Intrauterine insemination with donor sperm: only the number of motile spermatozoa inseminated influences both pregnancy and live-birth rates / 亚洲男科学杂志(英文版)

Intrauterine insemination with donor sperm (IUI-D) is an assisted reproductive technology (ART) offered to couples with definitive male infertility or risk of genetic disease transmission. Here, we sought to evaluate our practice in IUI-D and identify factors that influenced the success rate. We performed a retrospective, single-center study of all IUI-D procedures performed at Lille University Medical Center (Lille, France) between January 1, 2007, and December 31, 2017. Single and multivariate analyses with a mixed logistic model were used to identify factors associated with clinical pregnancies and live births. We included 322 couples and 1179 IUI-D procedures. The clinical pregnancy rate was 23.5%, and the live birth rate was 18.9% per IUI-D. In a multivariate analysis, the women's age was negatively associated with the live birth rate. The number of motile spermatozoa inseminated was the only factor associated with both clinical pregnancies and live births, with a chosen threshold of 0.75 million. The clinical pregnancy and live birth rates were, respectively, 17.3% and 13.0% below the number of motile spermatozoa inseminated threshold and 25.9% and 21.0% at or above the threshold (all P = 0.005). The number of motile spermatozoa inseminated was the only factor that significantly influenced both pregnancies and live-birth rates after IUI-D. Indeed, below a threshold of 0.75 million motile spermatozoa inseminated, those rates were significantly lower. Application of this number of motile spermatozoa inseminated threshold may help centers to allocate donations more effectively while maintaining reasonable waiting times for patients.

Effects of sperm DNA fragmentation index on semen parameters and pregnancy outcomes in intrauterine insemination / 中华男科学杂志

Objective@#To analyze the correlation of the sperm DNA fragmentation index (DFI) level with semen parameters and pregnancy outcomes of artificial insemination of the husband (AIH) in the cycle of intrauterine insemination (IUI).@*METHODS@#We collected the clinical data on 777 cases of IUI, including female clinical indicators, male semen parameters, sperm DFI and pregnancy outcomes. According to the DFI level, we divided the patients into three groups: DFI < 15%, 15% ≤ DFI < 30% and DFI ≥ 30%.@*RESULTS@#The sperm DFI level was significantly elevated with the increased age of the males (P = 0.002) and closely related to the total number of motile sperm (P = 0.002) and total sperm motility (P = 0.000) before treatment, as well as to sperm concentration (P = 0.000), total sperm motility (P = 0.001) and total number of progressively motile sperm (P = 0.000) after density gradient centrifugation. The rate of clinical pregnancy was decreased in the DFI ≥ 30% group. There were no statistically significant differences between sperm DFI and the rates of clinical pregnancy and abortion.@*CONCLUSIONS@#Male age significantly affects the sperm DFI level. Sperm DFI is closely related to sperm motility and total number of progressively motile sperm, but not to the rates of clinical pregnancy and abortion in patients undergoing IUI. IUI can be used as an effective method of assisted reproduction for male infertility./.

Comparison of pregnancy outcome between clomiphene citrate and sequential clomiphene citrate+human menopausal gonadotropin in intrauterine insemination

Background: Intrauterine insemination (IUI) has been widely used as a common treatment for infertile couples. This study compares the sequential clomiphene citrate (CC) treatment with CC and human menopausal gonadotropin (hMG) treatment in women undergoing IUI. Therefore, this study was designed to determine the effects of addition of gonadotropin (CC+hMG) would improve the pregnancy rate in women undergoing IUI. And also compare the sequential CC+hMG treatment with CC treatment in women undergoing IUI. Methods: A cross-sectional study design was conducted at D. Y. Patil Fertility Centre, D.Y Patil Hospital, Navi Mumbai from September 2018 to August 2019. Source populations were all patients who live in Mumbai, Maharashtra, India. A total of 67 patients were enrolled in this study. (It consisted of 67 sub fertile couples undergoing ovarian stimulation for IUI cycles). Results: There was no significant difference between the two studied groups regarding endometrial thickness (8.3±2.1 versus 9.7±2.8, respectively), number of mature follicles on the day of hCG injection (3.3±1.2 versus 3.5±1.1, respectively) and, but there was significant difference between the CC+hMG group and CC group regarding the total dose of gonadotropins used in ovulation induction (305±23.8 versus 655±192; total IU, respectively) p<0.05. Conclusions: Women undergoing IUI, ovarian stimulation CC combined with hMG, significantly improved the pregnancy and live birth rates as compared to that of CC group. In women undergoing ovarian stimulation and IUI, there are no significant differences in pregnancy and live birth rates among the various stimulation protocols.

Does increasing the number of inseminations per cycle increase the probability of conception? a randomized trial comparing single versus double intrauterine insemination

Background: Intrauterine insemination (IUI) remains an inexpensive, non-invasive, and effective first-line artificial insemination technique. The technique of IUI has evolved through various innovations since the time Cohen published the first report of IUI in 1962, and the success rate increased from 5% to >20%. The success of IUI depends upon several factors; two such prognostic factors are the timing and frequency of insemination.  The objective of this study was to compare the effectiveness of single versus double intrauterine insemination.Methods: This prospective randomized study was carried out in 130 patients with male factor infertility, PCOS and unexplained infertility. Patients were randomly assigned into two groups. In the first group of 65 patients, single IUI was applied at 36 to 40 hours after HCG administration, to the other 65 patients in the second group, double IUIs were applied at 12 to 16 hours and 36 to 40 hours after HCG administration. The primary end-point of the study was to compare the clinical pregnancy rate between the two groups.Results: The overall pregnancy rate was 18.46% (12/65) for single IUI group and 30.76% (20/65) for double IUI group. There was a no statistically significant difference between single and double IUI groups (p=0.16).Conclusions: This study did find a higher pregnancy rate following double IUI; however, the difference was not statistically significant. Further, larger sample size studies are required to determine if double IUI increases the pregnancy rate.

Hysteroscopic polypectomy versus expectant management in endometrial polyps in asymptomatic infertile women: a meta-analysis

Background: Endometrial polyp is a hyperplastic structural abnormality of the uterine cavity and is one of the most commonly found intrauterine abnormalities. The endometrial polyp is mostly asymptomatic and sometimes diagnosed only during infertility investigation. The influence of endometrial polyps on female infertility is not completely understood, however, due to the possibility of endometrial polyps influencing fertility, their removal is usually performed in women undergoing infertility treatment.Methods: This meta-analysis was performed through an electronic search using MEDLINE, PubMed in October 2017, bringing together the terms of interest in order to select studies that would compare polypectomy and expectant management for endometrial polyps in sub fertile women. Four articles were selected according to the inclusion and non-inclusion criteria.Results: Five variables were collected from the selected articles to be compiled and analyzed (rate of live births per transferred embryo, chemical pregnancy rate, spontaneous abortion rate, implantation rate and clinical pregnancy rate), none of which showed any difference statistically significant in conduct.Conclusions: The data concluded that there is no statistical significance between expectant management and polypectomy.

Comparative Study between Timed Intercourse and Intrauterine Insemination in Ovulation Stimulated Cycles in Unexplained Infertile Couples

Background and Objectives: It cannot be stressed enough that infertility is a problem of the couple and not an individualalone. IUI as a mode of artificial insemination is widely used in treating couples with unexplained infertility. The present studywas done with the objective of comparing the effectiveness of TI and IUI with husband’s sperm in couples with unexplainedinfertility undergoing superovulation with clomiphene.Methodology: In this cross-over study, a total of 60 couples with unexplained infertility were subjected to controlled ovarianhyperstimulation with clomiphene and prospectively randomized to receive either TI (Group A) or IUI (Group B). The groupswere interchanged when pregnancy was not achieved in either group after three cycles of each intervention.Results: A positive pregnancy test was seen in both IUI and TI after cross-over. There were seven pregnancies (four in IUI andthree in TI), out of which 6 (85.71%) were viable pregnancies, while one was non-viable (14.29%). Both IUI and TI had threeviable pregnancies each. The one non-viable pregnancy was from the IUI group.Interpretation and Conclusions: The findings of the present study showed that both TI and IUI are effective treatment modalitiesfor women with unexplained infertility. Although the addition of IUI to ovulation induction does increase the cycle fecundability,it does not improve the fecundity.

Implementation of an in-house flow cytometric analysis of DNA fragmentation in spermatozoa / 亚洲男科学杂志(英文版)

An increased amount of DNA fragmentation in the spermatozoa (SDF) is linked to male infertility. The Sperm Chromatin Structure Assay (SCSA) is widely used for analysis of SDF. However, the current software (SCSASoft®) linked to this assay is licensed and often located within larger diagnostic centers. In this study, we present a protocol for using other types of software than SCSASoft® to determine the SDF index (DFI) with clinical relevance. This protocol is engineered after collecting and analyzing 254 samples from fertility patients and sperm donors over a 15-month period. DFI is analyzed using a strict protocol where the spermatozoa are treated with a strong acid (pH 1.2) followed by acridine orange. DFI is determined by a standard flow cytometric software, FACSDiva 6.1.3. Analysis of the outcome of the fertility treatment is included for 137 patients receiving either intrauterine inseminations (IUI) or timed coitus (TC). The results show that the chance of pregnancy declines as DFI increases. We also found that the male DFI affects the chance of pregnancy independent of the female age. We have shown that a standard flow cytometric software can be used when determining a clinical relevant DFI. These findings are a significant step toward implementing the analysis as a part of the routine, in-house diagnosing of the male fertility patient and subsequently optimizing the treatment course of the couple with reduced human and financial costs.

Resultados de inseminación intrauterina en parejas del programa privado del centro de reproducción humana (crh), universidad de valparaíso, entre los años 2012 - 2016 / Results of intrauterine insemination in couples between 2012 and 2016 in the human reproduction center private program, Valparaiso University

Objetivos: Evaluar los resultados de los ciclos de baja complejidad del programa privado de atención del Centro de Reproducción de la Universidad de Valparaíso, entre los años 2012 - 2016. Objetivo secundario, evaluar las tasas de embarazo y recién nacido vivo en casa, según patología y rango etario. Diseño: Estudio Descriptivo retrospectivo. Setting: Centro de reproducción humana, Universidad de Valparaíso. Pacientes: 165 parejas infértiles. Intervención: Inseminación intrauterina. Outcome principal: Tasa de embarazo y de recién nacido vivo por ciclo inseminado. Resultados: De un total de 165 pacientes que recibieron tratamientos de reproducción medicamente asistidos, un 25,5% de las parejas inseminadas lograron embarazo, con una tasa de embarazo de 13,8% por ciclo inseminado. Un 23% de las parejas inseminadas, logró un recién nacido vivo en casa. La tasa de recién nacido vivo fue de 12,5% por ciclo inseminado. Conclusiones: Las tasas de embarazo y recién nacido vivo son comparables a las publicadas en la literatura, tanto nacional como internacional, lo que permite que se siga posicionando la inseminación intrauterina como el tratamiento de primera línea de la pareja infértil.

Objectives: To evaluate low complexity cycles in a private program in the Valparaíso University Reproduction Center between 2012 and 2016. Secondary objective, evaluate pregnancy and live birth rates according to pathology and age range. Design: Descriptive retrospective study. Setti ng: Human Reproduction Center, Valparaíso University. Patients: 165 infertile couples. Intervention: intrauterine insemination. Principal outcome: Pregnancy and live births rates per insemination cycle. Results: Of a total of 165 patients receiving medically assisted reproduction treatments, 25.5% of the couples achieved pregnancy with a pregnancy rate of 13.8% per insemination cycle. 23% of the inseminated couples achieved a live birth. The rate of live births was 12.5% per insemination cycle. Conclusion: Pregnancy and live birth rates are comparable with those published in the national and international literature; hence intrauterine insemination remains first line treatment for infertile couples.

Hysteroscopic salpingosonography: a novel technique for infertile patients

Background: Infertility is akin to curse in our country. Patients of infertility run from pillar to post to get relief. Government Hospitals in India lie at the tail end of window-shopping of infertility centres by the patients having exhausted all their resources. Patients report without any detailed records, lost reports, coming after long hiatus of having stopped treatment in desperation, making one wonder how to proceed. At the other end are patients who have undergone laparotomy for various reasons like intestinal obstruction, tubercular abdomen, adnexal masses and their tubal status is not very clear on HSG. So, repeat laparoscopy in the former group and performing ab initio in the latter, involves putting the patients to the risk of general anesthesia, injury to internal organs due to anticipated adhesions. Although Hassan’s technique of open trocar entry is well accepted the first port entry, whatever be the mode, is an entry open to risks.Methods: In a selected group of infertile women, a baseline TVS was done on 2/3 day of menses and on the 7/8 day of menstrual cycle hysteroscopy was done which was immediately followed by another transvaginal ultrasound. The descriptive statistics is presented in the form of percentages and appropriate graphs.Results: Among the 54 patients who underwent this procedure, 65% had normal uterine cavity. 18% were referred for IVF. 9.2% conceived post procedure.Conclusions: Successive use of transvaginal ultrasound after hysteroscopy i.e Hysteroscopic sonosalpingography is a useful procedure in a select group of infertile patients.

A study for evaluation of two protocols comprising of clomiphene citrate, human menopausal gonadotropin with or without follicle stimulating hormone for ovulation induction in patients with infertility for intrauterine insemination

Background: To compare two protocols comprising of FSH/CC/HMG and CC/HMG for ovulation induction and IUI in women with infertility.Methods: 60 women with unexplained infertility were randomized using sequentially numbered opaque envelope method. Group A received inj FSH 150 units on day 2 of menstrual cycle and clomiphene citrate 100 mg from day 3-7, followed by injection HMG 150 units on day 9 of menstrual cycle. Group B received clomiphene citrate 100 mg from day 3-7, and HMG 150 units on day 7 and 9 of the menstrual cycle.  Ovulation triggered with hCG 5000 units when dominant follicle was 18mm. Single IUI was done 36-42 hours afterwards.Results: Pregnancy occurred in 3 out of 30 women in 116 cycles Group A (with FSH) with a pregnancy rate of 10 percent, and 2.8% per cycle. In group B (without FSH) pregnancy occurred in 3 out of 30 women in 117 cycles with pregnancy rate of 10 percent, and 2.6% per cycle. The number of follicles per cycle was 1.36 and follicle size was 18.57 mm in group A. While in Group B numbers of follicles per cycle were 1.22, with average size of 18.9mm. Mean endometrial thickness was 7.7mm in Group A and 6.37 in Group B (p=.01, significant). Mild OHSS was observed in one woman in Group B. No other side effects were observed in both the groups.Conclusions: The controlled ovarian stimulation regimes used in this study are equally effective, easy to administer, require less intensive monitoring and fewer medications, with little risk of OHSS and multiple gestation.

Comparison of intrauterine insemination and timed intercourse following controlled ovarian hyperstimulation in unexplained infertility: a randomized controlled trial

Background: Being a diagnosis of exclusion the treatment options of unexplained infertility are often empiric. There is significant dilemma regarding the superiority of one over another. Despite increasing use of intrauterine insemination (IUI) in adjunct to controlled ovarian hyperstimulation (COH) there is scarcity of randomized controlled trials (RCT) from developing countries. Objective was to compare IUI and timed intercourse (TI) in super ovulated cycles among couples with unexplained infertility over one year.Methods: In this prospective randomized controlled trial total 85 patients were randomly assigned into group 1 (COH with IUI, N= 44) and group 2 (COH with TI, N=41). Patients underwent COH using sequential Clomiphene Citrate and injection human menopausal gonadotrophin followed by IUI in group 1 and timed intercourse in group 2. Either protocol was repeated for three consecutive cycles. Finally, both groups were compared for clinical pregnancy rate, adverse effects and acceptability of the treatment process and outcome. Comparison was done by Student’s unpaired t test for continuous and 2-tailed chi square test for categorical variables.Results: Clinical pregnancy rates following COH/IUI and COH/TI were 13.64% and 19.51% respectively. There was observable difference in the acceptability of the outcome (38.64% in IUI and 56.09% in TI group). All the results including complications and side effect rates were statistically insignificant.Conclusions: Present study failed to show any improvement of pregnancy rates following addition of IUI over TI and it raised the probability that the outcome of the procedure may not be well accepted.

Predictive value of uterine artery: peak systolic velocity on the day of trigger for clinical pregnancy rate in infertile women

Background: The purpose of the study is to evaluate the role of uterine artery blood flow parameter measured by uterine artery two-dimensional (2D) power coloured doppler (PCD) ultrasound in predicting fertility outcomes in women undergoing ART treatment.Methods: It is prospective observational study. Total of 60 patients were included  of receiving infertility treatment in the age group20-40 years. 20 patients were selected for timed intercourse , 20 patients were selected for intrauterine insemination , 20 patients were selected for invitro fertilization. Transvaginalsonography will be done on the day of trigger by BHCG , UA PSV were measured,  and endometrial blood flow will be assessed. Predictivity of pregnancy rate  will be looked after by 3 ways: BHCG values  , UPT, Gestational sac  on USG.Results: In TI/IUI/IVF cycles the Doppler parameter PSV of uterine artery (23.08+/-3.39 vs 20.37-/+5.43) in pregnant vs non-pregnant group did not differ significantly. The mean PSV   of UA shows no significant difference women who were became pregnant during treatment and the women who were not became pregnant.Conclusions: With help of Doppler parameter imaging of women undergoing infertility it was found that UA PSV is non-significant to decide the prediction of pregnancy outcome.

Retrospective analysis of efficacy of washed husband semen IUI for oligoasthenoteratospermia in an urban centre

Background: The true incidence of male subfertility is unknown due to great variability in the prevalence of subfertility. Artificial insemination with husband’s semen is the most widely used treatment for male infertility, usually presumed because of oligospermia, and for what is called ‘mucus hostility’ when there is failure of sperm penetration of cervical mucus despite normal seminal analysis.Methods: The study was conducted in 438 couples with male factor infertility at the ARTC (artificial reproductive technique centre) of Sri Ramakrishna Hospital, Coimbatore. Results of at least two seminograms (based on WHO norms) were used to primarily classify males into three categories-oligozoospermic, asthenozoo spermic and oligoasthenoteratospermic. The media used were the Earle’s Balanced Salt Solution (EBSS), Ham’s F10 and Medicult. EBSS and Ham’s F10 were obtained as “readymade” solutions from Sigma, USA. Medicult was imported from Denmark. EBSS and Ham’s F10 were supplemented with protein using FCS (Fetal cord Serum) or HEPES (4(2-hydroxyethyil)-1-piperazineethanesulfonic acid). Benzyl pencillin, 60mg per litre and Streptomycin, 50mg per litre were also to the media.Results: By the DMRT analysis of post wash count, the influence of the count below 5 million or above 20 million on the pregnancy rate was significant at all the levels of male factor.Conclusions: Considering the male factor, in cases of oligoasthenoteratospermia, IUI has a positive significant effect on the success rate of pregnancy at all three levels of the post wash sperm count.

Tasa acumulada de embarazo clínico y en curso en ciclos de inseminación intrauterina y análisis de los ciclos según la edad, conteo de folículos maduros y estimulación con antagonista de GnRH / Clinical and ongoing cumulative pregnancy rates in cycles of intrauterine insemination and analysis of the cycles according to age, follicular count and GnRH antagonist use

Resumen Objetivo: Determinar la tasa acumulada de embarazo clínico en ciclos de inseminación intrauterina en pacientes estimuladas con gonadotropinas según el número de folículos maduros desarrollados y edad, así como la influencia de los antagonistas de GnRH en su desarrollo y en la tasa de embarazo. Materiales y métodos: Estudio analítico, retrospectivo, en el que se evaluaron ciclos de inseminación intrauterina de pacientes con diferentes protocolos de gonadotropinas en un periodo de dos años. La muestra se dividió en grupos: menores de 35 y más o menos mayores de 35 años y uso o no de antagonista de GnRH. Resultados: Se evaluaron 229 ciclos de inseminación intrauterina en 172 pacientes; de éstas 64% eran menores de 34 años (grupo 1) y 36% mayores de 35 años. El 50% de las pacientes desarrolló de 2 a 3 folículos maduros y 10% de 4 a 6, con una tendencia en aumento de la tasa de embarazo con el desarrollo de hasta 4 folí culos maduros. El antagonista de GnRH no parece relacionarse con mejores tasas de embarazo clínico o en curso en ciclos con más de un folículo maduro. La tasa acumulada de embarazo clínico en tres ciclos fue de 40.6%, mientras que la tasa acumulada de embarazo en curso fue 26.1%. Conclusiones: Hubo relación proporcional entre el número de folículos maduros desarrollados y la tasa de embarazo clínico y en curso. La edad no parece haber tenido influencia en las tasas de em barazo y no pudo demostrarse la eficacia del antagonista en ciclos con desarrollo multifolicular.

Abstract Objective: To determine the cumulative clinical pregnancy rate in cycles of intrauterine insemination with gonadotropin stimulation in relation to number of mature follicles and age and the use of GnRH antagonist on its development. Materials and methods: Analytical, retrospective study in which intrauterine insemination cycles of patients with different gonadotropin protocols were evaluated over a period of two years. The patients were divided in two groups: <35 and ≥35 years old and the use of GnRH antagonist. Results: We evaluated 229 cycles of intrauterine insemination in 172 patients; Of these 64% were under 34 years old (group 1) and 36% over 35 years. The use of antGnRH did not appear to have relation with better clinical and ongoing pregnancy rates in cycles with more than one mature follicle. The cumulative pregnancy rate in three cycles was 40.6%, and cumulative ongoing pregnancy rates was 26.1%. Conclusions: The more mature follicle developed the higher clinical and ongoing pregnancy rates. The age did not appear to have influence in the pregnancy rates, there is no better pregnancy rates with use of antGnRH in cycles with multifolicular developed.

In vitro culture medium for sparse spermatozoa improves human sperm motility / 中华男科学杂志

Objective@#To investigate whether in vitro culture medium (IVCM) for sparse spermatozoa can improve human sperm motility for the purpose of helping clinicians, laboratorians and patients choose a better strategy of assisted reproduction.@*METHODS@#Semen samples were obtained from 178 males for routine semen examination from March to August 2016, including 151 cases of asthenozoospermia and 27 cases of normal sperm motility. A total of 200 μl was collected from each sample and divided into two equal portions and equal volumes of IVCM (experimental group) and F10 (1×) (control group) were added to the two portions, respectively, followed by 30-minute incubation at 37℃ in an incubator with 5% CO2. Sperm concentration, motility and viability and the percentages of progressively motile, non-progressively motile and immotile sperm were recorded before and after incubation.@*RESULTS@#After activated with IVCM, neither the samples with asthenozoospermia nor those with normal sperm motility showed any statistically significant difference in sperm viability from the baseline or the control group (P>0.05). The rates of progressively and non-progressively motile sperm from the asthenozoospermia males were increased by 14.02% and 4.86% respectively, while that of immotile sperm decreased by 19.01% in the experimental group (P >0.01), and similar results were observed in the semen samples from the men with normal sperm motility. The percentage of reduced immotile viable sperm was positively correlated with that of immotile viable sperm in both the asthenozoospermia patients (r = 0.260, P <0.01) and the men with normal sperm motility (r = 0.679, P <0.01).@*CONCLUSIONS@#IVCM can increase sperm motility without affecting sperm viability in men with either asthenozoospermia or normal sperm motility. The larger the proportion of immotile viable sperm, the higher the percentages of progressively and non-progressively motile sperm in the semen after IVCM activation, and this correlation is more significant in men with normal sperm motility than in asthenozoospermia patients.

Influence of total progressively motile sperm count after treatment on outcomes of intrauterine insemination with husband′s sperm / 重庆医学

Objective To investigate the influence of total progressively motile sperm count(TPMSC) after treatment on clinical outcomes of intrauterine insemination(IUI) with the husband′s sperm in ovulation-promoting cycles.Methods The clinical data in 4179 cases undergoing IUI with the husband′s sperm in ovulation-promoting cycles were retrospectively analyzed.The correlation between clinical pregnancy rate and TPMSC was analyzed.Results Among all the clinical data,TPMSC was to 100×106 in occasional live sperm.TPMSC60×106 had no pregnancy.A total of 4 154 cases of TPMSC (0.15-60.00)×106 were analyzed.The female age,duration of infertility,number of follicles and endometrial thickness(EDM) had no statistical differences among various groups.The clinical pregnancy rate was 13.5%(576/4 154),the group with the highest clinical pregnancy rate was (5.00-<10.00)×106.But there was no statistically significant difference in clinical pregnancy rate among groups(P=0.133).Conclusion Performing IUI in PMSC (0.15-60.00)×106 after processing can get preferable pregnancy rates.

Effect of methods of invigorating spleen and kidney on the pregnancy outcome of artificial insemination in infertile men with asthenospermia / 实用医学杂志

Objective To explore the effect of invigorating splcen and kidney methods on the pregnancy outcome of the intrauterine insemination (IUI) in infertile men with asthenospermia.Methods a total of 78 male infertility patients with spleen and kidney deficiency type were collected,all cases were randomly allocated into three groups,group A using methods of invigorating spleen and kidney,group B using Antioxidant therapy,and group C as the blank group.There are 26 cases in each group.One course of treatment lasts for 12 weeks.Before and after treatment,the changes of sperm quality index were analyzed by computer assisted sperm analysis (CASA) and sperm morphology.The pregnaucy outcome after IUI was followed up.Results After the treatment,sperm motility and sperm forward movement (PR) difference before and after treatment in group A with was statistically significant (P ＜ 0.05).The differences between patients with semen volume,sperm concentration,sperm morphology and sperm motility parameters before and after treatment in three groups were not statistically significant (P ＞ 0.05).Clinical pregnancy rate and cumulative pregnancy rate and the live birth rate in group A were higher than that of group B and group C,but the difference was not statistically significant (P ＞ 0.05).Conclusion Invigorating spleen and kidney method can improve the sperm motility and forward movement speed of the type of patients for the treatment of male infertility patients with asthenospermia,and it is helpful to improve the pregnancy outcome of the IUI.

Men with a complete absence of normal sperm morphology exhibit high rates of success without assisted reproduction / 亚洲男科学杂志(英文版)

In couples with infertility, abnormal strict morphology of 0% normal forms (NF) is a criterion to proceed rapidly to in vitro fertilization (IVF). Since no data currently exist, we investigated the outcomes for men with 0% NF to determine reproductive success without the use of assisted reproductive technologies (ART). A cohort of 24 men with 0% NF were identified (2010-2013) with 27 randomly selected men with ≥4% NF as controls. Patient charts were reviewed with men contacted and administered an Institutional Review Board (IRB)-approved telephone questionnaire to ascertain outcomes. After a median follow-up time of 2.5 years, 29.2% of men with 0% NF did not require ART for their first pregnancy (controls = 55.6%, P ≤ 0.05). When all pregnancies were analyzed together, men with 0% NF achieved twenty pregnancies of which 75% did not require IVF (controls = thirty pregnancies; 76.7% did not require IVF). The average age of men and female partners was similar between men with 0% NF and ≥4% NF. All men had normal follicle-stimulating hormone (FSH), testosterone, prolactin, sex hormone-binding globulin (SHBG), and estradiol. Although, global semen parameters were worse in men with 0% NF, when a first pregnancy was a natural conception (NC), 100% of men with 0% NF (n = 7/7) and 37.5% of controls (n = 3/8) went on to have a subsequent pregnancy via NC. Men with 0% NF conceived without IVF in 29.2% of cases compared to 55.6% of controls. Strict morphology should not be used to predict fertilization, pregnancy, or live birth potential. In men with 0% NF, alternative modalities should be considered before immediate IVF.

Protocolos de estimulación ovárica en inseminación artificial según el patrón utilizado de glicosilación de la hormona folículo estimulante / The impact of different ovarian stimulating protocols in artificial insemination based on the glycosylation pattern of the follicle stimulating hormone

Resumen ANTECEDENTES: los estudios clínicos que comparan diferentes protocolos de estimulación ovárica no son concluyentes. Nuestro estudio compara tres protocolos según el patrón de glicosilación de la hormona folículo estimulante (FHS) que imita el ciclo natural para inseminación artificial. OBJETIVO: proponer un protocolo de estimulación ovárica secuencial con FSH urinaria (isoforma ácida) seguido de FSH recombinante (isoforma menos ácida) y evaluar su efectividad respecto de los esquemas tradicionales de estimulación con FSH recombinante (FSHr) y FSH urinaria (FSHu). MATERIALES Y MÉTODOS: estudio de cohortes, retrospectivo, efectuado entre mayo de 2012 y mayo 2015 en parejas infértiles en protocolo de inseminación artificial. El grupo de estudio se dividió en tres: 1) FSHr, 2) FSHhp y 3) estimulación sequencial: FSHhp + FSHr. Para el análisis estadístico se utilizaron χ2, ANOVA o test Mann-Whitney. Los resultados se reportan con límite de significación de p < 0.05. RESULTADOS: se estudiaron 178 parejas infértiles en protocolo de inseminación artificial y se efectuaron 299 ciclos de estimulación ovárica con inseminación artificial; grupo 1) 99 con FSHr, 2)100 con FSHhp y 3) 100 con estimulación sequencial: FSHhp + FSHr. Los resultados gestacionales fueron mayores en el grupo FSHu y secuencial. En el análisis costo-efectividad se observó menor tasa con el esquema secuencial en comparación con los otros dos. Al comparar los tres protocolos según los intentos previos de inseminación, en la serie con intentos previos, se encontraron diferencias estadísticamente significativas en βHCG y gestación al comparar FSHr versus secuencial. El protocolo FSHr fue menos efectivo que los otros dos tratamientos. CONCLUSIONES: se planteó la estimulación ovárica controlada con protocolo secuencial en pacientes que recibirían inseminación artificial y, aunque no se encontraron diferencias significativas, sí se observó una tendencia en la que tanto la dosis como los días de estimulación requerida son menores con este protocolo que con los clásicos con FSHr o FSHu.

Abstract BACKGROUND: Earlier trials comparing different ovarian stimulating protocols in assisted reproduction found no significant differences in the results. OBJECTIVE: To evaluate the effect of three different stimulation protocols based on the glycosylation pattern of the follicle stimulating hormone (FSH) in an intrauterine insemination (IUI) program. The stimulating protocols are: human FSH (acidic isoform), recombinant FSH (less acidic isoform) and combined urinary and recombinant FSH. MATERIALS AND METHODS: Cohort study, retrospective, conducted between May 2012 and May 2015 in infertile couples in protocol of artificial insemination. The study group was divided into three: 1) FSHr, 2) FSHhp and 3) sequential pacing: FSHhp + FSHr. For statistical analysis, χ2, ANOVA or Mann-Whitney test were used. The results are reported with a significance limit of p < 0.05. RESULTS: 178 infertile couples were studied in an artificial insemination protocol and 299 cycles of ovarian stimulation were performed with artificial insemination; Group 1) 99 with FSHr, 2) 100 with FSHhp and 3) 100 with sequential stimulation: FSHhp + FSHr. CONCLUSION: In this study, controlled ovarian stimulation with sequential protocol was considered in patients who would receive artificial insemination and, although no significant differences were found, a trend was observed in which both the dose and the days of stimulation required are lower with this protocol than with the classics with FSHr or FSHu.