Novel modified criteria for sperm morphology in oocyte insemination could reduce ICSI rates without affecting IVF outcomes.

OBJECTIVE: To evaluate the IVF outcomes of conventional insemination for less severe teratozoospermia (LST) patients (sperm morphology >2% and <4% normal forms and total motile sperm count ≥10 × 106) and normal sperm patients defined by WHO criteria 2010 in the interest of reducing intracytoplasmic sperm injection (ICSI) rate in IVF. MATERIALS AND METHODS: In this retrospective study, a total of 330 patients were recruited in the conventional IVF insemination. Among them, there were 76 patients in LST group and 254 patients in the normal sperm group. Fertilization rate, abnormal fertilization rate, embryo quality, implantation rate, chemical pregnancy rate, clinical pregnancy rate, abortion rate and live birth rate were assessed. RESULTS: No statistical differences were achieved in the percentage of normally fertilized eggs (85.9% vs. 85.8%), abnormal fertilization rates of 1 PN (2.76% vs. 3.01%) or 3 PN (5.70% vs. 6.30%), good embryo rate (52.4% vs. 51.5%), implantation rate (20.9% vs 17.5%), chemical pregnancy rate (45.1% vs. 39.4%), clinical pregnancy rate (36.0% vs. 31.7%), live birth rate (28.9% vs. 26.7%) and abortion rate (9.6% vs. 10.2%) between LST group and normal sperm group regardless of the sperm morphology. CONCLUSION: Patients with less severe teratozoospermia may not need ICSI in their IVF treatment since the outcomes particularly the fertilization rates were not affected by the less compromised sperm morphology at all when compared with the normal sperm patients.

Cryotop vitrification as compared to conventional slow freezing for human embryos at the cleavage stage: survival and outcomes.

OBJECTIVE: This study was conducted to compare the efficacy of cryotop vitrification of human cleavage-stage embryos to that of conventional slow freezing of these embryos with respect to survival. A second objective was to compare the two cryopreservation techniques with respect to outcomes for a cohort of women. MATERIALS AND METHODS: Cleavage-stage embryos from 102 patients were cryopreserved either by vitrification (57 patients) or by traditional slow freezing (45 patients). After thawing, rates of embryo survival, implantation, and clinical pregnancy were determined. RESULTS: Survival of embryos was significantly higher with the vitrification procedure as compared to traditional slow freezing [287/298 (96.3%) vs. 294/446 (65.9%); p < 0.05). Rates of implantation and clinical pregnancy were also significantly higher using vitrification procedure as compared to the slow freezing procedure (24.3% vs. 7.1% and 35.6% vs. 15.6% respectively, p < 0.05). CONCLUSION: As compared to conventional slow freezing, cryopreservation of human cleavage-stage embryo using vitrification results in higher rates of embryo survival, implantation, and clinical pregnancy. Vitrification therefore represents the superior cryopreservation technique for cleavage-stage embryos.

Relationship of progesterone/estradiol ratio on day of hCG administration and pregnancy outcomes in high responders undergoing in vitro fertilization.

OBJECTIVE: To evaluate the predictive value of a serum P/E(2) ratio measured on the day of hCG administration regarding pregnancy outcomes in high responders undergoing IVF. DESIGN: Retrospective study. SETTING: Teaching hospital. PATIENT(S): Two hundred twenty-three infertile women classified as high responders in IVF-ET cycles. INTERVENTION(S): Eligible infertile women undergoing IVF were assigned to four groups according to serum P levels on the day of hCG administration: group 1, P2.0 ng/mL. The relationship of E(2) level and P/E(2) ratio on the day of hCG administration and pregnancy outcomes was analyzed. MAIN OUTCOME MEASURE(S): Implantation and pregnancy rate. RESULT(S): Patients in group 4 had highest E(2) level and P/E(2) ratio, as well as lowest implantation and pregnancy rates. Using P for grouping, the sensitivity/positive predictive values (%/%) of P/E(2) ratio in the four groups were 15/66, 30/65, 30/60, and 25/41, respectively. CONCLUSION(S): Using the level of a single sex hormone on hCG day to predict pregnancy outcome in high responders undergoing IVF is confounding, whereas using a P/E(2) ratio on hCG day is theoretically reasonable. However, the low sensitivity and positive predictive value make the use of P/E(2) clinically unfeasible.

An increased serum progesterone-to-estradiol ratio on the day of human chorionic gonadotropin administration does not have a negative impact on clinical pregnancy rate in women with normal ovarian reserve treated with a long gonadotropin releasing hormone agonist protocol.

OBJECTIVE: To evaluate the relationship between serum P:E(2) ratio on the day of hCG administration and the clinical outcomes in infertile women with normal ovarian reserve treated with a long GnRH agonist (GnRH-a) protocol. DESIGN: Retrospective analysis of IVF-embryo transfer data. SETTING: University teaching hospital. PATIENT(S): One hundred thirty-nine infertile women with normal ovarian reserve, who received IVF-embryo transfer with a long GnRH-a protocol. INTERVENTION(S): Cycles were grouped according to whether premature luteinization (PL) appeared on the day of hCG administration. Premature luteinization was defined as a P:E(2) ratio >or=1.2 by using receiver operator characteristic analysis. MAIN OUTCOME MEASURE(S): Treatment cycle hormonal characteristics and clinical outcomes. RESULT(S): The P:E(2) ratio on the day of hCG administration was significantly higher in the PL (n = 41) compared with the non-PL (n = 98) group (2.4 +/- 1.5 and 0.6 +/- 0.3, respectively). The mean number of oocytes retrieved in the PL and non-PL groups were 4.2 +/- 2.8 and 12.7 +/- 6.6, respectively. However, the difference between the clinical pregnancy rates (PR) in the PL and non-PL groups was not statistically significant (29.3% vs. 34.5%). In a logistic regression analysis, the P:E(2) ratio showed no statistically significant correlation with pregnancy outcome. CONCLUSION(S): The increased serum P:E(2) ratio on the day of hCG administration, as an indicator of PL, has a poor predictive value on IVF outcomes in infertile women with normal ovarian reserve treated with a long GnRH-a protocol.