Clinical application of a new assisted hatching method using a piezo-micromanipulator for morphologically low-quality embryos in poor-prognosis infertile patients.

OBJECTIVE: To assess the effect of a assisted hatching technique using a piezo-micromanipulator on pregnancy rates in poor-prognosis infertile patients. DESIGN: A prospective randomized study. SETTING: The Infertility and IVF unit of the Kyoto University Hospital. PATIENT(S): Infertile patients who had been treated for >4 years and failed in previous IVF trials at least twice. INTERVENTION(S): Two hundred forty-eight IVF cycles from 173 patients were divided into two groups: cycles with the transfer of embryos treated by assisted hatching and cycles with the transfer of nontreated embryos. Each group was subdivided into two groups according to embryo morphology: cycles in which three or two morphologically good-quality embryos were transferred and cycles in which one or no morphologically good-quality embryos were transferred. Assisted hatching was performed by a piezo-micromanipulator. MAIN OUTCOME MEASURE(S): The clinical pregnancy rates and implantation rates. RESULT(S): The clinical pregnancy and implantation rates were significantly higher in the assisted hatching group of patients with three or two good-quality embryos than in the other three groups. CONCLUSION(S): The assisted hatching using a piezo-micromanipulator improved the pregnancy and implantation rates in poor-prognosis infertile patients with good-quality embryo transfer but had no effect in patients with low-quality embryo transfer.

A new assisted hatching technique using a piezo-micromanipulator.

OBJECTIVE: To estimate the efficacy of a new assisted hatching technique using a piezo-micromanipulator to support embryonic implantation. DESIGN: Sibling spare embryos from human cycles of IVF were allocated to either a treated group for assisted hatching by a piezo-micromanipulator or a nontreated control group. SETTING: The Infertility and IVF unit of the Kyoto University Hospital. PATIENT(S): Sixty-eight women undergoing conventional IVF treatment. INTERVENTION(S): One hundred ten spare 4- or 8-cell embryos from 68 patients undergoing IVF were treated with the new assisted hatching technique, and the results were compared with those obtained for 112 sibling embryos without the treatment. In the assisted hatching procedure, zona thinning combined with drilling was performed by the vibration of a microneedle produced by the piezo-micromanipulator unit. MAIN OUTCOME MEASURE(S): The rates of partial hatching and completely hatched blastocysts. RESULT(S): The rates of hatching and of hatched blastocysts per total developing blastocysts were significantly higher in the treated group (86.7% and 33.3%, respectively) than in the control group (15.3% and 2.8%, respectively). CONCLUSION(S): These results demonstrate that the newly devised zona thinning and drilling technique using a piezo-micromanipulator is useful for assisted hatching.

[Prediction of the degree of nocturnal oxygen desaturation in sleep apnea syndrome by estimating the testosterone level].

We studied the influence of hypoxia due to sleep apnea on testosterone (T) secretion. It was conducted on the basis of an idea that sustained hypoxia may depress T secretion. The subjects consisted of 15 male patients with no drug administration whose complaints were snoring and/or obesity. The subjects participated in a sleep study on two consecutive nights. During the first night we collected blood samples starting every 4 hours from 10 PM via a catheter and measured T. From the data of the second night, we calculated total desaturation time with more than 4% from the baseline SaO2. According to the amount of this desaturation time, the subjects were divided into 2 groups; desaturation time less than 80 min in group 1 and longer in group 2, respectively. The peak value was seen at 6 AM in group 1 and at 10 AM in group 2. We investigated the correlation between the ratio of T10/T6, which is the ratio of T level at 10 AM to that at 6 AM, and parameters of sleep disorders related to oxygen desaturation. Total 4% desaturation time in total sleep period and non REM period significantly correlated with this ratio. From the diagram illustrating the correlation between the ratio and total 4% desaturation time in total sleep period, we could assume that if the ratio is beyond 1, the subject may have had more than about 80 min of total 4% desaturation time.