Quantifying the effectiveness and cost-efficiency of food supplementation with antioxidants for male infertility

In male infertility, complementary treatment with antioxidant-containing food supplements quadruples the spontaneous pregnancy rate and reduces the cost per pregnancy by 60%.     

After the FLUSH trial: a prospective observational study of lipiodol flushing as an innovative treatment for unexplained and endometriosis-related infertility

OBJECTIVES: To assess the demographics, efficacy and safety of lipiodol flushing fertility treatment. DESIGN: Prospective observational study. SETTING: Secondary level care infertility clinic and radiology centre based in Auckland, New Zealand. POPULATION: The first cohort of 100 New Zealand women with infertility to undergo lipiodol flushing as an innovative fertility treatment. METHODS: Women received lipiodol flushing performed by a hysterosalpingogram technique and were followed up at 6 months. MAIN OUTCOME MEASURES: Clinical pregnancy at 6 months post-treatment; and live birth or ongoing pregnancy. RESULTS: The overall pregnancy rate was 30% and the live birth or ongoing pregnancy rate 27%. For women under 40 years old, a 32% pregnancy rate and a 25% live birth or ongoing pregnancy rate were seen in women with unexplained infertility, and a 50% pregnancy rate and a 47% live birth or ongoing pregnancy rate were seen in women with endometriosis. Of women aged 40 years and older, the pregnancy rate was 13% and the live birth or ongoing pregnancy rate was 13%. The pregnancy rates included those occurring after additional interventions, such as intrauterine insemination and in vitro fertilisation, accounting for 12 of the 30 pregnancies. There were no treatment complications. CONCLUSION: This study provides further evidence of the efficacy and safety of lipiodol flushing fertility treatment.     

A randomized study of intracytoplasmic sperm injection (ICSI) versus subzonal insemination (SUZI) for the management of severe male-factor infertility

Objective Our objective was to compare the fertilization rates achieved by ICSI versus SUZI in couples with severe male infertility.Design This was a randomized, prospective study.Setting The study took place at the In-Vitro Fertilization-Embryo Transfer Unit, Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center.Materials and Methods Oocytes of 12 patients were randomly allocated to either ICSI or SUZI procedures. Each woman thus served as her own control. All 12 patients had undergone at least two previous in vitro fertilization cycles with no fertilization or had a very low sperm count, i.e., a total motile sperm count of less than 0.5 × 10 ⁶.Results A total of 117 oocytes was obtained for fertilization. Of these oocytes, 16% (10/63) were successfully fertilized by SUZI, compared to 33% (18/54) treated by ICSI. This difference was statistically significant (P < 0.05). Of the 12 cycles, ICSI provided embryos in 10 cycles (83%), while SUZI was successful in only 6 cycles (50%). Four pregnancies were achieved: 33% per attempt, or 40% per transfer.     

Incidental deviation of short and long GAG repeats in the androgen receptor gene for Japanese male infertility

Aim:  The present study investigated whether the CAG repeat length in exon 1 of the androgen receptor gene on the X chromosome is associated with male infertility.
Methods:  The CAG repeat length between the two groups of 143 idiopathic infertile Japanese men with severe oligozoospermia or non-obstructive azoospermia and 100 fertile men were analyzed. The azoospermia factor deletions were also analyzed.
Results:  Although there was no significant difference in the mean length between the two groups observed ( P  = 0.055), the distribution in the infertile men was wider than that in the fertile men. Similar results were detected in the combined data from previous Japanese reports and our present data including 261 infertile and 235 fertile men. We detected 12 and 34 CAG repeats in the present study that were the shortest and the longest repeats in Japan, respectively.
Conclusions:  These results suggest that excessive expansion or reduction of CAG repeats might be related to impaired spermatogenesis. (Reprod Med Biol 2003; 2 : 145–150)     

An evaluation of the effect of pentoxifylline on sperm function and treatment outcome of male-factor infertility: A preliminary study

Objective Our objective was to study the effect of pentoxifylline (PF) on fertilization rates in couples with previous failure of fertilization and male-factor infertility and to determine the predictive value of conventional semen analysis parameters in selecting the couples who would benefit from the elective use of PF in IVF.Design This prospective controlled study was conducted in an assisted conception unit.Methods Sixty-nine couples with previous failed IVF cycle, who had a low fertilization rate and/or male-factor infertility, were recruited to the study. Multiple follicular development was induced using the same protocol of human menopausal gonadotropin and gonadotropin releasing hormone analogue in both cycles. The oocytes were inseminated with spermatozoa treated with PF. The fertilization rates in the PF cycle were compared to the reference cycle based on semen analysis parameters and previous fertilization rates.Results In couples with male infertility, the fertilization rate improved significantly, from 17 to 50% in PF cycles (P<0.001). A significant improvement in fertilization rate was also demonstrated in couples with previous poor fertilization. <30% (P<0.01). particularly in those with a very low fertilization rate, <20% (P<0.001). Although there was an overall improvement in fertilization rates in couples with male-factor infertility, there was no cutoff value in sperm motility that would make a significant difference in the impact of PF on fertilization rates.Conclusion Couples with poor fertilization rates in vitro benefit with a significant improvement in fertilization by the elective use of PF. The improvement is most significant in couples with previous complete failure of fertilization and poor fertilization rates, <30%.     

An open multicenter study to compare the efficacy of intraperitoneal insemination and intrauterine insemination following multiple follicular development as treatment for unexplained infertility

Purpose: This multicenter study was carried out to compare the efficacy of intrauterine insemination (IUI) and intraperitoneal insemination (IPI) associated with multiple follicular development as treatment for unexplained infertility. Method: A total of 205 couples completed the trial. Sixty-seven couples underwent treatment with IPI (group A) and 138 couples underwent treatment with IUI (group B). Results: Clinical pregnancy was obtained in 23 couples in group A (pregnancy rate: 34.3%) and in 36 couples in group B (pregnancy rate: 26.1%). No significant difference was observed between group A and group B. As for the evolution of pregnancies and the incidence of twin pregnancies, no significant difference was observed between the two groups. Conclusions: Because IUI and IPI allow us to obtain same results and IPI is more invasive than IUI, the latter technique can be considered the method of choice and IPI should be used when IUI is difficult to perform, as in the presence of a tight cervical canal. The following persons from the Department of Obstetrics and Gynaecology, University of Cagliari, Cagliari, Italy, also contributed to the conduct and analysis of the study: V. Mais and A. M. Paoletti.     

Functional performance study of an adapted design of the woman’s condom: a crossover,noninferiority, randomized clinical trial

Objectives: We aimed to assess the functional performance and safety of a modified Woman’s Condom (WC2) against the existing FC2 female condom.

Study design: This randomized clinical trial enrolled 287 women in one South African site. The primary outcome of the study was the rate of female condom failure. Participants were asked to use five of each female condom type and to collect information on use in a condom log at home and were interviewed after use of each FC type.

Results: Noninferiority was demonstrated for the WC2 with respect to the reference condom FC2 for all condom functions. The WC2 was found to be superior to the FC2 reference condom for clinical failure (p?=?.000), total female condom failure (p?=?.001), misdirection (p?=?.000) and slippage (p?=?.004).

Conclusion: The WC2 female condom performs as well as the FC2 female condom and offers good stability during use.

Implications: Results from this study will inform further refinement of this female condom design, resulting in a new and potentially less expensive Woman’s Condom.