Assisted Reproductive Technology Attempts Research Articles

Sperm cryopreservation protocol for micro-TESE-retrieved sperm.

Azoospermia is characterized by the absence of sperm in the ejaculate and is categorized into obstructive azoospermia (OA) and nonobstructive azoospermia (NOA). For men with NOA, testicular sperm extraction (TESE) is the only method to obtain sperm for assisted reproductive technology (ART). Given the rarity of these sperm and the unpredictable success of subsequent retrieval attempts, cryopreservation of microdissection-TESE-obtained sperm is essential. Effective cryopreservation prevents the need for repeated surgical procedures and supports future ART attempts. After first delving into the physiological and molecular aspects of sperm cryopreservation, this review aims to examine the current methods and devices for preserving small numbers of sperm. It presents conventional freezing and vitrification techniques, evaluating their respective strengths and limitations in effectively preserving rare sperm, and compares the efficacy of using fresh versus cryopreserved testicular sperm.

Prevalence of Psychological Stress Among Women Attending the Assisted Reproductive Technology (ART) Unit at King Abdulaziz Medical City: A COVID-19 Pandemic Experience.

Aim The present study aimed to measure the prevalence of psychological stress among women attending the Assisted Reproductive Technology (ART) unit in King Abdulaziz Medical City during the COVID-19 pandemic. Method The study adopted a descriptive cross-sectional design and was conducted between January 2020 and December 2022. A sample of 104 women attending the ART unit were recruited in this study. To collect data, the researchers developed a study questionnaire that consisted of 26 items. Nine items were designed to measure the participants' demographic characteristics, and 17 items were designed to depict their responses related to psychological stress during the COVID-19 pandemic. Data were analyzed using the Statistical Product and Service Solutions (SPSS) (v. 26l; IBM SPSS Statistics for Windows, Armonk, NY). Chi-square and t-tests were used to assess the association between stress and sociodemographics. Results The findings of the study showed an overall prevalence of 86.53% (n=90).Levels of psychological stress were moderate (34.62%, n=36), severe (39.42%, n=41), and extremely severe (12.50%, n=13). The study found that there is a significant statistical interaction between the number of previous ART attempts and psychological stress (p=0.0019). Conclusion The study concluded that women attending the ART unit at King Abdulaziz Medical City (KAMC), Riyadh, Saudi Arabia, were experiencing high levels of psychological stress, and these levels were affected by the number of previous ART attempts.

Ovarian Follicular Response Is Altered by Salpingectomy in Assisted Reproductive Technology: A Pre- and Postoperative Case-Control Study.

Objectives: The goal of this study was to assess the effect of unilateral salpingectomy on the number of mature follicles in the ipsilateral ovary during an assisted reproductive technology (ART) stimulation cycle, as compared to the contralateral ovary. Methods: This was a retrospective, single-center, case-control cohort study conducted from 2017 to 2022. Patients from 18 to 43 years old who underwent at least one ART cycle before and after a unilateral salpingectomy were included. The number of recruited follicles, including mature (≥16 mm) and intermediate follicles (13-15.5 mm), on the salpingectomy side (case) were compared to those present on the contralateral ovary (control) during an ART attempt. To take into account the inter-ovarian variability, the comparison was performed on two ART cycles, performed before then after the salpingectomy. Results: Overall, 24 patients were included in our study. While the number of mature follicles was similar in both ovaries before surgery, the mean number of mature follicles was significantly reduced after salpingectomy in the operated side, as compared to the control side, being, respectively 3.00 vs. 5.08 (p = 0.048). There was no significant difference between the intermediate and total recruited follicles. Conclusions: Our study suggests that salpingectomy may impact the follicle recruitment on the ipsilateral side by altering the vascularization during mesosalpinx coagulation. Gynecologists should be mindful of this concept and accurately set surgical indications. Beyond the indication, this emphasizes the critical role of having infertility surgeons sensitive to fertility preservation for optimal management of ART patients. Further studies with larger patient populations are required to confirm these results.

Marital Suffering and the Assisted Reproductive Technology Process: The Case of an Infertile African Spouse

This work deals with the Assisted Reproductive Technology (ART) process, of an infertile spouse who faces a proposal for Artificial Insemination with Donor (AID), in a cultural context where male infertility is still taboo and where this practice is not yet really anchored in manners. Indeed, research in clinical psychology does not sufficiently consider this aspect of the suffering in the couple. However, according to ethno-psychiatric theory, the therapeutic route of the African patient depends largely on cultural representations of his disease. This work aims to study the repercussions of the suffering of an infertile African spouse on his ART/AID process. This research was conducted with three infertile men ranging in age from 37 to 44; after experiencing the failure of the first ART attempt, they were called upon to undergo an AID protocol. Data were collected using semi-structured individual research interviews and the Hospital Anxiety and Depression scale (HADs). These data were analyzed using content analysis technique. Thus, the suffering of the infertile spouse at this level can be justified by cultural constraints, the shame of the social gaze, the secrecy maintained by the culture on this practice. Sometimes, this spouse perceives his infertility as the consequence of villain-induced mystical persecution; which generates tensions between him and his spouse, his family and those close to him. Under the cultural pressure that demands a blood child, this ART/AID process is camouflaged by shame, doubt about the quality of the unborn child and even about the competence of the medical workers. The positive diagnosis of anxio-depressive syndrome in the participants after analysis of the HADs scores would also be justified by the absence of psychological care in the ART/AID process.

Effect of endometrial injection scratching in cycles of treatment by assisted reproductive technology methods

Objective: optimization of pregravid (pre-pregnancy) preparation in patients with tubal-peritoneal infertility factor and marked delay in endometrial development after unsuccessful assisted reproductive technology (ART) treatment by the use of endometrium injection scratching technology with autoplasma.Material and methods. Study included 40 cases of unsuccessful treatment attempts for tubal-peritoneal factor infertility with severe delay of endometrial development and 10 patients with tubal-peritoneal factor infertility with normal endometrium with one or more unsuccessful ART attempts on history and the existence of cryopreserved embryos of satisfactory quality from previous cycles of assisted reproductive technology. The average age was 39.5 ± 3.1 years. Patients were divided into groups: I – 21 patients who underwent endometrial injection scratching and hormonе replacement therapy (HRT) with a standard (4/6 mg) dose of estradiol; II – 19 patients who were prescribed HRT with a standard (4/6 mg) dose of estradiol; control – 10 patients with normal endometrium who underwent cryo-ET with standard (4/6 mg) dose of estradiol.Clinical results were evaluated and compared in terms of pregnancy rate per embryo transfer and pregnancy loss rate in the first trimester. The correspondence of the morphofunctional structure of the endometrium was evaluated by ultrasound, cytologically, Doppler measurements, histologically, immunohistochemically and via selective electron microscopy. Endometrium was 8.9 ± 1.1 mm during the period of progesterone prescription in the cryoembryo transfer cycle. All participants were transferred day 5 embryos. Results. In the cryo-ET program autoplasma injection scratching in patients with marked delay of endometrial development after the first seven days of monotherapy with a starting dose of estradiol was accompanied by a significant improvement in clinical outcomes in terms of pregnancy rate (25%) and definite decrease of early reproductive losses (25%).Conclusions. After pre-pregnancy preparation according to our method, it is quite sufficient to perform HRT with a standard dose of estradiol (4/6 mg/day) before starting progesterone irrespective of the endometrial development degree. Meanwhile, injection scratching is advisable to be prescribed in cases of marked delay in the endometrium development and it should be combined with physiotherapy methods.

Le syndrome des ovaires polykystiques n’altère pas les taux de blastulation ni les taux cumulés de naissances vivantes

ObjectivesPolycystic ovarian syndrome (PCOS) brings complications in the management of the assisted reproductive technology (ART) because of an oocyte quality probably impaired due to modifications of intra- and extra-ovarian factors. Our study aimed to investigate the extended culture in PCOS patients and its influence on the cumulative live birth rates. MethodsFifty-nine PCOS patients (as defined by the Rotterdam criteria) and 114 normo-ovulatory patients (i.e. with tubal, male or idiopathic infertility, regular cycles and AMH>2ng/mL) aged<37years old who underwent a 1st or 2nd ART attempt with extended culture to day 6 were included from October 2015 to December 2017. The blastulation and cumulative live birth rates were compared between the two groups. ResultsThe PCOS and control patients were 32.22 and 32.91years old respectively (P=0.05). The median number of oocytes retrieved was significantly higher in the PCOS group and the median oocyte maturity rate significantly lower compared with controls. The blastulation rates were similar between the PCOS and the control groups, respectively 57.8% vs. 58.6%, P=0.88. Because of the risks of hyperstimulation syndrome, a freeze all strategy was achieved for 38.9% of PCOS patients vs. 14.0% of the control patients (P<0.01). The cumulative live birth rates were not statistically different: 31.7% in the PCOS group vs. 37.2% in the control group, P=0.50. ConclusionsPCOS was not observed to affect the extended culture nor the cumulative live birth rates in comparison to normo-ovulatory patients, supporting the blastocyst transfer strategy as a suitable option to PCOS patients.

Prevalence of Inherited and Acquired Thrombophilia in Females Post Multiple Assisted Reproductive Technology (ART) Attempts

Introduction: A link between thrombophilia and female infertility has been previously reported and the role of thrombophilia in multiple ART failures has been debated. Most meta-analyses of existing studies yield inconclusive and contradictory results that no antithrombotic therapy could, to-date, be indicated in thrombophilia patients with ART failure(s) without clinical thrombosis. As analysis of a large cohort is therefore warranted, we embarked on this study to identify the true prevalence of thrombophilia in a large number of women who presented for infertility and recurrent ART failures evaluation to detect the true prevalence of thrombophilia.Methods: This is an IRB-approved retrospective cohort analysis of Egyptian women with 3 or more ART attempts referred to our center NSA-Diagnostic Laboratories from 1/1/2009 to 1/1/2015. Females with known venous thromboembolism (VTE) prior to infertility evaluation were excluded. Aspirin use and results of thrombophilia testing were collected on all patients. Thrombophilia testing included Factor V Leiden mutation (FVL), prothrombin gene mutation, Plasminogen Activator Inhibitor-1 (PAI-1), Factor XIII level, b-Fib, HPA, ACE, ApoB, ApoE, anticardiolipin IgG and IgM (ACLG, ACLM respectively), Protein C deficiency, Protein S deficiency, antithrombin (AT), lupus anticoagulant (LA), CD16, CD56, methylenetetrahydrofolate reductase (MTHFR) A or C, and homocysteine level. Thrombophilia was categorized into simple and complex reflecting 1 and >1 homozygous mutations detected, respectively. Demographic characteristics and the prevalence of the different mutations were analyzed. Statistical analysis was performed using SPSS software version 20.0.Results: Inclusion criteria and all data were available in 2585 female subjects. Age range was 21-43. While all subjects had at least one or more mutation(s) of any kind, 305 subjects (11.8%) did not have any homozygous mutations. Simple thrombophilia (one homozygous mutation) was found in 894 patients (34.6%). Complex thrombophilia (more than one homozygous mutation) with 2, 3, 4, and 5 concomitant abnormalities was encountered: in 35.8%, 13.5%, 3.9% and 0.4%, respectively. Prevalence of homozygous and heterozygous mutations was as follows: FVL (2.9%; 21.9%), prothrombin gene mutation (0.1%; 4.0%), PAI (17.4%; 67.5%), factor XIII (1.2%; 23.7%), b-Fib (39.2%; 2.7%), HPA (10%; 30%), ACE (49.6%; 49.2%), ApoB (0.1%; 0%), ApoE (62.7%; 21.3%). ACLG was positive in 1.2%, ACLM in 3.6%, Protein C deficiency in 0.4%, Protein S deficiency in 0.2%, AT in 1.0%, LA in 1.8%, CD16 in 0.1%, CD56 in 1.1% and hyperhomocysteinemia in 0.7%. Heterozygous and homozygous MTHFR A (45.1%; 9.8%), MTHFR C (35.3%; 7.7%) mutations were noted. When compared to historical controls in the literature, similar prevalence was found for Protein C/S deficiencies, higher prevalence for FVL and Prothrombin gene mutation, and a lower prevalence for hyperhomocysteinemia in our cohort. No VTE was reported in subjects from the time of testing until data collection and follow up. Prophylactic anticoagulation with low molecular weight heparin and low dose aspirin in subjects were noted. All subjects with successful pregnancies post identification of thrombophilia were prescribed prophylactic anticoagulation with low molecular weight heparin through pregnancy and for 6 weeks postpartum. Low dose aspirin and first trimester steroids were also used. Analysis of full term pregnancy as an outcome is underway.Discussion: Thrombophilia prevalence in infertile Egyptian women presenting to our center with multiple failed ART attempts is higher for certain mutations than reported in the literature. Our cohort is unique in that women did not have a history of clinically evident VTE and had a higher prevalence of complex homozygous mutations. Our study has implications on the evaluation of female patients with infertility and helps set up the stage for future prospective and interventional trials using antithrombotic therapy. DisclosuresNo relevant conflicts of interest to declare.

Анамнестичні фактори, які формують репродуктивне здоров’я жінок із неодноразовими невдалими спробами запліднення in vitro

The proportion of patients with multiple unsuccessful attempts of assisted reproductive technology (ART) is about 30% of all patients treated with the use of ART. Women with history of unsuccessful ART attempts - a special category of patients who require emergency attention and a thorough examination at the stage of preparation for superovulation stimulation,the selection of embryos and endometrium preparation for embryo transfer. The objective: to distinguish high-risk group of unsuccessful attempts based on a detailed analysis of anamnestic and clinical data of infertile women with repeated unsuccessful ART attempts that requires more in-depth study of hormonal features, ovarian reserve and condition of the endometrium. Materials and methods. For better understanding of the problem of repeated unsuccessful ART attempts and сreation of efficient infertility treatment algorithms for these couples we conducted a thorough analysis of anamnestic data of three groups of infertile women (105 patients), which were distributed by age: group I – younger than 35, the II group – from 35 to 40, the III group - over 40 years. These groups of patients were compared with each other and with the control group of healthy women (30 persons). Results. Leading stress factors in the percentage three times prevailed in the group of infertile women and had a direct connection with the fact of procedure «fertilization in vitro» and chronic stressors caused by prolonged infertility. Primary infertility was observed significantly more frequent in patients younger than 35 years (p &lt;0.05), secondary infertility - mostly in the second and third experimental groups (p &lt;0.05). Noteworthy significant percentage of wellknown causes of infertility and idiopathic factor in all groups, and the prevalence of tubal-peritoneal factor in the second and third experimental groups, and endocrine dysfunction in the I experimental group. The most common disorder among this category of woman was polycystic ovary syndrome. Frequency of usual miscarriage among patients of I ana II groups was two times higher than in the third group (p &lt;0.05). Among the experimental groups the leading place belongs urinary tract infection, respiratory tract diseases, pathologies of the cardiovascular system. Data of the stratified analysis show an increase likelihood of repeated unsuccessful ART attempts under the influence of constant chronic stress (odds ratio OR=2.06; 95% CI: 0.95–3.17; p&lt;0.05). Conclusions. Among infertile patients with repeated unsuccessful ART attempts must be separated a high risk group of failures. The identity depends on the duration of infertility, female age and leading combination of factors. Key words: repeated unsuccessful ART attempts, anamnesis, infertility, high risk.

Women infected with human immunodeficiency virus type 1 have poorer assisted reproduction outcomes: a case-control study

To compare the efficacy of assisted reproductive technology (ART) in women infected with human immunodeficiency virus type 1 (HIV-1) versus HIV-negative controls. Retrospective case-control study. University hospital ART unit. Eighty-two women infected with HIV-1 and 82 women as seronegative controls. Ovarian stimulation, oocytes retrieval, standard invitro fertilization (IVF) or intracytoplasmic sperm injection, embryo transfer. Clinical pregnancies and live-birth rates. After oocyte retrieval, all women infected with HIV-1 infected were matched 1:1 to HIV-negative controls according to the following criteria: date of ART attempt, age, parity, main cause of infertility, ART technique, and rank of attempt. Only the first IVF cycle during the study period was considered for each couple. We found no statistically significant differences between the two groups for ovarian stimulation data, fertilization rate, or average number of embryos transferred. The clinical pregnancy rate per transfer was statistically significantly lower for the cases compared with the controls (12% vs. 32%), as were the implantation rate (10% vs. 21%) and the live-birth rate (7% vs. 19%). In one of the largest studies to pair six factors that influence the results of ART, HIV infection in women was associated with poorer outcomes after ART. These results suggest that women with controlled HIV-1-infection should be counseled not to delay ART in cases of self-insemination failure or other causes of infertility. Fertility preservation by vitrification of oocytes in women whose pregnancy should be delayed may be an important future consideration.

Higher pregnancy rates using testicular sperm in men with severe oligospermia

To evaluate assisted reproductive technology (ART) outcomes using testicular sperm in oligospermic men who previously failed to achieve paternity using TUNEL-positive ejaculated sperm. Retrospective cohort. Academic medical center. Twenty-four oligospermic men who failed one or more ART cycles using ejaculated sperm with TUNEL-positive proportion >7%, and subsequently underwent microsurgical testicular sperm extraction (TESE). TESE followed by intracytoplasmic sperm injection (ICSI). TUNEL-positive level in ejaculated and testicular sperm; clinical pregnancy. The mean TUNEL-positive level was 24.5% for ejaculated sperm, and 4.6% for testicular sperm. Clinical pregnancy was achieved in the first ART cycle with testicular sperm in 12 (50%) out of 24 couples. There was no statistically significant difference in maternal and paternal age, maternal gravity and parity, number of previous ART attempts, concentration or motility of retrieved sperm, number of oocytes retrieved, fertilization rate, or number of embryos transferred between couples who did and did not achieve pregnancy. No miscarriages occurred. All 12 pregnancies resulted in the delivery of healthy children. The percentage of TUNEL-positive cells is lower in testicular sperm for oligospermic men who have abnormal ejaculated sperm DNA fragmentation. The use of testicular sperm for ICSI was associated with a 50% pregnancy and live-birth rate for couples who had previously failed one or more IVF-ICSI cycles with ejaculated sperm. No other clinical predictors of successful pregnancies after the use of surgically retrieved sperm could be identified. In men with elevated TUNEL-positive ejaculated sperm and failed ART, TESE may be considered.

Is intracytoplasmic morphologically selected sperm injection (IMSI) beneficial in the first ART cycle? A multicentric randomized controlled trial

Intracytoplasmic morphologically selected sperm injection (IMSI), by selecting spermatozoa at high magnification improves the outcome of intracytoplasmic sperm injection (ICSI) mainly after several failures. However, only few monocentric randomized studies are available and they do not analyse results as a function of sperm characteristics. In 255 couples attempting their first assisted reproductive technology (ART) attempt for male infertility (motile sperm count <1×10⁶ after sperm selection, but at least 3×10⁶ spermatozoa per ejaculate to allow a detailed analysis of sperm characteristics), a prospective randomized trial was performed to compare the clinical outcomes of IMSI and ICSI and to evaluate the influence of sperm characteristics on these outcomes. IMSI did not provide any significant improvement in the clinical outcomes compared with ICSI neither for implantation (24% vs. 23%), nor clinical pregnancy (31% vs. 33%) nor live birth rates (27% vs. 30%). Moreover, the results of IMSI were similar to the ICSI ones whatever the degree of sperm DNA fragmentation, nuclear immaturity and sperm morphology. These results show that IMSI instead of ICSI has no advantage in the first ART attempts. However, this does not rule out IMSI completely and more randomized trials must be performed especially regarding patients carrying severe teratozoospermia, or high sperm DNA fragmentation levels or having previous ICSI failures.

Does the bromocriptine-rebound method improve embryo quality?

To examine whether the bromocriptine-rebound (BR) method improves pregnancy outcomes after previous unsuccessful assisted reproductive technology (ART) attempts. PATIENTS/STUDY DESIGN: In this study we retrospectively analyzed data from a total of 121 women with normal serum prolactin (PRL) levels and a history of repeated unsuccessful ART procedures. Pregnancy outcomes and hormonal data were compared between the long protocol and BR method. Both procedures were similar, except that in the BR method, bromocriptine was administered daily from day 5 of the preceding cycle until 7 days before ovarian stimulation. The number of fertilized oocytes, cleaved embryos and transplant embryos were significantly higher with the BR method than with the long protocol even though the numbers of retrieved oocyte were same in both groups. The ratio of the good embryos, the clinical pregnancy rate was higher with the BR method than with the long protocol. The embryo score with the BR method were significantly higher than that with the long protocol. BR method could provide the better embryos and improve the transplantation rate in women with previous unsuccessful ART attempts.

Outcomes From Treatment of Infertility With Natural Procreative Technology in an Irish General Practice

We evaluated outcomes in couples treated for infertility with natural procreative technology (NaProTechnology [corrected] NPT), a systematic medical approach for optimizing physiologic conditions for conception in vivo, from an Irish general practice. All couples receiving treatment from 2 NPT-trained family physicians between February 1998 and January 2002 were studied. The main outcome was live birth, and secondary outcomes included conceptions and multiple births. Crude proportions and adjusted life-table proportions were calculated per 100 couples. A total of 1239 couples had an initial consult for NPT, of which 1072 had been trying for at least a year to conceive and initiated treatment. The average female age was 35.8 years, the mean duration of attempting to conceive was 5.6 years, 24% had a prior birth, and 33% had previously attempted treatment with assisted reproductive technology (ART). All couples were taught to identify the fertile days of the menstrual cycle with the Creighton Model FertilityCare System, and most received additional medical treatment, including clomiphene (75%). In life-table analysis, the cumulative proportion of first live births for those completing up to 24 months of NPT treatment was 52.8 per 100 couples. The crude proportion was 25.5. Younger couples and couples without previous ART attempts had higher rates of live birth. Among live births, there were 4.6% twin births. NPT provided by trained general practitioners had live birth rates comparable to cohort studies of more invasive treatments, including ART. Further studies are warranted to compare NPT directly to other treatments.

Sperm DNA decondensation assay and selection of assisted reproductive technology method

Previously, sperm DNA integrity testing was reported to predict failure of sperm with assisted reproductive technology (ART) regardless of insemination method. Recent publications indicate that the sperm DNA integrity test, SCSA/SDFA, can identify reduced chances for success in some ART methods but not for others. The sperm DNA decondensation (SDD) test, a sperm function test, also previously has been shown to predict failure in all types of subsequent ART attempts. However, recent unpublished data suggest that ICSI can overcome sperm DNA function abnormalities identified by the SDD test. The goal of this retrospective review was to determine if SDD had predictive capability in current IUI and IVF insemination protocols. Retrospective chart review. Within a single fertility practice, all males electing to proceed with SDD testing were identified. ART success, defined as presence of fetal heart beat at 8–10 weeks gestation, was determined for first IUI or IVF attempt after SDD testing. An abnormal SDD score was defined as less than 80% of the control and normal was defined as greater than or equal to 80% of the control. There were no exclusions for female factor or WHO male factor etiology. SDD scores and first IUI or IVF attempt outcome data were available for 58 males. Forty-three males had normal SDD scores and had a 22% success rate with IUI (N = 23) and 35% with IVF (N = 20) attempts. Fifteen males had abnormal SDD scores with a 0% success rate with IUI (N = 6) and IVF (N = 9) attempts. The difference between the 28% success rate of SDD normal patients (N = 43, IUI/IVF combined) and 0% with SDD abnormal patients (N = 15, IUI/IVF combined) was statistically significant using Fischer's exact test (P=0.0325) (Odds Ratio >5). An additional 18 patients underwent IVF with ICSI where 81% (N = 16) of males with normal SDD scores had success and 100% (n = 2) with an abnormal SDD had success, although there was not sufficient statistical power to conclude that the groups were different. There was no significant difference for the average age and FSH levels of female partners between SDD normal and SDD abnormal groups. Overall clinical pregnancy rates for this fertility practice at the time of this study were: IUI, 15%; IVF and ICSI, 53%. Based upon preliminary retrospective data, the SDD may be able to identify those male patients with reduced chances of success with IUI and IVF who may benefit from earlier consideration of ICSI. Further definitive studies are needed.

Oocyte quality in patients with severe ovarian hyperstimulation syndrome: A self-controlled clinical study

To investigate the oocyte quality in patients with severe ovarian hyperstimulation syndrome (OHSS). Self-controlled clinical study. University teaching hospital. Twenty-two patients from our assisted reproductive technology (ART) program who developed severe OHSS during their first controlled ovarian hyperstimulation for IVF or intracytoplasmic sperm injection (ICSI) (OHSS cycles) during a period of 10 years and had a second ART attempt performed in our center in which OHSS did not develop (control cycles). IVF and ICSI. Oocyte yield and quality, fertilization rate, embryo yield and quality, implantation rate, and pregnancy rate. The total number of oocytes retrieved and the mean number of metaphase II oocytes were significantly higher in patients with OHSS than in control cycles. Fertilization rates were similar in both groups of ART cycles, and thus the number of viable embryos were significantly higher in OHSS cycles. Implantation and pregnancy rates were similar in OHSS and control cycles. Oocyte and embryo yield and quality were similar in early and late OHSS. Oocyte yield and quality, embryological outcome, and implantation and pregnancy rates were similar in patients with and without polycystic ovarian syndrome (PCOS) both in cycles developing OHSS and control cycles. Oocyte quality is not compromised in severe OHSS cycles irrespective of whether patients had or did not have PCOS.

Spontaneous abortion among pregnancies conceived using assisted reproductive technology in the United States

Objective To examine rates and risk factors for spontaneous abortion among pregnancies conceived using assisted reproductive technology (ART). Methods Subjects were 62,228 clinical pregnancies resulting from ART procedures initiated in 1996–1998 in US clinics. Spontaneous abortion was based on ART clinic report and was defined as loss of the entire pregnancy. Spontaneous abortion rates for ART pregnancies were compared with spontaneous abortion rates from the National Survey of Family Growth, a population-based survey of US women 15–44 years. Results The spontaneous abortion rate among ART pregnancies was 14.7%. This was similar to rates among pregnancies reported in the National Survey of Family Growth. Among pregnancies conceived with the patient’s oocytes and freshly fertilized embryos, the spontaneous abortion risk ranged from 10.1% among women 20–29 years to 39.3% among women older than 43. Spontaneous abortion risk among pregnancies conceived with donor eggs was 13.1% with little variation by patient age. Spontaneous abortion risk was increased for pregnancies conceived with frozen and thawed embryos and decreased among multiple-gestation pregnancies. Spontaneous abortion risk was increased among women reporting previous spontaneous abortions and ART attempts, and among women who used clomiphene or zygote intrafallopian transfer. Pregnancies conceived by young women, but gestated by a surrogate, were at increased risk for spontaneous abortion in comparison with young women who gestated their own pregnancies. Conclusion These findings suggest that ART does not pose a risk for spontaneous abortion. Factors related to oocyte or embryo quality are of primary importance in assessing spontaneous abortion risk.

Effect of repeated assisted reproductive technology cycles on ovarian response

Objective: To assess the effect of repeated assisted reproductive technology (ART) cycles on the ovarian response in patients treated with human menopausal gonadotropins and GnRH agonists. Design: Retrospective analysis. Setting: Tertiary referral center. Patient(s): Three thousand two hundred forty-nine patients who had completed at least two in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) cycles (minimum two, maximum six cycles per patient). Intervention(s): Nine thousand three hundred seventy-nine repeated IVF/ICSI cycles. Main Outcome Measure(s): Mean number of cumulus oocyte complexes (COC) retrieved per cycle, mean number of ampules used per attempt. Result(s): Repeated ART cycles did not exert a significant effect on the mean number of COC retrieved per attempt in contrast to maternal age, which was inversely related to the mean number of COC retrieved in all cycles performed. Across repeated ART attempts, an increase in the mean number of ampules used per cycle was observed. This was due to an effect of maternal age, which increased in line with the mean number of ampules used per cycle, as well as to an age-independent effect of repeated cycles. Conclusion(s): An age-independent deterioration of the ovarian response appears to occur across repeated ART cycles.

Some cases of human male infertility are explained by abnormal in vitro human sperm activation

To determine if a human sperm activation assay can be used to evaluate males exhibiting otherwise unexplained infertility. Sperm from age-matched fertile and idiopathic infertile males were assayed in the human sperm activation assay and the results were compared. A portion of the sperm from the idiopathic infertile males also was used in assisted reproductive technology (ART) attempts at pregnancy. Idiopathic infertile couples who had extensive fertility testing with no identified problems that would explain their infertility. Fertile males that had fathered one or more children. Sperm nuclear decondensation-recondensation and DNA synthesis. Pregnancies resulting from ART using semen from a male whose sperm responded abnormally in the human sperm activation assay. Thirteen (22%) of 59 idiopathic infertile males produced sperm that responded abnormally in the human sperm activation assay. Only 1 (1.7%) of 59 fertile males produced sperm that responded abnormally in the human sperm activation assay. The percentage of abnormal responders in the patient group exhibiting unexplained infertility was significantly higher than in the fertile male group. No sperm samples that responded abnormally in the human sperm activation assay resulted in pregnancies when used in ART. The human sperm activation assay is a new and independent indicator for some cases of infertility that otherwise would be unexplained. The human sperm activation assay appears to have utility in determining a sperm sample's efficacy for fertilization in ART attempts at pregnancy.