Sperm fine-needle aspiration (FNA) mapping after failed microdissection testicular sperm extraction (TESE): Location and patterns of found sperm / 亚洲男科学杂志(英文版)

We sought to evaluate the ability of fine-needle aspiration (FNA) mapping to find sperm and to guide sperm retrieval after failed microdissection testicular sperm extraction (micro-TESE) in nonobstructive azoospermic men. In this study of consecutive male infertility cases, interventions included testicular FNA mapping and subsequent sperm retrieval. Outcomes included the frequency and location of found sperm on FNA maps after failed micro-TESE and the salvage sperm retrieval success. Among 548 patients undergoing FNA mapping from 2010 to 2016, 82 men with previous micro-TESE procedures were identified. The mean time between micro-TESE and FNA mapping was 2.2 years. A total of 2825 (1424 on right and 1401 on left) sites were mapped. At least one site revealed mature sperm in 24 (29.3%) of 82 men with prior failed micro-TESE procedures. There was an equal likelihood of detecting sperm in either testis (6.1% right; 5.7% left; P = 0.58). Digital 'heat maps' revealed differences in sperm findings within the testis with mature sperm more likely found in the testis periphery rather than centrally. Fifteen (62.5%) patients subsequently underwent sperm retrieval procedures guided by FNA maps. Sufficient sperm were retrieved in all cases, and in 10 (66.7%) of 15 cases, extra sperm were frozen for future use. In a significant proportion of failed micro-TESE procedures representing the largest study to date, sperm were detected by FNA mapping and could be reliably retrieved through FNA map-guided surgical sperm retrieval. When present, sperm were more likely to be found in the testis periphery rather than centrally with FNA mapping.

Adverse perinatal outcomes and related factors analysis of twin pregnancy in young cases after IVF/ICSI-ET / 实用医学杂志

Objective To compare the perinatal outcomes between singleton and twin pregnancies and the influencing factors in young cases(age < 35)after in vitro fertilization/egg cell sperm injection-embryo transfer (IVF/ICSI-ET). Methods A retrospective study was performed to analysis the perinatal outcomes of the young cases after IVF/ICSI-ET from January 2015 to July 2016.Results The total abortion rate,early abortion rate and the average body weight of the twin group were significantly lower than the singleton group(P < 0.05),the mid-term abortion rate,the preterm delivery rate,cesarean section rate and the low birth weight rate were opposite (P<0.05),while the total pregnancy loss rate and the rate of birth defects were not significantly different between the groups(P>0.05).The frozen-thawed embryo transfer,blastocyst transfer and double-embryo transfer were the risk factors of twin pregnancy. Conclusions Twin pregnancy may increase the risk of adverse perinatal outcomes. Selective single blastocyst transfer during frozen-thawed cycle is an effective measure for young cases,in which it can keep a balance between high clinical pregnancy rate and reducing twin pregnancy rate.

Sperm fine-needle aspiration (FNA) mapping after failed microdissection testicular sperm extraction (TESE): location and patterns of found sperm / 亚洲男科学杂志(英文版)

We sought to evaluate the ability of fine-needle aspiration (FNA) mapping to find sperm and to guide sperm retrieval after failed microdissection testicular sperm extraction (micro-TESE) in nonobstructive azoospermic men. In this study of consecutive male infertility cases, interventions included testicular FNA mapping and subsequent sperm retrieval. Outcomes included the frequency and location of found sperm on FNA maps after failed micro-TESE and the salvage sperm retrieval success. Among 548 patients undergoing FNA mapping from 2010 to 2016, 82 men with previous micro-TESE procedures were identified. The mean time between micro-TESE and FNA mapping was 2.2 years. A total of 2825 (1424 on right and 1401 on left) sites were mapped. At least one site revealed mature sperm in 24 (29.3%) of 82 men with prior failed micro-TESE procedures. There was an equal likelihood of detecting sperm in either testis (6.1% right; 5.7% left; P = 0.58). Digital "heat maps" revealed differences in sperm findings within the testis with mature sperm more likely found in the testis periphery rather than centrally. Fifteen (62.5%) patients subsequently underwent sperm retrieval procedures guided by FNA maps. Sufficient sperm were retrieved in all cases, and in 10 (66.7%) of 15 cases, extra sperm were frozen for future use. In a significant proportion of failed micro-TESE procedures representing the largest study to date, sperm were detected by FNA mapping and could be reliably retrieved through FNA map-guided surgical sperm retrieval. When present, sperm were more likely to be found in the testis periphery rather than centrally with FNA mapping.

Resultados en ciclos de FIV-ICSI adicionando hormona luteinizante recombinante a la hormona folículo estimulante recombinante con menotropinas durante la estimulación ovárica en pacientes mayores de 35 años / Results in IVF-ICSI cycles adding luteinizing hormone recombinant to follicle stimulating hormone recombinant with menotropins during ovarian stimulation in patients over 35 years-old

Resumen OBJETIVO Evaluar los resultados en ciclos de FIV-ICSI de dos protocolos de estimulación ovárica en mujeres mayores de 35 años e investigar si agregar hormona luteinizante recombinante a FSH-r en un protocolo de estimulación mejora la respuesta ovárica y, en consecuencia, las tasas de embarazo en este grupo poblacional. MATERIALES Y MÉTODOS Estudio longitudinal, observacional y retrospectivo efectuado en pacientes de la Clínica de Reproducción Hisparep del Hospital Español con diagnóstico de infertilidad, mayores de 35 años, que recibieron un ciclo de hiperestimulación ovárica controlada con FIV-ICSI durante el periodo 2014-2016. El análisis estadístico se efectuó con la prueba de t de Student para muestras independientes. Los estudios se analizaron con el paquete estadístico SPSS IBM, versión 22. RESULTADOS Se analizaron 201 mujeres con infertilidad, mayores de 35 años. El grupo 1 (n = 101) de FIV-ICSI recibió estimulación con hormona folículo estimulante recombinante y hormona luteinizante recombinante 2:1 con menotropinas (Pergoveris® y Merapur®) a partir del segundo día del ciclo. El grupo 2 (n = 100) recibió hormona folículo estimulante recombinante y menotropinas (Gonal F® y Merapur®); en ambos esquemas se utilizó antagonista de GnRH a partir del día 7 del ciclo. La media de ovocitos aspirados fue de 7.5 en el grupo 1 y 9.1 en el grupo 2 (p = 0.058). La media de ovocitos maduros fue 6.2 en el Grupo 1 vs 7.4 en el grupo 2 (p = 0.085). La tasa de fecundación en el grupo 1 fue de 57 vs 67% en el grupo 2 (p = 0.045). En el grupo 1 la tasa de implantación por embrión transferido en fresco fue 24.1 vs 10.3% en el Grupo 2 (p = 0.40), la tasa de recién nacido vivo fue de 30% en el Grupo 1 vs 20.6% en el Grupo 2. La media de embriones vitrificados en el Grupo 1 fue 1.47 vs 1.38 en el Grupo 2. CONCLUSIONES La probable ventaja de la complementación con hormona folículo estimulante recombinante durante la estimulación ovárica en mujeres mayores de 35 años es de interés y se requiere su evaluación en estudios posteriores.

Abstract OBJECTIVE To evaluate the reproductive effects when recombinant luteinizing hormone is added and to compare two stimulation schemes by number of aspirated oocytes, mature oocytes, fertilization and implantation rates, live newborn and number of vitrified embryos. MATERIALS AND METHODS Longitudinal, observational and retrospective study carried out in patients of the Hisparep Reproduction Clinic of the Spanish Hospital with diagnosis of infertility, over 35 years old, who received a controlled ovarian hyperstimulation cycle with IVF-ICSI during the period 2014-2016. The statistical analysis was carried out with the Student t test for independent samples. The studies were analyzed with the IBM SPSS statistical package, version 22. RESULTS We analyzed 201 women with infertility, over 35 years of age. Group 1 (n = 101) of IVF-ICSI received stimulation with recombinant follicle-stimulating hormone and recombinant luteinizing hormone 2: 1 with menotropins (Pergoveris® and Merapur®) from the second day of the cycle. Group 2 (n = 100) received recombinant follicle stimulating hormone and menotropins (Gonal F® and Merapur®); in both schemes, GnRH antagonist was used from day 7 of the cycle. The average number of aspirated oocytes was 7.5 in Group 1 and 9.1 in Group 2 (p = 0.058). Mean mature oocytes were 6.2 in Group 1 vs 7.4 in Group 2 (p = 0.085). The fertilization rate in group 1 was 57 vs. 67% in Group 2 (p = 0.045). In Group 1 the implantation rate per embryo transferred fresh was 24.1 vs 10.3% in Group 2 (p = 0.40), the live newborn rate was 30% in Group 1 vs 20.6% in Group 2. The mean number of vitrified embryos in Group 1 was 1.47 vs 1.38 in Group 2. CONCLUSIONS The probable advantage of supplementation with recombinant follicle-stimulating hormone during ovarian stimulation in women over 35 years of age is of interest and its evaluation is required in subsequent studies.

Diagnóstico genético pré-implantacional e seu valor prognóstico em tecnologia de reprodução assistida: revisão da literatura / Preimplantation genetic diagnosis and its prognostic value in assisted reproduction technology: literature review

O diagnóstico genético pré-implantacional, associado a técnicas de reprodução assistida como a fertilização in vitro, permite a seleção de pré-embriões euploides para transferência. Nos últimos anos, tem sido indicado visando o aumento nas taxas de sucesso de tratamento, na sua forma de rastreio de aneuploidias para um grupo de pacientes de alto risco reprodutivo como: idade materna avançada, aborto recorrente e falhas repetidas de tratamentos. O objetivo desta revisão é avaliar o valor prognóstico da realização do diagnóstico genético pré-implantação, associado às técnicas de fertilização in vitro e injeção intracitoplasmática de espermatozoide (ICSI), revisar as limitações da técnica e sua eficácia. Embora este grupo com elevado risco reprodutivo apresente alta taxa de aneuploidia, não foram encontrados dados consistentes na literatura a favor da realização do rastreio genético de aneuploidias; portanto, ainda são necessários estudos com grupos mais bem definidos para que o diagnóstico genético pré-implantacional possa ser confirmado como uma ferramenta para aumento de taxas ou como procedimento de rotina, até sua eficácia ser provada.(AU)

The preimplantation genetic diagnosis associated with assisted reproduction technology, as in vitro fertilization, allows selecting euploid pre-embryos for transfer. In recent years, it has been performed as a screening tool for aneuploidy with the purpose of increasing reproductive rates in patient populations at high risk of aneuploidy, such as: advanced maternal age, recurrent pregnancy loss and repeated in vitro fertilization failures. The aim of this review is to evaluate the prognostic value of preimplantation genetic diagnosis, associated with in vitro fertilization and intracytoplasmic sperm injection (ICSI) techniques, to review technology?s limitations and its effectiveness. Although this high risk population group presents high rate of aneuploidy, this review has not shown consistently data in the literature in favor of preimplantation genetic screening; therefore, more studies with well-defined groups are still needed in order that preimplantation genetic diagnosis may be confirmed as a tool for increasing rates or as a routine procedure, until technique?s problems are solved and its effectiveness, proven.(AU)

Avaliação da reserva ovariana na propedêutica da infertilidade / Ovarian reserve evaluation in the propedeutic of infertility

A atenção dada ao potencial reprodutivo diante o envelhecimento ovariano foi realçada pela tendência da mulher moderna de postergar a maternidade e pela procura cada vez maior por serviços de reprodução assistida. Nesse contexto, a avaliação da reserva folicular ovariana surge como tentativa de aferir sua capacidade funcional, melhor aconselhar os casais interessados e nortear protocolos de estimulação, para amenizar encargos emocionais e financeiros de um processo cujos resultados ainda se encontram aquém do desejado. Neste texto, abordam-se a situação atual de marcadores endócrinos basais e dinâmicos e os marcadores ecográficos comuns na avaliação da reserva ovariana em mulheres candidatas a ciclos assistidos.

The attention given to reproductive potential along ovarian ageing process has been enhanced with the trends of modern women to postpone maternity and due to progressive number of couples looking for assisted reproduction treatment. In this context, evaluation of ovarian follicular reserve has been taken into account, with the aim to determine gonadal functional capacity, to afford a better counselling of couples and to coordinate stimulation protocols, diminishing emotional and financial onuses of a complex process with still unsatisfactory results. The scope of this article is to briefly present current situation of basal and dynamic endocrine, and sonographic markers commonly used in ovarian reserve evaluation in candidates for assisted reproductive programs.

A cytogenetic study of couples with recurrent spontaneous abortions and infertile patients with recurrent IVF/ICSI failure.

PURPOSE: This study was conducted to determine the frequency and contribution of chromosomal abnormalities in miscarriages and in couples with recurrent in vitro fertilization/intra cytoplasmic sperm injection (IVF/ICSI) failure. MATERIALS and METHODS: A total of 221 individuals; 79 with three or more recurrent spontaneous abortions and 142 with at least three IVF/ICSI failures. Chromosomal analysis from peripheral blood lymphocytes was performed according to standard cytogenetic methods using G-banding technique. RESULTS: Abnormal karyotype was found in 21 (9.50%) individuals. Of these 21 subjects, 4 (19.04%) exhibited sex chromosomal abnormalities and 17 (80.96%) had autosomal abnormalities. Male partners had significantly higher chromosomal abnormalities (5.88%) than of females (3.61%). These abnormalities were also higher in patients with recurrent spontaneous abortions than with IVF/ICSI failure (P < 0.05). CONCLUSIONS: These data may be indicative that chromosomal abnormalities are involved more in spontaneous abortions than in recurrent IVF/ICSI failure. Cytogenetic analysis could be valuable for these couples when clinical data fail to clarify the cause.

The association of CAG repeat length polymorphisms of androgen receptor gene and spermatogenesis impairment in several Indonesian men.

Spermatogenesis impairment is the main cause of infertility in men. Androgen is believed to play a critical role in regulating spermatogenesis. Androgen acts by binding to the androgen receptor (AR) which is a protein regulator of DNA transcription. Exon 1 of AR gene contains a CAG repeat length polymorphism and it is believed to interfere AR function. This study includes DNA isolation from peripheral blood and amplification of CAG repeat fragments by PCR method. CAG repeat lengths were determined by electrophoresis on 6% denaturing gel polyacrylamide. We found that the mean CAG repeat lengths were 24,3 ± 3,4 in oligozoospermic/azoospermic men and 22,7 ± 2,7 in normozoospermic men. The difference in CAG repeat length between the two groups was statistically significant (p = 0,031, t-test). Nevertheless, there was no correlation between CAG repeat lengths and sperms concentration (rs = -0,038; p = 0,775). This result suggest that the expansion of CAG repeat length was not the main cause of spermatogenesis impairment.

De novo Fetal Chromosomal Abnormalities after Assisted Reproductive Technology / 대한산부인과학회잡지

We experienced two cases of de novo fetal chromosomal abnormalities after assisted reproductive technology (ART): One case was reciprocal translocation 46,XX,t(6;14)(p21.3;q12) after intracytoplasmic sperm injection and embryo transfer (ICSI-ET) and the other case was 46,X,iso(Xq) after in vitro fertilizaton and embryo transfer (IVF-ET), both were diagnosed prenatally by amniocentesis and postnatally cord blood culture. We report these cases with a brief review of literatures.