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Background- Different success rate of Intracytoplasmic Sperm injection (ICSI) are seen in different causes of infertility. In present study, we evaluated ICSI outcome in different causes of infertility. Materials and Methods- This is a retrospective study of ICSI cycles performed on 120 subjects at ART unit of Omega hospital Pvt Ltd, Nagpur between Jan 2020 and December 2021 to see ICSI outcomes in different causes of infertility. In present Results- study, out of 120 subjects, majority 52(43%) subjects were in the age group of 31-35 years followed by 49(41%) subjects in 25-30 years age group.Majority 55(46%) subjects were having infertility of 5-10 years, 52(43%) subjects were having infertility of <5 years. Majority 83(69%) subjects were having primary infertility. 45(37%) subjects had male infertility, 41(34%) subjects had ovulatory factor, 15(13%) subjects had unexplained infertility. 77(64%) subjects had biochemical pregnancies. 64(53%) subjects had clinical pregnancy by Ultrasound. 59(49%) subjects had live birth. 17(14%) subjects had abortion, 13 (11%) subjects had preterm labour. 3(2%) babies had to be admitted in NICU. Most important 74% mothers & 96% babies reported no complications. We found that ICSI is an effective option in couples with different causes of infertility. Therefore, Conclusion- physicians should have adequate training and required information regarding ICSI to improve the pregnancy outcomes reducing burden of infertility in the community.
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Introduction: Assisted reproductive technology has been developed significantly throughout the past few years, particularly diagnosing and treating male infertility. Many studies have been performed showing that Intracytoplasmic Sperm Injection (ICSI) is a successful method to attain clinical pregnancy and live birth through impaired spermatozoa characteristics or low sperm count, such as severe oligospermia. Severe oligospermia indicates low sperm count, which in some cases leads to azoospermia. Severe oligospermia can be caused by several factors such as genetics or medication. In search of efficient treatment for couples with Severe oligospermia, numerous retrospective and prospective researches have reported high pregnancy and live birth rates through testicular sperm for men with severe oligospermia and cryptozoospermia with or without high sperm DNA damage. The research showed that the use of testicular sperm in combination with ICSI yielded a high pregnancy rate and live births over another source of sperm, such as ejaculated sperms. Moreover, the use of ICSI in severe oligospermia has shown successful fertilization and pregnancy. Methods: In search for effective treatment for couples with severe male factor, a number of small retrospective and prospective studies have reported high pregnancy and live birth rates using testicular sperm for men with necrozoospermia, cryptozoospermia and oligozoospermia with or without elevated sperm DNA damage. Although the data suggest that there may be some benefit in performing testicular sperm retrieval (TSR)-ICSI in select groups of non-azoospermic infertile men, there are potential risks involved with TSR. Clinicians should balance these risks prior to the recommendation of TSR-ICSI on the result of a semen analysis or sperm DNA test alone. Careful evaluation and management of male factor infertility is important. The use of TSR-ICSI in the absence of specific sperm DNA defects is still experimental. Discussion: In 1992 and subsequently, several reports indicated that ICSI was a successful technique to achieve clinical pregnancy and live birth using spermatozoa with severely impaired characteristics. The initial optimism over the ability of ICSI to overcome significant sperm abnormalities was later tempered by the findings of more recent publications suggesting that some sperm deficits may not be as effectively treated with ICSI. Conclusion: Severe oligospermia indicates low sperm count, which can lead to male infertility; severe oligospermia which can be overcome through ICSI. Genetic factors like microdeletions of the Y chromosome (Yq) can cause severe oligospermia or chemotherapy molecules, affecting the sperm count directly.
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Women were studied undergoing ICSI for 84 who suffer non-pregnancy at the Fertility Center, Al-Sadr Medical Hospital in Najaf Governorate, Period between January 2019 and March 2020. WBC, Vitamin D3 and ß-hCG were measured, The pregnant women was divided into (Pregnancy Group, and spontaneous miscarriage) and then demonstrate the immunological effect on pregnancy of women after ICSI technique. Current resultsstudy showed a significant increase (p<0.05) in hormone level ß-hCG is evidence of the presence of high success rates for pregnancy in women who performed operations IVF, where the success rate at the beginning of the matter reached 61.9%, after which it decreased to 33.3% after the first three months due to the occurrence of spontaneous miscarriage of pregnant women due to various immunological and physiological reasons, a positive correlation between the level of ß-hCG and other parameters in the study (Vitamin D3 -WBC).Also The current resultsshowed a significant decrease in a groups (pregnancy failure) and the group (spontaneous miscarriage) compared with the control group (continued pregnancy) in relation to the level of vitamin D3 Also, The current results showed a significant increasein (pregnancy failure) and (spontaneous miscarriage) compared with control groups (continuation of pregnancy) in relation WBC numbers, and the present study founds a negative relationship between the level of vitamin D3 and WBC.
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Humanos , Feminino , Gravidez/imunologia , Aborto Espontâneo/imunologia , Colecalciferol/deficiência , Injeções de Esperma Intracitoplásmicas/métodos , Gonadotropina Coriônica/imunologia , Leucócitos/imunologiaRESUMO
Background: The short and long co-incubation time of gametes for in vitro fertilization are still debatable issues. This study aims to investigate the effects of short and long co-incubation time of gametes on fertilization, polyspermy, embryonic developmental potential, and clinical outcomes.Methods: Sixty-five patients undergoing IVF treatment were invited to participate in the study between May 2017 and March 2019. Ovarian hyperstimulation was prescribed and oocytes were obtained by trans-vaginal aspiration under ultrasound guidance. Sibling oocytes were randomly allocated to short co-incubation for 4 hours (Group I) in 352 oocytes and long co-incubation for 16-18 hours in 363 oocytes (Group II). Rescue ICSI was carried out if total fertilization failure was documented. Fertilization, embryonic development, and pregnancy outcomes were determined.Results: No significant differences between short and long co-incubation were found in fertilization, polyspermy, cleavage, blastocyst, implantation, clinical pregnancy, and live birth rates.Conclusions: The present study showed that short co-incubation of gametes had no significant difference in fertilization, polyspermy, embryo development, and pregnancy outcomes when compared to long co-incubation. The short co-incubation with early cumulus cell removal and rescue ICSI may have the potential to help a couple who had total fertilization failure.
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Background & objectives: The detailed assessment of sperm morphology is important in the semen of infertile men because there is a low proportion of normal spermatozoa. One of the parameters of such sperm morphology is the acrosome, and its effect on assisted reproductive outcomes is controversial. This study was undertaken to evaluate the association between different forms of acrosome on the chromatin status and the assisted reproductive outcomes. Methods: A total of 1587 unstained sperms from 514 infertile men were captured and analyzed for different acrosome forms (normal, large, small, skew, amorphous acrosome and without acrosome) in real time during intracytoplasmic sperm injection into oocytes. The association between the percentage of sperms with atypical acrosome and head shapes and the sperm chromatin status was studied. Fertilization, zygote and embryo quality and clinical pregnancy rates were calculated for different groups of sperms. Results: The highest frequency of irregular shapes of acrosomes, such as small, large and amorphous, was observed in abnormal ellipticity, anteroposterior symmetry and angularity parameters, respectively (P <0.05). The fertilization rate of injected sperms with large (P <0.01) and small (P=0.001) acrosomes and without acrosome (P=0.001) was significantly lower in comparison with normal acrosomes. The quality of zygotes (Z3, P=0.05), embryos (grade C, P <0.05) and the pregnancy rate (P=0.001) from injected sperms with large acrosomes were significantly lower compared with normal acrosomes. Interpretation & conclusions: Our findings showed that the different sperm acrosome morphologies (e.g., large, small, and without acrosome) might negatively relate with chromatin integrity and decrease the sperm's fertility potential and pregnancy rate during intracytoplasmic sperm injection (ICSI) cycles.
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Background: Infertility is defined as failure to conceive a clinical pregnancy after 12 months or more of regular unprotected intercourse. The birth of Louis Brown opened door to whole new world. Science of reproduction unfolded with better understanding of physiology and pharmacology of gonadotropins. Improved stimulation protocol, and lab facilities are available for IVF and intracytoplasmic sperm injection (ICSI). The objective of this study was to study relation between uterine scoring system for reproduction (USSR) scoring and pregnancy rate in patients undergoing ICSI and embryo transferred.Methods: A prospective observational study was conducted. Study comprised 48 women visiting with infertility for ICSI and embryo transfer. Baseline scan done on day2 of menses. Patients started on estradiol valerate for endometrial preparation. Transvaginal sonography done on 10th day of menstrual cycle for USSR scoring. USSR scoring includes parameters such as endometrial thickness, endometrial layering, myometrial contractions, myometrialechogenecity, uterine artery Doppler flow, endometrial blood flow, myometrial blood flow.Results: Out of total 48 infertility patients for embryo transfer 22 conceived, which gives 45.83% pregnancy rate. No patients had a perfect score of 20. Patients with score of 17-19 had pregnancy rate of 66%. Endometrial thickness of 10-14mm gave optimum result of 52%. Pulsatality index <2.19 was associated with pregnancy rate of 66%.Conclusions: USSR scoring is highly indicative of good pregnancy outcome in patients undergoing ICSI and embryo transfer. Endometrial morphology and thickness was strongly correlated with successful pregnancy outcome.
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Background: Globally, the prevalence of infertility is around 10% of the total population. 30% of these have male factor infertility. Azoospermia is found in 1% of men, in 20% of which, the etiology is a bilateral obstruction of the male genital tract while others have non obstructive azoospermia. In azoospermic men sperms are microsurgically retrieved from epididymis and testes by TESA and PESA respectively. The aim of this study was to evaluate the outcomes of intracytoplasmic sperm injection ICSI using surgically retrieved sperm of azoospermic men either obstructive or nonobstructive and to compare it with ejaculated sperms in men having severe oligospermia.Methods: This was retrospective cohort study conducted based on the data collected from our reproductive endocrinology and infertility unit, 126 ICSI cycles performed during the period of 5 years were taken and divided into two groups, one with patients having ejaculated sperms with oligospermia and other group with patients who had surgically retrieved normal sperms due to azoospermia. Outcome of these ICSI cycles included fertilization, cleavage, biochemical and clinical pregnancy was assessed.Results: In present study it was found that ICSI outcome was comparable in both the groups with ejaculated sperm and surgically retrieved sperm as fertilization rate (72% vs 65%), Implantation Rate (58 vs 51%), clinical pregnancy rate (CPR) (51% vs 44.82%) observed with ejaculated or retrieved sperm group respectively showed no statistical difference.Conclusions: Present study shows that minimally invasive techniques of PESA and TESA can be successfully performed to retrieve sperm for ICSI in the treatment of azoospermic men which gives them the chance to father their biological child. The result of this study indicates that treatment outcomes of PESA/TESA-ICSI cycles compare favourably with that of ICSI using ejaculated sperm.
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Background: The aim is to evaluate spindle position of metaphase II oocyte and the development of embryos originated from oocytes with spindle and without spindle.Methods: Cross-sectional analysis Research: 250 MII oocytes were analyzed with polarized microscope in Military Institute of Clinical Embryology and Histology, Vietnam Military Medical University.Results: Spindles were detected in 170 (77.98%) of 218 metaphase II oocytes, 115 spindles (67.65%) of MII oocytes is beneath or adjacent to the first polar body, 55 oocytes had the spindle located between 300 and 1800 away from the first polar body. Fertilization rate and the rate of good quality embryos in oocytes with a visible spindle (77.98% and 61.02%) were higher than those in oocytes without a visible spindle (22.02% and 36.84%), the difference was statistically significant with p <0.001 and p <0.05.Conclusions: The spindle position of metaphase II oocytes is not always beneath or adjacent to the first polar body. Fertilization rate and the rate of good quality embryos in oocytes with a visible spindle were higher than those in oocytes without a visible spindle.
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Introducción La infertilidad por factor masculino afecta al 30% de las parejas infértiles y la evaluación seminal es crítica en las determinaciones que conllevan a un posible tratamiento con el fin de tener un resultado exitoso. Objetivo El objetivo de este estudio fue evaluar la relación que existe entre los parámetros seminales convencionales y funcionales, con las tasas de fecundación, desarrollo embrionario y embarazo obtenidas después de inyección intracitoplasmática de espermatozoides (ICSI). Métodos 36 muestras seminales de parejas que se sometieron a ICSI (18 usando oocitos propios y 18 de donante), fueron evaluadas de manera convencional, posteriormente se seleccionaron los espermatozoides, se realizó ICSI y una alícuota se utilizó para cuantificar las siguientes pruebas funcionales: potencial de membrana mitocondrial, integridad de la membrana, detección de especies reactivas de oxígeno e índice de fragmentación del ADN. Resultados No se encontraron diferencias significativas en cuanto a los parámetros convencionales y funcionales en los dos grupos, como tampoco se encontró una relación significativa entre los parámetros evaluados y los resultados de ICSI. Sólo se observó que la tasa de embarazo fue mayor en el grupo de oocitos donados (p < 0,0001). Conclusiones Los datos obtenidos en este estudio sugieren que no existe correlación entre los parámetros evaluados y los resultados de ICSI. Eso se debe probablemente, a que la selección de los espermatozoides tanto por gradientes de densidad como la posterior selección durante el procedimiento del ICSI, tiene un bajo poder predictivo sumado a la capacidad que tiene el oocito de reparar los daños presentes en el espermatozoide.
Background Male infertility affects 30% of infertile couples and seminal evaluation is critical in the determinations that lead to a possible treatment in order to have a successful outcome. Objective The objective of this study was to evaluate the relationship between conventional and functional seminal parameters, with the rates of fertilization, embryo development and pregnancy obtained after ICSI. Methods 36 semen samples of couples that underwent ICSI (18 using own oocytes and 18 from donors) were conventionally evaluated, spermatozoa were subsequently selected, ICSI was performed and an aliquot was used to quantify the following functional tests: mitochondrial membrane potential, membrane integrity, reactive oxygen species detection and DNA fragmentation index. Results There were no significant differences in the conventional and functional parameters in the two groups, nor was there a significant relationship between the parameters evaluated and the ICSI results. It was only observed that the pregnancy rate was higher in the group of donated oocytes (p < 0.0001). Conclusions The data obtained in this study suggest that there is no correlation between the parameters evaluated and the ICSI outcome. This is probably because the selection of spermatozoa by density gradients in addition to the subsequent selection during ICSI has a low predictive power and also the ability of the oocyte to repair the damage present in the spermatozoa.
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Humanos , Masculino , Feminino , Espermatozoides , Doadores de Tecidos , Taxa de Gravidez , Injeções de Esperma Intracitoplásmicas , Fertilização , Espécies Reativas de Oxigênio , Desenvolvimento Embrionário , Fragmentação do DNA , Potencial da Membrana Mitocondrial , InfertilidadeRESUMO
We sought to evaluate the ability of fine-needle aspiration (FNA) mapping to find sperm and to guide sperm retrieval after failed microdissection testicular sperm extraction (micro-TESE) in nonobstructive azoospermic men. In this study of consecutive male infertility cases, interventions included testicular FNA mapping and subsequent sperm retrieval. Outcomes included the frequency and location of found sperm on FNA maps after failed micro-TESE and the salvage sperm retrieval success. Among 548 patients undergoing FNA mapping from 2010 to 2016, 82 men with previous micro-TESE procedures were identified. The mean time between micro-TESE and FNA mapping was 2.2 years. A total of 2825 (1424 on right and 1401 on left) sites were mapped. At least one site revealed mature sperm in 24 (29.3%) of 82 men with prior failed micro-TESE procedures. There was an equal likelihood of detecting sperm in either testis (6.1% right; 5.7% left; P = 0.58). Digital 'heat maps' revealed differences in sperm findings within the testis with mature sperm more likely found in the testis periphery rather than centrally. Fifteen (62.5%) patients subsequently underwent sperm retrieval procedures guided by FNA maps. Sufficient sperm were retrieved in all cases, and in 10 (66.7%) of 15 cases, extra sperm were frozen for future use. In a significant proportion of failed micro-TESE procedures representing the largest study to date, sperm were detected by FNA mapping and could be reliably retrieved through FNA map-guided surgical sperm retrieval. When present, sperm were more likely to be found in the testis periphery rather than centrally with FNA mapping.
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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.
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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)
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Humanos , Masculino , Testículo/embriologia , Testículo/patologia , Biópsia/métodos , Injeções de Esperma Intracitoplásmicas/métodos , Azoospermia/diagnóstico , Azoospermia/patologia , Recuperação Espermática , Estudos Prospectivos , Estudos Retrospectivos , Pesquisa Comparativa da EfetividadeRESUMO
Resumen OBJETIVO Evaluar los resultados en ciclos de FIV-ICSI de dos protocolos de estimulación ovárica en mujeres mayores de 35 años e investigar si agregar hormona luteinizante recombinante a FSH-r en un protocolo de estimulación mejora la respuesta ovárica y, en consecuencia, las tasas de embarazo en este grupo poblacional. MATERIALES Y MÉTODOS Estudio longitudinal, observacional y retrospectivo efectuado en pacientes de la Clínica de Reproducción Hisparep del Hospital Español con diagnóstico de infertilidad, mayores de 35 años, que recibieron un ciclo de hiperestimulación ovárica controlada con FIV-ICSI durante el periodo 2014-2016. El análisis estadístico se efectuó con la prueba de t de Student para muestras independientes. Los estudios se analizaron con el paquete estadístico SPSS IBM, versión 22. RESULTADOS Se analizaron 201 mujeres con infertilidad, mayores de 35 años. El grupo 1 (n = 101) de FIV-ICSI recibió estimulación con hormona folículo estimulante recombinante y hormona luteinizante recombinante 2:1 con menotropinas (Pergoveris® y Merapur®) a partir del segundo día del ciclo. El grupo 2 (n = 100) recibió hormona folículo estimulante recombinante y menotropinas (Gonal F® y Merapur®); en ambos esquemas se utilizó antagonista de GnRH a partir del día 7 del ciclo. La media de ovocitos aspirados fue de 7.5 en el grupo 1 y 9.1 en el grupo 2 (p = 0.058). La media de ovocitos maduros fue 6.2 en el Grupo 1 vs 7.4 en el grupo 2 (p = 0.085). La tasa de fecundación en el grupo 1 fue de 57 vs 67% en el grupo 2 (p = 0.045). En el grupo 1 la tasa de implantación por embrión transferido en fresco fue 24.1 vs 10.3% en el Grupo 2 (p = 0.40), la tasa de recién nacido vivo fue de 30% en el Grupo 1 vs 20.6% en el Grupo 2. La media de embriones vitrificados en el Grupo 1 fue 1.47 vs 1.38 en el Grupo 2. CONCLUSIONES La probable ventaja de la complementación con hormona folículo estimulante recombinante durante la estimulación ovárica en mujeres mayores de 35 años es de interés y se requiere su evaluación en estudios posteriores.
Abstract OBJECTIVE To evaluate the reproductive effects when recombinant luteinizing hormone is added and to compare two stimulation schemes by number of aspirated oocytes, mature oocytes, fertilization and implantation rates, live newborn and number of vitrified embryos. MATERIALS AND METHODS Longitudinal, observational and retrospective study carried out in patients of the Hisparep Reproduction Clinic of the Spanish Hospital with diagnosis of infertility, over 35 years old, who received a controlled ovarian hyperstimulation cycle with IVF-ICSI during the period 2014-2016. The statistical analysis was carried out with the Student t test for independent samples. The studies were analyzed with the IBM SPSS statistical package, version 22. RESULTS We analyzed 201 women with infertility, over 35 years of age. Group 1 (n = 101) of IVF-ICSI received stimulation with recombinant follicle-stimulating hormone and recombinant luteinizing hormone 2: 1 with menotropins (Pergoveris® and Merapur®) from the second day of the cycle. Group 2 (n = 100) received recombinant follicle stimulating hormone and menotropins (Gonal F® and Merapur®); in both schemes, GnRH antagonist was used from day 7 of the cycle. The average number of aspirated oocytes was 7.5 in Group 1 and 9.1 in Group 2 (p = 0.058). Mean mature oocytes were 6.2 in Group 1 vs 7.4 in Group 2 (p = 0.085). The fertilization rate in group 1 was 57 vs. 67% in Group 2 (p = 0.045). In Group 1 the implantation rate per embryo transferred fresh was 24.1 vs 10.3% in Group 2 (p = 0.40), the live newborn rate was 30% in Group 1 vs 20.6% in Group 2. The mean number of vitrified embryos in Group 1 was 1.47 vs 1.38 in Group 2. CONCLUSIONS The probable advantage of supplementation with recombinant follicle-stimulating hormone during ovarian stimulation in women over 35 years of age is of interest and its evaluation is required in subsequent studies.
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Resumen Objetivo: Determinar si la histeroscopia operatoria mejora los resultados reproductivos en pacientes a quienes se efectúa transferencia embrionaria y reportar los hallazgos histeroscópicos más frecuentes, previos a la transferencia de embriones. Materiales y métodos: Estudio retrospectivo, observacional y longitudinal efectuado en pacientes con diagnóstico de infertilidad de la Clínica de Reproducción Asistida Hisparep que recibieron ciclos de FIV-ICSI con histeroscopia previa a la transferencia embrionaria. Se compararon las tasas de implantación entre los distintos grupos y efectuó estadística descriptiva con c2. Resultados: Se analizaron 255 pacientes con diagnóstico de infertilidad. El estudio histerosópico previo a la transferencia de embriones reportó que 122 (47%) tenían pólipos endometriales, 70 (28%) cavidad uterina normal, 27 (11%) sinequias uterinas, 24 (9%) miomatosis submucosa y 12 (5%) malformación mülleriana de tipo útero septado. 185 pacientes con alteración en la cavidad uterina se intervinieron por vía histeroscópica para corrección, antes de la transferencia embrionaria; de éstas, 44 (24%) quedaron embarazadas. A las que tenían malformación mulleriana se les resecó el tabique uterino y en 9 pacientes se logró el embarazo (75%). A las pacientes del grupo 4 se les practicó adherenciolisis y 6 lograron el embarazo (22%). En el grupo 2, posterior a la polipectomia, 26 pacientes quedaron embarazadas (21%) y en el grupo 3, posoperadas de miomectomia submucosa, 3 (12%) lograron el embarazo. De las pacientes del grupo 1 con cavidad uterina normal (n = 70), a quienes se efectuó transferencia embrionaria, 37 (53%) consiguieron quedar embarazadas. Conclusiones: En las pacientes con subfertilidad y poliposis endometrial, la histeroscopia es un recurso útil para detectar anormalidades susceptibles de corrección antes de la transferencia embrionaria.
Abstract Objective: To determine if operative hysteroscopy improves reproductive outcomes in patients who undergo embryo tansfer and report the most frequent hysteroscopic findings prior to embryo transfer. Materials and methods: Retrospective, observational and longitudinal study performed in patients with diagnosis of infertility of the Clínica de Reproducción Asistida Hisparep, Mexico, who received IVF-ICSI cycles with hysteroscopy prior to embryo transfer. The implantation rates between the different groups were compared and descriptive statistics were performed with c2. Results: 255 patients with a diagnosis of infertility were analyzed. The hysteroscopic study prior to embryo transfer reported that 122 (47%) had endometrial polyps, 70 (28%) normal uterine cavity, 27 (11%) uterine synechiae, 24 (9%) submucosal myomatosis and 12 (5%) Mullerian malformation of septate uterus type. 185 patients with alteration in the uterine cavity were intervened hysteroscopically for correction, before the embryo transfer; of these, 44 (24%) became pregnant. Those who had Müllerian malformation resected the uterine septum and in 9 patients pregnancy was achieved (75%). The patients in group 4 underwent adherenciolisis and 6 achieved pregnancy (22%). In group 2, after polypectomy, 26 patients became pregnant (21%) and in group 3, postoperated by submucosal myomectomy, 3 (12%) achieved pregnancy. Of the patients in group 1 with normal uterine cavity (n = 70), to whom embryo transfer was made, 37 (53%) were able to get pregnant. Conclusions: In patients with subfertility and endometrial polyposis, hysteroscopy is a useful resource to detect abnormalities susceptible to correction before embryo transfer.
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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.
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Objective To compare the perinatal outcomes between singleton and twin pregnancies and the influencing factors in young cases(age < 35)after in vitro fertilization/egg cell sperm injection-embryo transfer (IVF/ICSI-ET). Methods A retrospective study was performed to analysis the perinatal outcomes of the young cases after IVF/ICSI-ET from January 2015 to July 2016.Results The total abortion rate,early abortion rate and the average body weight of the twin group were significantly lower than the singleton group(P < 0.05),the mid-term abortion rate,the preterm delivery rate,cesarean section rate and the low birth weight rate were opposite (P<0.05),while the total pregnancy loss rate and the rate of birth defects were not significantly different between the groups(P>0.05).The frozen-thawed embryo transfer,blastocyst transfer and double-embryo transfer were the risk factors of twin pregnancy. Conclusions Twin pregnancy may increase the risk of adverse perinatal outcomes. Selective single blastocyst transfer during frozen-thawed cycle is an effective measure for young cases,in which it can keep a balance between high clinical pregnancy rate and reducing twin pregnancy rate.
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We sought to evaluate the ability of fine-needle aspiration (FNA) mapping to find sperm and to guide sperm retrieval after failed microdissection testicular sperm extraction (micro-TESE) in nonobstructive azoospermic men. In this study of consecutive male infertility cases, interventions included testicular FNA mapping and subsequent sperm retrieval. Outcomes included the frequency and location of found sperm on FNA maps after failed micro-TESE and the salvage sperm retrieval success. Among 548 patients undergoing FNA mapping from 2010 to 2016, 82 men with previous micro-TESE procedures were identified. The mean time between micro-TESE and FNA mapping was 2.2 years. A total of 2825 (1424 on right and 1401 on left) sites were mapped. At least one site revealed mature sperm in 24 (29.3%) of 82 men with prior failed micro-TESE procedures. There was an equal likelihood of detecting sperm in either testis (6.1% right; 5.7% left; P = 0.58). Digital "heat maps" revealed differences in sperm findings within the testis with mature sperm more likely found in the testis periphery rather than centrally. Fifteen (62.5%) patients subsequently underwent sperm retrieval procedures guided by FNA maps. Sufficient sperm were retrieved in all cases, and in 10 (66.7%) of 15 cases, extra sperm were frozen for future use. In a significant proportion of failed micro-TESE procedures representing the largest study to date, sperm were detected by FNA mapping and could be reliably retrieved through FNA map-guided surgical sperm retrieval. When present, sperm were more likely to be found in the testis periphery rather than centrally with FNA mapping.
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Resumen OBJETIVO: primario, determinar la influencia de la obesidad paterna en la tasa de embarazo, implantación, aborto y de recién nacido en casa en pacientes que reciben tratamientos de fertilización in vitro con ICSI. El objetivo secundario: determinar el efecto del índice de masa corporal del padre en la calidad seminal y embrionaria y en la tasa de fertilización. MATERIALES Y MÉTODOS: estudio retrospectivo, comparativo y observacional al que se incluyeron ciclos ICSI con transferencia embrionaria. Los ciclos se dividieron en 3 grupos según el IMC paterno: peso normal (18.5-24.99 kg/m2), sobrepeso (25-29.99 kg/m2) y obesidad (≥ 30 kg/m2). RESULTADOS: se estudiaron 365 ciclos consecutivos en fresco en los que se encontró un incremento significativo en la tasa de aborto en pacientes con obesidad comparados con el grupo sano (39.0 vs 12.9, p = 0.02), y una significativa disminución en la tasa de recién nacido en casa (38.6 vs 23.6; p = 0.04), además de menor tasa de embriones de excelente calidad, sin afectar la tasa de fertilización con ICSI. CONCLUSIONES: los resultados demuestran que aun cuando las tasas de embarazo e implantación son elevadas en pacientes con sobrepeso y obesidad con técnicas de alta complejidad o ICSI, el desarrollo embrionario, la tasa de aborto y tasa de recién nacido en casa se ven afectados por el incremento del IMC paterno.
Abstract OBJECTIVE: The aim of the present study was primarily to determine the influence of paternal obesity on pregnancy, implantation, abortion and take home baby rates in patients undergoing in vitro fertilization with ICSI. Secondly, to determine the impact of paternal body mass index (BMI) on semen parameters, fertilization rate and embryo quality. MATERIALS AND METHODS: Retrospective, comparative and observational study. 352 cycles of ICSI with embryo transfer were included. They were divided in three groups based on male BMI: Normal (18.5-24.99 kg/m2), overweight (25-29.99 kg/m2), and obesity (≥30 kg/m2). RESULTS: Male obesity was associated with a significant increased miscarriage rate when compared with the normal group (39.0 vs 12.9, p = 0.02) and a significantly lower take home baby rate (23.6 vs 38.6, p = 0.04). We also found a lower rate of top quality embryos, without affecting fertilization with ICSI. CONCLUSION: Our results demonstrate that even though pregnancy and implantation rates are elevated when ICSI is performed in overweight and obese patients, embryo development, miscarriage and take home baby rates are affected with increased paternal BMI.
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Objective To investigate the effects of sperm DNA fragmentation (SDF)and sperm morphology on the fertilization and embryo development in ICSI.Methods SDF and sperm morphology were detected in the meanwhile of taking eggs in 1 45 ICSI treatment cycle.On the basis of SDF index (DFI)divided into group A (DFI≤30%)and group B (DFI >30%).According to the normal sperm morphology divided into group C (NMSR≥4%), group D (1 %≤NMSR 30% and NMSR 0.05).(2)The normal fertilization rate was statistically significant in group C,group D,group E (χ2 =34.5,65.8,11 .8,all P 0.05).(3 )The normal fertilization rate,embryo utilization rate,good quality embryo rate,implantation rate and clinical pregnancy rate in group F were significantly higher than those in group G,and normal fertilization rate,embryos utilization rate,good quality embryo rate had statistically significant differences (χ2 =37.5,1 1 .0,4.3,all P <0.05). Conclusion Sperm abnormal morphology has negative effect on fertilization,and the high DNA fragments have negative effects on fertilization and embryo development.
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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.