Conventional IVF versus ICSI in sibling oocytes from couples with endometriosis and normozoospermic semen

Purpose

This study compares the fertilization rate and embryonic development of oocytes randomly inseminated by conventional IVF or ICSI in patients with endometriosis and normozoospermic semen during IVF cycles.

Methods

Sibling oocytes were randomized to be inseminated either by ICSI or IVF. Rates of fertilization, cleavage, blastulation and embryonic morphology were assessed.

Results

A total of 786 sibling cumulus-oocyte complexes (COC) were randomized between insemination by conventional IVF (387 COC) or ICSI (399 COC). A significantly higher fertilization rate was found in the ICSI group (ICSI versus IVF, 73.3±23 % versus 54.7±31.9 % respectively; P=0.003), yielding a higher mean number of day 2 embryos (5.2±3.4 versus 3.6±2.9 respectively; P=0.002). Triploid fertilization rate (3PN/COC) was significantly higher in the IVF group compared to the ICSI group (3.9±8.7 % versus 0.9±3.1 % respectively; P=0.02). The morphology score and rate of development of day 2 and 3 embryos were not different between the two groups. Comparison of embryo transfer cycles in which either IVF or ICSI only embryos were transferred did not reveal any statistically significant differences in pregnancy or implantation rates.

Conclusion

ICSI appears to be a better treatment option than conventional IVF in endometriosis-associated infertility, since it offers the advantages of higher fertilization rate and mean number of embryos and lower rate of total fertilization failure and triploid fertilization.     

Live birth achieved despite the absence of ejaculated spermatozoa and mature oocytes retrieved: a case report

The most common reason for in vitro fertilization (IVF) cycle cancelation is a lack of quality gametes available for intracytoplasmic sperm injection (ICSI). Here we present the successful fertility treatment of the couple affected by obstructive azoospermia combined with suboptimal response to controlled ovarian stimulation. Since the conventional approach appeared ineffective to overcome both partnersˈ specific problems, the targeted interventions, namely, (1) pharmacological enhancement of sperm motility and (2) polarized light microscopy (PLM)-guided optimization of ICSI time, were applied to rescue the cycle with only immature oocytes and immotile testicular sperm retrieved. The treatment with theophylline aided the selection of viable spermatozoa derived from cryopreserved testicular tissue. When the traditional stimulation protocol failed to produce mature eggs, non-invasive spindle imaging was employed to adjust the sperm injection time to the maturational stage of oocytes extruding a polar body in vitro. The fertilization of 12 late-maturing oocytes yielded 5 zygotes, which all developed into blastocysts. One embryo was transferred into the uterus on day 5 post-fertilization, and another 3 good quality blastocysts were vitrified for later use. The pregnancy resulted in a full-term delivery of a healthy child. This case demonstrates that the individualization beyond the standard IVF protocols should be considered to maximize the chance of poor-prognosis patients to achieve pregnancy with their own gametes.     

Spontaneous pregnancies following discontinuation of IVF/ICSI treatment: an internet-based survey

The objective was to determine the likelihood of conceiving spontaneously following cessation of IVF/ICSI; how long does it take and what factors are associated with conception? The design was an internet-based survey. All registered users of www.ivf-infertility.com received an electronic questionnaire addressing issues relating to the duration and cause of infertility, number of IVF/ICSI cycles and outcome, whether they conceived following cessation of IVF/ICSI and the time taken to conceive and outcome. Four hundred and eighty four patients responded of whom 403 met the study criteria. The overall cumulative live birth rate over a 6-year period following cessation of IVF/ICSI was 29%. Eighty-two percent of conceptions occurred within 2 years. Positive factors associated with spontaneous conception were unexplained infertility (p?=?0.02), ovulation dysfunction (p?=?0.01), infertility less than four years prior to IVF/ICSI (p?=?0.045) and 2 years or less since discontinuation of IVF/ICSI (p?p?=?0.02). In conclusion, 29% of couples conceived spontaneously over a 6-year period following the cessation of IVF/ICSI. The findings of this study can be used to counsel and reassure women following IVF/ICSI.     

Timing and duration of use of GnRH antagonist down-regulation for IVF/ICSI cycles have no impact on oocyte quality or pregnancy outcomes

PURPOSE: To evaluate whether oocyte quality, implantation and pregnancy outcomes in in vitro fertilization (IVF)/intra-cytoplasmic sperm injection (ICSI) are related to the duration of gonadotropin-releasing hormone (GnRH)-antagonist use or the timing of its initiation. METHODS: Retrospective cohort study of 178 conventional IVF/ICSI cycles. All patients underwent ovarian stimulation with gonadotropins and GnRH-antagonist for pituitary down-regulation. Spearman correlations and logistic regression were used for statistical analysis. RESULTS: There was no correlation between the duration of use or the timing of initiation of GnRH-antagonist with oocyte quality or implantation and pregnancy outcomes. Oocyte quality was influenced by the peak estradiol. Implantation was influenced by the patient's age. Early pregnancy loss, by the endometrial thickness on human chorionic gonadotropin-day. Ongoing pregnancy was independent from the variables evaluated. CONCLUSIONS: GnRH-antagonist duration of use or starting day did not influence oocyte quality, implantation rates, and pregnancy rates. We hypothesize that a follicle stimulating hormone/luteinizing hormone dose increase when antagonist was started, may have had an impact on our findings.     

Oral antioxidants supplementation for women with unexplained infertility undergoing ICSI/IVF: Randomized controlled trial

Objective: Good oocyte quality and maturity are important prerequisites for high fertilization and implantation rates in IVF/ICSI treatment cycles. Reactive oxygen species (ROS) are produced within ovarian follicles, especially during the ovulation process, and increased ROS activity may be a cause of impaired oocyte maturation and higher rate of failure of IVF/ICSI cycles. Study design: RCT evaluating the effect of antioxidant supplementation on ICSI/IVF outcomes. Two hundred and eighteen women with unexplained subfertility undergoing IVF/ICSI were randomized into two groups. The study group (n = 112) received daily oral antioxidants in the form of multivitamins and minerals (amino acid chelated) while the control group (n = 106) did not. Main outcomes were number of mature metaphase II (MII) oocytes and clinical pregnancy rate. Results: There were no significant changes between the groups as regards age, BMI, basal FSH, number of mature (MII) oocytes (12.7 ± 9.4 vs. 13.2 ± 8.6, P = 0.7) and clinical pregnancy rate per woman randomized (38% vs. 34%; [OR = 1.2; 95% CI, 0.70–2.11]. Conclusion: Oral antioxidants in the form of a combination of multivitamins and minerals (amino acid chelated) did not improve oocyte quality and pregnancy rates in women with unexplained infertility undergoing IVF/ICSI treatment.     

Pregnancy outcome and live birth after IVF and ICSI according to embryo quality

Purpose: The pregnancy outcome and the chances of birth were assessed according to embryo quality after IVF or ICSI. Methods: The implantation rate (IR), the loss of gestational sacs rate (LGSR), and birth rate (BR) were determined according to the cleavage stage and the integrity of blastomeres after day-2 homogeneous embryo transfers (n = 1812). Results: The LGSR was higher after transfers of 2–3-cell or 5–6-cell embryos and was significantly increased when more than 20% of the embryo volume was fragmented in 4-cell embryos. After transfers of 4-cell embryos without fragmentation, the BR was significantly higher than the BR after transfers of 4-cell embryos with 1–20% fragmentation (16.6% vs 13.1%). The difference was the consequence of a higher IR (20.4% vs 17.3%) but also of a lower LGSR (18.9% vs 24.2%). Conclusions: Not only implantation and the ability to give a pregnancy, but also the capacity to give a live birth are dependent on the embryo quality.     

Outcome of conventional IVF and ICSI on sibling oocytes in the case of isolated teratozoospermia

Purpose

To reevaluate the effect of isolated teratozoospermia on IVF and determine if there was any therapeutic benefit to isolated teratozoospermia by ICSI, since there are no widely accepted criteria for the treatment technique about isolated teratozoospermia.

Methods

A total of 441 couples with >20 million and progressive motility >30 % sperm undergoing their first IVF/ICSI cycle were included in the study between 2008 and 2010, for whom at least 8 oocytes were retrived. Isolated teratozoospermia was diagnosed in 183 of the included couples, and the rest couples (normal sperm morphology) were studied as control. Sibling oocytes were randomized to be inseminated either by ICSI or IVF. Fertilization rate, embryo quality, pregnancy rate, implantation rate and spontaneous abortion rate were assessed.

Results

There was no difference in the percentage of eggs fertilized, implantation rate, pregnancy rate and spontaneous abortion rate between conventional IVF and ICSI regardless of the percentage of normal morphology. The day 3 embryonic morphology and rate of development were not different despite the insemination method and percentage of normal morphology.

Conclusion

Because isolated teratozoospermia did not influence the major indices of IVF and the unnecessary use of ICSI is time-consuming, costly and potential risks, couples with isolated teratozoospermia need not be subjected to ICSI.     

Blastocyst transfer and gender: IVF versus ICSI

Purpose  

To investigate the difference in sex ratio in our centre after day 5 embryo transfer among neonates delivered after fresh in vitro fertilization (IVF), fresh intra cytoplasmatic sperminjection (ICSI) and frozen embryo replacement (FER) compared to expected sex ratio in normal population.     

二甲双胍对多囊卵巢综合征患者体外受精结局影响的系统评价

目的:本研究旨在评价即将或正在进行体外受精/胞浆内单精子注射(IVF/ICSI)治疗的多囊卵巢综合征(PCOS)患者辅助服用二甲双胍的临床价值。方法:计算机检索PubMed、Embase、Cochrane图书馆、CNKI、VIP和万方数据库,查找有关二甲双胍对PCOS患者体外受精结局的随机对照试验或交叉试验,检索时间截至2011年2月。按Cochrane系统评价方法及英国国家卫生服务部评价与传播中心制定的卫生保健系统评价指南,对纳入研究进行质量评价和资料提取后,采用RevMan软件进行Meta分析。结果:共纳入9个试验,共11篇文献。Meta分析结果显示:对行IVF/ICSI的PCOS患者,二甲双胍干预组和安慰剂组在临床妊娠例数(OR=1.82,95%CI1.28～2.59)、胚胎移植数(MD=0.12,95%CI0.03～0.21)、卵巢过度刺激综合征(OR=0.39,95%CI0.21～0.70)、药物不良反应发生例数(OR=9.49,95%CI4.10～21.97)方面的比较,差异有统计学意义(P<0.05),而在卵巢刺激时间、重组人卵泡刺激素总剂量、血清雌激素水平、收集卵泡数、受精率、新生儿活产率、和...     

血脂水平与体外受精周期胚胎质量的相关性初步研究

目的:研究不孕症患者血脂水平与体外受精(IVF/ICSI)胚胎质量的相关性。方法:对行IVF/ICSI治疗、符合纳入标准的646例不孕症患者的资料进行回顾性分析,测定、分析血清三酰甘油(TG)、总胆固醇(TC)、高密度脂蛋白(HDL)、非高密度脂蛋白(nonHDL)、低密度脂蛋白(LDL)和脂蛋白(a)[LP(a)]水平与胚胎质量的关系。血脂水平和IVF/ICSI胚胎质量相关性采用Spearman相关分析。结果:患者年龄、体质量指数(BMI)、基础FSH、窦卵泡数、Gn用量及血脂水平临床妊娠组和非临床妊娠组之间均无统计学差异;受精率、卵裂数、优质胚胎数和优质胚胎率临床妊娠组均显著高于未临床妊娠组(P<0.05)。血脂水平和IVF/ICSI胚胎质量相关分析显示:TG和TC与卵子数、受精数及卵裂数均显著负相关,TC、LDL及nonHDL与优质胚胎数呈显著负相关(P<0.05),其余均无统计学意义。结论:血脂水平临床妊娠组与未临床妊娠组间均无统计学差异;IVF/ICSI胚胎质量与TC、LDL及nonHDL呈显著负相关。     

Bilateral ovarian abscesses following transvaginal oocyte retrieval for IVF: a case report and review of literature

Ultrasound-guided transvaginal oocyte retrieval (TVOR) is a relatively simple and atraumatic method with rare complications as well as the possibility of doing it under sedation. It has become the method of choice in most IVF centres, because it results in excellent oocyte yields, with increased speed and excellent follicle and major pelvic vessel visualization, thereby decreasing the probability of vessel puncture [1]. However, the technique is not without risk such as pelvic infection, bleeding secondary a blood vessel puncture or pelvic visceral trauma. Consumption coagulopathy is a serious complication of pelvic infection and sepsis which can be life threatening if not diagnosed and corrected early, especially if surgical intervention is required. We present a case of bilateral ovarian abscesses following transvaginal oocyte retrieval showing early signs of consumption coagulopathy.     

The impact of unicornuate uterus on perinatal outcomes after IVF/ICSI cycles: a matched retrospective cohort study

Objective: To evaluate the impact of unicornuate uterus on perinatal outcomes after in vitro fertilization and/or intracytoplasmic sperm injection (IVF/ICSI) cycles.

Methods: We performed a retrospective cohort study including 160 women with unicornuate uterus and 1:1 matched controls with normally shaped uterus. They received IVF/ICSI treatment during January 2009 and December 2011. The perinatal outcomes were followed up till December 2014.

Results: There were no significant differences in pregnancy rate, clinical pregnancy rate or live birth rate (53.6 versus 52.7, 41.4 versus 43.5, 33.8% versus 31.8%) between unicornuate uterus group and controls. Their biochemical pregnancy rate (22.8 versus 17.5%) and miscarriage rate (16.0 versus 18.8%) were similar. No significant differences were identified in preterm birth rate (18.3 versus 11.8%), birthweight (3.24?±?0.60 versus 3.33?±?0.54?kg) or birth length (50.47?±?2.33 versus 50.06?±?2.40?cm) among the singletons. However, lower gestational age (35.56?±?2.68 versus 36.71?±?1.73, p?=?.019), higher preterm birth rate (55.0 versus 34.4%, p?=?.038), lower birthweight (2.33?±?0.58 versus 2.69?±?0.38?kg, p?=?.001), lower birth length (45.33?±?2.46 versus 48.88?±?2.06?cm, p?=?.000), as well as higher rate of very low birthweight (13.2% versus 0, p?=?.007) were found for the twins from unicornuate uterus group.

Conclusions: The results indicated unimpaired pregnancy and perinatal outcomes for women with unicornuate uterus conceiving one fetus. However, close attention should be paid to twin pregnancy in unicornuate uterus owing to increased risks of prematurity and low birthweight. Selected single embryo transfer is recommended for women with unicornuate uterus undergoing IVF/ICSI cycles.     

Accumulation of oocytes from a few modified natural cycles to improve IVF results: a pilot study

Purpose

To evaluate the role of co-transfer of embryos derived from vitrified oocytes accumulated during the previous modified natural cycles and an embryo developed from the last one as an alternative to repetitive single embryo transfer in a fresh modified natural cycle.

Methods

Thirty-six patients underwent ICSI procedure with three frozen natural oocytes supplemented by a fresh one obtained from the fourth modified natural cycle. Thirty-one controls received at least three consecutive single embryo transfer in a fresh modified natural cycle.

Results

In the study group the oocyte retrieval, survival and total fertilization rate were 73.0 %, 78.1 %, and 64.5 %, respectively. Fifty-two embryos were transferred in 29 transfers. In the control group the oocyte retrieval and fertilization rate was 77.4 % and 83.7 %, respectively. Fifty single embryo transfers were performed. Of a total 14 pregnancies obtained in the study group 10 were defined as clinical and 4 as abortions. In the control group a total of 8 single clinical pregnancies and 2 miscarriages were encountered. The overall (20.0 % vs 48.2 %) and the clinical (16.0 % vs 34.4 %) pregnancy rate were significantly higher in the study group having cumulative embryo transfer following the oocyte accumulation.

Conclusions

These data demonstrate that the co-transfer of embryos derived from vitrified oocytes accumulated during the previous modified natural cycles and an embryo developed from the last fresh modified natural cycle assure an excellent clinical outcome with the overall and clinical pregnancy rate significantly higher compared to the repetitive single embryo transfer in a fresh modified natural cycle.     

Unexpected repeat immature oocyte response after IVF stimulation: a case report

The purpose of ovarian stimulation in IVF is to recover mature oocytes at metaphase II stage which are capable of fertilization either when mixed with sperm or after ICSI. However, there have been instances when even after controlled ovarian stimulation (COS) and correct administration of human chorionic gonadotrophin (hCG) trigger for final oocyte maturation, the oocytes were found to be arrested at germinal vesicle (GV) or metaphase I (MI) stage. Similar dilemma is faced in cases of empty follicle syndrome (either genuine or due to inadequate response), however, in this condition, there is no retrieval of oocytes despite presence of mature looking follicles. We present an interesting case where despite presence of normally growing follicles and documentation of correct response to trigger and rise in estradiol levels, two subsequent IVF cycles; one triggered with recombinant hCG and second with GnRH agonist, hCG failed to yield mature oocytes. Both cycles yielded expected number of oocytes but all at immature MI stage even after dual trigger.     

Unexplained total abnormal fertilization of donor oocytes in ICSI with using spermatozoa from different patients

Abstract

In this report, we present a case of unexplained total triploidy of donor eggs fertilized by ICSI from four different male partners of different couples. Woman who served as a donor was 27?year old, had her own healthy child, and previously twice served as a donor with normal fertilizations and healthy baby born.     

Pregnancy and delivery after in vitro maturation of naked ICSI GV oocytes with GH and transfer of a frozen thawed blastocyst: case report

Purpose : To determine if GV oocytes, collected at the time of ICSI, can be matured in vitro and rescued for therapeutic treatment. A patient for whom all the collected oocytes at the GV stage after a classical COH protocol were matured in vitro with GH. Method : All the naked oocytes were matured in a culture medium (ISM2) containing 15% patient serum +1.6 units of GH (Saizen) per millilitre. Oocytes were incubated overnight at 37°C. The MII oocytes obtained were micro-injected. A fresh transfer was performed and a supernumerary blastocyst was frozen. Results : The patient was pregnant and delivered a healthy girl after transfer of the frozen/thawed blastocyst. The baby girl is now 2 years old. Conclusion : In vitro maturation with GH allows rescuing naked GV oocytes collected at the time of ICSI. GH action does not pass through the cumulus cells. According to the possible lack of synchrony between the embryo and the uterus, we recommend to freeze the embryos obtained and to replace them in a controlled cycle.