ABSTRACT
Objective@#This study was conducted to investigate the relationship of semen parameters in samples used for intracytoplasmic sperm injection (ICSI) with fertilization and pregnancy rates in infertile couples. @*Methods@#In this prospective study of Infertile couples with male factor infertility that had undergone ICSI, fractions of the same semen samples obtained for microinjection (to ensure the best predictability) were evaluated to determine the semen parameters and sperm DNA fragmentation index (DFI) on the day of oocyte recovery. @*Results@#In total, 120 couples completed the study and were subdivided into fertilized (n=87) and non-fertilized couples (n=33). The fertilized couples were further classified into pregnant (n=48) and non-pregnant (n=39) couples. Compared to non-fertilized and non-pregnant couples, fertilized and pregnant couples showed statistically significantly higher sperm viability and percentage of normal sperm morphology, as well as significantly lower sperm DFI values. A receiver operating characteristic curve analysis of data from the 120 ICSI cycles showed that sperm viability, normal sperm morphology percentages, and sperm DFI were significant prognostic indicators of fertilization at cutoff values of 40%, 7%, and 46%, respectively. A sperm DFI of 46% showed sensitivity and specificity of 95% and 90%, respectively, for predicting fertilization, and no clinical pregnancies occurred in couples with a sperm DFI above 46%. @*Conclusion@#Semen parameters from the ICSI day sample, especially sperm viability, normal morphology, and DFI, had an impact on fertilization and pregnancy outcomes in ICSI cycles.
ABSTRACT
Total knee replacement in severe deformities is a challenging procedure. Varus and flexion are the commonest deformities seen. Thorough soft tissue release and balancing is the key to a successful outcome. We tried to correct these cases without the need for expensive augments and specialized prosthesis. Our study included 30 knees in 23 patients with severe flexion and varus deformities. The average preoperative varus deformity was 20° [range, 14-38°] and the average flexion deformity was 15.6° [range, 5-30°]. Bone graft was used in 8 cases [26%] and tibial stems in 2 cases [6%]. No constrained prosthesis was used. The average follow up was 31 months [range, 8-65 months]. The average postoperative range of flexion was 115° [range, 90-147°], range of extansion between 0-6° and the average varus correction was 26° [range, 12-42°]. At the final follow up, we had 15 excellent, 12 good, 2 fair and 1 poor functional result, giving a 90% success rate. Our techniques resulted in restoration of alignment and stability without the need for wedges or constrained prosthesis with encouraging early and mid-term results