ABSTRACT
Background: Intracytoplasmic sperm injection (ICSI) is introduced as a treatment modality for severe male factors infertility. It is an effective form of infertility treatment. Progress in the micromanipulation, now is bringing a new way in the treatment of severe male factor infertility to achieve acceptable rates of fertilization and pregnancy success. Objective: To evaluate the difference between ejaculated and surgically retrieved sperm on intra cytoplasmic sperm injection (ICSI) outcomes. Design: A Correlative study. Setting: Dwarozh- IVF center. Patients and Methods: One hundred twenty patients have been taken in Dwarozh and International infertility centers in Sulaimani, for male infertility indications with normoovulatory female partners of ages less than 38 years, from 1st of September 2010 to 1st of September 2013. We divided patients into two groups: patients with normal ejaculation;group one (G1), and patients with surgically retrieved spermatozoa (normal sperms); group two (G2), all underwent Intracytoplasmic Sperm Injection (ICSI) cycles. Main Outcome Measures: Fertilization, cleavage, biochemical and clinical pregnancy rates. Results: The fertilization rate has been found 72.6% in G1, while in G2 it is 60.4% and a significant statistical difference was observed in fertilization rates between the two groups with a P value of less than 0.01. Also it has been found that in G1, 90.2% of oocytes were cleaved, while in G2, 89% of oocytes were cleaved, no significant statistical difference was observed in cleavage rates between the two groups, with a P value of more than 0.05. It has been found that in G1, pregnancy was positive (+ve) biochemically in 65% of the cases, while pregnancy was positive (+ve) clinically in 45% of the cases. In G2 pregnancy were (+ve) biochemically in 28.3%, while pregnancy was (+ve) clinically in 15% of the cases, with significant statistical differences in both biochemical and clinical pregnancies between the two groups with a P value of less than 0.01. Conclusions: It has been found, with the use of ICSI cycles in the treatment of male factor infertility, there are significant differences in reproductive outcomes between cycles using ejaculated and surgically retrieved sperm. The data show that ICSI is aacceptable treatment option in oligospermic and azoospermic males. Acceptable rates of fertilization, cleavage and pregnancy success can be attainwith ICSI from patients with Azoospemia, reaching levels comparable with those of patients using ejaculated spermatozoa for ICSI.
ABSTRACT
ntroduction: Non-invasive selection of developmentally human oocytes may increase the overall effi ciency of human assisted reproduction. Morphologic abnormalities in the oocyte are relevant for determining its developmental fate. Th e objective is to evaluate the infl uence of MII oocyte morphology on intra cytoplasmic sperm injection (ICSI) outcomes. Material and Methods: 132 patients undergoing ICSI cycles and having female factors of infertility and unexplained infertility. Couples having male factors of infertility were excluded. A total of 1200 oocytes were retrieved from 132 ICSI cycles, of which 1056 MII oocytes were evaluated. Th e criteria for morphological evaluations were: (i) Normal MII oocytes showing clear cytoplasm with uniform texture and homogenous fi ne granularity, a round or ovoid fi rst polar body with a smooth surface, and perivitelline space of normal size. (ii) MII oocytes with extra cytoplasmic abnormalities (fi rst polar body and perivitelline space abnormalities). (iii) MII oocytes with cytoplasmic abnormalities (dark cytoplasm, granular cytoplasm, inclusion body and presents of vacuoles). (iv) MII oocytes with combined abnormalities. Result: From 1056 MII oocytes, 180 (17.04%) had normal morphology while 876 (82.95%) had at least one demonstrable morphological abnormality. Cytoplasmic abnormalities were observed in 516 (58.9%) of the oocytes. Extra cytoplasmic abnormalities were observed in 104 (11.87%) while combined abnormalities were responsible for the remaining 256 (29.22%). Th ere were no signifi cant diff erences in fertilization, cleavage, and embryo quality between the groups but there was a highly signifi cant diff erence in implantation rate which was higher in the group of normal oocytes morphology than abnormal oocytes morphology, oocytes with cytoplasmic, extracytoplasmic and combined abnormality 11.11%, 7.33%, 9.03%, 2.3%, and 4.34% respectively. Conclusion: MII oocyte morphology did not aff ect fertilization, cleavage, and embryo quality, but aff ecting implantation rate.