Outcome Of Assisted Reproductive Techniques Research Articles

ART outcome in young women with premature ovarian aging.

Background:Young women with signs of ovarian aging are a matter of concern as far as their reproductive performance is concerned. With more women approaching infertility centers with this problem, it becomes necessary to understand what reproductive outcomes are possible in such cases. Female age and basal Follicle stimulating hormone (FSH) level, both are strong independent predictors of In Vitro Fertilization (IVF) outcome.Objective:To correlate age-related basal FSH with IVF outcome in women with premature ovarian aging in gonadotropins-induced cycles.Materials and Methods:Between January 2011 and October 2012, a total of 135 women undergoing IVF and ICSI cycles with antagonist protocol were included in this retrospective cohort study. Basal FSH concentrations were measured and the women's ages were calculated before they were undergoing pituitary desensitization and its correlation with assisted reproduction technique (ART) outcome was evaluated.Results:Increasing FSH was associated significantly with reduced number of oocytes retrieved, and embryos obtained. Young women with high FSH up to 20 produced less but good quality embryo's resulting in sound pregnancy rate.Conclusion:FSH is a quantitative and age is a qualitative measure of ovarian reserve. Both are equally important in predicting IVF outcome. Basal FSH concentration should be restricted to counseling of patients on probability of achieving pregnancy, but should not be used to exclude them from fertility treatment.

Effect of laser assisted hatching on outcome of assisted reproductive technology

Objective: To determine whether laser-assisted hatching can improve clinical outcome of assisted reproductive techniques in both unselected patients and patients with advanced female age, with recurrent implantation failure, or who are using frozen-thawed embryos. Study design: Prospective randomized study. Patients and methods: 179 consecutive women scheduled for intracytoplasmic sperm injection (ICSI) were randomised to either laser assisted hatching (LAH) or non LAH group. Patients were divided into 94 test and 85 control groups. On the day of embryo transfer, the zona pellucida of the selected embryos in the test group was thinned by using an infrared optical laser system, whereas in the control group they were left intact. Clinical pregnancy rates (CPR) and implantation rates (IR) were estimated. Result(s): Patients that underwent LAH (n = 94) had CPR, and IR of 35.1% and 50%, respectively. Patients that did not undergo LAH (n = 85) had lower CPR (28.2%, P = 0.324) and IR (33%, P = 230), with no statistically significant difference P Conclusion: The current study suggested that there is no need for the routine use of laser assisted hatching. However, there is evidence of laser assisted hatching benefit in selected patients

Bed rest after embryo transfer: is it harmful?

Many interventions have been proposed to increase the success of assisted reproductive techniques (ART). The most controversial is bed rest after embryo transfer (ET). Patients are frequently advised to restrict their physical activity (PA) during ART, and many fertility clinics recommend bed rest after ET for variable periods of time. It is the author's belief, however, that there is insufficient evidence to support the recommendation of bed rest after ET. In fact, accumulated data indicate that bed rest after ET or restriction of PA during ART not only fails to bring about benefits, but may actually be detrimental and associated with worse ART outcomes. As such, it is considered that the long-standing policy of bed rest after ET should be abandoned. Patients should not be encouraged to rest in bed after ET, and should maintain their routine PA during ART. If the practice is to be changed, it is important to recognize the reasons why patients tend to restrict their PA during this time period. Health professionals may play a key role in this context.

Semen samples showing an increased rate of spermatozoa with imprinting errors have a negligible effect in the outcome of assisted reproduction techniques

The topic of imprinting defects present in the sperm of infertile patients has been addressed by several reports in the last few years. However, whether methylation abnormalities at one or few CpGs within an imprinted locus are pathological is a matter of debate. Moreover, whether imprinting anomalies in sperm could interfere with fertility treatment outcomes is still unknown. In this report we analyze the sperm DNA methylation profile of H19-ICR, KvDMR, SNRPN-ICR, IG-DMR and MEG3-DMR by pyrosequencing in 107 infertile men series and a control population of 30 proven fertile males. DNA methylation was statistically evaluated from two points of view: first, the methylation of each CpG was analyzed in the control population and the mean, standard deviation and range were determined and compared with infertile population data; second, in order to define altered methylation patterns for each region, a hierarchical cluster analysis was performed by which individuals were grouped in different clusters according to the degree of similarity of their methylation pattern. Two pieces of data supported the results obtained in the multi-variate analysis: the classification of the vast majority of control individuals in clusters with normal methylation patterns and the significant differences in methylation levels found between individuals within the normal and abnormal clusters. Individuals included in normal and abnormal methylation clusters were compared according to seminal parameters as well as to the outcome of assisted reproduction.

Female Infertility and Assisted Reproduction: Impact of Oxidative Stress-- An Update

Augmented levels of reactive oxygen species (ROS) that overpower the body’s antioxidant defenses result in oxidative stress (OS). Physiologically balanced levels of ROS and antioxidants maintain homeostasis in the body and allow for normal physiological processes to proceed. Physiological processes that involve oxygen consumption inevitably produce ROS. However, an overabundance of ROS leads to widespread injury to cells, and can damage DNA, lipid membranes, and proteins. An unfavorable reproductive environment hinders normal physiology secondary to this disruption of homeostasis. Infertility may be attributed to reproductive pathologies, leading to OS. Infertile couples often turn to assisted reproductive techniques (ART) to improve their chances for a successful pregnancy. In vitro techniques create an unfavorable environment for gametes and embryos by exposing them to a surplus of ROS in the absence of enzymatic antioxidant protection that normally exists in vivo. This article will review the currently available literature on the effects of ROS and OS on ART outcomes. The role of antioxidant supplementation of ART culture media continues to be a subject of interest to increase the likelihood for ART success. Keywords: Antioxidants, assisted reproduction, female infertility, oxidative stress, reactive oxygen species, Physiological processes, reproductive pathologies, gametes, embryos, Infertile couples

The escort study: efficacy, safety & clinical outcomes of assisted reproductive techniques

The escort study: efficacy, safety & clinical outcomes of assisted reproductive techniques

Expression of PARP1 in infertile men and correlation with DNA fragmentation index

Maintaining genomic integrity in sperm is vital for birth of healthy offspring. Sperm DNA damage is proposed to be a major cause of idiopathic infertility. Sperm DNA damage is associated with poor assisted reproductive technique (ART) outcome. DNA damage triggers modifications of proteins by Poly (ADP-ribose) polymerases (PARP) in the form of ADP-ribosylation that helps in recognition of DNA breaks and recruitment of enzymes. This study was planned to analyze the expression levels of PARP1 in the sperm samples from both infertile and control (fertile) men and correlate with sperm DNA damage.

Management of male-factor infertility

For many years, the management of male-factor infertility has been empirical rather than evidence-based. In current clinical practice, assisted reproductive techniques are the most successful methods of alleviating male-factor infertility. To date, it remains unclear what adjuvant actions can be taken to improve the outcome of assisted reproductive techniques for male-factor infertility. Evidence shows that smoking adversely affects sperm quality to some extent, and the genetic make-up of sperm to a greater extent; however, because of the scarcity and heterogeneity of studies, its effect on in-vitro fertilisation outcome remains largely unknown. Although smoking cessation should be part of the assisted reproductive techniques treatment plan, the benefit of antioxidant treatment in either smokers or non-smokers undergoing assisted reproductive techniques is still under scrutiny. Other lifestyle modifications in subfertile men, such as refraining from moderate alcohol and caffeine consumption, are even more controversial. When embarking on assisted reproductive techniques to alleviate male-factor infertility, intrauterine insemination may be considered as a first-line treatment for couples in whom the female partner has a normal fertility status, and at least 0.8×10(6) progressively motile spermatozoa are recovered after sperm preparation. If no pregnancy is achieved after three to six cycles of intrauterine insemination, in-vitro fertilisation can be proposed. When too few progressively motile spermatozoa are obtained after sperm processing for in-vitro fertilisation, or when surgically retrieved sperm are to be used, intracytoplasmic sperm injection is preferable. Although the outcome of no other assisted reproductive techniques has been scrutinised so much, and no large-scale 'macro-problems' have yet been observed after intracytoplasmic sperm injection, malformation rates are reported to be higher compared with the general population. Therefore, candidates for intracytoplasmic sperm injection should be rigorously screened before embarking on in-vitro fertilisation or intracytoplasmic sperm injection, and thoroughly informed of the limitations of our knowledge on the hereditary aspects of male infertility and the safety aspects of assisted reproductive techniques.

Male factor infertility and ART

For years, the management and treatment of male factor infertility has been 'experience' and not 'evidence' based. Although not evidence-based, current clinical practice involves extensive use of assisted reproductive techniques (ART). Where specific treatments are not indicated or have failed, ART have become popular adjunctive treatments for alleviating male factor infertility. According to the limited evidence available, intrauterine insemination (IUI) may be considered as a first-line treatment in a couple in which the female partner has a normal fertility status and at least 1×10(6) progressively motile spermatozoa are recovered after sperm preparation. If no pregnancy is achieved after 3-6 cycles of IUI, optimized in vitro fertilization (IVF) can be proposed. When less than 0.5×10(6) progressively motile spermatozoa are obtained after seminal fluid processing or sperm are recovered surgically from the testis or epididymis, intracytoplasmic sperm injection (ICSI) should be performed. Although the outcome of no other ART has ever been scrutinized as much before, no large-scale 'macroproblems' have as yet been observed after ICSI. Yet, ICSI candidates should be rigorously screened before embarking on IVF or ICSI, and thoroughly informed of the limitations of our knowledge on the hereditary aspects of male infertility and the safety aspects of ART.

Elimination of bacteria from human semen during sperm preparation using density gradient centrifugation with a novel tube insert

The occurrence of bacteria in sperm samples intended for in vitro fertilisation can compromise the outcome of assisted reproductive techniques. Effective semen processing procedures should therefore be implemented to remove bacteria from semen. Unfortunately, technique failure does occur whereby bacteria can be found in processed sperm preparations. To improve the effectiveness of semen processing, a novel centrifuge tube insert was developed to facilitate the layering of density gradients and semen, and to prohibit the re-infection of purified sperm pellets. The purpose of this study was to: (i) determine the prevalence and type of bacteria present in semen of patients participating in the Unit's assisted reproduction program and (ii) evaluate the effectiveness of density gradient centrifugation with the novel tube insert, for the elimination of bacteria and yeast from spiked human semen samples. A survey in 2007-2010 indicated that 50% of semen samples were found to have positive bacterial cultures. Semen processing by means of density gradient centrifugation with the novel tube insert eliminated significantly more in vitro derived (spiked) bacteria and yeast from semen compared to processing without the insert (P < 0.004). Therefore, it is highly recommended that the centrifuge tube insert, ProInsert™, be incorporated into assisted reproductive programs.

Effects of advanced selection methods on sperm quality and ART outcome: a systematic review

Current routine semen preparation techniques do not inclusively target all intrinsic sperm characteristics that may impact the fertilization potential. In order to address these characteristics, several methods have been recently developed and applied to sperm selection. The objective of this study was to systematically review the literature describing these advanced sperm selection methods focusing on their anticipated benefits on sperm quality and assisted reproductive technique (ART) outcome. Systematic literature review was conducted by means of a Medline literature search. Sperm quality parameters assessed included: motility, morphology, viability, DNA integrity, apoptosis and maturity. ART outcomes assessed included: fertilization, embryo quality, pregnancy, abortion and live birth rates. A total of 44 studies were identified describing four advanced sperm selection methods based on: (i) surface charge (electrophoresis and zeta potential), (ii) apoptosis (magnetic cell sorting and glass wool), (iii) membrane maturity (hyaluronic acid binding) and (iv) ultramorphology (high magnification). Selection of high-quality sperm including improvements in DNA integrity, resulted from the application of these methods. Fertilization and pregnancy rates showed improvement following some of the advanced sperm selection techniques. While some of the advanced sperm selection methods are of value in specific clinical ART settings, others are in need of further evaluation. More clinical studies on safety and efficacy are needed before the implementation of advanced sperm selection methods could be universally recommended in ART.

Uptake and outcome of assisted reproductive techniques in long-term survivors of SCT

We have audited the invitation for uptake and outcome of artificial reproductive techniques in patients undergoing SCT for haematological malignancy, with the aim of improving our pre-transplant counselling. A postal survey was sent to 434 patients in our centre surviving a minimum of 2 years after allo-SCT, of whom 221 patients responded. Of 112 male patients, 79 were offered sperm storage, 42 banked sperm and 25 subsequently attempted parenthood with stored sperm. A total of 18 were successful, with 29 children born a median of 8 years (range 1-22 years) following SCT. Of 72 females <42 years old, 33 were offered storage of embryos/eggs/ovarian tissue and 12 accepted. Following SCT, four women attempted pregnancy using cryopreserved embryos, with two successes. The majority of patients who were not counselled about infertility or not offered fertility-preservation options provided a likely reason, with completion of family being the most frequent. Nonetheless, 16 patients (11/72 women and 5/112 men) could not provide a reason for the lack of information/invitation. In conclusion, uptake of gamete/embryo storage is high when offered and collected material is used frequently. Pregnancies in partners of male patients were usually successful and our data highlight the value of prolonged cryostorage.

How to deal with fluid in the endometrial cavity during assisted reproductive techniques

Patients with endometrial cavity fluid (ECF) in assisted reproductive techniques (ARTs) are poor in prognosis. This review presents the research development of ECF during ARTs, particularly in treatment. ECF patients with or without tubal infertility may represent a different clinical entity. ECF impairs the ART outcome in tubal factor, but not polycystic ovarian syndrome, patients. Actually, it was tubal infertility, not only hydrosalpinx, that was related to the development of ECF. Both appearance time and accumulation amount of ECF are critical in the impact of ECF on the ART outcome. Since excessive ECF (equal to or higher than 3.5 mm in the anterior-posterior diameter) usually had a negative impact on the ART outcome, postponing embryo transfer should be considered. A nonexcessive ECF usually disappeared by the time of embryo transfer. The routine embryo transfer in these ECF patients could yield the same ART outcome as in patients without ECF. If a nonexcessive ECF persisted until the day of embryo transfer, particularly in patients with nontube infertility, transvaginal sonographic aspiration could be an alternative of treatment. The treatment of ECF during ARTs should be individual according to the causes, appearance time and accumulation amount of ECF.

Metabolomics in Reproductive Medicine: General Principles and Applications to the Study of Gametes, Embryos and Follicular Fluid

After more than 30 years following the birth of Louise Brown, the field of assisted reproduction techniques (ART) is still burdened by low pregnancy rates and relatively high multiple pregnancy rates. Embryo selection is still based on morphological criteria and any new technologies that would increase the ability to identify the most viable gametes and embryos would certainly improve ART outcome. Metabolomic profiling of both gametes and embryos appears to be highly promising to achieve this goal. The review will focus on the several applications of metabolomics in ART, where this quantitative, non-invasive, rapid approach could result in the generation of metabolite markers with high clinical impact. Nevertheless, extensive validation studies are needed before embryo screening tests based on metabolomic profiling become available for clinical use.

Treatment of sperm with extracellular adenosine 5'-triphosphate improves the in vitro fertility rate of inbred and genetically modified mice with low fertility

In vitro fertilization (IVF) is one of the most important techniques used for assisted reproduction in mouse colony management. As with natural mating, where mice have varying fertility indices, fertility rates of genetically modified (GM) [transgenic (Tg), knock out (KO) and congenic (Cg)] mice are influenced by their genetic background. Lines of GM mice that have poor fertility have a concomitant poor IVF outcome. Treatment of mouse sperm with extracellular adenosine 5'-triphosphate (ATPe) enhanced in vitro fertilization rates in outbred and hybrid mice. The objective of this study was to analyze the effects of using extracellular adenosine 5'-triphosphate-treated sperm for IVF of inbred wild type, and genetically modified mouse lines, for which standard IVF did not work well. The IVF was performed using the GM mice on C57BL/10SnJ, C57BL/6J, BALB/cJ and NFS/N background strains and wild type (WT) mice such as C57BL/6N, BALB/cAnN, and B6129SF1 strains. Oocytes from superovulated females were fertilized in vitro with sperm from the same background strain, and either treated or not treated with ATPe. The ATPe treatment enhanced IVF outcome in most of the GM and some WT strains, as indicated by the percentage of embryos that progressed to the two-cell stage. There was no marked difference between ATPe treated and control groups for the development rate of two-cell embryos to blastocysts in culture, or in the number of pups born after transfer of two-cell embryos into recipient females. The observed improvement of the IVF results following ATPe treatment of transgenic and KO mouse sperm were a potential solution for improving the outcome of assisted reproduction techniques used for rederivation or for gamete banking.

No complacency on severe maternal morbidity and other issues

No complacency on severe maternal morbidity and other issues

Comparison of semen quality and outcome of assisted reproductive techniques in Chinese men with and without hepatitis B

In this study, we aimed to determine the effects of hepatitis B virus (HBV) infection on sperm quality and the outcome of assisted reproductive technology (ART). A total of 916 men (457 HBV-positive and 459 HBV-negative) seeking fertility assistance from January 2008 to December 2009 at the Women's Hospital in the School of Medicine at Zhejiang University were analysed for semen parameters. Couples in which the men were hepatitis B surface antigen (HBsAg)-seropositive were categorized as HBV-positive and included 587 in vitro fertilisation (IVF) and 325 intracytoplasmic sperm injection (ICSI) cycles from January 2004 to December 2009; negative controls were matched for female age, date of ova retrieval, ART approach used (IVF or ICSI) and randomized in a ratio of 1:1 according to the ART treatment cycles (587 for IVF and 325 for ICSI). HBV-infected men exhibited lower semen volume, lower total sperm count as well as poor sperm motility and morphology (P < 0.05) when compared to control individuals. Rates of two-pronuclear (2PN) fertilisation, high-grade embryo acquisition, implantation and clinical pregnancy were also lower among HBV-positive patients compared to those of HBV-negative patients after ICSI and embryo transfer (P < 0.05); IVF outcomes were similar between the two groups (P > 0.05). Logistic regression analysis showed that HBV infection independently contributed to increased rates of asthenozoospermia and oligozoospermia/azoospermia (P < 0.05) as well as decreased rates of implantation and clinical pregnancy in ICSI cycles (P < 0.05). Our results suggest that HBV infection in men is associated with poor sperm quality and worse ICSI and embryo transfer outcomes but does not affect the outcome of IVF and embryo transfer.

High endogenous melatonin concentrations enhance sperm quality and short‐term in vitro exposure to melatonin improves aspects of sperm motility

Although human seminal fluid contains melatonin and spermatozoa reportedly possess membrane melatonin receptors, there are no experimental studies that have ascertained the relationship between melatonin and male infertility. This study evaluated whether urinary 6-sulfatoxymelatonin and urinary total antioxidant capacity correlate with different seminal parameters including sperm concentration, motility and morphology. Also, the in vitro effects of melatonin on human sperm motility were investigated. Semen samples from 52 men who were counselled for infertility were obtained. Sperm concentration was determined using the haemocytometer method, motility kinematic parameters were assessed using a computer-aided semen analysis system, while morphology and vitality were evaluated after Diff-Quick and Eosin-Nigrosin vital staining, respectively. For the quantification of urinary 6-sulfatoxymelatonin, a commercial ELISA kit was used, and urinary total antioxidant capacity was evaluated by means of a colorimetric assay kit. For the in vitro effects of melatonin, samples were incubated for 30min in the presence or absence of 1mm melatonin. Both urinary 6-sulfatoxymelatonin and total antioxidant capacity levels positively correlated with sperm concentration, motility and morphology, as well as negatively correlated with the number of round cells. Additionally, 30-min exposure of sperm to 1mm melatonin improved the percentage of motile and progressively motile cells and decreased the number of static cells, thereby promoting the proportion of rapid cells. Therefore, melatonin improves semen quality, which is important because melatonin supplementation may be potentially used to obtain a successful assisted reproductive technique outcome.

Human papilloma virus in the sperm cryobank: an emerging problem?

Human papilloma virus (HPV) infection is very common worldwide, but the actual incidence and significance of HPV infection in sperm are poorly understood. In this study, we evaluated the presence of HPV in spermatozoa from thawed semen samples previously stored in our sperm bank. We performed polymerase chain reaction and in situ hybridization for HPV detection in cryovials belonging to 98 oncology patients and in 60 semen samples from healthy controls. Statistical analysis was performed by two-tailed Student's t-test and Fisher's exact test. The frequency of HPV semen infection was 6.1% in thawed cryovials from patients and 3.3% in semen samples from controls. Among the patients, four were found positive for high-risk HPV, one for medium-risk HPV and another for low-risk HPV. Patients had a significantly higher percentage of infected sperm than controls. In conclusion, this report shows the presence of HPV in sperm cells from cryovials of a sperm bank. It is still unclear if HPV-infected sperm are able to cross-contaminate cryovials and impair the outcome of assisted reproduction techniques or to infect partners. Further studies are needed to understand whether screening for HPV should be performed in all semen samples before sperm banking or before intra-cytoplasmic sperm injection procedures.

Fragmentation et/ou décondensation de l’ADN spermatique : quelles conséquences ?

Absence of DNA fragmentation and/or decondensation is a marker of sperm quality and is related to outcome of assisted reproductive techniques: new tests have been set up to determine fragmentation rate.