Influence of early ICSI-derived embryo sHLA-G expression on pregnancy and implantation rates: a prospective study.

BACKGROUND: We have previously reported the retrospective observation that when at least one embryo, transferred on day 3, expressed sHLA-G above the geometric mean (sHLA-G+) 46 h post-ICSI, there was a marked improvement in both pregnancy (PR) and implantation (IR) rates. METHODS: The media surrounding individual embryos derived from ICSI performed on oocytes from 482 women < or =43 years of age were tested for sHLA-G expression by specific ELISA. RESULTS: We report here prospective results showing improved IVF results following the transfer of 'good quality' embryos (7-9 cells with <20% fragmentation) by preferentially including at least one sHLA-G+ embryos. PR and IR for women < or =38 years were 63% and 32% when one transferred embryo was sHLA-G+, and 69% and 36% when at least two embryos were sHLA-G+. When none of the embryos transferred was sHLA-G+, PR and IR were 25% and 13%, respectively. Comparable PR and IR for women 39-43 years were 29% and 11% when none of the transferred embryos were sHLA-G+; 38% and 15% when at least one sHLA-G+ embryo was transferred; and 61% and 26% when at least two 2 sHLA-G+ embryos were transferred. The data were stratified by patient age. CONCLUSIONS: PR and IR increased with the addition of each sHLA-G+ embryo, regardless of age. While there are significant barriers to routine embryo sHLA-G testing, we believe that if implemented, this would provide a mechanism for optimizing IVF PR while minimizing the risk of multiple pregnancies.

Evaluation of a large cohort of men presenting for a screening semen analysis.

OBJECTIVE: To determine: [1] what percentage of men in an infertile relationship will have a semen abnormality, [2] the average value for each semen parameter in this group of men, [3] the distribution of abnormal semen parameters in this group, and [4] if our data support the hypothesis that sperm concentration is declining. DESIGN: Retrospective cohort study. SETTING: County hospital university-based infertility clinic. PATIENT(S): Male partners of women presenting for an infertility evaluation. INTERVENTION(S): Semen specimens were collected after 2-5 days of abstinence. MAIN OUTCOME MEASURE(S): Sperm concentration, motility, and morphology. RESULT(S): Fifty-two percent of samples had at least one sperm abnormality based on World Health Organization criteria. Fifty-one percent had an abnormality in sperm motility, 18% in sperm concentration, and 14% in sperm morphology. Four percent of the patients were azoospermic. CONCLUSION(S): No decline in sperm density was revealed in semen collected by men presenting for an initial screening semen analysis.

The significance of polycystic-appearing ovaries versus normal-appearing ovaries in patients with polycystic ovary syndrome.

OBJECTIVE: To evaluate what hormonal or biochemical parameters are most highly associated with the finding of polycystic-appearing ovaries as compared with normal-appearing ovaries in women with polycystic ovary syndrome (PCOS). DESIGN: Prospective randomized study. SETTING: Academic medical center. PATIENTS: Ten women with PCOS-five with normal-appearing ovaries and five with polycystic-appearing ovaries-were matched for age and body mass index. All had serum T levels between 80 and 150 ng/dL (conversion factor to SI unit, 3.467). INTERVENTION(S): Insulin infusion for the purpose of performing insulin tolerance testing to evaluate insulin resistance or sensitivity. MAIN OUTCOME MEASURE(S): We measured serum T, DHEAS, androstenedione, sex-hormone binding globulin, 5 alpha-androstane-3 alpha-17 beta-androstenediol glucuronide, FSH, LH, insulin-like growth factor-I, insulin-like growth factor binding protein-1, and insulin-like growth factor binding protein-3. Insulin resistance, measured by insulin tolerance testing, also was done on the same day after the patient had fasted for at least 8 hours. RESULT(S): Serum androgens and binding proteins were not significantly different in both groups. Insulin tolerance testing demonstrated a slower glucose disappearance in the polycystic appearing ovary group (Kitt glucose was 4.58% +/- 1.4%/min in the normal-appearing ovaries group versus 2.07% +/- 1.07%/min in the polycystic-appearing ovaries group). CONCLUSION(S): Women with PCOS and polycystic-appearing ovaries do not demonstrate any definitive serum hormonal differences compared with women with PCOS and normal-appearing ovaries. The presence of polycystic-appearing ovaries correlates significantly with the presence of insulin resistance.