Choice of diagnostic methods in tubal obstructive diseases / 中国实用妇科与产科杂志

This review introduces the tubal liquidinstillations,hysterosalpingography(HSG),two-di-mensional/three-dimensional and dynamic three-di-mensional(four-dimensional)hysterosalpingo-contrastsonography,MRI-HSG,tubal patency test by hyster-oscopy and hysteroscopy-laparoscopy.We comparesthe advantages and disadvantages of various kinds oftests,mainly the different characteristics of oil-basedor water-based contrast medium,and the high falsepositive rate of HSG diagnosis of proximal obstruction,etc,in order to enable the readers to choose suitabletubal evaluation methods according to the conditions oftheir unit.

Sperm chromatin structure assay predicts the outcome of intrauterine insemination / 中华男科学杂志

<p><b>OBJECTIVE</b>Sperm chromatin structure assay (SCSA), as a clinically practical technique for the analysis of DNA damage, is rarely reported in China. This study focuses on the correlation of DNA damage with the pregnancy rate of intrauterine insemination (IUI).</p><p><b>METHODS</b>We performed semen analysis for 482 couples undergoing IUI, calculated the DNA fragmentation index (DFI) by SCSA, and observed the relationship between DFI and the pregnancy rate of IUI.</p><p><b>RESULTS</b>Clinical pregnancy was achieved in 5 (5.26%) of the 95 cases with DFI > 25%, and in 59 (15.25%) of the 387 cases with DFI < or = 25%. Those with sperm DFI >25% had significantly lower rates of biochemical pregnancy and clinical pregnancy than those with DFI < or = 25% (OR: 0.37, 95% CI: 0.14 - 0.96 and OR: 0.38, 95% CI: 0.16 - 0.97). No significant differences were found in the DFI of 54 cases between the first and the second cycle ([15.05 +/- 7.98]% vs [17.25 +/- 12.18]%, P > 0.05). Sperm DFI was significantly negatively correlated with sperm concentration, sperm motility and total progressively motile sperm count (P < 0.01).</p><p><b>CONCLUSION</b>The pregnancy rate of IUI is significantly lower in couples with DFI >25% than in those with DFI < or = 25%. Sperm DFI obtained from SCSA is partly correlated with sperm concentration and motility, and it is a robust predictor of the IUI outcome.</p>

Y-chromosome microdeletions do not affect the outcomes of ICSI for infertile males / 中华男科学杂志

<p><b>OBJECTIVE</b>To compare the outcomes of intracytoplasmic sperm injection (ICSI) for infertile males with Y-chromosome microdeletions and for those with azoospermia or severe oligospermia but without Y-chromosome microdeletions.</p><p><b>METHODS</b>We retrospectively analyzed 56 cycles of ICSI for 48 infertile cases with Y microdeletions (Group A) and 94 cycles for 90 cases with azoospermia or severe oligospermia but without Y-chromosome microdeletions (Group B) during the same period. We compared the two groups in the females' age, duration of infertility, males' age, number of oocytes retrieved, number of ICSI oocytes, fertilization rate, good embryo rate, number of embryos transferred, implantation rate, clinical pregnancy rate, abortion rate, live birth rate and babies' sexes.</p><p><b>RESULTS</b>There were no significant differences between Groups A and B in the females' age, duration of infertility, males' age, number of oocytes retrieved, number of ICSI oocytes and number of embryos transferred (P > 0.05), nor in the rates of fertilization (69.0% vs 73.2%), good embryos (53.3% vs 48.7%), implantation (24.0% vs 30.3%), biochemical pregnancy (41.1% vs 44.7%), clinical pregnancy (37.5% vs 35.1%), early abortion (4.8% vs 6.1%) and live birth (35.7% vs 29.2%) (P > 0.05).</p><p><b>CONCLUSION</b>Y-chromosome microdeletions do not affect the outcomes of ICSI. The affected couples should be informed of the necessity of prenatal genetic diagnosis before embryo implantation and the inevitability of vertical transmission to male offspring.</p>

Clinical value of artificial insemination by donor / 中华男科学杂志

<p><b>OBJECTIVE</b>To investigate the clinical value of artificial insemination by donor (AID).</p><p><b>METHODS</b>We retrospectively analyzed 480 cycles of AID among 258 infertile couples, who were divided according to the women's age into a < or = 30 yr group and a > or = 31 yr group.</p><p><b>RESULTS</b>A total of 120 pregnancies were achieved in 480 AID cycles, with a cycle pregnancy rate of 25.00% and a cumulative pregnancy rate of 46.51%. In the natural cycles, the cycle pregnancy rate was 29.65% and the cumulative pregnancy rate was 51.00% in the < or = 30 yr group, significantly higher than 13.33% and 25.00% in the > or = 31 yr group (P < 0.05). In the ovulation induction cycles, no significant differences were found in the cycle and cumulative pregnancy rates between the two groups (24.02 and 48.86% versus 23.81 and 43.48% , P > 0.05). The cycle and cumulative pregnancy rates decreased with the increase of infertility duration and the women's age, but had no significant differences. In the first four cycles, the cycle pregnancy rates were 24.03, 24.94, 24.69 and 25.00% (P > 0.05), and the cumulative pregnancy rates were 24.03, 39.53, 45.74 and 46.51%, with significant differences between the first cycle and the other three (P < 0.01).</p><p><b>CONCLUSION</b>Ovulation induction is superior to natural cycle in AID for older women. IVF/ICSI can be resorted to only after AID has failed three or four times.</p>

Fertilization of in vitro matured human oocytes by intracytoplasmic sperm injection (ICSI) using ejaculated and testicular spermatozoa / 亚洲男科学杂志(英文版)

<p><b>AIM</b>To evaluate the fertilization competence of spermatozoa from ejaculates and testicle when the oocytes were matured in vitro following intracytoplasmic sperm injection (ICSI).</p><p><b>METHODS</b>Fifty-six completed cycles in 46 women with polycystic ovarian syndrome were grouped according to the semen parameters of their male partners. Group 1 was 47 cycles that presented motile and normal morphology spermatozoa in ejaculates and Group 2 was the other nine cycles where male partners were diagnosed as obstructive azoospermia and spermatozoa could only be found in testicular tissue fragment. All female patients received minimal stimulation with gonadotropin. Immature oocytes were matured in vitro and inseminated by ICSI. The spermatozoa from testes were retrieved by testicular fine needle aspiration.</p><p><b>RESULTS</b>A total of 449 and 78 immature oocytes were collected and cultured for 48 hours, 75.5 % (339/449) and 84.6 % (66/78) oocytes were matured in Groups 1 and 2, respectively. The percentage of oocytes achieving normal fertilization was significantly higher in Group 1 than that in Group 2 (72.9 % vs. 54.5 %, P 0.05). There were no significant differences in the rates of oocytes cleavage and clinical pregnancies in these two groups [87.4 % (216/247) vs. 88.9 % (32/36); 21.3 % (10/47) vs. 44.4 % (4/9)]. A total of 15 babies in the two groups were healthy delivered at term.</p><p><b>CONCLUSION</b>It appears that IVM combined with ICSI using testicular spermatozoa can produce healthy infants, while the normal fertilization rate of in vitro matured oocytes after ICSI using testicular spermatozoa was significantly lower than using the ejaculated spermatozoa.</p>