SHORT COMMUNICATION: GIFT and IUI in the district general hospital

Recent reports on gamete intra-Fallopian transfer (GIFT) inhospitals without IVF support have been encouraging. We reporton the use of GIFT and intrauterine insemination (IUI) at NorthamptonGeneral Hospital, where capital costs for setting up the programmehave been low. To date seven IUI and three GIFT treatments havebeen completed, resulting in three IUI positive pregnancy tests.One miscarried after several positive -HCGs and one GIFT pregnancywas achieved.     

Sperm selection strategies and their impact on assisted reproductive technology outcomes

The application of assisted reproductive technologies (ART) has revolutionised the treatment of human infertility, giving hope to the patients previously considered incapable of establishing pregnancy. While semen analysis is performed to access whether a sample has an adequate number of viable, motile and morphologically normal sperm cells able to achieve fertilisation, sperm selection techniques for ART aim to isolate the most competent spermatozoon which is characterised by the highest fertilising potential. Based on the semen analysis results, the correct sperm selection technique must be chosen and applied. In this review, different sperm selection strategies for retrieving spermatozoa with the highest fertilising potential and their impact on ART outcomes are discussed. In addition, advantages and disadvantages of each method and the best suited techniques for each clinical scenario are described.     

处理后前向运动精子总数对夫精人工授精妊娠率的影响

目的:探讨处理后前向运动的精子总数(post-wash total mobile sperm count,PTMC)对夫精宫腔内人工授精(intrauterine insemination,IUI)妊娠率的影响。方法:回顾性分析因男方因素行IUI治疗的不孕夫妇的数据,并比较了PTMC(3.0~9.9)×10~6(研究组)及PTMC≥10×10~6(对照组)患者的IUI妊娠率。结果:共纳入139例(274个周期)患者。其中研究组87个周期,平均PTMC为(6.2±1.7)×10~6,对照组187个周期,平均PTMC为(25.6±13.7)×10~6,组间周期妊娠率差异无统计学意义(P0.05)。在139例患者中,有32例患者(55个周期)PTMC始终10×10~6,83例患者(149个周期)PTMC始终≥10×10~6,在4个周期后患者的累积妊娠率(cumulative pregnancy rate,CPR)分别为15.6%(5/32)和25.3%(21/83),组间比较也无统计学差异(P0.05)。在PTMC始终10×10~6组,在第4周期没有妊娠发生。结论:对于因男方因素行辅助生殖技术助孕治疗的患者,即使PTMC10×10~6也可以尝试IUI,并能获得较好的妊娠率,但对于反复PTMC10×10~6患者,不建议患者多次反复尝试,在经过3次IUI后仍未孕者,可考虑行IVF助孕治疗。     

Sperm DNA integrity assessment in prediction of assisted reproduction technology outcome

BACKGROUND: The sperm chromatin structure assay (SCSA) has beensuggested as a predictor of fertility in vivo as well as invitro. The available data however, have been based on limitednumbers of treatments. We aimed to define the clinical roleof SCSA in assisted reproduction. METHODS: A total of 998 cycles[387 intrauterine insemination (IUI), 388 IVF and 223 ICSI]from 637 couples were included. SCSA results were expressedas DNA fragmentation index (DFI) and high DNA stainable (HDS)cell fractions. Outcome parameters were biochemical pregnancy(BP), clinical pregnancy (CP) and delivery (D). RESULTS: ForIUI, the odds ratios (ORs) for BP, CP and D were significantlylower for couples with DFI >30% as compared with those withDFI 30%. No statistical difference between the outcomes of ICSIversus IVF in the group with DFI 30% was seen. In the DFI >30%group, the results of ICSI were significantly better than thoseof IVF. CONCLUSIONS: DFI can be used as an independent predictorof fertility in couples undergoing IUI. As a result, we proposethat all infertile men should be tested with SCSA as a supplementto the standard semen analysis. When DFI exceeds 30%, ICSI shouldbe the method of choice.     

人精子顶体反应检测临床应用价值探讨

[目的]检测Ca2 载体A23187诱导精子顶体反应(AR)率,探讨其临床应用价值。[方法]对51例患者检测A23187诱导精子AR率,分析其与精液常规分析、宫腔内人工授精(IUI)、体外受精(IVF)、单精子卵泡浆内注射(ICSI)结果的关系。[结果]①精液常规分析对诱导AR率的相关性不显著;②诱导AR率低于18.1%理论值时,IVF受精率理论值为0;③3次IUI失败者AR率较受精正常者降低(P<0.05)。④不明原因不育者精子AR率与IVF受精率、卵裂率关系呈正相关(r=0.89,P<0.05),与ICSI受精率、卵裂率无显著关系;用ICSI治疗,其受精率、妊娠率高于IVF治疗组。⑤IVF受精不良病例AR率低,用ICSI治疗后受精率、优质胚胎率升高(P<0.05)。[结论]Ca2 载体A23187诱导顶体反应能预测精子的受精能力,有助于男性不育的临床诊断与治疗。     

Is intrauterine insemination a viable treatment option for women over 43 years old? An analysis by ovarian stimulation protocol and sperm source

PurposeThe aim of this study was to determine how female age at the end of the reproductive spectrum effects success of natural cycle intrauterine insemination (IUI) or IUI in combination with ovarian stimulation.MethodsWe performed a retrospective cohort study of women 43 years of age and older at the time of IUI in a single academic fertility center between January 2011 and March 2018. Primary outcomes were both pregnancies and live births per cycle of IUI. Data are presented as percentage or mean ± SD. Fisher exact and chi-squared analyses were performed.ResultsThere were 9334 IUI cycles conducted during the study period. Of these cycles, 325 IUIs (3.5%) were for women aged 43 years and over at the time of insemination (43.6 ± 0.8, range 43 to 47 years). Analysis of these 325 IUI cycles revealed 5 biochemical pregnancies (1.5%) and only 1 live birth (0.3%). The pregnancy rate did not differ between IUIs using donor sperm (N = 1/49, 2.0%) compared to IUIs with partner sperm (N = 4/276, 1.4%). The pregnancy rate did not differ between IUIs with gonadotropins (N = 2/211, 0.9%), clomiphene or letrozole (N = 2/78, 2.6%), or natural cycle (N = 1/36, 2.8%).ConclusionsThe use of intrauterine inseminations in women 43 years of age and older is an ineffective treatment strategy. This is irrespective of the use of ovarian stimulation or donor sperm. Costly gonadotropin injections did not increase the chance of pregnancy nor did oral medication when compared to natural cycle IUIs.     

处理后前向运动精子总数对宫腔内人工授精妊娠率的影响

目的:探讨精液处理后前向运动精子总数(post-wash total mobile sperm count,PTMC)对单纯以少、弱精子症为病因引起不孕不育症患者的夫精宫腔内人工授精(intrauterine insemination,IUI)妊娠率的影响。方法:分析2015年3月至2016年3月单纯以少、弱精子症为适应症接受IUI治疗的125个周期的临床资料,按处理后前向运动精子数进行分组,A组19个周期:10×10~6、B组71个周期:10×10~6~20×10~6、C组35个周期:20×10~6,比较各组临床妊娠率。结果:周期总临床妊娠率15.20%,A组周期妊娠率10.53%,B组周期妊娠率16.90%,C组周期妊娠率14.29%,各组妊娠率比较差异无统计学意义(P0.05)。结论:(1)由少、弱精子症引起不育的患者行IUI治疗,即使PTMC10×10~6也能获得一定的妊娠率。(2)精液处理后前向运动精子数对IUI的妊娠率有一定影响,但妊娠率并非一定随着PTMC的增多而提高。     

白细胞精子症与宫腔内人工授精周期临床妊娠率的关系

目的:探讨白细胞精子症对行宫腔内人工授精(intrauterine insemination,IUI)后周期临床妊娠率的影响。方法:分析在本中心行IUI男性患者的精液检查结果,根据WHO推荐方法对185例男性患者的精液质量进行分析,采用联苯胺染色法检测精液白细胞浓度,并将患者分为白细胞精子症不育患者组(白细胞浓度>1×10~6/m L,n=33)和精液白细胞正常不育患者组(白细胞浓度≤1×10~6/m L,n=152)。比较两组间的精液量、精子浓度、精子正常形态率、处理前后前向运动精子总数、精子DNA碎片指数、周期临床妊娠率等方面的差异。结果:白细胞精子症不育组行IUI共47个周期,白细胞正常不育组行IUI共279个周期。两组间精液量、精子浓度、处理前后前向运动精子总数无显著性差异(P>0.05)。在精子正常形态率方面,白细胞精子症患者不育组低于白细胞正常不育患者组,有统计学意义(P<0.05)。精子DNA碎片指数方面,白细胞精子症患者不育组临床妊娠率高于白细胞正常不育患者组,有统计学意义(P<0.05)。但是,在临床妊娠率数据中,我们发现白细胞精子症患者不育组与白细胞正常不育患者组无显著差异(P>0.05)。结论:虽然白细胞精子症会影响精子的正常形态、精子存活率以及DNA碎片指数,但是白细胞精子症不影响IUI临床妊娠率。     

Management of endometrial polyps in subfertile women: a systematic review

The aim of this systematic review is to evaluate the evidence for the impact of polypectomy on fecundity, implantation and live birth rates in women who are trying to conceive spontaneously or by assisted conception. A literature search was performed to identify all controlled studies that compared the effects of polypectomy or conservative management of the polyp on pregnancy outcome. Among the three studies that met the inclusion criteria, only one was a randomized controlled trial, which reported a significantly higher pregnancy rates after polypectomy in women undergoing intrauterine insemination. The other two studies were retrospective and suggested no beneficial effects of polypectomy on women undergoing assisted conception. Meta-analytic pool was not feasible as the studies varied in their design and the characteristics. While there is some evidence from basic science studies to suggest a detrimental effect of polyps on fertility, the evidence from clinical studies is scarce and conflicting. Polyps diagnosed prior to commencement of controlled ovarian hyperstimulation (COH) for in vitro fertilization (IVF) should therefore be removed. The management of polyps seen during the course of COH for IVF should be individualized given the number of embryos created, the previous reproductive history of the patient and the individual clinics’ success rates for their frozen embryo programme.     

正常男性连续两次射精前后精液质量比较

目的研究连续射精对正常男性精液质量的影响。方法120名拟行宫腔内人工授精（IUI）的正常男性间隔24h各取精1次，采用WLJY-9000伟力彩色精子质量分析系统测定精液量、pH值、液化时间、精子密度、存活率、活动率、正常形态率、总精子数，进行统计学分析。结果精液量、总精子数、精子密度呈下降趋势，精子存活率和精子活动率（a＋b级）均呈上升趋势，但差异无统计学意义（P〉0．05）。结论正常男性精液量、总精子数随射精频度增加有所降低，而精子存活率和活动率有所增加，连续两次射精并不影响精液质量。