Effects of the hypo-osmotic swelling test on the outcome of intracytoplasmic sperm injection for patients with only nonmotile spermatozoa available for injection: a prospective randomized trial.

OBJECTIVE: Hypo-osmotic swelling test (HOST) has been shown to be an effective method for the selection of live sperm. On-going pregnancies were obtained by using HOST-selected sperm. The aim of this study was to evaluate the effect of using HOST-selected "live" sperm versus nonselected sperm on the outcome of intracytoplasmic sperm injection cycles when only nonmotile sperm were available for injection. DESIGN: Prospective randomized study. SETTING: Governmental tertiary care hospital. PATIENT(S): Thirty ICSI cycles with no motile sperm were included in this study. INTERVENTION(S): For the HOST group, potentially live spermatozoa detected by hypo-osmotic reaction of the tail were injected into oocytes. For the No-HOST group, the sperm were randomly injected into the oocytes without checking the viability. MAIN OUTCOME MEASURE(S): The fertilization, cleavage, embryo quality, pregnancy, and implantation rates were assessed for the two groups. RESULT(S): Among 30 cycles, 15 fall into each group. Fertilization, cleavage rates, and the number of good quality embryos were similar between two groups. CONCLUSION(S): HOST-selected live spermatozoa can be safely used for intracytoplasmic sperm injection to establish pregnancies. There is a tendency for higher pregnancy and implantation rates to result, but it does not reach statistical significance.

Day 5 versus day 3 embryo transfer: a controlled randomized trial.

Blastocyst transfer has been suggested to improve implantation rate without affecting pregnancy rate. The aim of this study was to compare the pregnancy and implantation rates of day 3 and 5 transfers in a prospective randomized manner. Patients with four or more zygotes were randomly allocated on day 1 to either day 3 or 5 transfers. Fertilization was achieved through regular IVF or intracytoplasmic sperm injection. Zygotes were kept in Medicult IVF medium for day 3 transfers and transferred into G1.2 and G2.2 on day 1 and 3 respectively for day 5 transfers. The morphologically best two or three embryos or blastocysts were chosen for transfer in both groups. Overall pregnancy rates per embryo transfer were the same (39%) in day 3 and 5 transfers. Implantation rates were 21 and 24% for day 3 and 5 transfers respectively. The pregnancy and implantation rates for day 5 transfers were significantly affected by the availability of at least one blastocyst to transfer and the number of zygotes. The number of good quality embryos on day 3 also significantly affected pregnancy and implantation rates on day 5 transfers. Multiple gestation rate, number of abortions and ongoing pregnancies were similar in both groups. In conclusion, day 3 and 5 transfer had similar pregnancy, implantation and twinning rates. Currently, day 5 transfers have no advantages over day 3 transfers.

Effects of reducing insemination time in human in vitro fertilization and embryo development by using sibling oocytes.

PURPOSE: Recent studies showed a beneficial effect of reducing the time of sperm-oocyte interaction on fertilization, division, and implantation rates of the oocytes obtained from randomized patients. In the present study, the effects of reduced insemination time on fertilization and embryo development were evaluated by using sibling oocytes from the same patient. METHODS: A total of 464 oocytes from 36 patients was randomly allocated to be inseminated for either 1 hr (reduced) or 18 hr (regular). RESULTS: Fertilization rates were not significantly different between reduced (135/229; 59%) and regular (150/235; 64%) groups. Cleavage rates and embryo quality were similar in both groups. A total of 135 embryos (73 from the reduced and 62 from the regular group) was transferred to 36 patients. Thirty-four embryos implanted in 18 patients (25.2% implantation and 50.0% pregnancy rates). CONCLUSIONS: Fertilization, cleavage, and embryo development from 1-hr insemination is comparable, not superior, to those from an 18-hr insemination time, which is commonly used in in vitro fertilization programs. These data suggest that reduced insemination time can be used during in vitro fertilization to avoid unnecessarily longer exposure to spermatozoa.