Presented at the Third Annual Congress of Andrology, April 27–May 2, 1985, Boston, Massachusetts.     

Ongoing pregnancy rates in in vitro fertilization are not dependent on the physician performing the embryo transfer

OBJECTIVE: To analyze the influence of the factor of the physician performing the ET with a standardized procedure on the ongoing pregnancy rates in an IVF-ET program. DESIGN: Prospective observational study. SETTING: Tertiary university hospital. PATIENT(S): Subfertile women with an IVF indication. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Ongoing pregnancy. RESULT(S): Six physicians performed 977 ETs. Ongoing pregnancy rates ranged from 19.1% to 29.0%, with an average rate of 23.1%. Logistic regression analysis revealed that physician is not a statistically significant variable. Differences between the pregnancy rates achieved by the physicians are within the limits of random variation. CONCLUSION(S): The probability of success in IVF is not dependent on the physician, provided the transfer procedure is standardized.     

Antiphospholipid antibodies and pregnancy rates and outcome in in vitro fertilization patients

Objective: To determine the relationship between antiphospholipid antibodies and pregnancy rates (PRs) and outcome among IVF patients.

Design: Prospective collection of all serum samples with assays for immunoglobulin G (IgG), IgA, and IgM antibodies for anticardiolipin, antiphosphatidyl serine, antiphosphatidyl ethanolamine, antiphosphatidyl choline, antiphosphatidyl inositol, antiphosphatidyl glycerol, and anti-phosphatidic acid being done following completion of all treatment cycles.

Setting: A tertiary care teaching hospital.

Patient(s): Seven hundred ninety-three patients attempting to conceive through IVF.

Main Outcome Measure(s): Pregnancy rates (PRs) and pregnancy loss rates relative to each of the various antiphospholipid antibodies that were measured.

Result(s): There were 528 pregnancies for an overall PR of 66%. Pregnancy rates were equal among patients with positive and negative antiphospholipid antibodies for each of the 21 measured antibodies. Use of receiver operator characteristic curves and logistic regression further confirmed that there was no relationship between PRs or outcome based on antiphospholipid antibodies for any definable threshold value.

Conclusion(s): Elevated antiphospholipid antibody levels are not associated with any change in PRs or pregnancy loss rates in patients attempting to conceive through IVF.     

Assessment of sperm chromatin condensation and ploidy status using flow cytometry correlates to fertilization,embryo quality and pregnancy following in vitro fertilization

Purpose  

Sperm flow cytometry (SFC) was used to evaluate the association of sperm chromatin condensation and ploidy with fertilization, embryo development, pregnancy and abortion rates following IVF.     

体外受精-胚胎移植技术中74例异位妊娠的临床分析

目的:分析体外受精-胚胎移植(in vitro fertilization and embryo tranfer,IVF-ET)助孕技术中发生异位妊娠的影响因素、诊断、治疗方法及预防措施。方法:回顾性分析IVF-ET助孕技术中发生异位妊娠74例患者的临床资料。结果:所有接受IVF-ET的1 585患者中,共发生异位妊娠74例,异位妊娠发生率为4.67%;异位妊娠类型中输卵管妊娠71例,占总异位妊娠的95.95%。新鲜胚胎移植周期组异位妊娠发生率(5.41%)显著性高于冷冻胚胎复苏移植(frozing embryo transfer,FET)周期组(2.35%)(P<0.05)。移植深度距离宫底>1.2 cm时异位妊娠发生率显著性低于移植深度0.8~1.2 cm组。结论:IVF-ET助孕技术中异位妊娠发生率较自然妊娠过程中高;输卵管因素、促排卵药物的应用以及胚胎移植的深度是异位妊娠发生的主要影响因素。     

A formula for scoring human embryo growth rates in in vitro fertilization: Its value in predicting pregnancy and in comparison with visual estimates of embryo quality

Two systems for measuring embryo development in vitro were evaluated. One was a 1–4 scale based on a subjective evaluation of embryo quality (EQ) from microscopic appearance. In addition, a formula for scoring embryo growth rate in vitro was developed. The embryo development rating (EDR) was based on the ratio between the time at which embryos were observed at a particular stage after insemination and the time at which they would be expected to reach that stage in a hypothetical ideal growth rate with a cell cycle length of 11.9 hr. Using this scoring system, normally growing embryos scored 100. This approach was aimed at partially normalizing the data and allowed all embryos to be analyzed similarly regardless of the time of observation. Analysis of 1539 embryo replacements resulting in 232 clinical pregnancies showed that both EDR and embryo-quality scores were of value in predicting success, with clinical pregnancy most likely to eventuate from a combination of moderate to good EQ scores (2–4) coupled with average or above-average growth rates (EDR scores from 90 to 129). Poor-quality and very slowly or very rapidly growing embryos were underrepresented in cycles that proceeded to pregnancy. These inferences were based on all embryos transferred (mean, 2.73 per transfer cycle), and they were substantiated by an analysis of 33 pregnancies resulting from replacement of a single embryo and from 18 pregnancies in which all embryos scored the same with both systems. EQ and EDR were significantly associated with each other and together provide a valuable guide in predicting pregnancy, in selecting embryos for freezing, and in monitoring day-to-day performance in the in vitro fertilization (IVF) program.     

Human follicular fluid proteoglycans in relation to in vitro fertilization

Objective: To determine whether the concentrations of proteoglycans and hyaluronan in human follicular fluid (FF) are associated with follicular volume, oocyte fertilization, and ET during IVF.Design: The FF from individual follicles were collected. Enzyme-linked immunosorbent assay methods for quantification of a larger chondroitin sulfate proteoglycan and a smaller composite heparan-chondroitin sulfate proteoglycan were established. Hyaluronan and E₂ were measured by RIA techniques.Patient(s): Sixteen infertile women participating in the IVF program.Main Outcome Measure(s): Concentrations of the proteoglycans, follicular volume, fertilization, and ET rates.Result(s): The follicles contained high concentrations of proteoglycans with an average of 0.8 mg/mL of FF, and approximately 70% consisted of the larger chondroitin sulfate proteoglycan, and 30% of the heparan-chondroitin sulfate proteoglycan. A negative correlation was found between the follicular volume, the chondroitin sulfate proteoglycan (r = −0.43), and hyaluronan (r = −0.56). The percentage of embryos developed in culture was significantly higher in follicles larger than 2 mL. A significant and 35% lower concentration of the chondroitin sulfate proteoglycan was found in larger follicles from which subsequent ET was observed. The heparan-chondroitin sulfate proteoglycan and hyaluronan were both unrelated to fertilization and ET in vitro.Conclusion(s): Lower concentrations of chondroitin sulfate proteoglycan were associated with higher follicular volumes and greater fertilization and ET rates. These associations could merely reflect the maturation of the follicle or a role of the chondroitin sulfate proteoglycan in the fertilization process.     

Conversion of high-response gonadotropin intrauterine insemination cycles to in vitro fertilization results in excellent ongoing pregnancy rates

OBJECTIVE: To determine whether conversion of gonadotropin/IUI cycles at high risk of high-order multiple pregnancies to IVF yields a pregnancy rate high enough to warrant the added intervention. DESIGN: Case-control study. SETTING: Brigham and Women's Hospital assisted reproductive technology program. PATIENT(S): Seventy-seven patients converted from gonadotropin/IUI to IVF, 77 consecutive age and attempt number-matched controls (sequential controls [SCs]), and 77 consecutive age-, attempt-, and E(2)-matched controls (E(2) controls [ECs]). INTERVENTION(S): Gonadotropin/IUI cycles with exuberant responses were converted to IVF (cases) to avoid cycle cancellation and high-order multiple pregnancies. MAIN OUTCOME MEASURE(S): Pregnancy rates, delivery rates, E(2) levels, follicle and oocyte number, and fertilization and implantation rates. RESULT(S): Compared with SCs and ECs, cases had more follicles (16.3 +/- 0.6 vs. 13.3 +/- 0.9 and 14.4 +/- 0.9) and higher E(2) at hCG administration (1,951 +/- 93 vs. 1,568 +/- 96 and 1,939 +/- 89 pg/mL). Delivery rates among the three groups (45.5% vs. 32.5% and 39.0%) did not differ significantly. Despite the transfer of fewer embryos in cases than in controls (2.5 +/- 0.1 vs. 3.1 +/- 0.1 and 2.9 +/- 0.1), three triplet pregnancies occurred in cases and three in controls. CONCLUSION(S): Conversion of high responder gonadotropin/IUI patients to IVF is an effective alternative to cycle cancellation and offers a delivery rate as high or higher per cycle than that of planned IVF. Sample size limited the statistical power of the study.     

The effect of medical clowning on pregnancy rates after in vitro fertilization and embryo transfer

This experimental prospective quasi-randomized study examining the impact of a medical clowning encounter after embryo transfer (ET) after in vitro fertilization (IVF) found that the pregnancy rate in the intervention group was 36.4%, compared with 20.2% in the control group (adjusted odds ratio, 2.67; 95% confidence interval, 1.36-5.24). Medical clowning as an adjunct to IVF-ET may have a beneficial effect on pregnancy rates and deserves further investigation.     

Ovarian cyst aspiration prior to initiating ovarian hyperstimulation for in vitro fertilization

Twenty-three consecutive patients presenting for in vitro fertilization were evaluated with transvaginal sonography on cycle day 3, prior to initiating ovarian hyperstimulation. Three of these patients were noted to have large ovarian cysts. All three underwent transvaginal aspiration of the cysts, followed immediately by initiation of ovarian hyperstimulation. Following oocyte retrieval, in vitro fertilization, and embryo transfer, all three women achieved pregnancy. We conclude that cyst aspiration is not contraindicated when an ovarian cyst is encountered in the follicular phase of an in vitro fertilization cycle.     

Predictive value of basal androgen levels on ongoing pregnancy rates during in vitro fertilization cycles

We aimed to evaluate the impact of elevated basal androgen levels on the endometrial receptivity. This study retrospectively enrolled 5278 fresh in vitro fertilization (IVF) cycles and sought to determine whether increased basal androgen levels are associated with adverse outcomes in regard to ongoing pregnancy rates. The results showed that the average age of our sample was 29.31 years. Almost 61.6% of all embryo transfers were with Day 3 embryos and the remaining 38.4% were with Day 5 embryos. The ongoing pregnancy rate was 56.4%. The ongoing pregnancy rates according to the various ordinal serum androgen intervals (<10.00, 10.00–19.99, 20.00–29.99, 30.00–39.99, and ≥40.00?ng/dL) were 60.12, 56.62, 58.64, 55.48, and 50.17%, respectively. The ongoing pregnancy rates were significantly lower in patients with high basal androgen levels (e40?ng/dL) (p?<?.05). Multivariate regression analysis showed that age, BMI, and endometrial thickness were inversely associated with basal androgen levels (p?相似文献   

Egg production predicts a doubling of in vitro fertilization pregnancy rates even within defined age and ovarian reserve categories

OBJECTIVE: To examine the age-independent association of ovarian response and IVF outcome in women with normal and abnormal ovarian reserve. DESIGN: Retrospective analysis. SETTING: Academic IVF center. PATIENT(S): Four thousand eight hundred sixty-two consecutive IVF cycles. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Outcome of IVF was analyzed as a function of ovarian response to controlled ovarian hyperstimulation and ovarian reserve. RESULT(S): The mean patient age was 36.2 +/- 4.5 years. Younger patients and patients with normal ovarian reserve were found to have better implantation and clinical pregnancy rates. Patients with normal ovarian reserve had a higher number of oocytes retrieved, mature oocytes, two-pronuclei embryos, and embryos transferred. A greater number of embryos were transferred for patients with higher ovarian response. Higher clinical pregnancy rates were seen in those patients who had more oocytes retrieved for all patients, regardless of age and ovarian reserve. In fact, clinical pregnancy rates more than doubled for specific patient groups. CONCLUSION(S): In an age-independent fashion, ovarian response is highly predictive of IVF outcome in women with normal and abnormal ovarian reserve. These findings highlight the importance of not solely relying on age when presenting and discussing IVF outcome data and are useful information when helping patients interpret their IVF cycle response.