[Impact of gamete cell quality on the outcome of intracytoplasmic sperm injection]

Background: the quality of the gametes used for an intracytoplasmic microinjection of spermatozoïde is a significant factor which can influence pregnancy rates

Aim: To assess the effect of conventional sperm parameters, origin of spermatozoa and oocyte quality on pregnancy rate in ICSI

Methods: A retrospective and comparative study of 500 women who underwent ICSI cycle during the study period from January 2004 to December 2005. Conventional sperm parameters [count, motility and morphology] and oocyte quality [mature and immatures oocytes] was compared in two groups of patients: Those achieving a pregnancy: The "pregnancy+" group and those failing to have a pregnancy: The "pregnancy-" group

Results: Among the conventional sperm parameters, only spermatozoa count after preparation was significantly higher in "pregnancy+" group [p=0,02]. We found significantly more pregnancies in ejaculated and epididymal sperm groups than in the testicular one [p<10-3]. The number of oocyte retrieved was significantly higher in "pregnancy+" group [13,9 +/- 7 vs 10,6 +/- 7,6 ; p<10-3] with mainly mature oocyte [metaphaseII] [9,1 +/- 5,5 vs 6,6 +/- 5,4 ; p<10-3]. Analysis of ROC curve and logistic regression study show that for mature oocyte, the most discriminative cut-off for predicting pregnancy is 4 [OR=2,1 ; LR+=6,7 ;IC[1 ;1,4] ; p0,009]

Conclusion: Conventional parameters of ejaculated sperm have almost no influence on pregnancy rates in ICSI. Testicular sperm seem to have worse results. The number of oocytes retrieved and the proportion of mature oocytes [metaphaseII] affect markedly the prognosis

Clinicals and biologicals aspects of ICSI cycles on polycystic ovary syndrome patients

To analyse clinical and biological pecularities of Polycystics Ovarian Syndrome[PCOS] patients enrolled on ICSI cycles and compare them to normo-ovulatory women. 100 controlled ovarian stimulation cycles for ICSI in women with PCOS and 200 cycles in normo-ovulatory women. There was no significant difference in term of cancellation rate [5,5% in PCOS group vs 5%;NS]. The mean number of follicles was higher in patients with PCOS [18,1 +/- 8,5 vs 9,4 +/- 5,5;p<0,05], Oocyte mature rate and fertilization rate were higher in PCOS group [67% vs 52%; p<0,05] [75% vs 63,7%; p<0,05] respectively. Grade 1 Embryo rate was significantly higher in PCOS group [69% vs 53%; p<0,05]. Implantation rate [16,6% vs 12,1%; NS] and clinical pregnancy rate per transfer [3 1,5% vs 22,2%; NS] did not differ statistically in the two groups. Miscarriage rate was higher in PCOS group but this did not reach the statistical significance [20% vs 7,1%; NS]. 11 cases of Ovarian hyperstimulation syndrome occurred in PCOS group versus 4 on normo-ovulatory group. Use of ICSI as fertilization technique was correlated with good biologic parameters on PCOS patients with better fertilization rate and embryo quality and similar pregnancy rate comparing to normo-ovulatory women. However, it still be great concern about high risk of miscarriages and Hyperstimulation ovarian syndrome