¿Cuál es la razón para hacer todo inyección intracitoplasmática de espermatozoides ICSI?

El empleo de la técnica de inyección intracitoplasmática de espermatozoides ICSI sin atender las indicaciones originadas en los estudios previos a la pareja infértil ha conducido a que un número importante de clínicas de medicina reproductiva del mundo hagan un uso indiscriminado de la misma. La presente revisión analiza los motivos que condujeron a esto y plantea posibles respuestas o discusiones a este proceder.

The use of intracytoplasmic sperm injection ICSI without attending the findings from previous studies to the infertile couple has led to the indiscriminate use of this procedure in a significant number of clinics of reproductive medicine in the world. The present review analyses the reasons that led to this situation and raises possible answers or discussions to this proceeding.

Telomere length in cumulus cells as a potential biomarker of embryo quality and pregnancy rate / 实用医学杂志

Objective To investigate the relationship of relative telomere length in cumulus cells(CCs) with oocytes at different mature stages and the outcome of intracytoplasmic sperm injection and embryo transfer (ICSI-ET). Methods Oocyte-cumulus complex samples were collected from 92 patients undergoing ICSI-ET and patients were divided into group A including 55 women≤35 years and group B 37 women>35 years. The embryonic development ability and the result of clinical pregnancy were recorded in different groups. DNA was extracted from CCs and assessed for telomere length by real-time quantitative PCR. Results In ICSI-ET,the relative telomere length of CCs gradually shortened with the age.There was a significantly longer telomere length of CCs in the preg-nant subgroup than that in the non-pregnant subgroup in the two groups(P < 0.05). Conclusion The telomere length of CCs may be associated with the pregnancy outcome in ICSI-ET.

Evaluación de la eficacia de los laboratorios de embriología y anatomía patológica en el análisis de las biopsias testiculares de pacientes azoospérmicos / Evaluation of the Efficacy of the Laboratories of Embryology and Pathological Anatomy in the Analysis of Testicular Biopsies of Patients with Azoospermia

Objetivos: El propósito de este estudio es evaluar la eficacia de los laboratorios de embriología y de anatomía patológica para hallar espermatozoides en las muestras de tejido testicular obtenido por biopsia testicular (testicular sperm extraction, TESE) en pacientes con azoospermia no obstructiva. Materiales y métodos: Se realizó un análisis retrospectivo y prospectivo de todos los pacientes con azoospermia no obstructiva atendidos en CRECER y en la Clínica Privada Pueyrredón, entre enero de 2006 y diciembre de 2016. En este estudio solo se incluyeron aquellos pacientes en los que la muestra obtenida con TESE fue enviada simultáneamente al anatomopatólogo y al laboratorio de embriología. Para el análisis de los resultados de las biopsias el estudio se detuvo a fines de 2016, pero el seguimiento de los pacientes continuó hasta el mes de octubre de 2017, registrándose todos aquellos casos que realizaron procedimientos de inyección intracitoplasmática de espermatozoides (intracytoplasmic sperm injection, ICSI) con muestras obtenidas de TESE y se anotó la obtención de embriones, embarazos y nacimientos. Resultados: El laboratorio de embriología halló espermatozoides en 36 de los 68 pacientes (52,9%), mientras que el laboratorio de patología solo informó presencia en 21 pacientes (30,88%). Hubo acuerdo en el hallazgo de espermatozoides entre ambos laboratorios en 20 de los 68 casos (29,41%), mientras que en 16 pacientes el laboratorio de embriología encontró espermatozoides donde el de patología no pudo hacerlo (23,53%). Al mismo tiempo, el laboratorio de patología halló espermatozoides solo en un caso en el que el de embriología informó su ausencia para la misma muestra analizada (1,47%) (p=0,0003). Conclusiones: El laboratorio de embriología es significativamente más eficaz para determinar la presencia de espermatozoides en las muestras de TESE, teniendo mejor rendimiento que el de patología, por lo que consideramos que, si las muestras fueran analizadas solo por el patólogo, se perdería la posibilidad de lograr muchos embarazos realizando ICSI más TESE.(AU)

Objectives: The purpose of this study is to evaluate the efficacy of embryology and pathological anatomy laboratories to find spermatozoa in testicular tissue samples obtained by testicular sperm extraction (TESE) in patients with non-obstructive azoospermia. Materials and methods: It was carried out a retrospective and prospective analysis of all the patients with non-obstructive azoospermia treated at CRECER and at Clínica Privada Pueyrredón, between January 2006 and December 2016. This study only includes patients in whom the sample obtained with TESE was sent at the same time to the pathology and embryology laboratory. For the analysis of the results of the biopsies, the study was stopped at the end of 2016, but the follow-up of the patients continued until October 2017, registering all those cases that performed intracytoplasmic sperm injection (ICSI) with samples obtained from TESE and wrote down the patients who´ve got embryos, pregnancies, and births. Results: The embryology laboratory found sperm in 36 of the 68 patients (52.9%), while the pathology laboratory only reported presence in 21 patients (30.88%). There was agreement in the finding of sperm between both laboratories in 20 of the 68 cases (29.41%), while in 16 patients the embryology laboratory found sperm where the pathology department could not do so (23.53%). At the same time, the pathology laboratory found sperm only in one case in which the embryology department reported its absence for the same sample analyzed (1.47%) (p=0.0003). Conclusions: The embryology laboratory is significantly more efficient to determine the presence of sperm in the samples of TESE, having better performance than the pathology one. Taking into account that, we believe that if the samples are only analyzed by the pathologist, the possibility of getting many pregnancies performing ICSI plus TESE would be lost. (AU)

Subclinical Hypothyroidism and Intracytoplasmic Sperm Injection Outcomes / Hipotireoidismo subclínico e resultados de Injeção intracitoplasmática de espermatozoide

Abstract Purpose Whether preconception elevated concentrations of thyroid-stimulating hormone (TSH) compromises reproductive outcomes in patients undergoing assisted reproduction techniques (ARTs) remains unclear. This study therefore compared the reproductive outcomes in patients with TSH concentrations of < 2.5 mIU/L, 2.5-4.0 mIU/L, and 4.0-10.0mIU/L undergoing controlled ovarian stimulation (COS) for in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI). Methods This retrospective cohort study evaluated the medical records of all women with measured TSH concentrations who underwent IVF/ICSI between January 2011 and December 2012. The patients were divided into three groups: TSH < 2.5mIU/L (group 1); THS ≥2.5 and < 4.0 mIU/L (group 2); and THS ≥4 mIU/L and < 10.0 mIU/L (group 3). Patients who were administered levothyroxine for treating hypothyroidism were excluded from the analysis. The primary endpoints were clinical pregnancy,miscarriage, live birth and multiple pregnancy rates. Results During the study period, 787 women underwent IVF/ICSI. Sixty were excluded because their TSH concentrations were unavailable, and 77 were excluded due to their use of levothyroxine. The prevalence of patients presenting elevated concentrations of TSHwas of 5.07% (using a TSH threshold of 4.0 mIU/L) and of 29.99% (using a TSH threshold of 2.5 mIU/L). Patient characteristics, type of COS, and response to COS did not differ among the three groups, and there were no differences in clinical pregnancy (24.4% versus 25.9% versus 24.2%, p = 0.93); miscarriage (17.1% versus 14.3% versus 12.5%, p = 0.93); live birth (20.2% versus 22.2% versus 21.2%, p = 0.86); and multiple pregnancy rates (27.0% versus 21.4% versus 25.0%, p = 0.90) respectively. Conclusion Response to COS, live birth, and miscarriage rates were not altered in women with elevated concentrations of TSH undergoing IVF/ICSI, regardless of using a TSH threshold of 2.5mIU/L or 4.0mIU/L. These findings reinforce the uncertainties related to the impact of subclinical hypothyroidism on reproductive outcomes in women undergoing COS for ARTs.

Resumo Objetivos Se concentrações elevadas de hormônio estimulante da tireoide (TSH) antes do parto comprometem resultados reprodutivos em pacientes submetidas a técnicas de reprodução assistida (TRA) é incerto. Este estudo comparou resultados reprodutivos de pacientes com concentrações de TSH < 2,5 mIU/L; 2,5-4,0 mIU/L e 4,0-10,0 mIU/L submetidas a estimulação ovariana controlada (EOC) para fertilização in vitro (FIV)/injeção intracitoplasmática de espermatozoide (ICSI). Métodos Este estudo de coorte retrospectiva avaliou prontuários médicos de todas as pacientes que tinham registro de concentrações de TSH submetidas a FIV/ICSI entre janeiro de 2011 e dezembro de 2012. As pacientes foram divididas em três grupos: aquelas com TSH < 2,5 mIU/L (grupo 1); entre 2,5 e 4,0 mIU/L (grupo 2) e entre 4,0 mIU/L e 10,0 mIU/L (grupo 3). As pacientes que estavam em uso de levotiroxina para tratamento de hipotireoidismo foram excluídas da análise. Os desfechos primários foram taxas de gravidez clínica, de abortamento, de nascido vivo e de gravidez múltipla. Resultados Durante o período do estudo, 787 mulheres foramsubmetidas a FIV/ICSI. Sessenta foram excluídas por causa da indisponibilidade das concentrações de TSH, e 77 foram excluídas porque estavam usando levotiroxina. A prevalência de pacientes apresentando elevação das concentrações de TSH foi de 5,07% (usando um limite de TSH de 4,0 mIU/L) e 29,99% (usando um limite de TSH de 2,5 mIU/L). As características das pacientes, tipo de EOC e reposta à EOC não diferiram entre os três grupos, nem houve diferenças nas taxas de gravidez clínica (24,4% versus 25,9% versus 24,2%, p = 0,93); abortamento (17,1% versus 14,3% versus 12,5%, p = 0,93); nascido vivo (20,2% versus 22,2% versus 21,2%, p = 0,86); e taxas de gestação múltipla (27,0% versus 21,4% versus 25,0%, p = 0,90), respectivamente. Conclusão Resposta à EOC, taxa de nascido vivo e de abortamento não foram alteradas em mulheres submetidas a FIV/ICSI com concentrações elevadas de TSH independente de usar um limite de 2,5 ou 4,0 mIU/L. Estes achados reforçam as incertezas relacionadas ao impacto do hipotireoidismo subclínico nos resultados reprodutivos de mulheres submetidas a EOC para TRA.

A Case of Two Sets of Monozygotic Twins after ICSI and Blastocyst Transfer / 대한산부인과학회지

One of the most important complications in assisted reproductive technology (ART) is multiple pregnancy, which is associated with an increased risk of maternal and perinatal complications. There have been several attempts to achieve the highest pregnancy rates while minimizing multiple pregnancy rates in in vitro fertilization and embryo transfer (IVF-ET). One approach for this purpose is extended embryo culture and transfer of fewer (one or two) blastocysts. However, there are emerging concerns about the increase of the risk for embryo splitting and subsequent monozygotic multiple pregnancy with this approach. Recently, there have been several reports on the possible increased risk of monozygotic twinning after extended embryo culture and blastocyst transfer. We have experienced a case of two sets of monozygotic twins after intracytoplasmic sperm injection (ICSI) and transfer of two blastocysts. We report the first case of pregnancy of monozygotic twins after blastocysts transfer with a brief review of literature in Korea.

Obstetric Outcomes and Congenital Malformations of Children born after Intracytoplasmic Sperm Injection According to the Origin of Sperm / 대한산부인과학회지

OBJECTIVE: To analyze the obstetric outcomes, the incidence of congenital malformations and chromosomal anomalies of neonates born after intracytoplasmic sperm injection (ICSI) according to the origin of sperm. METHODS: A total of 103 neonates born from ICSI between January 1995 and January 2004 was included. They were divided into three groups: ejaculated (n=73), epididymal (n=17) and testicular (n=13) groups. We compared obstetric outcomes such as pregnancy rates, preterm birth rates, abortion rates, multiple pregnancy rates, gestational age at birth, birth-weight, and the incidence of congenital malformations and chromosomal anomalies. RESULTS: There were no differences among the three groups in terms of pregnancy rates, preterm birth rates, abortion rates, multiple pregnancy rates, gestational age at birth and birth-weight. There were no differences in the incidence of low birth-weight babies and very low birth-weight babies. Major malformations were observed in two cases of ejaculatory group (2.7%) and one of testicular group (7.7%). Major malformations included two gastrointestinal malformations and one cleft lip. Minor malformations were observed in three cases of ejaculatory group (4.1%) and one of testicular group (7.7%). Chromosomal anomalies were observed in 6 cases of 105 pregnancies (5.7%), and all of them were from the ejaculatory group. Two cases had autosomal numerical anomalies and 4 cases autosomal structural anomalies. However, sex chromosomal anomalies were not detected in this study. CONCLUSION: The obstetric outcomes, the incidence of congenital malformations and chromosomal anomalies in ICSI babies were not different according to the origin of sperm. These findings should be further investigated in larger long-term studies.

The Study on Comparison of Clinical Outcomes of Intracytoplasmic Sperm Injection in Patients with Epididymal Sperm and Testicular Sperm / 대한불임학회지

OBJECTIVE: This study was carried out to compare the clinical outcomes of intracytoplasmic sperm injection (ICSI) in patients with obstructive azoospermia according to sperm retrieval site and technique; microsurgical epididymal sperm aspiration (MESA), percutaneous epididymal sperm aspiration (PESA), testicular sperm extraction by open biopsy (TESE). METHODS: The outcomes of ICSI and IVF-ET were evaluated and compared among 3 groups. Seventy three men suffering from infertility due to obstructive azoospermia had 107 ICSI cycles using MESA (21 cycles in 15 patients), PESA (26 cycles in 17 patients) and TESE (60 cycles in 41 patients). RESULTS: In the clinical outcomes in patients undergoing ICSI with epididymal or testicular sperm, there were no significant differences in fertilization rate (66.1% vs. 60.5%), cleavage rate (94.9% vs. 97.6%), cumulative embryo score (CES) (51.3 vs. 58.8), implantation rate (7.9% vs. 6.1), and clinical pregnancy rate per ET (30.4% (14/46) vs. 25.4% (15/59)) between both groups. Also, in the clinical outcomes in ICSI patients using MESA, PESA, TESE, there were no significant differences in fertilization rate (61.8%, 69.4%, 60.5%), cleavage rate (92.1%, 97.3%, 97.6%), CES (38.1, 52.0, 58.8), implantation rate (9.5%, 6.6%, 6.1%), and clinical pregnancy rate per ET (35% (7/20), 26.9% (7/26), 25.4% (15/59)) among 3 groups. CONCLUSION: When compared with MESA or TESE, PESA, the clinical outcomes were similar in ICSI patients with obstructive azoospermia whatever the origin or the technique of sperm retrieval. However, we considered PESA is more time-saving and cost effective for ICSI in patients with obstructive azoospermia.

The Study on Comparison of Clinical Outcomes of Intracytoplasmic Sperm Injection in Patients with Epididymal Sperm and Testicular Sperm / 대한불임학회지

OBJECTIVE: This study was carried out to compare the clinical outcomes of intracytoplasmic sperm injection (ICSI) in patients with obstructive azoospermia according to sperm retrieval site and technique; microsurgical epididymal sperm aspiration (MESA), percutaneous epididymal sperm aspiration (PESA), testicular sperm extraction by open biopsy (TESE). METHODS: The outcomes of ICSI and IVF-ET were evaluated and compared among 3 groups. Seventy three men suffering from infertility due to obstructive azoospermia had 107 ICSI cycles using MESA (21 cycles in 15 patients), PESA (26 cycles in 17 patients) and TESE (60 cycles in 41 patients). RESULTS: In the clinical outcomes in patients undergoing ICSI with epididymal or testicular sperm, there were no significant differences in fertilization rate (66.1% vs. 60.5%), cleavage rate (94.9% vs. 97.6%), cumulative embryo score (CES) (51.3 vs. 58.8), implantation rate (7.9% vs. 6.1), and clinical pregnancy rate per ET (30.4% (14/46) vs. 25.4% (15/59)) between both groups. Also, in the clinical outcomes in ICSI patients using MESA, PESA, TESE, there were no significant differences in fertilization rate (61.8%, 69.4%, 60.5%), cleavage rate (92.1%, 97.3%, 97.6%), CES (38.1, 52.0, 58.8), implantation rate (9.5%, 6.6%, 6.1%), and clinical pregnancy rate per ET (35% (7/20), 26.9% (7/26), 25.4% (15/59)) among 3 groups. CONCLUSION: When compared with MESA or TESE, PESA, the clinical outcomes were similar in ICSI patients with obstructive azoospermia whatever the origin or the technique of sperm retrieval. However, we considered PESA is more time-saving and cost effective for ICSI in patients with obstructive azoospermia.

Artificial Fertilization and Childbirth with Ejaculatory Stimulation in Spinal Cord Injured Man

Infertility due to ejaculatory failure and poor semen quality is a main problem for sexual dysfunction of spinal cord injured (SCI) men. A 27-year-old paraplegic man who wished to father children was induced to repeated ejaculations for eight times with a rectal probe electrical stimulation at one or two weekly interval. For the 4th to 8th stimulations, the subject took pseudoephedrine 20 mg, three times a day orally to improve the semen quality. We report a triplet childbirth between the SCI man and his healthy wife through the ejaculatory stimulations in conjuction with advanced reproductive techniques such as in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI).

Transfer of Human Blastocyst Following In Vitro Culture for Five Days in In Vitro Fertilization and Embryo Transfer / 대한산부인과학회잡지

OBJECTIVE: To evaluate the clinical efficacy of human blastocyst transfer following in vitro culture for five days in in vitro fertilization and embryo transfer (IVF-ET), and to compare the efficiency of P1-BL and G1-G2 media in the culture of human blastocyst. METHODS: Seventy-two infertile patients undergoing blastocyst transfer in IVF-ET were classified into the conventional IVF (n=52) and ICSI (n=20) groups, and P1-BL (n=37) and G1-G2 (n=35) groups. The outcomes of blastocyst transfer cycles were evaluated and compared, respectively. RESULTS: There were no significant differences in the outcomes of controlled ovarian hyperstimulation (COH) and IVF-ET, such as duration of COH, total dosage of gonadotropins used, serum estradiol (E2) level on hCG day, numbers of oocytes retrieved and fertilized, and number of blastocysts transferred between the conventional IVF and ICSI groups, and between P1-BL and G1-G2 groups, respectively. Total blastulation rate was significantly higher in IVF group than ICSI group (53.6% vs. 37.3%, p<0.05). Implantation, clinical pregnancy, and multiple pregnancy rates were significantly higher in IVF group than ICSI group (15.1% vs. 4.1%, p<0.05; 36.5% vs. 15.0%, p<0.05; 36.8% vs. 0%, p<0.01). There were no significant differences in total blastulation, implantation, and clinical pregnancy rates between P1-BL and G1-G2 groups. However, multiple pregnancy rate was significantly higher in G1-G2 group than P1-BL group (60.0% vs. 8.3%, p<0.05). CONCLUSIONS: In human blastocyst transfer following in vitro culture for five days in IVF-ET, conventional IVF showed better outcomes of embryo development and pregnancy than ICSI. The efficiency of P1-BL media in the culture of human blastocyst was comparable to that of G1-G2 media. Further investigation will be necessary to compare the efficiency of various media in the blastocyst culture and to confirm the risk of multiple pregnancy in cases using G1-G2 media.

Transfer of Human Blastocyst Following In Vitro Culture for Five Days in In Vitro Fertilization and Embryo Transfer / 대한산부인과학회잡지

OBJECTIVE: To evaluate the clinical efficacy of human blastocyst transfer following in vitro culture for five days in in vitro fertilization and embryo transfer (IVF-ET), and to compare the efficiency of P1-BL and G1-G2 media in the culture of human blastocyst. METHODS: Seventy-two infertile patients undergoing blastocyst transfer in IVF-ET were classified into the conventional IVF (n=52) and ICSI (n=20) groups, and P1-BL (n=37) and G1-G2 (n=35) groups. The outcomes of blastocyst transfer cycles were evaluated and compared, respectively. RESULTS: There were no significant differences in the outcomes of controlled ovarian hyperstimulation (COH) and IVF-ET, such as duration of COH, total dosage of gonadotropins used, serum estradiol (E2) level on hCG day, numbers of oocytes retrieved and fertilized, and number of blastocysts transferred between the conventional IVF and ICSI groups, and between P1-BL and G1-G2 groups, respectively. Total blastulation rate was significantly higher in IVF group than ICSI group (53.6% vs. 37.3%, p<0.05). Implantation, clinical pregnancy, and multiple pregnancy rates were significantly higher in IVF group than ICSI group (15.1% vs. 4.1%, p<0.05; 36.5% vs. 15.0%, p<0.05; 36.8% vs. 0%, p<0.01). There were no significant differences in total blastulation, implantation, and clinical pregnancy rates between P1-BL and G1-G2 groups. However, multiple pregnancy rate was significantly higher in G1-G2 group than P1-BL group (60.0% vs. 8.3%, p<0.05). CONCLUSIONS: In human blastocyst transfer following in vitro culture for five days in IVF-ET, conventional IVF showed better outcomes of embryo development and pregnancy than ICSI. The efficiency of P1-BL media in the culture of human blastocyst was comparable to that of G1-G2 media. Further investigation will be necessary to compare the efficiency of various media in the blastocyst culture and to confirm the risk of multiple pregnancy in cases using G1-G2 media.

Cumulative Pregnancy Rate of In Vitro Fertilization and Embryo Transfer With Intracytoplasmic Sperm Injection / 대한산부인과학회잡지

OBJECTIVE: To compare the clinical outcomes between Day 2 and Day 3 embryo transfer(ET) groups in in vitro fertilization and embryo transfer(IVF-ET) with intracytoplasmic sperm injection(ICSI). METHODS: From May, 1997 to December, 1998, 174 cycles of IVF-ET with ICSI were performed and classified into two groups: Day 2 ET group(n=134) and Day 3 ET group (n=40). In Day 3 ET group, embryos fertilized after ICSI were cultured in vitro for further 24 hours in M3 media. RESULTS: There were no significant differences in the age and BMI of patients, basal serum FSH level, protocol of controlled ovarian hyperstimulation(COH), indication of ICSI, and source of sperm for ICSI between two groups. Only the number of the previous failed IVF-ET cycles was significantly higher in Day 3 ET group(p<0.05). Serum E2 level on hCG day, the numbers of oocytes retrieved after COH, oocytes fertilized after ICSI, and embryos transferred, and the rates of fertilization, cleavage, and implantation showed no significant differences. However, cumulative embryo score(CES) was significantly higher in Day 3 ET group(p<0.05). Although there were no significant differences in the rates of pregnancy per ET, spontaneous abortion, and live birth, the rates of biochemical and multiple pregnancy were significantly higher in Day 3 ET group(p<0.05). CONCLUSIONS: In IVF-ET with ICSI, the relatively higher CES may contribute to the higher risk of multiple pregnancy in Day 3 ET group, compared with the conventional Day 2 ET group.

Cumulative Pregnancy Rate of In Vitro Fertilization and Embryo Transfer With Intracytoplasmic Sperm Injection / 대한산부인과학회잡지

OBJECTIVE: To evaluate the cumulative pregnancy rate(CPR) of in vitro fertilization and embryo transfer(IVF-ET) with intracytoplasmic sperm injection(ICSI). METHODS: Medical records of 260 infertile patients undergoing 519 cycles of IVF-ET with ICSI from January, 1994 to December, 1999 were retrospectively reviewed. The CPR beyond 12 weeks of gestation was estimated by Kaplan-Meier method. The CPRs were compared by log-rank test between groups divided by age of patients, indication of ICSI, and method of sperm retrieval for ICSI. RESULTS: As 70 patients achieved an on-going pregnancy after IVF-ET with ICSI, the PR was 26.9% per patient and 13.5% per cycle. The overall CPR was 54.9% after 6 cycles of IVF-ET with ICSI. As expected, age had a significant strong effect on the CPR; CPRs afer 4 cycles of ICSI were 61.8% in the age group of 30 years(n=81), 43.7% in 31-35 years(n=106), and 15.3% in 36 years(n=73). There was no significant difference in the CPR between abnormal semen analysis group(n=184) and prior low fertilization rate group(n=66). In abnormal semen analysis group, the CPR of surgically retrieved sperm subgroup(n=60) was not significantly different from that of ejaculated sperm subgroup(n=124). CONCLUSIONS: The CPR of IVF-ET with ICSI was presented, and it could be of much help in the clinical counseling of IVF-ET patients. ICSI technique could be used successfully for IVF-ET in infertile couples who had the male factor infertility or the past history of low fertilization rate in the previous cycles.

The Outcome of Sperm Retrieval and Intracytoplasmic Sperm Injection in Patients with Obstructive Azoospermia: Impact of Previous Tuberculous Epididymitis / 대한산부인과학회잡지

OBJECTIVE: To investigate the intluence of previous tuberculous epididymitis in infertile males with obstructive azoospermia on the outcome of sperm retrieval and intracytoplasmic sperm injection(ICSI) in IVF-ET propam. METHODS: Retrospective analysis was paformed in 26 patients with obstructive azoospermia undergoing sperm retrieval and ICSI at Seoul National University Hospital from January, 1996 to August, 1997; 12 cycles in 5 patients with tuberculous obstructive azoospermia(Group A), and 40 cycles in 21 patients with non-tuberculous obstructive azoospermia(Group B). RESULTS: There was no significant difference in the clinical pregnancy rate(PR) per fresh transfer between Groups A and B(20.0%[2/10] vs. 26.8%(11/41)). The rates of embryo implantation and clinical miscarriage were also comparable in both groups(6.3% vs. 11.1%, 50.0% vs. 9.1%). This tendencies were also similar after including five cryopreserved-thawed transfer cycles. CONCLUSION: Embryo quality and pregnancy outcome in sperm retrieval and ICSI were comparable in both the tuberculous and non-tuberculous obstructive azoospermia patients. Our results suggest that previous history of tuberculous epididymitis in patients with obstructive azoospermia does not affect the outcome of sperm retrieval and ICSI.

Comparison with Ejaculated and Testicular Spermatozoa in Combination with Intracytoplasmic Sperm Injection in Men with Totally Immotile Spermatozoa / 대한산부인과학회잡지

With the advent of intracytoplasmic sperm injection (ICSI), the fertiliution and pregnancy have been reported even in complete asthenozoospermia. However, the results of ICSI in men with totally immotile sperm was still disappointing. The reasons for the total lack of sperm movement are not yet determined. The immotility of ejaculated spermatozoa is probably caused by sperm degeneration during epididymal transport, therefore higher viable spermatozoa can be obtained by testicular sperm recovery in some cases with low viability and total lack of movement of ejaculated spermatozoa. Recourse to testicular spermatozoa for ICSI is thus an alternative treatment possibility in this kind of pathology. This clinical study was performed to investigate the efficacy of ICSI employing testicular and ejaculated spermatozoa. From December 1995 to March 1998, 35 couples with totally immotile spermatozoa were included in the study. In 14 patients, the ejaculated spermatozoa were used whereas in 21 patients the spermatozoa were recovered from the testis. There were no significant differences in the fertilization and cleavage rates between the testicular sperm group with 62.6%, 52.7% and the ejaculated sperm group with 56.1%, 74.3%. Two pregnancies were achieved, one in the testicular spnm poup and the other in the ejaculated group. A healthy child was delivered at term in the ejaculated sperm group, but a clinical abortion occurred in a pregnancy in the testicular sperm group. In conclusion, it was suggested that ICSI using ejaculated sperm might be a primary treatment in cases with totally immotile spermatozoa and, if failed, testicular sperm could be used as an alternative mode of heatment.

Clinical Usefulness of Intracytoplasmic Sperm Injection of 1-day-old Unfertilized Oocyte during IVF-ET / 대한산부인과학회잡지

OBJECTIVE: To analyze the efficacy of intracytoplasmic sperm injection (ICSI) for totally unfertilized oocytes by the conventional insemination during in vitro fertilization and embryo transfer (IVF-ET) METHODS: From March 1996 to April 1998, 15 couples who experienced total fertilization failure after conventional IVF without severe male factor infertility in semen analysis were evaluated. Fertilization were assessed by the presence of 2 pronucleus (PN) after 14-16 hours of conventional insemination. All unfertilized oocytes were reinseminated by ICSI and checked for signs of fertilization between 6-10 hours after ICSI. The embryos with fertilization and development were transferred to the uterine cavity and the outcome was analyzed. RESULTS: Total numbers of unfertilized oocytes were 120, and total numbers of oocytes injected on day 1 using ICSI were 102. Total numbers of oocytes with normal fertilization after ICSI were 74 and mean fertilization rate of 71.1 +/- 24.0% was obtained. The numbers of embryos transferred was 3.6 +/- 1.7. The biochemical pregnancy rate was 13.3% (2/15) and the clinical pregnancy rate was 6.7% (1/15) per cycle. CONCLUSION: ICSI to totally unfertilized oocytes by conventional insemination technique during IVF-ET on the next day of oocyte retrieval seems to be a relatively successful mean and afford a chance of pregnancy to the infertile couples whom the ET could not perfomed to because of total fertilization failure."

Intracyplasmic Sperm Injection in Patients with Past History of Failed or Poor Fertilization in Previous IVF - ET Cycles : Comparison with Patients with Severe Male Factor / 대한산부인과학회잡지

OBJECTIVE: The purpose of this study was to determine whether intracytoplasmic sperm injection(ICSI) could overcome the defects of oocytes in IVF-ET patients with previous fertilization failure by conventional fertilization technique. Design: Retrospective study Materials and METHODS: A total of 119 ICSI cycles in 57 IVF-ET patients performed from May, 1995 to December, 1997 was enrolled. Subjects were divided into two groups: FR group included 66 ICSI cycles in 35 patients with normal sperm who underwent ICSI due to past history of failed or poor fertilization in the previous IVF-ET cycles, and OAT group included 53 ICSI cycles in 22 patients with severe oligoasthenoterato- zoospermia(OAT) which was defined as sperm concentration < 20 million/ml, mo#dlity < 30% and normal morphology < 4% by strict morphologic criteria. The outcomes of ICSI were analyzed and compared in both groups. RESULTS: The age of female patients, basal serum FSH level, and the numbers of oocytes retrieved and metaphase II oocytes were all comparable in both groups. The fertilization rate after ICSI was similar in both groups(68.7+/-25.3% vs. 67.7+/-24.5%), as were the cleavage rate of normally fertilized oocytes(93.1+/-21.4% vs. 89.3+/-21.6%), the number of embryos transferred(4,00+/-1.98 vs. 4.64+/-2.10), and cumulative embryo score(CES) indicating the quality of embryos(47.3+/-33.2 vs. 54.1+/-33.2). The implantation rate(4.3+/-10.5% vs. 3.8+/-11.0%) and the clinical pregnancy rate per cycle(15.2% vs. 13.2%) were also comparable in both groups. CONCLUSIONS: Although it has been shown that there is a higher risk of chromosomal abnormalities in oocytes from IVF-ET patients with pevious failed or poor fertilization, higher implantation and clinical pregnancy rates wer#e not observed in patients with OAT following ICSL Therefore, the functional defect of sperm such as loss of capacitation, defect of aaasome reaction, and abnormality of nucleus decondensation should be also considered in patients with previous failed or poor fertilization.

Clinical Usefulness of Basal FSH as a Prognostic Factor in Patients undergoing Intracytoplasmic Sperm Injection / 대한산부인과학회잡지

OBJECTIVE: To determine if basal serom follicle stimulating harmone (FSH) level could be a prognostic factor of the clinical outcome in in vitro fertilization and embryo transfer (IVF-ET) with intracytoplasmic sperm injection (ICSI) in the couples with male factor infertility. Materials and METHOD: From December 1995 to March 1998, total 118 patients with male factor infertility were included in this study. Patients were allocated to the low basal FSH group (>8.5 mIU/ml) and the high basal FSH group (>8.5 mlU/ml). The basal levels of FSH were measured in the 3rd day of menstrual cycle preceding ovarian stimulation cycle in total IVF cycles by immunoradiometric assay (IRMA). Statistical analysis was performed using Student's t-test, Fishers exact test, and x2 test as appropriate. Statistical significance was defined as p < 0.05. RESULTS: The total dose of exogeneous gonadotropin required in the patients of the high basal FSH group was significantly higher than that of the patients with the low basal FSH poup (p < 0.05). The numbers of retrieved oocytes, oocytes with grade I, II, fertilized oocytes, cleaved oocytes, embryos with grade I, II, and transferred embryos were significantly higher in the low basal FSH group (p < 0.05), The clinical pregnancy rate per cycle in the low basal FSH gmup (15.7%) seemed to be higher than that in the high basal FSH poup (3.4%) (p 0.08), however, there was no statistically significant difference between the two groups. CONCLUSION: These results suggested that the basal FSH levels could be predictive of pregnancy outcome and the results of ovarian stimulation in IVF-ET using ICSL.

Prenatal Cytogenetic Analysis of 145 Fetuses Conceived by Intracytoplasmic Sperm Injectiion ( ICSI ) / 대한산부인과학회잡지

Prenatal diagnoses were performed in 145 fetuses resulting from 73 singleton and 36 twin pregnancies, all established by intracytoplasmic sperm injection (ICS: amniocentesis in 108 patients and Chorionic villus sampling in one. The prenatal cytogenetic results were obtained from pregnancies after ICSI using ejaculated spermatozoa, epididymal spermatozoa, testicular spermatozoa and after the replacement of frozen-thawed embryos derived from ICSI. The Karyotypes were normal in 138 cases (95.2%) of the prenatal diagnoses and there were 2 cases (1.4%) de novo and 5 cases (3.4%) inherited chromosomal aberrations. The two cases of de novo abnormalities were: 46, XY, t(6;7)(q21;p22) and 47, XY, +21 (trisomy 21).

Microassisted Fertilization of Human Oocytes with Intracytoplasmic Sperm Injection in In VitroFertilization Program / 대한산부인과학회잡지

In spite of much progress in in vitro fertilization and embryo transfer(IVF-ET) program,the pregnancy rate remains at 20~30%, and the endometrial implantation rate per embryotransferred at 10%. Although IVF-ET is widely applied in the treatment of coupleswith male factor infertility, it may fail in many infertile couples with normal semen parameters,and certain couples cannot be accepted for standard IVF-ET due to unfertilization orextremely low fertilization rate of oocytes. Recently, several procedures of microassistedfertilization(MAF) using micromanipulation have been introduced, and pregnancies and birthshave been obtained after intracytoplasmic sperm injection(ICSI).This clinical study was performed to develop and establish ICSI as an effective procedureof MAF in infertile couples who could not be accepted for standard IVF-ET becauseof extremely impaired semen characteristics(Group A) and because of failure in fertilizationof extremely low fertilization rate of oocytes with the conventional fertilization technique inthe previous IVF-ET cycles(Group B). From March, 1995 to December, 1996, a total of 114cycles of IVF-ET with ICSI in 65 infertile patients were included in study group, and theoutcomes of ICSI were analyzed according to fertilization rate, cumulative embryo score(CES), and pregnancy rate.In Group A, 34 patients were evaluated with semen score such as number of totalmotile sperms, and then divided into 4 groups accordingly. In 62 ICSI cycles, the numberof oocytes retrieved after controlled ovarian hyperstimulation(COH) was 12.4+/-6.8, and thenumber of oocytes optimal for ICSI procedure was 8.8+/-5.5. The fertilization rate of 65.7+/-23.6% could be obtained after ICSI. The number of embryos transferred was 4.4+/-2.2 withthe mean CES of 50.5+/-34.3 in ICSI cycles. The overall pregnancy rate was 24.2%(15/62)per cycle and 44.1%(15/34) per patient. There were no significant differences in the pregnancyrates among 4 groups. Although more mature oocytes were retrieved, the fertilizationrate was significantly lower in Group A-1 compared with Group A-IV. However, semenscore did not clearly affect the outcomes of ICSI in couples with severe male factor infertility.In Group B, the number of oocytes retrieved after COH was 10.5+/-6.1 in 49 previouscycles, and 10.8+/-5.7 in 52 ICSI cycles. In ICSI cycles, the number of oocytes optimal forICSI procedure was 8.5+/-5.1 with the fertilization rate of 72.4+/-22.5%. The number ofembryos transferred was 1.4+/-2.4 in previous cycles, and 4.7+/-1.8 with the mean CES of 50.4+/-29.9 in ICSI cycles. In ICSI cycles, the overall pregnancy rate was 30.8%(16/52) percycles and 51.6%(16/31) per patients.In conclusion, MAF of human oocytes with ICSI is a promising fertilization method forIVF-ET patients, especially with few spermatozoa for the conventional methods of in vitroinsemination and with the past history of failure in fertilization or low fertilization rate inthe previous cycles, and ICSI using micromanipulation procedures applied to human oocyteswill provide a range of novel techniques which may dramatically improve the pregnancy ratein IVF-ET program and contribute much to the effective management of infertile couples.