[Successful pregnancy following laser-assisted selection of viable but immotile spermatozoa for intracytoplasmic sperm injection: A report of 2 cases].

OBJECTIVE: To investigate the feasibility and clinical application value of selecting viable spermatozoa by noncontact diode laser. METHODS: We obtained immotile spermatozoa from 2 infertile men with obstructive azoospermia or severe asthenospermia and selected viable spermatozoa using a single laser shot at the sperm tail. Those that responded to the laser shot by a curling reaction of the tail were regarded as presumably viable and used for intracytoplasmic sperm injection (ICSI). RESULTS: The mean fertilization rate was 88.89% after ICSI with the laser-selected viable spermatozoa. Both of the embryo transfers resulted in a single pregnancy. CONCLUSION: Noncontact diode laser is a useful alternative for the assessment of sperm viability, which may help to achieve successful pregnancy.

[Effects of IVF versus ICSI on the outcomes of elective blastocyst culture].

OBJECTIVE: To explore the effects of different fertilization methods on the outcomes of elective blastocyst culture. METHODS: We retrospectively analyzed the outcomes of elective blastocyst culture for 1 153 cycles of IVF and 205 cycles of ICSI performed between january 2009 and December 2012. RESULTS: A total number of 14 748 embryos in the IVF group and 2 655 embryos in the ICSI group underwent sequential blastocyst culture, with 7 871 blastocysts formed in the former and 1 210 in the latter. No cycles were canceled for no blastocyst formation in either of the two groups. The rates of quality embryos, blastocyst formation and embryo utilization were significantly higher in the IVF than in the ICSI group (64.77 vs 58.72%, 53.37 vs 45.57%, and 60.06 vs 52.17%, all P < 0.05), but the rates of implantation, clinical pregnancy and abortion showed no significant differences between the two groups (48.94 vs 51.43%, 49.03 vs 52.02%, and 11.69% vs 15.56, all P > 0.05). CONCLUSION: With the same inclusion criteria of selective blastocyst culture, IVF has a lower risk of cycle cancellation due to no blastocyst formation and therefore may effect higher rates of blastocyst formation and embryo utilization than ICSI. Our study suggested that appropriate inclusion criteria of selective blastocyst culture should be laid down according to different fertilization methods.

[Predictive value of sperm morphology according to WHO Laboratory Manual for the Examination and Processing of Human Semen (5th Ed) on the outcomes of IVF-ET].

OBJECTIVE: To determine the predictive value of sperm morphology based on the criteria of the 5th edition of the WHO Laboratory Manual for the Examination and Processing of Human Semen (WHO5) on the outcomes and neonatal status following IVF-ET. METHODS: According to the strict criteria of WHO5, we obtained semen samples from 789 subjects and allocated them to a normal group (morphologically normal sperm > or = 4%, 754 cycles) and a teratozoospermia group (morphologically normal sperm < 4%, 35 cycles). We made comparisons between the two groups in the rates of normal fertilization, cleavage, quality embryo, implantation, clinical pregnancy and miscarriage as well as the status of the neonates. RESULTS: No significant differences were observed in the couples' age, mean number of oocytes, and mean stature and body mass index of the women between the two groups (P > 0.05). The teratozoospermia group showed slightly lower rates of fertilization, cleavage, quality embryo, embryo cryopreservation, implantation and pregnancy, but a higher rate of miscarriage than the normal group (P > 0.05). Apart from 141 on-going pregnancies (140 in the normal and 1 in the teratozoospermia group), 228 healthy infants were born following 789 transfer cycles, 213 (141 singletons and 36 twins) in the former and 15 (9 singletons and 3 twins) in the latter group. Congenital defects were found in none of the neonates, and there were no significant differences in the gestation period, premature birth rate and low body weight between the two groups (P > 0.05). CONCLUSION: Sperm morphology according to the criteria of WHO5 has but a limited value in predicting the outcomes and neonatal status following IVF-ET.

[Effects of artificial shrinkage of blastocoeles before vitrification on pregnancy outcome].

OBJECTIVE: To investigate the effects on pregnancy outcome and neonate by artificial shrinkage by microsucting the fluid of expanded blastocysts before vitrification using glass micropipette (GMP). METHODS: From Jan. 2006 to Dec. 2009, 342 vitrified-thawed blastocyst cycles from patients that performed in vitro fertilization-embryo transfer (IVF-ET) or intracytoplasmic sperm injection (ICSI) were enrolled in this study in Reproductive Medicine center, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region. Three hundred and fourteen cycles of expanded blastocysts were artificially shranked by microsucting blastocoelic fluid with a micro-needle before vitrification as artificial shrinkage group, in the mean time, 28 cycles without artificial shrinkage were chosed as control group. The survival rate, implantation rate, clinical pregnancy rate and transfer canceled rate were compared between artificial shrinkage group and control group. Among pregnant women, the miscarriage rate, live birth rate, congenital birth defect rate, neonatal weight and gestational age were compared with those of fresh embryo transfers in 520 cycles. RESULTS: The blastocyst survival rate, implantation rate and clinical pregnancy rate were 95.3% (403/423), 38.0% (153/403), 44.6% (140/314) in artificial shrinkage group and 64.3% (27/42), 7.4% (2/27), 7.1% (2/28) in control group, respectively, which reached statistical difference (P < 0.05). The transfer canceled rate was 0 in artificial shrinkage group and 25.0% (7/28) in control group, which also reached statistical difference (P < 0.05). Among pregnant patients, the miscarriage rate of 18.2% (10/55), live birth rate of 80.0% (44/55), gestational age of (38.2 ± 1.3) weeks, congenital birth defect rate of 2.1% (1/47), birth weight of newborns of (2989 ± 640) gram in artificial shrinkage group were not significantly different with 17.5% (91/520), 74.0% (385/520), (37.9 ± 2.3) weeks, 1.7% (8/479) and (2856 ± 640) gram in fresh embryo transfer group (P > 0.05). CONCLUSION: Artificial shrinkage by microsucting blastocoelic fluid with a micro-needle before vitrification significantly improved the vitrification effects of expanded blastocyst and no distinct increasing rate of neonates congenital anomality were observed.

[Influence of sperm morphology on the outcomes and neonatal status in IVF-ET].

OBJECTIVE: To determine the influence of sperm morphology on the outcomes and status of the neonates in in vitro fertilization and embryo transfer (IVF-ET). METHODS: Strictly based on the WHO criteria, we divided semen samples into a moderately abnormal group (sperm of normal morphology 5% - 10%), a mildly abnormal group (10% < sperm of normal morphology < 15%) and a normal group (sperm of normal morphology > or = 15%) , and compared the rates of fertilization, cleavage, quality embryos, implantation, clinical pregnancy and live births among the three groups. RESULTS: There were not significant differences in the patients' age among the three groups (P > 0.05). The fertilization rate was markedly lower in the moderately abnormal than in the mildly abnormal group (63.70% vs 73.74%, P < 0.05), but not significantly different from the normal group (63.70% vs 68.05%, P > 0.05). The rate of quality embryos of the normal group was the highest, significantly higher than that of the moderately abnormal group (44.83% vs 35.75%, P < 0.05), but no statistically significant differences were observed in the rates of cleavage, implantation and clinical pregnancy among the three groups (P > 0.05). A total of 125 babies were born from the 280 ET cycles, including 73 singletons and 26 twins, of whom none showed any congenital birth defects. No statistically significant differences were found in the rates of abortion, ectopic pregnancy and premature delivery, nor in the mean gestational period and average body weight of the neonates among the three groups (P > 0.05). CONCLUSION: Moderately abnormal sperm morphology did not affect the fertility rate of IVF, but significantly decreased the quality of embryos; mildly abnormal sperm morphology had no obvious influence on the rates of fertilization, cleavage, quality embryos, implantation, clinical pregnancy and live births; while normal sperm morphology played a limited role in predicting the outcomes and status of the neonates in IVF-ET.