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.     

Levels of Tektin 2 and CatSper 2 in normozoospermic and oligoasthenozoospermic men and its association with motility, fertilization rate, embryo quality and pregnancy rate

Purpose

To compare the expression profiles of Tektin 2 and CatSper 2 motility proteins in the spermatozoa of normozoospermic and oligoasthenozoospermic men and determine its correlation with sperm motility, fertilization rate, embryo quality and pregnancy rate.

Methods

Tektin 2 and CatSper 2 protein expression was studied using Western Blotting and immunofluorescence. Tektin 2 and CatSper 2 protein levels were quantified by ELISA.

Results

Oligoasthenozoospermic men were found to have lower fertilization rates, poor embryo quality and lower pregnancy rates as compared to normozoospermic men. The levels of Tektin 2 and CatSper 2 are significantly lower in spermatozoa of oligoasthenozoospermic men as compared to normozoospermic controls; the levels were also lower in immotile fraction as compared to motile fraction of spermatozoa obtained from normozoospermic individuals. The levels of Tektin 2 and CatSper 2 were higher in individuals demonstrating sperm motility >60 % as compared to sperm motility <30 %. Tektin 2 but not CatSper 2 levels were positively associated with fertilization rate, embryo quality and pregnancy rate.

Conclusion

Levels of Tektin 2 and CatSper 2 proteins are positively associated with sperm motility parameters. Measurements of Tektin 2 levels can be correlated with the clinical outcome of ICSI.     

Sperm DNA fragmentation index,as measured by sperm chromatin dispersion,might not predict assisted reproductive outcome

Objective

Routine semen parameters have limited clinical diagnostic value for predicting male infertility. The aim of this study was to investigate the association between sperm DNA fragmentation index (DFI) and semen quality, and between DFI and clinical pregnancy rate of in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI).

The impact of ejaculatory abstinence on semen analysis parameters: a systematic review

Objective

The aim of this study was to evaluate recent publications and determine the impact of ejaculatory abstinence on semen analysis parameters as well as fertility outcomes.

Methods

This was a systematic review of 28 recent publications. The focus of this study was the impact of abstinence on semen parameters and fertility outcomes in papers published since the year 2000. The specific parameters evaluated were volume, sperm count, motility, morphology, pH, DNA fragmentation rate, viability, and pregnancy or fertilization rates following assisted reproduction.

Results

Twenty-eight recent publications met inclusion criteria. Analysis of publications showed that longer abstinence is associated with increases in semen volume and sperm count. Studies evaluating the effect of abstinence on motility, morphology, and DNA fragmentation rates are contradictory and inconclusive, although a trend appears to exist toward improvements in semen parameters with shorter abstinence. Semen pH was unaffected by abstinence. The majority of publications found no difference in rates of viability with varying abstinence times, although total number of viable sperm increases with increasing abstinence. Some studies evaluating the impact of ejaculatory abstinence on intrauterine insemination (IUI), intracytoplasmic sperm injection (ICSI), and in vitro fertilization (IVF) demonstrated an association between short abstinence and improved outcomes.

Conclusions

The impact of abstinence on sperm quality is complex. While certain semen parameters improve with longer abstinence, others appear to improve with shorter abstinence. No clear recommendations can be made regarding ideal abstinence due to the conflicting nature of current evidence. Going forward, more research is needed to evaluate the impact of abstinence on pregnancy and fertilization rates.

     

Live birth after SrCl2 oocyte activation in previous repeated failed or low fertilization rates after ICSI of frozen-thawed testicular spermatozoa: case report

Purpose

To report a live birth resulting after strontium chloride (SrCl₂) oocyte activation in a couple with complete fertilization failure or low fertilization rates following intracytoplasmic sperm injection (ICSI) of frozen-thawed testicular spermatozoa.

Methods

The couple underwent ICSI of frozen-thawed testicular spermatozoa. After ICSI, the oocytes were artificially activated by SrCl₂ because the results of fertilization were not satisfactory in the previous cycles. The main outcome measures were fertilization, pregnancy, and birth.

Results

In the first and second cycles performed previously at another clinic, fertilization rates were 9.1 % and 0.0 %, respectively. In the third cycle, 31 metaphase II oocytes were retrieved. After sperm injection, all of the oocytes were stimulated using SrCl₂ for activation. Sixteen oocytes were fertilized (51.6 %), and a single embryo was transferred into the uterus on Day 3. A healthy girl weighing 2750 g was born at 40 weeks of gestation by caesarean section.

Conclusions

This result suggests that SrCl₂ could be useful for oocyte fertilization in case of repeated complete fertilization failure or low fertilization rates following ICSI of frozen-thawed testicular spermatozoa.     

Relationship of sperm DNA fragmentation, apoptosis and dysfunction of mitochondrial membrane potential with semen parameters and ART outcome after intracytoplasmic sperm injection

Purpose

The objective of this study was to assess the relationship of DNA damage, apoptosis and dysfunction of mitochondrial membrane potential (MMP) in ejaculated spermatozoa with semen parameters (sperm concentration, motility and normal morphology) and to evaluate their effects on assisted reproductive technology (ART) outcomes after intracytoplasmic sperm injection (ICSI).

Methods

Semen parameters in 120 infertile couples who underwent ICSI treatment were routinely analyzed and examined for the incidence of sperm DNA fragmentation (DF) by the sperm chromatin dispersion test (SCD). Whereas the incidences of sperm apoptosis and dysfunction of MMP were assessed by flow cytometry. The correlation among different sperm factors and ART outcomes was evaluated statistically.

Results

Sperm parameters were negatively related to DF (motility and normal morphology, p?<?0.01), apoptosis (concentration, motility and normal morphology, p?<?0.01, p?<?0.05 and p?<?0.05, p?<?0.01 respectively), and dysfunction of sperm MMP (concentration, motility and normal morphology, p?<?0.01). DF also showed a positive correlation with apoptosis and dysfunction of sperm MMP (p?<?0.05, and p?<?0.01 respectively). However, there was no significant correlation among DF, apoptosis and dysfunction of sperm MMP with ART outcomes, except early apoptosis which showed significant (p?<?0.05) negative correlation with pregnancy rate.

Conclusion

In the present study; DF, apoptosis and dysfunction of sperm MMP indicated negative relationship with sperm parameters. Although there was a negative correlation between early apoptosis and pregnancy rate, no significant correlation was observed between these parameters and ICSI outcomes.     

Estudio de la integridad del ADN espermático en relación con la calidad seminal y los resultados del ciclo de fecundación in vitro

Objective

To establish the relationship between the degree of sperm DNA fragmentation and seminal parameters, male age and outcome of in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI).

Subjects and methods

The sample consisted of 43 couples undergoing IVF/ICSI. The mean age of men was 35.62 ± 4.87 years and that of women was 33.88 ± 3.95 years. We prospectively analyzed sperm DNA fragmentation from each patient by the Sperm Chromatin Structure Assay (SCSA) and correlated the findings with seminal parameters (volume, concentration, progressive motility and morphology), IVF/ICSI outcomes and male age. IVF/ICSI outcome was evaluated by measuring the fertilization rate, embryo quality and the pregnancy and miscarriage rates.

Results

DNA fragmentation was negatively correlated with progressive motility (p = 0.000) of fresh and capacitated (p = 0.041) semen. Older patients had a significantly lower percentage of progressive motility in fresh seminal samples (p = 0.034) and worse sperm DNA quality (p = 0.043). There were no significant differences between the fragmentation rate and fertilization rate, embryo quality, and the pregnancy and miscarriage rates.

Conclusions

DNA fragmentation is inversely correlated with progressive motility in fresh seminal samples. DNA fragmentation does not predict the IVF/ICSI outcome but screening for sperm DNA damage may provide useful information in the diagnosis of idiopathic male infertility. Seminal quality is affected by increasing male age.     

IVF/ICSI outcomes between cycles with luteal estradiol (E2) pre-treatment before GnRH antagonist protocol and standard long GnRH agonist protocol: a prospective and randomized study

Objective

To study if luteal E₂ pre-treatment before GnRH antagonist protocol improves IVF/ICSI outcomes compared with standard long GnRH agonist protocol.

Design

A prospective, randomized and controlled study.

Setting

ART center of a state public hospital

Patient(s)

Two hundred twenty infertile women underwent IVF/ICSI treatments.

Intervention(s)

Participants received oral Estradiol Valerate 4 mg/day preceding the IVF cycle from day 21 until day 2 of next cycle before GnRH antagonist protocol (E₂ pre-treatment group n?=?109) or received standard long GnRH agonist protocol as control group (n?=?111).

Main outcome measure(s)

Number of oocytes collected, MII oocytes, fertilization, implantation, live birth and early pregnancy rate, and hormone profiles.

Result(s)

E₂ pre-treatment exerted a significant suppressive effect on FSH but not LH secretion compared with basal FSH and LH levels. In E₂ pre-treatment group serum LH level was significantly higher during COH and serum P was also significantly higher on the day of HCG injection compared with control group. Five patients from E₂ pre-treatment group had elevated LH at all time (≥10 IU/L) and also a concomitantly high P (>1 ng/mL). Two of the five women achieved pregnancy but had early pregnancy loss. Overall, IVF/ICSI outcomes such as implantation, clinical pregnancy and live birth rates were similar between E₂ pre-treatment and control groups.

Conclusion(s)

Luteal E₂ pre-treatment before GnRH antagonist protocol significantly increases serum LH level and incidence rate of premature LH but no significant effect is observed on implantation, clinical pregnancy, live birth and early pregnancy loss rates compared with long GnRH agonist protocol. However, more studies in large numbers of cycles are needed to confirm that increased serum LH level by E₂ pre-treatment during COH has no negative effect on the IVF/ICSI outcomes.     

Delayed intracytoplasmic sperm injection (ICSI) with trophectoderm biopsy and preimplantation genetic screening (PGS) show increased aneuploidy rates but can lead to live births with single thawed euploid embryo transfer (STEET)

Purpose

The aim of this study was to report the results of IVF with trophectoderm biopsy and preimplantation genetic screening (PGS) following delayed intracytoplasmic sperm injection (ICSI).

Methods

Patients undergoing IVF with PGS and delayed ICSI were included in the study. Indications for delayed ICSI included absent or poor fertilization via standard insemination or more than 50 % immature oocytes, noted post-cumulus stripping for standard ICSI procedure. Delayed ICSI was performed the day after retrieval due to absent or poor fertilization. The immature oocytes were kept in extended culture, and if demonstrated maturity, ICSI was performed. Primary outcome included fertilization rate and blastocyst stage formation, defined by the number of blastocysts for biopsy. Secondary outcome included aneuploidy rate and pregnancy outcomes following single thawed euploid embryo transfers (STEET).

Results

Sixteen patients with delayed ICSI were included in the study. Twelve were due to poor fertilization and four secondary to immature oocytes. A total of 219 oocytes were retrieved; ten were frozen upon patient request, 168 had standard insemination, and 13 had routine ICSI on the day of retrieval. A total of 129 oocytes underwent delayed ICSI. Sixty-three (49 %) fertilized, 19 (14.7 %) reached blastocysts for biopsy; fivw of which were chromosomally normal (26.3 %). Three patients underwent STEET of a delayed ICSI embryo; all three resulted in live births, including one embryo biopsied on day 8 of development.

Conclusion

Fertilization failure or an excessive proportion of immature oocytes in an IVF cycle, necessitating delayed ICSI, showed equivalent fertilization and blast formation rates. With the implementation of trophectoderm biopsy and PGS, these embryos can lead to healthy live born babies.

     

Aneuploidy in abortuses following IVF and ICSI

Purpose

To compare aneuploidy rates in first trimester pregnancy losses following IVF ± ICSI.

Methods

A retrospective cohort analysis of karyotypes of abortuses following conventional IVF (n = 159) and ICSI (n = 196).

Results

50.1% of losses were found to be cytogenetically abnormal among all patients undergoing IVF ± ICSI. A significant increase in fetal aneuploidy rate was noted with increasing maternal age (<30 years = 26.1% vs. 31 to 34 years. = 38.2% vs. 35 to 39 years. = 51.3% vs. >39 years. = 65.9%). Aneuploidy rates were similar in the ICSI vs. conventional IVF groups (52.6% vs. 47.2% [p 0.31, RR 1.11, 95% CI 0.90, 1.38]). More sex chromosome anomalies were noted in the ICSI group.

Conclusions

The aneuploidy rate in first trimester abortuses significantly increases with increasing maternal age. ICSI was not shown to significantly increase the aneuploidy rate. However, more sex chromosome anomalies were found among pregnancies resulting from ICSI.     

An auto-controlled prospective comparison of two embryos culture media (G III series versus ISM) for IVF and ICSI treatments

Purpose

To compare the effects of 2 different media on embryo morphology and development at days 2/3.

Method

Six hundred seventy-six attempts from 512 couples were included in this prospective auto-controlled study. Sibling oocytes of all couples undergoing an IVF (n?=?286) or ICSI (n?=?390) attempt were randomly assigned to either GIII series (Vitrolife) or ISM (Medicult) media. Primary end points were fertilization and embryo morphology rates.

Results

Fertilization rates in GIII series and ISM (IVF: 59.9 vs 62.0% and ICSI: 65.7 vs 66.8%) respectively were not different. GIII series showed an increase, compared to ISM, of early cleavage rate, (IVF: 25.8 vs 16.2% (p?=?0.005); ICSI: 40.8 vs 25.5% (p?<?0.0001), and good embryo morphology rate at day 2 [IVF: 64.6 vs 57.3% (p?=?0.01); ICSI: 74.2 vs 69.4 (p?=?0.03)] and at day 3 [IVF: 57.5 vs 49.0% (p?=?0.02); ICSI: 67.2 vs 61.6% (p?=?0.01)].

Conclusions

Embryo morphology at days 2/3 was significantly enhanced when the embryos were cultured in GIII series.     

Impact of vaginal ascorbic acid on abnormal vaginal microflora

Background

In recent years, it has become evident that ovarian stimulation, although a central component of in vitro fertilization (IVF), may itself has detrimental effects on oogenesis, embryo quality, endometrial receptivity, and perhaps also perinatal outcomes.

Objective

To evaluate the effect of higher gonadotrophin dose on clinical pregnancy rate in normo-responder ICSI cycles with long protocol.

Methods

A retrospective study was planned in the Department of Reproductive Endocrinology of Zekai Tahir Burak Women’s Health Education and Research Hospital. 362 normo-responders undergoing ICSI cycles with long protocol were included in the study. Group 1 (n = 260): Total gonadotrophin dose <2198 IU and Group 2 (n = 102): Total gonadotrophin dose >2198 IU. Laboratory IVF outcome, clinical pregnancy rate were evaluated.

Result(s)

There was no statistically significant difference between peak estradiol levels, endometrial thickness, fertilization rates among the Group 1 versus Group 2 (p > 0.05). But there was a statistically significant difference in age, baseline FSH, oocyte number, 2PN, and clinical pregnancy among the Group 1 versus Group 2. Clinical pregnancy rate were significantly higher in Group 1 compared with Group 2 (p < 0.001). Lower gonadotrophin dose, 2PN was an independent positive predictor of clinical pregnancy (OR 2.65 for gonadotrophin dose, OR 1.1 for 2PN)

Conclusion(s)

Higher total gonadotrophin dose adversely affect clinical pregnancy in normo-responder patients undergoing ICSI cycles with long protocol.     

Homologe intrauterine Insemination

Background

The aim of this retrospective study was to evaluate homologous intrauterine insemination (IUI) before in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI).

Patients and methods

A total of 448 patients were included. Data were collected from 1,086 treatment cycles.

Results

The live birth rate (BTH rate) was about 17% per couple. About 87% of all live births were achieved within the first three IUI cycles (P=0.05). A significantly better likelihood of pregnancy was found for patients with polycystic ovarian syndrome PCOS (P<0.05). Patients who were not tested for their tubal patency achieved a higher BTH rate compared to patients undergoing this investigation (P<0.05).

Conclusion

Using a minimally invasive method with easy handling and little psychological distress compared to IVF/ICSI, IUI should be a first step in infertility treatment. An evaluation of tubal patency beforehand seems indicated only if there is a specific patient history.     

Intracytoplasmic sperm injection outcomes of obstructive and nonobstructive azoospermic men

Purpose

We aimed to compare the outcomes of intracytoplasmic sperm injection (ICSI) cycles in ostructive and nonobstructive azoospermic men.

Methods

In this retrospective study, we searched the first ICSI cycle parameters of 211 azoospermic men. Our main outcomes were the average fertilization rate, implantation rate, pregnancy and miscarriage rates.

Results

The results of this study showed that although the males with obstructive azoospermia had better fertilization and biochemical pregnancy rates than the ones with nonobstructive azoospermia, clinical pregnancy and miscarriage rates among the groups were similar.

Conclusion

ICSI overcomes the obstacles related to the sperm in its function as a carrier but it cannot alter the message carried by the male gamete.     

The role of diagnostic hysteroscopy before the first in vitro fertilization/intracytoplasmic sperm injection cycle

Objective

To assess the role of diagnostic hysteroscopy in pregnancy outcome in patients starting the first in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI).

Materials and methods

A total of 567 infertile women who underwent first IVF treatment were reviewed retrospectively. Two hundred and fifteen (37.9?%) women underwent diagnostic hysteroscopy before the scheduled controlled ovarian hyperstimulation (COH). Two hundred and eighty-four (50.1?%) women only accepted transvaginal ultrasonography (TVU), and 68 (12.0?%) woman did not receive hysteroscopy and TVU before COH. Primary outcome measure was the live birth rate. Secondary outcome measures were the implantation rate, clinical pregnancy rate, and miscarriage rate.

Results

There was no difference among three groups with regard to number of oocytes retrieved, fertilization rate, implantation rate, clinical pregnancy rate, miscarriage rate, and live birth rate per cycle. The implantation rate and clinical pregnancy rate were significantly lower in the cycles with endometrial thickness <8?mm on human chorionic gonadotropin day (P?=?0.001 and 0.018, respectively). Women with greater body mass index (>22) were associated with higher incidence of intrauterine lesions (22 of 36, 61.1?%).

Conclusion

Diagnostic hysteroscopy prior to COH may not increase the implantation rate and live birth rate for the first IVF/ICSI programs. The efficacy of routinely performing diagnostic hysteroscopy before the first IVF program is needed to re-evaluate.     

The effect of chromosomal polymorphisms on the outcomes of fresh IVF/ICSI–ET cycles in a Chinese population

Purpose

Chromosomal polymorphisms (CPs) have been reported to be associated with infertility; however, their effects on the outcomes of in vitro fertilization/intracytoplasmic sperm injection–embryo transfer (IVF/ICSI–ET) are still controversial. In this retrospective study, we aimed to evaluate the effect of CPs on IVF/ICSI–ET outcomes.

Methods

To investigate whether CPs affected the outcomes of fresh IVF/ICSI–ET cycles in a Chinese population, we evaluated infertile couples with male carriers of CPs (n?=?348), infertile couples with female carriers (n?=?99), and unaffected couples (n?=?400) who had received their first treatment cycles in our hospital between January 2013 and March 2015.

Results

CPs in either male or female carriers seemed to have adverse effects on IVF/ICSI–ET outcomes. CPs in male carriers affected outcomes mainly by decreasing the rates of fertilization, embryo cleavage, good quality embryos, clinical pregnancies, ongoing pregnancies, and deliveries as well as increasing the biochemical pregnancy rate (P?<?0.05); CPs in female carriers affected outcomes only by lowering the embryo cleavage rate (P?<?0.05). The mean fertilization rate of couples with male CP carriers undergoing IVF was significantly lower than that in those undergoing ICSI (61.1 versus 66.5 %, respectively; P?=?0.0004).

Conclusions

Our data provide evidence for the involvement of CPs in the poor outcomes of fresh IVF/ICSI–ET cycles in a Chinese population. The use of ICSI might improve outcomes by increasing the fertilization rate for men with CPs.

     

Successful intracytoplasmic sperm injection with testicular spermatozoa from a man with multiple morphological abnormalities of the sperm flagella: a case report

Purpose

The purpose of this study is to analyze the sperm morphology of a Chinese man affected with multiple morphological abnormalities of the sperm flagella (MMAF) and observe the intracytoplasmic sperm injection (ICSI) outcome.

Methods

A Chinese man was diagnosed with multiple morphological abnormalities of the sperm flagella by semen analysis and electron microscopy. Testicular spermatozoa were injected intracytoplasmically, and the following ICSI results were observed.

Results

All the spermatozoa from his ejaculate were immotile and morphologically abnormal in the flagellum. In transmission electron microscopy assays, most spermatozoa showed disorganized fibrous sheath, accompanied by distortion of various cytoskeletal components, and missing of the central pair microtubules. Testicular sperm was injected to the oocytes in two ICSI cycles, with fertilization rates of 45.5 and 40.0%. Finally, a healthy female infant was delivered at the second ICSI cycle.

Conclusions

Fertilization and pregnancy could be achieved by intracytoplasmic sperm injection, regardless of severe flagellar defects. ICSI is effective for MMAF-affected man, and testicular sperm is an alternative when no motile sperm is available.

     

Sperm telomere length in donor samples is not related to ICSI outcome

Purpose

Variations in sperm telomere length (STL) have been associated with altered sperm parameters, poor embryo quality, and lower pregnancy rates, but for normozoospermic men, STL relevance in IVF/ICSI is still uncertain. Moreover, in all studies reported so far, each man’s STL was linked to the corresponding female partner characteristics. Here, we study STL in sperm donor samples, each used for up to 12 women, in order to isolate and determine the relationship between STL and reproductive outcomes.

Methods

Relative STL was determined by qPCR in 60 samples used in a total of 676 ICSI cycles. Univariable and multivariable statistical analyses were used to study the STL effect on fertilization rate; embryo morphology; biochemical, clinical, and ongoing pregnancy rates; and live birth (LB) rates.

Results

The average STL value was 4.5 (relative units; SD 1.9; range 2.4–14.2). Locally weighted scatterplot smoothing regression and the rho-Spearman test did not reveal significant correlations between STL and the outcomes analyzed. STL was not different between cycles resulting or not in pregnancy and LB (Mann-Whitney U test, p?>?0.05). No significant effect of STL on reproductive outcomes was found, with the OR for each unit increase in STL (95% CI) of 0.94 (0.86–1–04), 0.99 (0.9–1.09), 0.98 (0.89–1.09), and 0.93 (0.8–1.06) for biochemical, clinical, and ongoing pregnancy and LB, respectively. The multilevel analysis confirmed that the effect of STL on fertilization; biochemical, clinical, and ongoing pregnancy; and LB was not significant (p?>?0.05).

Conclusion

After addressing STL independently from female variables, results show that STL measurement is not useful to predict reproductive outcomes in ICSI cycles using donor semen.