Relationship of follicular size to the development of intracytoplasmic sperm injection-derived human embryos.

OBJECTIVE: To compare the embryonic development of oocytes obtained from follicles of different sizes. MATERIALS AND METHODS: Oocytes (n = 819) were retrieved from women at 40 years of age or younger during 86 in vitro fertilization cycles and categorized as small, medium, or large based on the estimated volume of follicular fluid at the time of retrieval. RESULTS: The rates of good quality embryos from the large, medium, and small groups on days 2 and 3 were 76.85% and 66.20%, 74.00% and 61.33%, and 69.81% and 58.49%, respectively. There were no significant differences in the rates of good quality embryos between the three follicular volume groups. CONCLUSION: Even though fewer oocytes completed maturation in the small follicle group than in the other two groups, the quality of the embryos in all three groups was the same on days 2 and 3. These findings suggest that follicles of all sizes should be aspirated during the intracytoplasmic sperm injection cycle as follicles of every size were a good source of embryos.

Distinction between paternal and maternal contributions to the tripronucleus in human zygotes obtained after in vitro fertilization.

OBJECTIVE: The aim of this study was to determine the genetic composition of tripronuclear (3PN) zygotes. Fluorescence in situ hybridization (FISH) was used to quantify the sperm tails in human 3PN zygotes. MATERIALS AND METHODS: Ovarian hyperstimulation was performed using a standard long protocol consisting of gonadotropin-releasing hormone agonist (GnRHa) with human menopausal gonadotropins (HMG) and/or recombinant follicle stimulating hormone (rFSH). Human chorionic gonadotropin (hCG) was administered when at least two leading follicles reached 18 mm in mean diameter. Oocytes were retrieved from the follicles transvaginally under ultrasound guidance 34-36 hours after administration of hCG. The oocytes were examined 16-18 hours after fertilization for the presence and number of pronuclei. The 3PN zygotes were then fixed and extracted in buffer at 37 degrees C for 60 minutes. After washing in a blocking solution, the 3PN zygotes were prepared for indirect immunofluorescence using monoclonal antibody and Hoechst dye 33342 to visualize the number of pronuclei. RESULTS: Twenty-one 3PN zygotes were randomly collected for evaluation. The number of 3PN zygotes containing one, two or four sperm tails were two (10%), 18 (85%) and one (5%), respectively. CONCLUSION: Based on our observations, additional pronuclei are mainly of paternal origin.

Comparison of day 2 tubal embryo transfer with day 3 embryo transfer into the uterus of intracytoplasmic sperm injection derived human embryos.

OBJECTIVE: To compare the results of embryo transfer into the uterus (ET) performed on day 3 vs. tubal embryo transfer (TET) on day 2 in couples diagnosed with male factor infertility. MATERIALS AND METHODS: We collected data from 34 and 110 patients who underwent intracytoplasmic sperm injection (ICSI) followed by either TET on day 2 or ET on day 3 (January 2001-June 2005), respectively. All couples were diagnosed with male factor infertility; there were no tubal or uterine factors, diminished ovarian reserve, pelvic adhesions, history of polycystic ovary syndrome or previous ovarian surgery. RESULTS: The clinical pregnancy rates of day 2 TET and day 3 ET following ICSI were 64.71% and 57.27% (p > 0.05), respectively. The corresponding implantation rates were 35.47% and 29.58% (p > 0.05), respectively. CONCLUSION: The implantation and clinical pregnancy rates of ET on the 3rd day following ICSI were similar to the rates obtained with TET 2 days after ICSI. Therefore, ET performed 3 days after ICSI should be the first choice for couples with male factor infertility, while day 2 TET remains a good alternative, especially for women with normal tubal function and known difficulties of transcervical ET.

Effect of endometrial cavity fluid on clinical pregnancy rate in tubal embryo transfer (TET).

PURPOSE: In this study, we assess whether the endometrial cavity fluid (ECF) generated physiologically by the genital tract have negative effect on the pregnancy rate during tubal embryo transfer (TET) in patients who do not have hydrosalpinx or bilateral tubal obstruction. METHODS: We retrospectively collected samples from 176 women with 195 cycles receiving TET due to male factor, unexplained infertility or endometriosis from June 1999 to Dec. 2003, and divided them into two groups (group I: patient with fluid accumulation >1 mm in the anterior-posterior diameter in the uterine cavity; group II: patient without fluid accumulation in the uterine cavity). Endometrium thickness was measured as a maximal distance between anterior and posterior myometrium-endometrium interface under the long-axis view. The A-P diameter of ECF was measured via vaginal sonar on the day of ovum pick-up (OPU). RESULTS: From a total of 195 ART cycles involving 176 patients, the accumulation of ECF was detected in 10 cycles (5.1%). Seven of ten cycles (70%) with the accumulation of ECF were proved to be pregnant clinically. However, in the rest 185 cycles (group II), 98 of them (53%) were proved to be pregnant. At the mean time, the implantation rate was 29.03% and 25.71% in the groups I and II, respectively. No significant difference of the clinical pregnancy rate and the implantation rate was found between the two groups. CONCLUSIONS: According to our study, if the ECF was generated physiologically by the genital tract during controlled ovarian hyperstimulation (COH), the clinical pregnancy rate is not worse and no influence of embryo implantation was found.