[GnRH agonist triggering in IVF and luteal phase support in women at risk of ovarian hyperstimulation syndrome]. / Déclenchement de l'ovulation par agonistes du GnRH en FIV et soutien de la phase lutéale chez les femmes à risque d'hyperstimulation ovarienne.

OBJECTIVE: To evaluate the efficacy and safety of ovulation triggering by agonists in antagonists IVF cycles with fresh embryo transfer in modulating low HCG dose for luteal phase support in patients at risk of ovarian hyperstimulation syndrome (OHSS). PATIENTS AND METHODS: In an observational study from September 2011 to March 2013, we triggered with agonist 107 cycles with OHSS risk, we initially triggered 39 cycles with 2 doses of Triptorelin 0.1 mg. Injection of 1500 IU HCG was performed one hour after the pick up and a second injection of 1500 IU was made 5 days later (group 1) combined with 400 mg of natural progesterone vaginally. In the following 68 cycles we removed the second HCG injection and increased to 600 mg vaginal progesterone associated with E2 4 mg orally (group 2). RESULTS: Group 1: the ongoing pregnancy rate and birth rate in fresh cycle is respectively 37.1% and 34.3% and the cumulative ongoing pregnancy rate and birth rate per patient is 43.6% and 41%. We recorded three late onset OHSS in pregnant women. Group 2: ongoing pregnancy rate in fresh cycle is 39.6%, the current cumulative ongoing pregnancy rate per patient was 45.6%. We observed a case of early onset OHSS. DISCUSSION AND CONCLUSION: Triggering with agonist and administering an injection of 1500 IU of HCG the day of the pick up appears to be effective in women at risk of OHSS. The exclusion of all OHSS is still not reached. The search for the best protocol and its indications should continue.

[Influence duration of the use of estrogens beyond the menses in estradiol IVF antagonist programming cycles]. / Influence de la durée de prise d'estrogènes au-delà des règles dans les cycles FIV antagonistes programmés par les estrogènes.

OBJECTIVE: To evaluate by the birth rate the impact of the number of days of estrogens continued beyond the menses in a four days estradiol IVF antagonist programming cycles. PATIENTS AND METHODS: Retrospective study from September 2004 to January 2009 among women of age ranging between 25 and 38 years. Four milligrams of provames is prescribed 3 to 5 days before the theorical menses and continued until the beginning day of stimulation, which is distributed equitably between Thursday and Sunday. The birth rate is evaluated according to the number of days of estrogen continued beyond the menses within a limit from 1 to 8. RESULTS: No significant difference appears neither in the duration of stimulation, in the quantity of gonadotrophin, the oocytes pick up, nor in the rate of birth between the groups. CONCLUSION: The programming by estrogens of the antagonist IVF cycles implies a variable number of days of estrogens continued beyond the menses, which does not seem to affect the birth rate.

[Efficiency of antagonist IVF cycle programming by estrogens]. / Efficacité de la programmation des cycles FIV en antagonistes par les estrogènes.

OBJECTIVE: Assess the efficiency of estradiol programming in In Vitro Fertilization (IVF) with antagonists by comparing with classical long luteal agonist protocol. PATIENTS AND METHODS: It is a prospective randomized study, comparing 426 cycles in the arm estradiol antagonist with 412 cycles in the arm long agonist. Estradiol 4 mg/day begins on the 25th day of the previous cycle and continues during the menses until the first day of the stimulation which is from Thursday to Sunday whatever the beginning of the menses. The luteal protocol use Decapeptyl 0,1mg which begins on the 20th day of the previous cycle. RESULTS: Our two populations are similar. No pick-up has been done on Sunday. We have got significantly less oocytes and embryos in estradiol-antagonist (6,8+/-5,3 vs 7,6+/-5,7) and (3,7+/-3,2 vs 4,1+/-3,6) respectively. The ongoing pregnancy rate is comparable in the two groups: 28,6 % for estradiol antagonist 27,9 % for agonist for the whole population and 37 % vs 34,8 % respectively when at least one top embryo was transferred. DISCUSSION AND CONCLUSION: Programming antagonist cycles with estradiol allows the organization of the center; it is easy to implement and seems to give results as good as a long agonist protocol.

Changes in protamine 1 distribution in human sperm nucleus during in vitro sperm-oocyte interaction: an immunoelectron microscopic study.

OBJECTIVE: To determine whether the process of sperm nuclear destabilization would begin before sperm-oocyte fusion in humans. DESIGN: Changes in the distribution of human protamine 1 were investigated in human spermatozoa from the ejaculate, in spermatozoa selected by swim-up or Percoll techniques, and in spermatozoa bound to zona pellucida (ZP) from oocytes that failed to fertilize in an IVF program. SETTING: Center for Infertility and Assisted Reproductive Technology, and university departments. PATIENT(S): Fifteen couples undergoing an IVF program. INTERVENTION(S): Women underwent a similar superovulation induction protocol that consisted of GnRH agonist associated with hMG. MAIN OUTCOME MEASURE(S): Comparative immunoelectron microscopic study of sperm nucleus labeling with an anti-human protamine 1 specific protamine monoclonal antibody. RESULT(S): After selection by swim-up or by Percoll, spermatozoa show a significantly lower nuclear labeling than in the ejaculate. After binding to the ZP, labeling increases, more in spermatozoa selected by swim-up than by Percoll, but, after Percoll selection, labeling in zona-bound spermatozoa is lower than in the ejaculate. CONCLUSION(S): In humans sperm binding to the ZP induces differences in the accessibility of the anti-human protamine 1 antibody, which are consistent with structural rearrangements of the DNA-nucleoproteins complex. These modifications must be a prelude to sperm decondensation, protamines replacement by histones, and subsequent reactivation of the sperm genome in the oocyte.

Nuclear maturity of human spermatozoa selected by swim-up or by Percoll gradient centrifugation procedures.

OBJECTIVE: To investigate the relationship between sperm preparation techniques and nuclear maturity, as evidenced by the electrophoretic profiles of sperm nuclear proteins. DESIGN: Analysis of sperm nuclear quality in sperm populations used for IVF. SETTING: Center for infertility and assisted reproductive technology and university departments. PATIENTS: Twenty-seven men undergoing an infertility work-up. MAIN OUTCOME MEASURES: Comparative electrophoretic investigation of nucleoproteins extracted from spermatozoa selected by swim-up or Percoll techniques. RESULTS: Nuclear maturity level is improved after the two methods of selection but is more improved after Percoll. In the two groups, selected spermatozoa contain less histones. Moreover, Percoll gradients appeared to enrich for spermatozoa with less intermediate proteins and more mature nucleoproteins of P2 family than swim-up spermatozoa. CONCLUSION: Percoll may offer advantages in terms of the quality of the selected spermatozoa that may influence the outcome of assisted conception techniques.

1H nuclear magnetic resonance of human seminal plasma in in vitro fertilization attempts: use of automatic spectrum analysis.

Seminal plasma affects the quality of spermatozoa. The possible use of 1H nuclear magnetic resonance (NMR) analysis of human seminal plasma to determine a full biochemical profile that would allow the prediction of successful in vitro fertilization was examined. Two seminal plasma patterns (GI and GII) were found. The main compounds in GI were glycerophosphorylcholine, citrate and lactate, and in GII, choline and amino acids. These patterns did not fit into the usual spermogram classes. However, GI exhibited the higher pregnancy rate, suggesting that the equilibrium established between the components in seminal plasma affected not only the quality of spermatozoa but also embryonic quality.

[Intratubal transfer of an embryo or a zygote. (TET or GIFT) Past, present and future? Comparative study of tubal embryo transfer (TET) versus in vitro fertilization]. / Le transfert intratubaire d'embryon ou de zygote (TET ou ZIFT). Passé, présent et avenir? Etude comparative tubal embryotransfer (TET) versus FIVETE.

The pregnancy rate per transfer does not appear to be increased if the embryos are placed in the Fallopian tube rather than using in-vitro fertilization or inserting the gametes into the tubule ampulla. Consequently, the indications are specific to particular cases.

Electrophoretic characteristics of nuclear proteins from human spermatozoa.

A comparative electrophoretic analysis of nuclear proteins was investigated in ejaculated human semen. The results confirm the biochemical heterogeneity of nucleoproteins in sperm with normal routine parameters and demonstrate the same heterogeneity in semen with defective routine parameters: nucleoproteins comprise histones, intermediate proteins, and protamines in the two groups. Individual qualitative and quantitative differences are observed within and between the two groups. The results allow a better knowledge of nuclear characteristics of ejaculated human spermatozoa but it does not permit the establishment of a relationship between biochemical heterogeneity of sperm nucleus and decreased fertility.

Human spermatozoal nuclear maturity in normozoospermia and asthenozoospermia.

Ejaculated human spermatozoa were studied to assess their nuclear maturity. After SDS or SDS-EDTA treatment, asthenozoospermic semen had a lower resistance to decondensation than normozoospermic semen and contained more stained immature nuclei after aniline blue staining. It showed a higher uptake of ethidium bromide, specific for DNA. There was no difference in the binding of 14C iodoacetamide in the two groups. Therefore, asthenozoospermic semen could be characterized by its relative nuclear immaturity.

Effect of duration of abstinence on maturity of human spermatozoa nucleus.

Human sperm are a heterogeneous population, particularly with respect to their morphology, motility, and degree of nuclear maturity. The characteristics of human sperm and the degree of nuclear condensation with variable sexual abstinence times (long, 7 days; short, 12 h) have been studied. Long abstinence led to an increase in the number of sperm and a decrease in their motility, but their morphology remained unchanged. The DNA-protein complex demonstrated by ethidium bromide uptake was unchanged, but there was a significant increase in nuclear stability upon treatment with SDS. The duration of abstinence hardly affected the degree of nuclear condensation or stability of human sperm. The heterogeneity observed is essentially of testicular origin.

PIP: Spermatogenesis is a constant process; however, periods of abstinence do affect the number of sperm stored in the tail of the epididymis and the vas deferens as well as the percentage of stable nuclei. Volunteers either abstained for a short period of 1 ejaculation/day or a longer period of 1 ejaculation/7 days. Longer periods of abstinence showed an increase in sperm volume, concentration, and total count, as well as decreased sperm motility. Sperm morphology, however, showed no change. Longer abstinence also produces an increase in the percentage of stable nuclei, as shown when 50 mcl sperm was combined in solutions of 0.5 ml 1% sodium dodecyl sulphate and the same solution with 0.5 ml 1% ethidium bromide. Finally, shorter periods of abstinence were not shown to increase homogeneity of sperm populations, the composition of which is determined by testicular origin.