Chlamydia trachomatis urogenital infection in women with infertility.

PURPOSE: The study objective was to evaluate the prevalence of urogenital Chlamydia trachomatis (C.tr.) infection in women with diagnosed infertility. MATERIAL AND METHODS: The study involved patients from the Department of Gynecological Endocrinology and from the Center for Reproductive Medicine "Kriobank" in Bialystok. Female patients (n=71), aged 23-41, were divided into two groups according to the main diagnosis: A--tubal infertility (23) and B--infertility of another origin (48). For direct testing, PCR method was used to detect C.tr. infection in cervical samples (Roche, Molecular Systems, N.J., USA). Specific IgA and IgG anti-chlamydial antibodies in the serum were determined by immunoenzymatic assay (medac, Hamburg, Germany). Diagnostic procedures were performed at the Centre for STD Research and Diagnostics in Bialystok. RESULTS: In group A, C.tr. infection was detected in: 8.7% patients, in group B--8.3%. Specific anti-C.tr. antibodies IgA were detected in: 13.0% in group A and 6.3% in group B, IgG respectively in 39.1% and in 10.4%. CONCLUSIONS: 1. C.tr. infection is very important etiological factor of female infertility. 2. The detection of specific antichlamydial antibodies is a valuable, noninvasive diagnostic procedure. 3. Infertile women should be routinely tested for C.tr. infection.

Rescue ICSI of unfertilized oocytes after IVF.

BACKGROUND: Failed fertilization after IVF occurs in 10-20% of cycles. Conflicting results of rescue fertilization by ICSI have been reported. We therefore compared the success rate in terms of fertilization and pregnancy of cycles in which rescue ICSI was performed with those from a matched control group of primarily ICSI cycles. METHODS: Unfertilized oocytes from IVF cycles with total fertilization failure where at least four metaphase II oocytes were available were treated by ICSI (group I; n = 120). A matched control group was established with patients undergoing ICSI during the same period (group II; n = 280). RESULTS: Both fertilization rate and the proportion of embryos with four blastomeres on day 2 after ICSI were significantly higher in the control group (P < 0.05). Embryo quality, however, was comparable in both groups. The pregnancy rate in the control group was 25.3% whereas in group I with rescue ICSI, no pregnancy was obtained. CONCLUSIONS: Although unfertilized oocytes after IVF can be fertilized by ICSI, the developmental potential of the ensuing embryos is very poor. Therefore, rescue ICSI after total failure of fertilization is not recommended.

The outcome of intracytoplasmic injection of fresh and cryopreserved ejaculated spermatozoa--a prospective randomized study.

BACKGROUND: The overall aim of this prospective, randomized study was to compare the reproductive potential of fresh and frozen-thawed ejaculated spermatozoa from oligoasthenoteratozoospermic patients in an intracytoplasmic sperm injection (ICSI) procedure. METHODS: All patients consenting to participate in this study had a sperm sample frozen prior to the start of a cycle. Patients were randomized using a random number table to undergo ICSI with either fresh (group A, n = 118) or frozen-thawed (group B, n = 122) spermatozoa. All prognostic variables were equally distributed among the two groups. RESULTS: The pregnancy rate per started cycle was 29.7% in group A and 38.5% in group B, P > 0.05. A significant difference was observed in the rate of ongoing pregnancies between group A (23.7%) and group B (35.2%), P < 0.05. CONCLUSION: From our data we can conclude that cryopreservation of spermatozoa from men with poor sperm quality does not negatively affect fertilization and pregnancy rates after ICSI. A larger study will be needed to investigate whether the use of cryopreserved spermatozoa can be helpful in selecting the most vital spermatozoa for ICSI.

[Intracytoplasmic sperm injection (ICSI): the Bialystok experience]. / Wyniki leczenia nieplodnosci metoda icsi w osrodku bialostockim.

OBJECTIVE: To present a complete results of Intracytoplasmic Sperm Injection Program (ICSI) performed at IVF Unit in Bialystok, Poland. DESIGN: Retrospective data analysis. MATERIALS AND METHODS: A total of 2593 cycles of ICSI treatment were analyzed. The results of controlled ovarian hyperstimulation (COH), parameters of fertilization, early embryo development and clinical pregnancy rates were compared depending on the type of COH used. RESULTS: Overall, for 16708 MII oocytes microinjected, the 2 pronuclear fertilization rate was 54%. Embryo transfer was performed in 94% of started cycles and 629 clinical pregnancies were recorded, giving a clinical pregnancy rate of 24% per cycle and 26% per transfer. No influence of COH on embryological and clinical results was noted. CONCLUSION: Intracytoplasmic sperm injection can be used successfully to treat couples with male factor infertility and those who have failed standard IVF. Precisely adapted protocol of ovarian hyperstimulation for every patient could diminish the costs of treatment without negative influence on ICSI results.

[Reinsemination of oocytes by intracytoplasmic sperm injection after the failure of conventional fertilization. Early embryonal development]. / Mikroiniekcja plemnika do cytoplazmy (ICSI) oocytów nie zaplodnionych w warunkach IVF. Wczesny rozwój embrionalny zarodkow.

OBJECTIVE: To analyze the influence of intracytoplasmic sperm injection (ICSI) on early embryo development used for reinsemination of unfertilized 1-day-old oocytes. DESIGN: Prospective observational study. MATERIALS AND METHODS: A total of 126 embryos resulted from reinsemination by ICSI were analyzed with regard for the time course of cleavage and the quality of embryos at 48 hours after injection. Results were compared with those obtained in 698 embryos obtained after routine ICSI program. RESULTS: It has been shown that embryos derived from reinsemination developed slower in comparison with those obtained after regular ICSI program. At 48 hours after microinjection 50% of embryos achieved 4 blastomeres stage and 37% remained on 2 cells stage. 71% of regular ICSI embryos at this same time showed 4 blastomere or more, only 16% remained on 2 blastomeres stage. The quality of embryos was similar in two compared groups, however those obtained following reinsemination at 4 blastomere stage were significantly poorer quality. CONCLUSION: Embryos derived from reinsemination of 1-day old oocytes unfertilized after conventional IVF developed slower and the quality of embryos at 4 blastomere stage was poorer comparing to regular ICSI embryos.