Time intervals between semen production, initiation of analysis, and IUI significantly influence clinical pregnancies and live births.

PURPOSE: Does IDEF mapping help monitor the technical process of IUI and explore the potential improvements which might contribute to increased pregnancy and live birth rates? METHOD: Retrospective analysis of 1729 homologous IUI cycles of couples attending a fertility clinic in a university hospital setting. Standardized conventional semen parameters were analyzed and the semen samples prepared via discontinuous density gradient centrifugation. RESULTS: There was no significant association between sperm concentration, motility and morphology (analysis phase), and pregnancy outcome. Only female and male ages were significantly associated with the pregnancy outcome. There was a significant difference in the odds on clinical pregnancies and live births when analysis was ≤ 21 min initiated, and < 107 min between sample production and IUI, adjusted for male and female age. CONCLUSIONS: Adjusting for the couple's age, we could show that time intervals between semen production and analysis and IUI when kept low significantly influenced clinical pregnancies and live births.

Sperm DNA fragmentation in the total and vital fractions before and after density gradient centrifugation: Significance in male fertility diagnosis.

BACKGROUND: Sperm DNA fragmentation measured by different techniques make comparisons impossible due to lack of standardization. Induction of DNA damage after sperm preparation in the entire fraction has been observed on independent occasions but findings are not consistent. METHODS: Men presenting at a University hospital setup for infertility treatment. DNA damage via TUNEL assay was validated on fresh semen samples, as conventional semen parameters, to reduce variability of results. RESULTS: Sperm motility in neat semen inversely correlated with sperm DNA fragmentation in the total fraction, but, total count, leukocytes and immature germ cells significantly affected the vital fraction. Sperm DNA fragmentation was observed both in normal and subnormal semen samples, but was significantly different in the total fraction of astheno-, asthenoterato- and oligoteratozoospermic men. After density gradient centrifugation, sperm DNA fragmentation increased significantly in the total but decreased in the vital fraction. Advancing male age significantly influenced damage in the total but not in the vital population. CONCLUSIONS: These findings provide opportunities to investigate the significance of the total and the vital fractions both in natural conception and after different assisted reproductive technologies.

Risk factors and prediction of preeclampsia.

Inadequate trophoblast invasion of the spiral arteries in early pregnancy, an increased inflammatory response and changes in the immune answer to paternal antigens are considered aetiological factors in preeclampsia. Searching for factors related to these angiogenic, anti-angiogenic, immunologic and inflammatory mechanisms may provide methods to determine which patient will develop preeclampsia predating the onset of the clinical manifestations of the disease. Screening for preeclampsia in the first trimester has had Limited success. Currently, maternal characteristics, clinical history, maternal serum biochemistry and uterine artery Doppler sonography before 14 weeks are being investigated. Preeclampsia in a previous pregnancy is still the strongest predictor. In the second trimester, uterine artery Doppler has a detection rate around 60% but also a high false positive rate of 25%. First trimester uterine artery Doppler studies have high sensitivity but poor specificity with a high false positive rate. Combination of first trimester uterine artery Doppler with patient characteristics and maternal serum biochemistry, specifically placental protein 13 holds promise but further evaluation is needed. Maternal serum markers including inhibin A, activin A, soluble FMS-Like tyrosine kinase 1, endoglin, pregnancy associated plasma protein A and others, when used alone have proved poor predictors of preeclampsia. Most studies have been performed by a limited group of researchers in a population with a high risk and no validation studies of any method in other populations are available. Results are difficult to compare due to differences in methodology, and differences in the end point studied.There are still no good methods of preventing preeclampsia once a high risk has been determined.