Comparative analysis of the pregnancy rate via in vitro fertilization vs. previous artificial insemination in patients with unexplained infertility.

OBJECTIVE: To compare the clinical pregnancy rate among patients undergoing direct in vitro fertilization vs. in vitro fertilization after two cycles of intrauterine insemination in couples with unexplained infertility. METHODS: Comparative cross-sectional, retrospective study from 2016 to 2019, from the Centro Mexicano de Fertilidad Doctor Alberto Kably. The patients with unexplained infertility were divided into two groups, direct in vitro fertilization and a group of in vitro fertilization after intrauterine insemination, and we compared the rate of pregnancy and live births in both cases. RESULTS: 89 couples with unexplained infertility were included, the in vitro fertilization after intrauterine insemination group (n=46) and direct in vitro fertilization group (n=43). The direct in vitro fertilization group resulted in a higher clinical pregnancy rate throughout the study compared to the other group (55.8% vs. 34.8%, OR 2.37; 95% CI 1.008 - 5.57, p=0.046). However, there was no difference in the rate of live newborns (p=0.12). When analyzing the data by cycle, we noticed a statistical difference in both, the clinical pregnancy rate in the direct in vitro fertilization group (38.7% vs. 16.7%, OR 3.2; 95% CI 1.50-6.62), as well as the rate of live newborns (32.3 % vs. 14.6%, OR 2.79; 95% CI 1.28-6.07, p=0.008). CONCLUSIONS: In the in vitro fertilization group, as first-line treatment for unexplained infertility, the patients had a higher pregnancy rate.

[Impact of spermatozoid head anomalies as predictor factor of non-determined infertility]. / Impacto de las anormalidades de la cabeza del espermatozoide como factor pronóstico en la infertilidad de causa no determinada.

OBJECTIVE: To evaluate fertilization and pregnancy rates, and pregnancy outcome in women diagnosed with non-determined infertility, and its correlation with sperm head morphology anomalies. MATERIAL AND METHODS: Retrospective study (ANOVA) including 126 patients diagnosed with non-determined infertility, attended from January 2002 to December 2006, admitted to embryo transference fertilization program, both conventional in vitro and intracytoplasmatic sperm injection. Spermatic morphology was analyzed in accordance with Kruger's strict criterion. All of patients had spermatic morphology higher than 5%, with 7.17% average. They were divided into three groups, in accordance with sperm head morphology anomalies percentage: group 1, less than 30%; group 2, 31 to 39%, and group 3, more than 40%. All of them had oocyte insemination: half conventional in vitro and half intracytoplasmatic sperm injection. RESULTS: Group 1 had higher percentage of fertilization, over groups 2 and 3 (65.44, 49.5 and 57.23%, respectively; p = 0.002). Abortion numbers showed meaningful differences too; group 1 had no abortions, meanwhile groups 2 and 3 had 30.77 and 22.22%, respectively. CONCLUSIONS: Evaluation of sperm head morphology anomalies must be a prognostic factor in pregnancy evolution, in women with nondetermined infertility.

Falla inesperada en la fertilización in vitro convencional: reinseminación con ICSI o indicación de ICSI en ciclos subsecuentes / Unexpected failed fertilization in vitro: ICSI reinsemination or ICSI indication for subsequent cycles

The objective was to determine if intracytoplasmatic sperm injection (ICSI) for "rescue" of unexpected failed conventional insemination should be carried out for therapeutic or diagnostic purposes, that is, as a predictor for performing ICSI as a standard treatment in subsequent cycles. A retrospective clinical study was carried in 26 patients who showed unexplained fertilization failure on a first conventional IVF attempt, and reinsemination by ICSI was performed. We compared these results with those of 13 of the 26 patients who underwent a second attempt in which ICSI was used as the only insemination technique. A fertilization rate of 46.27 was achieved with reinsemination by ICSI but none resulted in pregnancy (0). Fertilization was achieved with ICSI in all patients with previous fertilization failure and a pregnancy rate of 38.46. Patient characteristics, cycle characteristics, sperm parameters or oocyte quality did not differ significantly between two groups. In conclusion, the ICSI reinsemination technique can give good fertilization rates but the potential of the generated embryos to achieve pregnancy seems to be low. In addition, it can be demonstrated that these patients have good possibilities of obtaining a pregnancy in a following cycle using ICSI.

Alteración en los potenciales de membrana mitocondrial y su relación exponencial con la translocación de fosfatidilserina en la membrana plasmßtica como marcadores en los eventos iniciales de apoptosis: evaluación en diferentes fracciones espermáticas / Changes in mitochondrial membrane potentials and its exponential relation with phosphatidylserine translocation in the plasma membrane as markers in the initial events of apoptosis: evaluation in different spermatic fractions

OBJECTIVE: To determine the integrity of the plasmatic membrane through phosphatidylserine (PS) translocation in two spermatic fractions and their correlation with the spermatic mitochondrial membrane potential. MATERIAL AND METHODS: The analysis of both spermatic fractions was carried out through a discontinuous gradient separation with Percoli, in order to obtain two samples with high and low mobility (90-40). Twelve patients were recruited for the initial evaluation of seminal parameters. Mitochondrial membrane integrity was determined using a second antibody (Mitosensor), and was analyzed by fluorescence microscopy, evaluating an average of 200 cells. A 450-490 nm excitation filter was used for this analysis. Cytoplasmatic assessment was carried out by anexine V bonding to PS, in order to determine the initial events of cellular death. Non parameter tests were used in order to determine the differences between mitochondrial potentials and plasmatic membrane processes. Linear correlation tests were used for the anexine V and Mitosensor ratios. RESULTS. Due to the study's design, some differences were observed regarding the displacement parameters and the presence of apoptosis, both, in the plasmatic membrane and in mitochondrial membrane potentials. A positive correlation between both, mitochondrial and cytoplasmic membrane functions was also found. CONCLUSIONS. This is the first study performing a comparative analysis between mitochondrial membrane function and cytoplasmatic PS expression as early cellular death markers. The male infertility population is probably associated with an increase in this kind of apoptosis processes.