Inseminação artificial homóloga póstuma: análise bioética do planejamento familiar / Posthumous homologous artificial insemination: a bioethical analysis of family planning / Inseminación artificial homóloga póstuma: un análisis bioético de la planificación familiar

Resumo Este artigo trata de questões relacionadas à inseminação artificial homóloga post mortem. Tomando como referência normas éticas que asseguram a livre escolha do casal no planejamento familiar, objetivou-se descobrir de que forma tais regulamentações influenciariam na concretização desse projeto parental. A partir do método hipotético-dedutivo, realizou-se revisão de literatura em bioética e biodireito, além de pesquisa documental no sítio eletrônico do Conselho Federal de Medicina. Refletiu-se, então, sobre o princípio de autonomia dos pacientes submetidos às técnicas de reprodução assistida, levando em conta algumas das repercussões dessa técnica sobre o direito de família e sucessões. Por fim, descreveu-se o método de casuística clínica, utilizado pelas clínicas como parâmetro para tomar decisões e aconselhar o cônjuge sobrevivente acerca da problemática da concepção póstuma.

Abstract This article discusses issues related to post mortem homologous artificial insemination. Taking as reference ethical norms that ensure the couple's free choice in family planning, the objective was to understand how such regulations would influence the accomplishment of this parental project. Using the hypothetical-deductive method, a literature review on bioethics and biolaw was carried out, in addition to a documentary research on the website of the Federal Council of Medicine. Then, reflections on the principle of autonomy of patients undergoing assisted reproduction techniques were made, considering some of the repercussions of this technique on family and succession law. Finally, a description of the method of clinical casuistry is presented, being used by clinics as a parameter to make decisions and advise the surviving spouse about the problem of posthumous conception.

Resumen Este artículo trata aspectos relacionados a la inseminación artificial homóloga post mortem. Con base en la normativa ética que garantiza la libre elección de la pareja en la planificación familiar, el objetivo fue identificar la influencia de la legislación en la realización de este proyecto parental. A partir del método hipotético-deductivo, se realizó una revisión bibliográfica sobre bioética y bioderecho, además de una búsqueda documental en el sitio web del Consejo Federal de Medicina. Con esto, se reflexionó sobre el principio de autonomía de los pacientes sometidos a técnicas de reproducción asistida, teniendo en cuenta algunas de las repercusiones de esta técnica en el derecho de familia y de sucesiones. Por último, se describió el método de la casuística clínica utilizado por las clínicas como parámetro en la toma de decisiones y asesoramiento al cónyuge sobreviviente en el tema de la concepción póstuma.

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./.

Time interval from the end of sperm processing to artificial intrauterine in semination with husband's sperm correlates to the rate of clinical pregnancy / 中华男科学杂志

<p><b>OBJECTIVE</b>To investigate the influence of the time interval from the end of semen processing to artificial intrauterine in semination with husband's sperm (AIH-IUI) on the rate of clinical pregnancy.</p><p><b>METHODS</b>This study involved 191 AIH-IUI cycles with the same ovulation induction protocol. After Percoll density gradient centrifugation, we divided the sperm into four groups based on the incubation time: 0-19, 20-39, 40-59, and 60-80 min, and again into another four groups according to the total progressively motile sperm count (TPMC): (0-9), (10-20), (21-30), and > 30 x 10(6). We analyzed the correlation of the clinical pregnancy rate with the time interval from the end of sperm processing to AIH-IUI and with other influencing factors, such as maternal age, infertility duration, and semen quality.</p><p><b>RESULTS</b>The rate of clinical pregnancy was significantly higher in the 20-39 min group (18.3%) than in the 0-19, 40-59, and 60-80 min groups (12.7, 11.4 and 9.1%) (all P < 0.05). The (10-20) x 10(6) group achieved a remarkably higher pregnancy rate (16.7%) than the (0-9), (21-30), and > 30 x 10(6) groups (0, 11.4, and 8.3%) (all P < 0.05). Logistic multivariate analysis showed that the rate of clinical pregnancy was decreased with the increased age of the women (OR 0.89, 95% CI 0.83-0.94) but significantly elevated in the 20-39 min group (OR 2.11, 95% CI 1.34-3.13) and of (10-20) x 10(6) group (OR 2.06, 95% CI 1.32-3.46).</p><p><b>CONCLUSION</b>The time interval from the end of sperm processing to AIH-IUI is a most significant factor influencing the rate of clinical pregnancy of AIH-IUI.</p>

Concentración espermática mínima requerida para inseminación intrauterina mediante capacitación por migración ascendente / Low sperm concentration required to IUI through training by upward migration

Objetivo: Determinar cuál es la cantidad mínima necesaria de espermatozoides móviles que se requiere para realizar la inseminación intrauterina y evaluar la morfología estricta de Kruger y la movilidad espermática antes y después de la capacitación por migración ascendente. Métodos: Estudio prospectivo de 35 muestras de semen de hombres infértiles, se lavaron alícuotas de 1 mL de semen fresco, se centrifugaron y sobre el centrifugado se colocó una capa de medio de capacitación para lograr una migración ascendente. Resultados: Los valores de movilidad y formas normales espermáticas se observaron significativamente aumentados en las muestras después de la capacitación. Fue posible recuperar ≥ 2 x 106 espermatozoides móviles aun en muestras aparentemente inapropiadas caracterizadas por hipospermia u oligozoospermia severa, pero contenían en el total del eyaculado al menos 5 millones de espermatozoides móviles que permitieron un elevado porcentaje de recuperación espermática. Conclusiones: La posibilidad de obtener altos porcentajes de recuperación de espermatozoides móviles en el total del eyaculado permite la inseminación intrauterina como técnica de reproducción asistida en pacientes oligozoospérmicos antes de elegir fertilización in vitro o inyección citoplasmática del espermatozoide cuando el factor masculino es la causa de infertilidad.

Objective: To determine what is the minimum necessary amount of motile sperm required for intrauterine insemination and to evaluate the Kruger strict morphology test and sperm motility before and after training sperm by swim up. Methods: Prospective study of 35 semen samples from infertile men, aliquots of 1 mL of fresh semen was washed, centrifuged and over the pellet was placed a layer of capacitation medium to achieve an upward migration. Results: The values of motility and normal sperm forms were observed in the samples significantly increased after the training. It was possible to recover ≥2 x 106 motile sperm even in seemingly inappropriate samples with hypospermia or severe oligozoospermia, but these contained in the total ejaculate at least 5 million of motile spermatozoa that allowed a high percentage of retrieval. Conclusions: The possibility of obtaining high recoveries of motile sperm in the total ejaculate allows IUI as assisted reproduction technique in oligozoospermic patients before choosing IVF or cytoplasmic sperm injection when the male factor is cause of infertility.

Cysclosporine-A versus prednisolone for induction of remission in auto-immune hepatitis: interim analysis report of a randomized controlled trial

Corticosteroids are used to induce remission in auto-immune hepatitis. They are not universally effective; therefore, alternative treatments are needed. In this study Cysclosporine-A has been compared with prednisolone as an alternative treatment in a randomized controlled trial. This paper is an interim analysis of an ongoing clinical trial. Sixteen years and older consenting patients were enrolled. Group-A received prednisolone and group-B cyclosporine-A according to a preset protocol and followed at regular intervals for 48 weeks. Final assessment was done at week 48. Primary outcome was response rate as defined below. [Complete response] was defined as achieving AST and ALT in the normal range and absence of any clinical signs of deterioration, and partial response was defined as a decrease in AST and ALT by less than half of their original values but not to within normal limit. Non-responding ones at week eight were switched to the other arm. Thirty-nine patients were enrolled [24 group-A, 9 male]. Mean AST and ALT at baseline were higher in group-B, but other variables were comparable. At week 12, 34.8% and 64.3% of group-A and B had achieved AST and ALT in the normal range less than 40 IU/L]respectively [P=0.081]. Corresponding figures at week 48 were 50.0% and 47.6% 0=0.62 and48 respectively]. At week 12, 86.9% and 85.7% of patients had AST and ALT levels less than twice upper normal limit in groups-A and B respectively [p=0.54 and 0.42]. Corresponding figures at week 48 were 90.0% for both groups. There was one treatment failure in group-B which did not respond to prednisolone either. Serious adverse events [death and liver transplantation] occurred in group-A only. Serum creatinine did not change during the study period in either group. According to our data, Cyclosporine-A is as effective as prednisolone for induction of remission in AIH. Adverse event and serious adverse were more common with prednisolone

Sperm acrosome reaction detection in intrauterine insemination / 中南大学学报(医学版)

OBJECTIVE@#To investigate the relationship between sperm acrosome reaction (AR) and the clinical pregnancy rate of intrauterine insemination (IUI).@*METHODS@#We detected the sperm spontaneous AR rate and Ca2+ ionophore A23187-induced AR rate in 128 patients who accepted IUI treatment, collected their clinical data and analysed the relationship between sperm AR rate and clinical pregnancy rate of IUI.@*RESULTS@#There was no statistical difference between the spontaneous AR rates in the pregnant group and the non-pregnant group (7.7% vs. 7.0%, P>0.05), but there was statistical difference between the induced AR rates(51.9 % vs. 43.5%, P<0.05). There was statistical difference in the clinical pregnancy rate among the 3 IUI groups divided by induced AR rate (≤20.0%, 20.1%-49.9%, and ≥50.0%; 4.8% vs. 12.5% vs. 18.6%, P<0.05).@*CONCLUSION@#The spontaneous AR rate has nothing to do with the clinical pregnancy rate of IUI, but the induced AR rate is associated with the clinical pregnancy rate of IUI.

The Use of Tenaculum During Intrauterine Insemination May Not Affect the Pregnancy Outcome

PURPOSE: The association between tenaculum application to the cervix just before embryo transfer and lower pregnancy rate has been reported. However, studies on the use of tenaculum in intrauterine insemination (IUI) cycles are not available. This study attempted to investigate whether the use of tenaculum affects the clinical outcomes of IUI. MATERIALS AND METHODS: Two hundred and thirty three CC/hMG/IUI cycles of one hundred and forty three couples were recruited at Seoul National University Hospital from October 2006 to December 2008. Mock insemination and IUI with or without tenaculum application to the cervix were also performed, and clinical pregnancy rate was compared. RESULTS: The incidence of difficult mock insemination at the beginning of cycle was higher in the tenaculum use group (p < 0.001). No significant statistical difference in the clinical pregnancy rate was observed between the groups with or without tenaculum application (12.1% vs. 18.5%; p = 0.175), which was not influenced by the difficulty of mock insemination. CONCLUSION: The use of tenaculum during IUI may not affect the pregnancy outcome. Our results need to be confirmed by a prospective study in a larger population.

Semen cryopreservation applied to intrauterine insemination cycles for oligospermia and asthenospermia in infertile men / 中华男科学杂志

<p><b>OBJECTIVE</b>To explore the application value of semen cryopreservation in intrauterine insemination cycles for the treatment of oligospermia and asthenospermia in infertile males.</p><p><b>METHODS</b>A total of 152 cycles of intrauterine insemination were performed for 103 couples with constitutional infertility, which were divided into Groups 1 (normal semen, n=53), 2 (oligospermia and asthenospermia, n=52) and 3 (fresh combined with cryopreserved semen, n=47). Semen parameters and forward motile sperm count after processing were recorded by Makler chamber, and all were followed up for the outcome of clinical pregnancy.</p><p><b>RESULTS</b>Compared with Group 2, Group 3 showed obviously lower semen volume, sperm motility and grade a sperm count before semen processing, with extremely significant differences (P < 0.01), but a higher rate of grade a sperm after semen processing, though with no significant differences (P > 0.05). There were no statistically significant differences in the pregnancy rate between Groups 2 and 3 (9.6% versus 14.9%, P > 0.05).</p><p><b>CONCLUSION</b>Semen cryopreservation can improve the forward motile sperm count and pregnancy rate in oligospermia and asthenospermia patients after intrauterine insemination. Semen cryopreservation combined with intrauterine insemination seems an ideal treatment for oligospermia and asthenospermia in infertile men.</p>

Natural cycle versus ovulation induction cycle in intrauterine insemination / 中华男科学杂志

<p><b>OBJECTIVE</b>To compare the results of the natural cycle and ovulation induction cycle in intrauterine insemination (IUI) for infertile couples of different ages.</p><p><b>METHODS</b>We retrospectively analyzed 746 IUI cycles for 363 infertile couples, who were divided into a natural cycle (NC) and an ovulation induction cycle (OIC) group. The two groups were respectively subdivided into a < 35 yr and a > or = 35 yr age group, and, according to the drugs used, the OIC group was again divided into subgroups of clomiphene citrate + Progynova (CC + P), menopausal gonadotropin (HMG) and CC + HMG. The rates of clinical pregnancy, abortion and delivery were compared among different groups.</p><p><b>RESULTS</b>The pregnancy rate was significantly lower in the NC than in the OIC group (11.35% versus 19.61%, P < 0.01), but the rates of abortion and delivery had no significant differences between the two groups (P > 0.05), nor did the rate of clinical pregnancy among the subgroups of CC + P, HMG and CC + HMG (18.00%, 25.00% and 19.35%, P > 0.05). The < 35-year-old patients showed statistically lower rates of pregnancy and delivery in the NC than in the OIC group (P < 0.01 and P < 0.05), while the > or = 35-year-olds exhibited no significant differences in the rates of clinical pregnancy, abortion and delivery between the two groups.</p><p><b>CONCLUSION</b>The ovulation induction cycle could achieve a higher pregnancy rate than the natural cycle in IUI, whether with CC + P, HMG or CC + HMG, particularly for the infertile patients under 35 years. But the natural cycle is preferable for the > or = 35-year-olds.</p>

Comparison of the methods of separating high-quality sperm for intrauterine insemination / 中华男科学杂志

<p><b>OBJECTIVE</b>To analyze and compare the pregnancy rates of intrauterine insemination (IUI) achieved by 3 optimized methods of separating high-quality sperm.</p><p><b>METHODS</b>The data from 452 infertile couples who underwent 671 IUI cycles in our reproductive medicine center were retrospectively analyzed. The patients were divided into three groups: 5% HSA Earle's swim-up, SpermRinse swim-up and SupraSperm density gradient centrifugation according to different methods for separating high-quality sperm, and the clinical pregnancy rates were compared.</p><p><b>RESULTS</b>In the 5% HSA Earle's swim-up group, 21 pregnancies were achieved in 221 cycles (9.5%) and in the SpermRinse swim-up group, 34 in 215 cycles (15.8%), with a significantly higher rate in the latter than in the former (P < 0.05). In the SupraSperm density gradient centrifugation group, there were 34 pregnancies in 235 cycles (14.5%), with no statistically significant difference from the other two groups (P > 0.05).</p><p><b>CONCLUSION</b>The SpermRinse swim-up method can improve the clinical pregnancy rate and is suitable for various types of sterile patients. SupraSperm density gradient centrifugation, as an effective method available for separating high-quality sperm, is particularly suitable for those with lots of inflammatory cells and dead and abnormal sperm in the semen.</p>

Letrozole compared to clomiphene citrate in patients with unexplained infertility undergoing IUI

To compare the efficacy of Ietrozole as ovulation induction agent for patients with unexplained infertility as regards is mean number of follicles resulting, endumetrial thickness and pregnancy rate [PR] in comparison to CC alone and in combination with gonadotropines [HMG] and Ietrozole in combination with HMG for COH and IUI A prospective randomized comparative study. Infertility outpatient clinic, Faculty of Medicine. Consequtive patients who agreed to participate were randomized on an alternating basis to receive either 2.5 mg bid letrozole or 50 mg bid CC on days 3-7, or letrozole followed by HMG, or CC followed by HMG 75IU/day until the day of HCG [15 patients in each group].Folliculometry starting D7 was done till the Ieading follicle[s] reached 18mm ovulation was triggered by HCG 10000 IU and endometrial thickness was measured on the day of HCG administration. A single IUI was done 36 hours after HCG administration. The luteal phase was supported by vaginal micronized progesterone 600 mg/day. Pregnancy was established by blood beta-subunit detection 2 weeks after IUI. A total of 60 patients [15 patients in each group] meeting the inclusion criteria were included All patients had primary unexplained infertility of less than 3 years and there was no statistically significant difference in age nor BMI between the 4 groups. The outcome measures we examined were endometrial thickness, mean number of mature follicles > 18 mm on day of HCG administration and pregnancy rate. The mean endometrial thickness was: 8.8 mm in the letrozole group, 8.3 mm in the CC group, 8.5 mm in the letrozole + HMG group. 9.9 mm in the CC + HMG group i.e. the showed the least mean endometrial thickness but with no statistically significant difference between the 4 groups. mean number of mature follicles >18 mm on the day of HCG was: 3.2 in the letrozole group. 2 6 in the CC group, 2.4 in the letrozole + HMG group .3.4 in the CC + HMG group with no statistically significant difference between the 4 groups. Pregnancy rate per cycle for the 4 groups was: 20% in the letrozole group, 40% in the CC' group, 13.3% in the letrozole + HMG group, 26.7% in the CC + HMG group with no statistically significant difference between the 4 groups. In conclusion we tailed to prove that there is clinical preference of Ietrozole or combined protocols over CC alone in COH + IUI or women with unexplained infertility, this could be attributed to the small sample size, bigger study is needed before Ietrozole is prescribed as a first- line induction drug being more expensive than CC

Suplementación parenteral de cobre en vacas gestantes: efecto sobre postparto y terneros / Parenteral supplementation of copper in gestation cows: effect on postpartum and calves

Objetivo. Evaluar el efecto del cobre en vacas gestantes sobre el comportamiento reproductivo posparto y la salud del ternero. Materiales y métodos. Se estudiaron 80 vacas divididas en dos grupos de 40 animales cada uno. El grupo A fue tratado con 2 ml de CuSO4 (2.5%) subcutáneamente. El tratamiento se inició a los 8 meses de gestación, y se repitió a los 30 y 90 días post parto. El grupo B, se uso como control. A las vacas se les analizó el perfil hematoquímico, intervalo parto primer servicio (IPPS), intervalo parto concepción (IPC), intervalo parto-parto (IPP), índice de natalidad (IN), índice de inseminación (II) y la eficiencia en la detección de la hembra en estro (EDHE) y a los terneros los parámetros hematoquímicos. Los datos se procesaron mediante Statgraphics Plus 5.0, para las diferencias entre medias de los datos hemoquímicos y reproductivos se aplicó (ANOVA) y comparaciones de proporciones IN y EDHE. Se empleó la correlación y regresión simple para demostrar la relación del cobre con las demás parámetros estudiados. Resultados. La administración subcutánea de cobre incrementó los niveles de dicho elemento en sangre, hierro y hemoglobina (p< 0.001); así como la disminución del IPPS, IPC, IPP, IN, EDHE, e II (p< 0.05). En los terneros se aumentó la cupremia (p< 0.001), la hemoglobina (p< 0.01) y las proteínas totales (p< 0.05). Conclusiones. El tratamiento aplicado incrementó los indicadores hematoquímicos y reproductivos en los animales tratados.

Infertilidade imunológica: doença auto-imune? / Immunology infertility: autoimmune disease?

A infertilidade imunológica é considerada uma doença auto-imune, por estar associada a uma classe de HLA. Ocorre em 20 por cento dos casais em idade reprodutiva. Pode afetar tanto homens quanto mulheres e acarretar complicações futuras, no momento da procriação. Nos homens o problema é decorrente de produção de anticorpos contra os espermatozóides. Esta entidade clínica decorre da associação de inúmeros fatores, tais como imobilização e(ou) aglutinação do esperma, bloqueio da interação oócito-espermatozóide, impedindo a implantação, e(ou) a suspensão do desenvolvimento do embrião. Infelizmente ainda não existe um método diagnóstico que possa ser considerado "padrão ouro". Os métodos atuais foram apenas a identificação do isótipos de imonoglobulina, sendo muito limitados. Para a descoberta exata e quantificação dos anticorpos é necessário radioimunoensaio específico. Existem três abordagens básicas de tratamento: remoção dos anticorpos antiespermatozóide, para restaurar a função do espermatozóide; redução da produção deste anticorpo, com imunossupressão; e a assistência reprodutiva, com injeção intracitoplasmática ICSI é recomendada como tratamento de primeira escolha nessa população de pacientes, pois contorna os problemas de ligação espermática deficiente e de penetração na zona pelúcida, resultando em taxas mais altas de fertilização e gravidez...

Comparação entre três esquemas de indução da ovulação para inseminação intra-uterina com relação à espessura endometrial e taxa de gravidez / Comparison between three protocols for ovulation Induction in cycles of intrauterine insemination and related endometrial thickness and pregnancy rate achieved in each protocol

OBJETIVO: comparar as taxas de gravidez e as espessuras endometriais médias obtidas com a utilização de três esquemas de indução da ovulação para inseminação intra-uterina (IIU). MÉTODOS: foram avaliados retrospectivamente 110 ciclos de IIU, sendo estes divididos em três grupos, de acordo com o protocolo de indução da ovulação utilizado: 100 mg de citrato de clomifeno (CC) do 3º ao 7º dia do ciclo (grupo CC, n=24); acrescentou-se ao esquema do grupo CC 75 UI de gonadotrofina menopáusica humana (hMG) nos dias 3, 5 e 7 do ciclo (grupo CC+hMG, n=29) e hMG isolado, 75 UI do 3º ao 8º dia do ciclo (grupo hMG, n=57). Para análise estatística foi utilizado o teste t de Student para comparação entre médias e o teste c² para comparação entre proporções. RESULTADOS: a média de idade das pacientes no início do tratamento foi de 33,3 anos (23 a 40 anos), sendo similar nos três grupos. A espessura endometrial média no dia da aplicação da gonadotrofina coriônica humana (hCG) foi significativamente maior no grupo hMG (10,2±0,2 mm) em comparação à obtida nos grupos CC e CC + hMG (7,9±0,4 e 8,7±0,2 mm, respectivamente, p<0,001). A taxa de gestação clínica média foi de 18,2 por cento, sendo semelhante nos três grupos (grupo CC=12,5 por cento; grupo CC+hMG=24,1 por cento; grupo hMG=19,3 por cento). CONCLUSAO: observou-se maior espessura endometrial média com o uso isolado de hMG em comparação ao uso isolado de CC ou à associação CC+hMG. Não foram observadas diferenças significativas entre as taxas de gestação clínica obtidas com os três esquemas de indução da ovulação utilizados (CC isolado, associação de CC e hMG e hMG isolado)

Effect of three different culture media on sperm activation of patients complaining from asthenozoos permia

Sperm activation in vitro was performed on 30 semen sample collected from patients complaining from asthenozoospermia. In this study, centrifugation washed - out technique was employed for sperm activation by using three different media, Earle's salt, dextrose 5 percent and normal saline. Three incubation period, 30, 45 and 60 minutes were used for all samples after activation. The result in this study revealed a significant improvement [p<0.01] in sperm motility percent and grade activity in case of Earle's and significant decrease [p<0.001] in recovery of sperm concentration abnormal sperm morphology percentage and leukocytes and phagocytes concentration for 30 minutes of incubation period. While in 45 and 60 minutes of incubation the significant improvement was observed [p<0.001] in all sperm parameters after activation compared to their values before activation by using the three different media. The comparison study of the sperm activation period between incubation period revealed a significant increase [p<0.01] in sperm motility and grade activity at 45 minutes compared to 60 minutes by using Earle's media. The result, also showed a significant increase in sperm motility and grade activity at 60 minutes incubation period compared to 30 minutes by using normal saline and dextrose 5 percent

Superovulation and intrauterine insemination in treatment of idiopathic infertility in 202 cycles / 中国医学科学院学报

<p><b>OBJECTIVE</b>To evaluate the effect of superovulation with recombinant follicle stimulating hormone (r-FSH) therapy and intrauterine insemination in the treatment of idiopathic infertility.</p><p><b>METHODS</b>Superovulation with r-FSH therapy and intrauterine insemination were used in 202 cycles of 88 couples in the Department of Obstetrics and Gynecology of Monash Medical Centre.</p><p><b>RESULTS</b>The per cycle ovulation rate and in-ovulation rate were 95.7% and 4.3% respectively, and the per cycle pregnancy rate was 11.6% with no cases of hyperstimulation. The cancelling rate was 7.4% because of the development of multiple follicles. The overall cumulative conception rate was 22.7% per patient, with 15% of twin pregnancies. There were no differences between pregnancy group and non-pregnancy group in age, BMI, treatment days, number of mature follicles, endometrial thickness and number of treatment cycles. The only significant parameter observed between the two groups was infertility time (P < 0.05), which was longer in non-pregnancy group [(30.52 +/- 13.08) months] than in pregnancy group [(24.25 +/- 6.45) months].</p><p><b>CONCLUSIONS</b>Superovulation and intrauterine insemination is a safe and more cost-effective method in treatment of idiopathic infertility.</p>

Treatment option for unexplained primary infertility following failed intrauterine insemination / 中华男科学杂志

<p><b>OBJECTIVE</b>To determine an optimal insemination technique for unexplained infertility patients undergoing IVF or ICSI following failed intrauterine insemination (IUI).</p><p><b>METHODS</b>Sixty-five cycles of 61 patients with failed IUI were divided into four groups: Group A (37 cycles of IVF), Group B (19 cycles of ICSI), Group C (4 cycles of IVF and ICSI: half and half), Group D (5 cycles of ICSI after failed IVF). The conventional IVF cycles were defined as Group E (37 cycles), and the conventional ICSI cycles defined as Group F (24 cycles). The fertilization rate, completely failed fertilization rate, high quality embryo rate, clinical pregnancy rate and the implantation rate were compared among all the groups.</p><p><b>RESULTS</b>There were statistically significant differences in the fertilization rate, completely failed fertilization rate between Groups A and E (55.4% vs 72.8%, P < 0.05; 21.6% vs 0%, P < 0.005), and Groups A and B (55.4% vs 68.4%, P < 0.05; 21.6% vs 0%, P < 0.01). In Group D, there was statistically significant difference in the fertilization rate between IVF cycles and ICSI cycles (12.2% vs 74.2%, P < 0.005).</p><p><b>CONCLUSION</b>The present study demonstrates that there may be 20% of totally failed fertilization in IVF cycles with unexplained primary infertility following failed IUI, and ICSI treatment can increase fertilization rate and avoid complete fertilization failure.</p>

Intracytoplasmic sperm injection procedure for infertility treatment in couples

A injeção intracitoplasmática de espermatozóide (ICSI) foi o procedimento aplicado em 68 pacientes com idade média de 34,7 anos. Foram realizadas as seguintes etapas: indução da ovulação; aspiração folicular; seleção dos oócitos e coleta de sêmen; injeção de espermatozóides e transferência dos embriões ao útero. Os resultados mostraram que 56 por cento dos problemas de infertilidade relacionam-se a fatores femininos. A maior freqüência de fatores masculinos e femininos que causaram infertilidade foram astenozoospermia (63 por cento) e fatores tubários (32,7 por cento), respectivamente. De um total de 695 oócitos aspirados, 453 (67,1 por cento) resultaram em zigotos com 2 pró-núcleos (2PN); 4 (0,55 por cento), 32 (4,42 por cento) e 2 (0,27 por cento) resultaram em zigotos 1PN, 3PN e 4PN, respectivamente. As taxas de gestação por ciclo e por transferência foram 25 por cento e 28,9 por cento, respectivamente. Nossos dados sugerem que a ICSI tem sido o método de escolha no tratamento da infertilidade devido a diversas etiologias, e os resultados mostraram que o sucesso nas taxas de fertilização tem aumentado as chances de gravidez

Effects of catheter depth and infused semen volume on the pregnancy of intrauterine insemination / 中华男科学杂志

<p><b>OBJECTIVE</b>To evaluate the effects of catheter depth and infused semen volume on the pregnancy rate of intrauterine insemination(IUI) with the husband's semen.</p><p><b>METHODS</b>According to different catheterizing distances from the fundus and infused semen volumes, 330 patients undergoing intrauterine insemination were randomly divided into 6 groups: A, 1 cm/0.5 ml; B, 1 cm/0.3 ml; C, 2 cm/0.5 ml; D, 2 cm/0.3 ml; E, 3 cm/0.5 ml and F, 3 cm/0.3 ml. The pregnancy rate was investigated in each group.</p><p><b>RESULTS</b>The pregnancy rates from group A to group E were 9.09% (5/55), 12.73% (7/55), 10.91% (6/55), 29.09% (16/55), 9.09% (5/55) and 12.73% (7/55), respectively. It was significantly higher in group D than in groups A, B, C, E and F(P < 0.05).</p><p><b>CONCLUSIONS</b>Catheterizing distance of 2 cm from the fundus with infused semen volume of 0.3 ml can significantly improve pregnancy rate in patients undergoing IUI with the husband's semen.</p>

Clinical observation on effect of zhenqi zhuanyin decoction combined with intrauterine insemination in treating spleen-kidney deficiency type patients of sterility with positive anti-sperm antibody / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To compare the effect of combined therapy of Zhenqi Zhuanyin Decoction (ZQZYD) and timely intrauterine insemination (IUI) with that of using ZQZYD and IUI separately in treating patients of sterility with positive anti-sperm antibody (AsAb).</p><p><b>METHODS</b>One hundred and three patients were randomly divided into 3 groups, 34 patients in Group A treated with combined ZQZYD and IUI, 34 in Group B treated with ZQZYD alone and 35 in Group C treated with IUI alone. The negative conversion rate of AsAb, pregnancy rate in patients, pregnancy rate in AsAb converted patients, as well as changes of TCM Syndrome and T-lymphocyte subsets were observed.</p><p><b>RESULTS</b>(1) The negative conversion rate of AsAb in the 3 groups was 76.47% (26/34), 82.35% (28/34) and 8.57% (3/35) respectively. (2) In Group A, the pregnancy rate was 41.18% (14/34), pregnancy rate in AsAb negative converted patients was 50.0% (13/26); in Group B, the respective criteria was 20.59% (7/34) and 21.43% (6/28) respectively; and in Group C, the pregnancy rate was 11.43% (4/35). The pregnancy rate in Group A was significantly higher than that in Group B or C (P < 0.01). (3) The effective rate on TCM Syndrome in Group A and B was 88.23% and 91.18% respectively (P > 0.05). (4) In Group A and B, CD4 decreased, CD8 increased and CD4/CD8 ratio decreased after treatment, which were significantly different from those before treatment and in Group C after treatment (P < 0.05).</p><p><b>CONCLUSION</b>Combined therapy of ZQZYD and IUAI shows a better effect in treating infertility with positive AsAb than that by ZQXYD or IUI alone.</p>