Take-home Baby Rate Research Articles

Association of sperm source with miscarriage and take-home baby after ICSI in cryptozoospermia: a meta-analysis of testicular and ejaculated sperm.

Miscarriage and take-home baby are the most important issues to patients with cryptozoospermia in receiving intracytoplasmic sperm injection (ICSI). The ICSI usually use ejaculated or testicular sperm. Unfortunately, no synthesized evidence reported miscarriage and take-home baby rate between the two sperm sources. This study aimed to compare the miscarriage and take-home baby rate of ICSI using testicular and ejaculated sperm in patient with cryptozoospermia. We conducted meta-analyses that were based on data from Cochrane library, Ovid, PubMed, ScienceDirect, Scopus, and Web of Science. The pooled analyses used risk ratio (RR) in random-effects model. Sensitivity analyses by subgrouping were completed to explore the associations between mean age and outcome. This study identified 331 potential citations and included four cohort studies for qualitative and quantitative synthesis. The four studies involved 331 patients with 479 ICSI cycles. The results showed no significant difference in miscarriage between testicular sperm group and ejaculated sperm group (RR=1.06, 95% CI 0.48-2.35, p=0.88). Yet, take-home babies per embryo transfer in testicular sperm group (53/226, 23.45%) was more than ejaculated sperm group (59/429, 13.75%) (RR=1.72, 95% CI 1.21-2.44, p=0.002). Similar results can be found in take-home babies per ICSI cycle (RR=1.77, 95% CI 1.28-2.44, p=0.0005), especially in younger couple (RR=1.93, 95% CI 1.11-3.34, p=0.02). No small study bias was detected in the analyses. This study found that testicular sperm has more advantage for ICSI in patients with cryptozoospermia, especially in younger couple. These findings may help guide us when deciding the optimal method of sperm harvest for men with cryptozoospermia. Comparing to ejaculated sperm, testicular sperm showed benefits for take-home baby rate, but not for miscarriage in patients with cryptozoospermia.

Which is the cost for having a live born with in vitro fertilization in women older than 40 years of age?

The aim of this study is to evaluate the reproductive results in women older than 40 years that realized an in vitro fertilization after the implementation of the National Law of Coverage for Assisted Reproductive. We analyzed, the cost that represent to our National Health System. Descriptive retrospective study. We analyzed 1102 IVF cycles carried out at our center from 2016 to 2017 in patients older than 40 years. Cycles with egg donation were excluded. Result variables analyzed were: cancellation rate (CR), pregnancy rate by oocyte retrieval (PROR), pregnancy rate per embryo transfer (PRET), miscarriage rate (MR) and take home baby rate (THBR). We calculated a cost/effectiveness relationship associated with these treatments in this particular group of patients that ended in a live born considering the impact in our national health system. The statistical analysis was performed using the Fischer’s exact test and ANOVA test with a significant p value <0.05. During this period we performed 3496 IVF cycles, from which 93.2% (3258) corresponded to cycles financed by the health system coverage and 33.8% of which were IVF cycles in women over 40 years of age. In the same period we compared THBH in women <35 years and 35-40 years with health coverage (48.9% and 42.3 % respectively), which were significantly higher than those in women > 40 (p<0.05). In our country for every completed IVF treatment, social and private health coverage system destine about USD 5000 (including assisted reproduction techniques and medication). Therefore, the cost for a healthy live born in women over 40 years is approximately USD 70.641 (1102 cycles x USD 5000/N° of live born: 78), 35-40: USD 11820 and <35: USD 10231. Maternal age directly influences THBR, with significant higher rates in women < 35 or 35-40 when compared to >40. There is no statistical difference (p= 0.18) in THBR within patients <40. The monetary cost estimated for having a healthy live born in women over 40 year of age is nearly 6 times higher when compared with women under 40. In women older than 40, our cost per healthy live born is higher than reported in the literature for the same age group. This might be a useful information in order to reevaluate the public health politics particularly in countries, like Argentina, that provides free assisted reproductive treatments in women over 40 year.Tabled 1ResultsAGEIVF CYCLESCR (%)PROR (%)PRET (%)MR (%)THBR (%)4028117.7 (50/281)16.0 (45/281)19.4 (45/231)42.2 (19/45)11.2 (26/231)4119723.8 (46/197)16.7 (33/197)21.8 (33/151)42.4 (14/33)12.6 (19/151)4221925.5 (56/219)12.7 (28/219)17.1 (28/163)32.1 (9/28)11.6 (19/163)4319827.3 (54/198)11.6 (23/198)14.3 (23/160)56.5 (13/23)6.2 (10/160)449725.7 (25/97)7.2 (7/97)11.2 (7/62)57.1 (4/7)4.8 (3/62)456839.7 (27/68)4.4 (3/68)7.3 (3/41)66.6 (2/3)2.4 (1/41)463151.6 (16/31)0 (0/31)0 (0/21)47616.6 (4/6)0 (0/6)0 (0/2)48250.0 (1/2)0 (0/2)0 (0/1)502100 (2/2)0 (0/2)521100 (1/1)0 (0/1) Open table in a new tab

A Powerful and Universal Preimplantation Genetic Diagnosis Protocol for Cystic Fibrosis

Background: Cystic fibrosis (CF) is one of the most common indications of preimplantation genetic diagnosis (PGD) for monogenic disorders worldwide. Aims: The aim of this article was to report a universal and powerful assay easily applicable to all couples requesting PGD for CF irrespective of the CFTR variants involved, in line with recently published CF-PGD guidelines. Results: A multiplex PCR protocol was developed including the study of the c.1521_1523del mutation with 12 closely linked polymorphic markers. Preliminary workup was performed for 53 couples and the protocol was clinically applied to 31 couples. All couples were informative for 7–12 markers. Of the 31 couples who initiated a PGD stimulation cycle, 17 couples had a baby. Therefore, the take-home baby rate was 60.7% per couple with an embryo transfer (17 out of 28 couples). Conclusion: This robust, simple, and reliable procedure should allow any couple at risk of transmitting CF to enrol in a PGD programme.

Retrospective comparison of intracytoplasmic sperm injection outcomes of sperm retrieved from a testicular biopsy and freshly ejaculated semen in oligozoospermia

ObjectiveThe aim of this study was to compare fertilisation, pregnancy rates and perinatal outcomes in patients undergoing intracytoplasmic sperm injection (ICSI) due to oligozoospermia. MethodsA total of 166 patients with oligozoospermia who underwent an ICSI procedure were included in the study. The subjects were divided into two groups according to the sperm retrieval technique used: group 1, ejaculated semen (n=111); group 2, surgical sperm retrieval (n=55). ResultsAlthough the clinical pregnancy rate was lower in group 2, the difference was not statistically significant (36.4% vs. 42.3%, p=0.460). The difference between fertilisation and take-home baby rates of the groups were not significantly different, either (p=0.486, p=0.419, consecutively). ConclusionTwo different sperm retrieval techniques used for ICSI had no statistically significant difference on intracytoplasmic sperm injection outcomes in oligozoospermic patients.

Is it worth reducing twins to singletons after IVF-ET? a retrospective cohort study using propensity score matching

To explore whether elective fetal reduction from dichorionic twins to singletons after IVF-ET (In vitro fertilization and embryo transfer) is associated with increased take-home baby rate and improved pregnancy outcome. A retrospective cohort study using propensity score matching. We conducted a retrospective cohort study of dichorionic twin pregnancy after IVF-ET between 2009 and 2015. The reduced group included 77 women who underwent transvaginal elective fetal reduction between 7 to 8 weeks of gestation. The non-reduced group (n=3589) comprised patients who were managed expectantly without elective fetal reduction (including patients with later selective fetal reduction due to fetal abnomalities, spontaneous fetal reduction after 7-8 weeks and induced labor due to maternal complications or complex fetal abnomalities). We conducted propensity score matching to control for maternal age, body mass index, infertility types and main causes of infertility. The primary assessment of pregnancy outcomes was take-home baby rate which was defined as taking home at least one live baby. Other measurements included the rates of adverse pregnancy outcome, early and late miscarriage, premature delivery as well as gestational age, birth weight and neonatal defects. After propensity score matching, 71 pairs (781 cases, 1:10 matched) were selected for further analyses. The take-home baby rates in the reduced group was significantly lower than in the control group (83.1% vs. 90.7%, OR0.50, 95%CI 0.27 to 1.03, P=0.042). The adverse outcome rate in the two groups were 19.7% vs. 13.5%, P=0.152. The miscarriage rate seems to be higher in the reduced group, but did not reach statistical significance (early miscarriage, 5.6% vs. 2.8%; late miscarriage, 7.0% vs. 5.6%; total, 12.7% vs. 8.5%). Premature delivery rate was lower in reduced group (12.7% vs. 46.3%, OR 0.17, 95%CI 0.08-0.33, P<0.001). Over 90% of premature deliveries in non-reduced group were over 32 weeks while the proportions were equal in reduced group. The median delivery age was 38 weeks and 36 weeks in reduced and non-reduced group (P<0.001). Birth weight was significantly higher in reduced group, with a median of 3.0Kg vs. 2.5Kg (P<0.001). Dichorionic twin pregnancies after IVF-ET with elective fetal reduction were at lower risk of premature delivery after 32 weeks of gestation, but the chance of taking home at least one live baby was significantly decreased.Tabled 1Comparisons of Pregnancy outcomes BEFORE and AFTER matchingVariablesBefore matching (N=3660)After matching (N=781)P valueReduced group (n=71)Non-reduced group (n=3589)Reduced group (n=71)Non-reduced group (n=710)>0.05Early miscarriage(<12w)4 (5.63%)109 (3.04%)4 (5.63%)20 (2.8%)>0.05Late miscarriage (>12w)5 (7.04%)160 (4.46%)5 (7.04%)40 (5.6%)>0.05Total miscarriage9 (12.67%)269 (7.50%)9 (12.67%)60 (8.5%)>0.05Preterm delivery <32 w5 (7.04%)142 (3.96%)5 (7.04%)30 (4.2%)>0.05Preterm delivery >32 w4 (5.63%)1557 (43.4%)4 (5.63%)299 (42.1%)0.00Total preterm delivery9 (12.67%)1699 (47.3%)9 (12.67%)329 (46.3%)0.00Term delivery53 (74.6%)1670 (46.5%)53 (74.6%)319 (44.9%)0.00Live Birth62 (87.3%)3369 (93.9%)62 (87.3%)648 (91.3%)>0.05Take home baby59 (83.1%)3361 (93.6%)59 (83.1%)644 (90.7%)0.04Adverse outcome14 (19.7%)449 (12.5%)14 (19.7%)95 (13.5%)>0.05 Open table in a new tab

Subclinical hypothyroidism: Is it important in intracytoplasmic sperm injection cycles?

Objective:To compare intracytoplasmic sperm injection (ICSI) outcomes of women with subclinical hypothyroidism with those of euthyroid women.Materials and Methods:A retrospective case-control study was conducted. Out of 2529 ICSI cycles evaluated, 41 women with hypothyroidism, 28 women with hyperthyroidism, and 128 women with subclinical hyperthyroidism were excluded, and 2336 cycles were analyzed. Women were identified as having subclinical hypothyroidism (case group, n=105) in the presence of a thyroid-stimulating hormone level >4.5 mU/L and normal free T4 and compared with euthyroid controls (n=2231).Results:The mean age, body mass index, day 3 follicle-stimulating hormone level, and antral follicle count of the study patients were similar to the control group (p>0.5). The cycle cancellation rate of the study group was similar to the control group (13.3% vs. 7.6%, p=0.1). The clinical pregnancy rate was 21.2% in the study group, which was significantly lower than the 35.8% in the control group (p=0.04). The take-home baby rate was also significantly lower in the study group compared with the control groups (13.5% vs. 31.4% respectively, p=0.01).Conclusion:Both the clinical pregnancy rate and the take-home baby rate is lower in women with subclinical hypothyroidism at the time of ICSI cycle.

Fertility outcomes after extended searches for ejaculated spermatozoa in men with virtual azoospermia

To assess the fertility outcomes of extended searches for ejaculated spermatozoa in men with virtual azoospermia. A retrospective cohort of 242 couples whose male partner suffered from nonobstructive azoospermia and who were treated with the use of intracytoplasmic sperm injection (ICSI). Not applicable. One hundred forty patients were referred to an extended search in the ejaculate and 102 patients were referred to microsurgical testicular sperm extraction (microTESE). None. Rates of sperm retrieval, fertilization, and pregnancy, take-home baby rate, and missed abortion rate were analyzed and compared. In the ejaculated spermatozoa group, motile spermatozoa were retrieved in 91 cases (65%) and on oocyte pick-up day in 71 cases (78%), compared with 70 cases (68%) in the microTESE group, with a similar incidence of sperm retrieval between groups. No significant difference was found between groups regarding mean number of embryo transfer and fertilization and pregnancy rates. There was no significant difference between groups regarding take-home baby rate. A significantly higher first-trimester missed abortion rate was found in the ejaculated sperm group (n = 14; 52%) compared with the microTESE group (n = 3; 8.6%). Conducting an extended spermatozoa search in the ejaculate of men with virtual azoospermia can provide pregnancy rates similar to those obtained with the use of microTESE, with a higher rate of spontaneous abortions in the ejaculate group.

OC-3a: Lifestyle modification increases the take-home baby rate in women with recurrent early miscarriages: a randomised study

OC-3a: Lifestyle modification increases the take-home baby rate in women with recurrent early miscarriages: a randomised study

Recurrence rates after abdominal and vaginal cerclages in women with cervical insufficiency: a validated cohort study.

To estimate the incidence of cervical insufficiency and compare recurrence rates of second trimester miscarriage/delivery in second and third pregnancies after prophylactic vaginal cerclage, abdominal cerclage, or no cerclage. Retrospective chart review of a representative register-based sample of 621 women with a spontaneous second trimester miscarriage/delivery in the first pregnancy in Denmark (1997-2012). We used strict criteria for the diagnosis of cervical insufficiency. The outcome of subsequent pregnancies was described by treatment with prophylactic vaginal cerclage, abdominal cerclage, or no prophylactic cerclage. Women were followed until June 2015. Of 621 women, 149 (24%) fulfilled the strict criteria of cervical insufficiency. Prophylactic treatment with abdominal cerclage (n = 20), vaginal cerclage (n = 59), and no prophylactic cerclage (n = 61) resulted in a second pregnancy ending before 28weeks in 5, 30, and 72% (p < 0.001) and before 34weeks in 10, 46, and 84% (p < 0.001), respectively. Take-home baby rate was 95% after abdominal cerclage, 73% after vaginal cerclage, and 33% after no cerclage. In a third pregnancy, abdominal cerclage (n = 47), vaginal cerclage (n = 38), and no cerclage (n = 8) resulted in pregnancy ending before 34 weeks of gestation in 2, 21, and 25%, respectively (p = 0.01). Cervical insufficiency was diagnosed in 24% of women with an initial second trimester spontaneous miscarriage/delivery. In second and third pregnancies, recurrence rates were significantly lower after prophylactic vaginal or abdominal cerclage compared with no cerclage.

Infertility and ovarian follicle reserve depletion are associated with dysregulation of the FSH and LH receptor density in human antral follicles

The low take-home baby rate in older women in Australia (5.8%) undergoing IVF (5.8%) is linked to the depletion of the ovarian reserve of primordial follicles. Oocyte depletion causes an irreversible change to ovarian function. We found that the young patient FSH receptor and LH receptor expression profile on the granulosa cells collected from different size follicles were similar to the expression profile reported in natural cycles in women and sheep. This was reversed in the older patients with poor ovarian reserve. The strong correlation of BMPR1B and FSH receptor density in the young was not present in the older women; whereas, the LH receptor and BMPR1B correlation was weak in the young but was strongly correlated in the older women. The reduced fertilisation and pregnancy rate was associated with a lower LH receptor density and a lack of essential down-regulation of the FSH and LH receptor. The mechanism regulating FSH and LH receptor expression appears to function independently, in vivo, from the dose of FSH gonadotrophin, rather than in response to it. Restoring an optimum receptor density may improve oocyte quality and the pregnancy rate in older women.

Rescue cerclage when foetal membranes prolapse into the vagina

A cross-sectional study was conducted to evaluate the efficacy of rescue cerclage in patients with a dilated cervix and prolapsed foetal membranes. Thirty-five patients presenting with cervical dilatation and prolapsed foetal membranes were included in the study. A McDonald cerclage was placed in 27 patients. The duration of pregnancy prolongation and the number of deliveries after 28 weeks were evaluated. The median prolongation of pregnancy after cerclage placement differed significantly between the cerclage and bed-rest groups (64 days versus 13.5 days). Of the 27 patients who had cerclage, 17 (63%) delivered after 28 weeks of gestation, whereas all patients in the bed-rest group delivered before 28 weeks of gestation. The take-home baby rate was 63% in the cerclage group. When pregnancies were complicated by cervical dilatation with membrane prolapse into the vagina, placement of a McDonald cerclage in appropriately selected patients can be a beneficial therapeutic option.Impact statementAlthough the effectiveness and safety of rescue cerclage is controversial, our study provides strong support for the notion that cervical cerclage accompanied by long-term broad-spectrum antibiotics improves the perinatal outcomes in singleton gestations with membrane prolapsed into the vagina.Further prospective randomised trial is required to prove these findings.

Testicular sperm extraction for patients with spinal cord injury-related anejaculation: A single-center experience.

To present a single-center experience with testicular sperm extraction and intracytoplasmic sperm injection for fathering biological children in patients with ejaculatory dysfunction as a result of spinal cord injury. Testicular sperm extraction was carried out in 52 male patients with ejaculatory dysfunction as a result of spinal cord injury. We investigated sperm retrieval rates and pregnancy rates from medical records. Data on age, testicular volume, hormonal status (luteinizing hormone, follicle stimulating hormone and testosterone), and time since spinal cord injury were obtained and analyzed to detect potential associations with the presence of spermatogenesis. Testicular sperm retrieval was achieved in 42 of 52 patients (80.7%). Intracytoplasmic sperm injection was carried out for 37 patients, and pregnancy was achieved in 32 (86.5%). The take-home baby rate was 70.2%. In the group with successful sperm extraction, testicular volume was significantly greater, time from spinal cord injury to extraction was significantly shorter, and serum luteinizing hormone and follicle-stimulating hormone levels were significantly lower. Serum follicle-stimulating hormone levels had the strongest association with feasibility of sperm retrieval by testicular sperm extraction. Furthermore, the sperm retrieval rates of patients injured within the preceding 12 years were significantly better than those injured longer before treatment (P = 0.045). Testicular sperm extraction and intracytoplasmic sperm injection seem to provide favorable results for patients with ejaculatory dysfunction as a result of spinal cord injury. However, early testicular sperm extraction is recommended, because sperm retrieval becomes more difficult with time from spinal cord injury.

Pregnancy, Delivery, and Neonatal Outcomes of In Vitro Fertilization-Embryo Transfer in Patient with Previous Cesarean Scar.

BackgroundWhat role should previous cesarean section play in affecting clinical pregnancy outcomes and avoiding the complications of in vitro fertilization? In this article, we focus on elective single-embryo transfer (eSET) versus double-embryo transfer (DET) and assess the clinical efficacy and safety of eSET in patients who have a previous cesarean scar.Material/MethodsThe pregnancy, delivery, and neonatal outcomes of 130 patients who had a previous cesarean scar and received in vitro fertilization-embryo transfer (IVF-ET) were retrospectively analyzed. The number of transferred embryos was chosen depending on patients’ desire after acknowledging all benefits and risks, including eSET (eSET group, n=56) and DET (DET group, n=74). A total of 101 patients with previous vaginal delivery receiving IVF-ET in the same period were included as a control group.ResultsThe pregnancy rates, multiple birth rates, abortion rates, ectopic pregnancy rates, gestational age at delivery, preterm birth rates, neonatal birth weight, and take-home baby rates were similar between the previous cesarean section group and the previous vaginal delivery group. A previous cesarean section scar did not affect embryo implantation and pregnancy outcomes in IVF. In the eSET and DET groups of previous cesarean section patients, the embryo implantation rates, pregnancy rates, abortion rates, and take-home baby rates were similar. However, the rate of multiple pregnancies reached 50% in the DET group, which led to more preterm births and lower birth weight.ConclusionsElective single-embryo transfer is a well-accepted strategy to avoid multiple pregnancies and improve the obstetric and neonatal outcomes of singleton pregnancy in IVF patients with a previous cesarean section.

Low-Molecular-Weight Heparin for the Treatment of Unexplained Recurrent Miscarriage With Negative Antiphospholipid Antibodies: A Randomized Controlled Trial.

Recurrent miscarriage (RM) is one of the most common clinical problems in reproduction with no definite cause in about 50% of the cases. The study aims to evaluate the effect of low-molecular-weight heparin (LMWH) in the treatment of women with RM negatively tested for antiphospholipid antibodies (APAs). An open-labeled registered randomized controlled study (NCT 01608347) included women who attended the outpatient clinic in Assiut Women Health Hospital and Nag-Hamady Central Hospital, Egypt, with 3 or more unexplained RM. Eligible participants were randomly assigned into 2 groups. The study group included 150 patients receiving LMWH (Tinzaparin sodium 4500 IU) subcutaneous daily injection with 500 µg folic acid once daily orally started once positive pregnancy test till the 20th week of gestation. The control group included 150 patients receiving the same dose of folic acid alone. The primary outcome of the study was the rate of continuation of a viable pregnancy after 20 weeks of gestation. There was no significant difference between both groups as regards age, parity, or number of previous miscarriages. There was a significant increase in women who continued their pregnancy beyond 20 weeks in the study group compared to the control group (73.3% vs 48%, respectively; P = .002). The take-home baby rate was also significantly higher in the LMWH group compared to the control group ( P = .001). Early start of LMWH decreases the incidence of miscarriage in the first 20 weeks of pregnancy in women with unexplained RM negative for APAs.

XM17 Follitropin Alfa (Ovaleap(®)): A Review in Reproductive Endocrine Disorders.

The subcutaneous recombinant human follicle-stimulating hormone XM17 follitropin alfa (Ovaleap(®)) is approved in the EU as a biosimilar of follitropin alfa (Gonal-f(®)) for use in all indications for which the reference product is approved, including as a multifollicular stimulant in women undergoing superovulation for assisted reproductive technology (ART) treatment. In a nonblind, phase I study in healthy female volunteers, the pharmacokinetic profile of XM17 follitropin alfa was bioequivalent to that of reference follitropin alfa following single dosing. Moreover, in a multinational, phase III study, the efficacy of XM17 follitropin alfa as a multifollicular stimulant was equivalent to that of reference follitropin alfa in terms of the number of retrieved oocytes (primary endpoint) in women undergoing controlled ovarian stimulation for ART treatment. There were no clinically relevant differences in oocyte quality between XM17 follitropin alfa and reference follitropin alfa, with biochemical, clinical and ongoing pregnancy rates and take-home baby rates not significantly differing between the treatment groups. XM17 follitropin alfa was generally well tolerated in this patient population, with its tolerability profile generally similar to that of reference follitropin alfa and with no new unexpected tolerability concerns identified. Thus, XM17 follitropin alfa is an effective treatment option in patients requiring follitropin alfa therapy for various reproductive endocrine disorders, providing a useful alternative to reference follitropin alfa.

Operative hysteroscopy for treatment of intrauterine pathologies does not interfere with later endometrial development in patients undergoing in vitro fertilization.

Operative hysteroscopy procedure is extensively used for the treatment of intrauterine abnormalities that can potentially cause infertility. To date, there are little data addressing the effect of operative hysteroscopy that applies electrical current for excision and its subsequent effect on endometrial thickness. This study was aimed to assess the effect of thermal resection used in operative hysteroscopy on endometrial thickness and on fertility outcome in women undergoing in vitro fertilization (IVF). A retrospective study conducted at Hadassah-Hebrew University Medical Center, a tertiary referral center. Included were IVF women who underwent an operative hysteroscopy throughout the years 2000-2010 for intrauterine pathologies. Throughout the years 2000-2010, 41 IVF women who underwent an operative hysteroscopy using electric current between their 82 IVF cycles were studied. The mean age of women at the time of the intervention was 37.1 years (36.7 and 37.5 at the IVF cycles before and after intervention, respectively). The maximal endometrial thickness before operative hysteroscopy was 10.7 mm compared to 9.5 mm after all procedures (P < 0.001). Excluding polypectomy cases (n = 24) the endometrial thickness was 9.9 mm before vs. 9.1 mm after operative hysteroscopy (P < 0.001). The clinical pregnancy rate was 19.5 % before as compared to 24.4 % after operative hysteroscopy (NS). The take home baby rate (THBR), however, was significantly increased following operative hysteroscopy for all indications from 2.4 to 12.2 % (P < 0.05). Despite the small change in endometrial thickness, our results indicate that using electric current is safe to treat intrauterine pathologies.

Blastocyst development in single medium with or without renewal on day 3: a prospective cohort study on sibling donor oocytes in a time-lapse incubator

To evaluate the efficiency of using a continuous (one-step) protocol with a single medium for the culture of human embryos in a time-lapse incubator (TLI). Prospective cohort study on sibling donor oocytes. University-affiliated in vitro fertilization (IVF) center. Embryos from 59 patients. Culture in a TLI in a single medium with or without renewal of the medium on day-3. Embryo morphology and morphokinetic parameters, clinical pregnancy, take-home baby rate, and perinatal outcomes. The blastocyst rates (68.3 vs. 66.8%) and the proportion of good-quality blastocysts (transferred plus frozen) obtained with the two-step (80.0%) protocol were statistically significantly similar to those obtained in the one-step protocol (72.2%). Similarly, morphokinetic events from early cleavage until late blastocyst stages were statistically significantly equivalent between both groups. No differences were found either in clinical pregnancy rates when comparing pure transfers performed with embryos selected from the two-step (75.0%), one-step (70.0%, respectively), and mixed (57.1%) groups. A total of 55 out of 91 embryos transferred implanted successfully (60.4%), resulting in a total of 37 newborns with a comparable birth weight mean among groups. Our findings support the idea that in a TLI with a controlled air purification system, human embryos can be successfully cultured continuously from day 0 onward in single medium with no need to renew it on day-3. This strategy does not affect embryo morphokinetics or development to term and offers more stable culture conditions for embryos as well as practical advantages and reduced costs for the IVF laboratory.

Obstetric and neonatal outcomes of delayed interval delivery in cerclage and non-cerclage cases: an analysis of 20 multiple pregnancies.

The aim of study is to compare maternal and fetal outcomes of pregnancies in which cerclage was placed following the loss of first fetus with those without cerclage placement in multiple pregnancies for delayed interval delivery. Records of pregnancies in which the first fetus was lost between 13-26 weeks and delayed delivery experienced for retained fetus(es), were collected retrospectively. A total of 20 patients including 11 twins, seven triplets and two quadruplets were evaluated. Cases with cervical cerclage placed after the first delivery were evaluated as the cerclage group (n = 11) and the cases without cerclage placement were evaluated as the non-cerclage group (n = 9). Median duration of delay was 22 days (range, 3-121) for both groups; 40 days (range, 5-121) in cerclage group and 12 days (range, 3-46) in the non-cerclage group (P = 0.003). Average birthweight of retained fetus(es) in the cerclage group was 850 ± 153.6 g (mean ± standard error [SE]) and 549.5 ± 149.1 g (mean ± SE) in the non-cerclage group (P = 0.04). Delivery week of retained fetus(es), live birth rate, take-home baby rate and chorioamnionitis ratio were not different in between the groups. Cervical cerclage after the first delivery is associated with a longer delivery interval and higher birthweight of retained fetus.

PD24-11 COMPARISON OF INTRACYTOPLASMIC SPERM INJECTION (ICSI) OUTCOMES BETWEEN EJACULATED AND TESTICULAR EXTRACTED SPERMATOZOA IN COUPLES WITH RECURRENT IMPLANTATION FAILURE

You have accessJournal of UrologyInfertility: Therapy1 Apr 2014PD24-11 COMPARISON OF INTRACYTOPLASMIC SPERM INJECTION (ICSI) OUTCOMES BETWEEN EJACULATED AND TESTICULAR EXTRACTED SPERMATOZOA IN COUPLES WITH RECURRENT IMPLANTATION FAILURE Mehmet Murad Basar, Nur Dokuzeylul-Gungor, Mehmet Ali Tufekci, Yesim Kumtepe-Colakoglu, Tugba Senel, and Semra Kahraman Mehmet Murad BasarMehmet Murad Basar More articles by this author , Nur Dokuzeylul-GungorNur Dokuzeylul-Gungor More articles by this author , Mehmet Ali TufekciMehmet Ali Tufekci More articles by this author , Yesim Kumtepe-ColakogluYesim Kumtepe-Colakoglu More articles by this author , Tugba SenelTugba Senel More articles by this author , and Semra KahramanSemra Kahraman More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.2002AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Testicular sperm usage is an alternative method for patients associated with lower fertilization and embryo cleavage rates in their previous ICSI with mature ejaculated sperm. The aim of the present study is to compare ICSI outcomes of couples with recurrent implantation failure after use of ejaculated versus testicular spermatozoa with different cycles in the same centre. METHODS This study included 140 ART cycles in 51 couples. Patients were divided into two groups according to source of spermatozoa. Group 1 included of 76 cycles using ejaculated spermatozoa in our center. If the patients had at least twice ICSI cycle with ejaculated spermatozoa and/or had total severe immotile sperm (no progressive motility), testicular spermatozoa was obtained with testicular sperm aspiration (TeSa) under local anesthesia in 64 cycles of group 2. Fertilization, embryo quality and clinical pregnancy rates were compared between groups. RESULTS Mean age of males and women were 38.2±7 (24-58) and 33.5±5.9 (21-44) years old, respectively. Previous ICSI cycles were 3.2±2.6 in ejaculated spermatozoa used patients and 3.4±2.4 in testicular spermatozoa used patients (p=0.279). In Group 1, total oocyte number and MII oocyte number were 8.9.±7.9 and 6.8±6. These parameters were10.5±7.4 and 8.2±6.1 in group 2, respectively. There were not found statistical difference between two groups according to these parameters (ptotaloocysts = 0.111; pMIIoocyts = 0.078). While fertilization rate was higher with ejaculated spermatozoa (79.3%) than testicular spermatozoa (74.9%) (p=0.103), pregnancy rate was statistically higher with testicular spermatozoa than ejaculated spermatozoa (41.7% vs 21.4%, respectively, p=0.021). Additionaly, ongoing pregnancy rate (OPR) and takehome baby rate (THBR) were higher with testicular spermatozoa than ejaculated spermatozoa (OPR: 26.7% vs 7.1%, p= 0.006; THBR: 24.6% vs 6.0%, p= 0,008). There were observed no complications after TESA in patients such as hematoma, pain etc. CONCLUSIONS ICSI cycle with testicular sperm is one of the best choices in idiopathic male fertility resulting in ICSI cycle failure with ejaculated sperm, and can have marked improvement in outcome. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e734 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Mehmet Murad Basar More articles by this author Nur Dokuzeylul-Gungor More articles by this author Mehmet Ali Tufekci More articles by this author Yesim Kumtepe-Colakoglu More articles by this author Tugba Senel More articles by this author Semra Kahraman More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Eliminating the effect of pathomorphologically formed sperm on resulting gravidity using the intracytoplasmic sperm injection method

The aim of the present study was to test whether it is possible to eliminate a high percentage of morphologically abnormal sperm in male ejaculate by assisted reproduction using the intracytoplasmic sperm injection (ICSI) method. Treatment success was evaluated by comparing fertilization, clinical pregnancy and reproduction rates between males with heavy teratospermia (≤1% morphologically normal spermatozoa) and males with a higher percentage (>1%) of normal sperm. In total, 174 patients who had previously undergone 174 ICSI cycles (1 per each pair) were evaluated retrospectively. In the group of patients with heavily impaired sperm morphology (n=37), the percentage of normal spermatozoa was ≤1%. In the second group, males with >1% normal spermatozoa (n=137) were considered as patients with mildly impaired sperm morphology. The results of partner fertilization in these two groups were compared and a lower number of fertilized oocytes was identified in the patients with heavily impaired sperm morphology (P=0.038). However, neither the gravidity nor the take-home baby rates of the partners differed between the patients with mildly and heavily impaired sperm morphology. Trends opposite to that for fertilization were observed for gravidity and delivery [odds ratio (OR), 0.62; 95% confidence interval (CI), 0.29–1.30; OR, 0.55; 95% CI, 0.26–1.24, respectively]. This indicates that the lower number of fertilized oocytes was not associated with the overall outcome of fertilization and that patients with heavily impaired sperm morphology experience the same benefit from ICSI as patients with mildly impaired sperm morphology.