Progesterone elevation on the day of oocyte retrieval and live birth rate after in vitro fertilisation treatment.

The objective of this study was to evaluate if progesterone elevation (PE) on the day of oocyte retrieval is associated with IVF outcome. A prospective cohort study of 400 IVF-ICSI cycles, with fresh embryo transfer on day 2-3 was performed. We proposed a serum progesterone (P) level on percentile (p) 90 as a threshold.Pregnancy rates were not affected, however there were more miscarriages (25.7% vs 43.8%) and lower live birth rate (LBR) (28% vs 23.1%) in the PE group (not statistically significant). We also found a positive correlation between P levels and retrieved and mature oocytes, total embryos, and good quality embryos. This is the first study to analyse LBR based on P levels on the day of oocyte retrieval. PE is not associated with the IVF outcome, but there is a trend to lower ongoing pregnancy rate and LBR and more miscarriages. Our results also show that P levels have no negative effects on oocyte and embryo quality.Impact statementWhat is already known on this subject? The influence of PE during IVF cycle on pregnancy rates remains controversial.What do the results of this study add? This is the first study to analyse LBR based on P levels on the day of oocyte retrieval.What are the implications of these findings for clinical practice and/or further research? We demonstrated that pregnancy rates were not affected by PE at oocyte retrieval, but there is a trend to lower ongoing pregnancy rate and LBR and more miscarriages. Randomised controlled trials are needed to offer more evidence of these relationships.

In vitro maturation, fertilization, embryo development & clinical outcome of human metaphase-I oocytes retrieved from stimulated intracytoplasmic sperm injection cycles.

BACKGROUND & OBJECTIVES: The major cause of fertilisation failure after ICSI is failure of the oocyte to initiate the biochemical processes necessary for activation. This inability could be ascribed to cytoplasmic immaturity of those gametes even if they had reached nuclear maturity. The activation of a mature oocyte is characterised by release from metaphase II (MII) arrest and extrusion of the second polar body, followed by pro-nuclear formation. The aim of this study was to evaluate the fate of in vitro matured (IVM) metaphase I (MI) oocytes subjected to intracytoplasmic sperm injection (ICSI) at different time intervals after extrusion of the first polar body (1PB) in in vitro fertilization (IVF) cycles. METHODS: A total of 8030 oocytes were collected from 1400 ICSI cycles, 5504 MII at the time of cumulus retrieval. Four hundred eight metaphase II (MII) (27.1%) matured to MII after in vitro culture for 2-26 h and 5389 sibling MII in the moment of oocyte denudation were injected. On the other hand, 49 ICSI cycles containing only MI oocytes at retrieval were injected at three different time intervals after reaching the MII. The intervals were as follows: 2-6 h (n=10), 8-11 h (n=4) and 23-26 h (n=10). Fertilization and development potential were evaluated in both studies. RESULTS: Fertilization, embryo cleavage and quality were significantly lower in IVM MI compared to MII at time of denudation. Pregnancy rate was higher in group MII. Pregnancy was achieved in three embryo transfers when ICSI was performed within 2-6 h (group I) and 8-11 h (group II) after PB extrusion. One pregnancy was obtained in group I and a healthy neonate was born. INTERPRETATION & CONCLUSIONS: Immature oocytes from women whose ovaries have been stimulated could be matured, fertilized by ICSI, cleaved in vitro and to give rise to a live birth. However, the developmental competence of embryos derived from immature oocytes is reduced, compared with sibling in vivo matured oocytes. Further, human IVM oocytes need between 2-6h after the 1PB extrusion to complete its maturation.

Estudio de la integridad del ADN espermático en relación con la calidad seminal y los resultados del ciclo de fecundación in vitro / Sperm DNA fragmentation in relation to seminal parameters and outcome of in vitro fertilization/intracytoplasmic sperm injection

Objetivo. Analizar la relación existente entre el grado de fragmentación del ADN espermático y los parámetros seminales, la edad del varón y los resultados del ciclo de FIV-ICSI. Sujetos y métodos. Cuarenta y tres pacientes sometidos a tratamientos de FIV-ICSI. La edad media de los varones fue 35,62±4,87 años. En este estudio prospectivo analizamos la fragmentación del ADN espermático mediante la técnica de SCSA (sperm chromatin structure assay) y los parámetros seminales clásicos (concentración, movilidad y morfología espermática). Los parámetros del ciclo de FIV-ICSI analizados fueron: tasa de fecundación, calidad embrionaria, tasa de embarazo, tasa de gestación y tasa de aborto. Resultados. La fragmentación del ADN está relacionada con un descenso en la movilidad progresiva de la muestra en fresco (p=0,000) y capacitada (p=0,041). También observamos un descenso en la movilidad progresiva de la muestra en fresco (p=0,034) y en la calidad del ADN espermático (p=0,043) en pacientes de mayor edad. No observamos relación entre la fragmentación y la tasa de fecundación, calidad embrionaria, tasa de embarazo y tasa de aborto. Conclusiones. El grado de fragmentación del ADN está inversamente correlacionado con la movilidad progresiva de la muestra seminal en fresco. La fragmentación del ADN no es útil como predictor del resultado del ciclo de FIV-ICSI, pero sí podría ser útil como herramienta diagnóstica ya que añade información al análisis seminal básico. Su valoración podría resultar de utilidad en determinados pacientes, como aquellos que presentan esterilidad idiopática. La calidad espermática del varón se ve afectada por el aumento en la edad(AU)

Objective. To establish the relationship between the degree of sperm DNA fragmentation and seminal parameters, male age and outcome of in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI). Subjects and methods. The sample consisted of 43 couples undergoing IVF/ICSI. The mean age of men was 35.62±4.87 years and that of women was 33.88±3.95 years. We prospectively analyzed sperm DNA fragmentation from each patient by the Sperm Chromatin Structure Assay (SCSA) and correlated the findings with seminal parameters (volume, concentration, progressive motility and morphology), IVF/ICSI outcomes and male age. IVF/ICSI outcome was evaluated by measuring the fertilization rate, embryo quality and the pregnancy and miscarriage rates. Results. DNA fragmentation was negatively correlated with progressive motility (p=0.000) of fresh and capacitated (p=0.041) semen. Older patients had a significantly lower percentage of progressive motility in fresh seminal samples (p=0.034) and worse sperm DNA quality (p=0.043). There were no significant differences between the fragmentation rate and fertilization rate, embryo quality, and the pregnancy and miscarriage rates. Conclusions. DNA fragmentation is inversely correlated with progressive motility in fresh seminal samples. DNA fragmentation does not predict the IVF/ICSI outcome but screening for sperm DNA damage may provide useful information in the diagnosis of idiopathic male infertility. Seminal quality is affected by increasing male age(AU)

Zygote score and status 1 or 2 days after cleavage and assisted reproduction outcome.

OBJECTIVE: To determine whether pronuclear morphology is a useful additional criterion when selecting embryos for transfer. METHOD: A modified Tesarik and Greco scoring system was used in this retrospective study to assess the pronuclear morphology of 883 zygotes from 214 in vitro fertilization or intracytoplasmic sperm injection cycles. Pronucleus size and presence of cytoplasmic halo were also noted. Embryo selection was performed on Day 2 or 3 following oocyte retrieval. The chi2, analysis of variance, Kruskal-Wallis, and Fisher exact tests were used where appropriate. RESULTS: A stepwise logistic regression revealed that a better embryo quality was associated with both pattern 0 of the scoring system and pronuclei of equal size on Days 2 or 3. Higher pregnancy and multiple gestation rates were obtained when at least 1 embryo classified as pattern 0 was included in the set of embryos transferred. CONCLUSION: Combined with embryo morphology evaluation on Days 2 and 3, a scoring system based on pronuclear morphology seems to provide a good criterion when selecting embryos for transfer.