Fresh Intracytoplasmic Sperm Injection Cycles Research Articles

P-001 Comparing two monomorphic teratozoospermia syndromes in terms of ICSI outcomes - Round vs. pin-head

Abstract Study question Whether ART clinical outcomes are affected at extremes of morphological presentations, in samples where typical forms are unavailable for ICSI. Summary answer The study found no correlation between the severity of sperm defect and ICSI results. What is known already One of the challenging topics in the field of Andrology is the predictive role of monomorphic teratozoospermia, specifically head defects, in assisted reproductive technology (ART) outcomes. The definitive requirement of conducting intracytoplasmic sperm injection (ICSI) is the presence of at least one motile spermatozoon. Two schools of thought provide contradicting views; some believe that sperm morphology can significantly predict fertilization, clinical pregnancy, and live birth rates in fresh ICSI cycles and others support that the degree or nature of sperm morphological dysfunction lacks a significant impact on the outcome of ICSI outcomes. Study design, size, duration This retrospective cohort study was included 7,881 couples with male factor infertility who underwent 11,536 IVF/ICSI cycles at a tertiary referral fertility center over a 13-year period. Participants/materials, setting, methods From this cohort, 10 cases were identified with >90% acephalic sperm syndrome and 11 patients had >90% globozoospermic sperm. The implantation rate, pregnancy, and live birth rates per initiated cycle (iC) and per patient were compared between the two groups. The rates were also compared between each group with the general ICSI population. Main results and the role of chance The data analysis suggests no statistically significant differences between the two patient groups. Implantation was 20% versus 15.1% (95% CI, 0.33 to 5.97; OR, 1.4) for round and pin-head groups. The pregnancy per iC and patient were 25% vs 23.1% (95% CI, 0.25 to 9.5; OR, 1.55) and 27.3% vs 30% (95% CI, 0.13 to 5.8; OR, 0.87) for round-head and pin-head groups, respectively. The live birth rates matched the pregnancy rates. For the general ICSI population the rates were as follows: implantation rate was 17.3%; pregnancy rate (per iC and per patient) was 27.2% and 44.7%; and live birth rate (per iC and per patient) was 23.2% and 38.2%. The study found no significant differences between the outcomes for the general ICSI population and the two groups. Limitations, reasons for caution It is uncertain whether this lack of association is genuine or whether it is affected by the limited number of cases with extreme monomorphic abnormalities. The absence of evidence should not be taken as evidence of absence. Wider implications of the findings Conducting such studies should be encouraged to provide insight by informing systematic reviews. A significant portion of existing literature on teratozoospermia comprises of case reports, which are rationally excluded from systematic reviews and meta-analyses. Additional research is warranted to definitively establish the investigated relationships. Trial registration number not applicable

O-019 Outcomes and correlations between traditional Intracytoplasmic Sperm Injection (ICSI) method and a new AI-enhanced system

Abstract Study question In the context of ICSI, how does the Sperm Tracer Deep Neural Network analysis compare to the embryologist’s sperm selection technique? Summary answer Sperm Tracer AI system significantly improves fertilization rates, offering a standardized, objective approach to sperm selection, but nuanced correlations highlight complexities in sperm parameters. What is known already Traditional sperm selection during ICSI relies on subjective, manual methods, introducing variability and affecting pregnancy success. In response, AI applications, aim to enhance objectivity, potentially improving pregnancy rates. Study design, size, duration Between September and December 2023, the study examined 26 fresh ICSI cycles in a total of 268 sibling oocytes. Men aged 18 years and above with 34.4 mean women’s age. The Sperm Tracer group underwent single embryo culture, while the Embryologists' group underwent group embryo culture. The study analyzes statistical differences in fertilization rates, day 3 and day 5 embryo development. The study duration aligns with the analyzed cycles. Participants/materials, setting, methods The study compared real-time AI-assisted sperm evaluation with the Sperm Tracer system to the traditional ICSI method by embryologists. Correlation analysis was performed for the following kinematic parameters: Amplitude of Lateral Head displacement (ALH), Dance (DNC), Linearity (LIN), Straightness (STR), Wobble (WOB), Curvilinear Velocity (VCL), Linear Velocity (VSL) and Average Path Velocity (VAP). Statistical analysis involved Odds Ratios (OR) with 95% confidence intervals, Mann-Whitney U tests and correlation analyses by Pearson’s coefficient. Main results and the role of chance The Sperm Tracer system exhibited a noteworthy enhancement in fertilization rates (OR: 0.46, 95% Confidence Intervals (CI) [0.23, 0.89], p = 0.0224) but no significant differences in cleavage stages, blastocyst formation, or the production of good-quality embryos compared to conventional methods. For correlation analysis used two groups of sperm population. Group A comprises spermatozoa subjected to ICSI with the Sperm Tracer system, resulting in unsuccessful oocyte fertilization and Group B consists of spermatozoa that achieved successful fertilization. In Group A, correlation analysis identified significant negative associations between DNC and linear parameters (LIN, STR, WOB) (p < 0.001), highlighting the clinical relevance in sperm motility. Group B displayed a distinct negative correlation between DNC and LIN (p = 0.03941), indicating potential effects on sperm linear velocity. LIN in Group A exhibited strong negative correlations with WOB (p = 0.0001), moderate negative correlations with STR (p = 0.0028), and VCL (p = 0.0773). Moreover, ALH analysis in Group A unveiled robust negative correlations with LIN, STR, and WOB, suggesting clinical significance in sperm motility. These intricate findings underscore the Sperm Tracer system's primary advantage in optimizing fertilization rates, offering valuable insights for refining sperm selection strategies in assisted reproduction. Limitations, reasons for caution The study faces limitations due to a small sample, impacting generalizability. Divergence in culture embryo strategies introduces bias, necessitating validation in larger studies. The system includes morphology analysis, but no data analysis has been conducted. Exploring the correlation between morphology, considering embryo culture variations, and motility could provide valuable insights. Wider implications of the findings This study highlights AI applications like Sperm Tracer, showcasing their potential to improve assisted reproduction outcomes. Recognizing AI's impact on IVF success is vital for adoption. Integrating AI into clinic protocols may boost IVF efficiency, requiring training for embryologists to ensure effective utilization. Trial registration number Not applicable

The impact of female BMI on sperm DNA damage repair ability of oocytes and early embryonic development potential in intracytoplasmic sperm injection cycles.

Obesity adversely influences the quality of oocytes and embryos and can affect DNA repair in embryos, leading to reproductive issues. However, the effects of body mass index (BMI) on DNA repair ability in oocytes during intracytoplasmic sperm injection (ICSI) cycles have not yet been investigated. Therefore, this retrospective study aimed to analyze the influence of sperm DNA damage on embryo development and reproductive outcomes in overweight/obese and normal-weight women in ICSI cycles. A total of 1,141 patients who received the first fresh ICSI cycle treatments were recruited from July 2017 to July 2021. Based on the BMI of the women, all patients were divided into normal weight (18.5≤BMI<25 kg/m2; n=824; 72.22%) and overweight/obese (BMI≥25 kg/m2; n=317; 27.78%) groups. Furthermore, according to the sperm DNA fragmentation index (DFI), these two groups were subdivided into two subgroups: DFI<30% and DFI≥30%. In the normal-weight women group, the embryonic development and reproductive outcomes of ICSI cycles were not statistically different between the two subgroups (DFI<30% and DFI≥30%). However, in the overweight/obese women group, couples with a sperm DFI≥30% had a significantly lower fertilization rate (76% vs. 72.7%; p=0.027), cleavage rate (98.7% vs. 97.2%; p=0.006), and high-quality embryo rate (67.8% vs. 62.6%; p=0.006) than couples with a sperm DFI<30%. When injected sperm with high DFI into the oocytes of overweight/obese women, resulting in lower fertilization, cleavage, and high-quality embryo rates in ICSI cycles, and the decreased early developmental potential of embryos from overweight/obese patients may be caused by the diminished capacity of oocytes to repair sperm DNA damage.

P-245 Birth of twenty-seven healthy babies following transfer of fresh and frozen-thawed embryos derived from monopronuclear zygotes: a retrospective study

Abstract Study question What are the neonatal outcomes of fresh/frozen-thawed embryos derived from monopronuclear zygotes (1PN)? Is there any influence of the method of fertilization? Summary answer A total of 231 monoembryonic transfers (TF) of fresh or frozen/thawed embryos derived from 1PN zygotes allows to the birth of twenty-seven healthy babies. What is known already Zygotes were classified 16 to 18 hours post insemination according to the extrusion of the second polar body and the number of pronuclei (PN). The «normally fertilized» zygotes display 2 PN and those with 0, 1 or more than 2 PN (&amp;gt; 2PN) are considered as abnormal. If some zygotes are always discarded (&amp;gt;2PN) due to the increased risk of aneuploidy, the transfer of embryos derived from 1PN zygotes remains more controversial. Study design, size, duration Our retrospective study included all conventional in vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI) and frozen embryo transfer (FET) cycles performed between january 2018 and december 2022. Embryo and pregnancy outcomes were analyzed in a first group of 781 fresh cycles (731 patients) and in a second group of 167 FET (150 patients) with embryos derived from 1PN zygote. Only monoembryonic transfers were analyzed for live birth rate (LBR). Participants/materials, setting, methods Only embryos derived from 1PN zygotes were analyzed in our study. For fresh cycles (n = 2762), embryo outcome was analyzed for 1234 (1PN) zygotes (IVF = 648 and ICSI = 586). Fresh embryo TF was performed in 64 cycles. For frozen cycles, TF was achieved in 167 cases. For a total of 231 TF on day 2, 3 or 5, pregnancy and live birth rates were analyzed. Main results and the role of chance At first, 46% of 1PN zygotes from fresh IVF cycles gave rise to embryos of sufficient quality to be transferred or frozen (day 3 or 5/6). This rate decreased to 33% in the fresh ICSI cycles. Blastulation rate was also more important in IVF group (44%) in comparison to ICSI group (20%) without signification (p = 0.1). Fresh TF of 64 patients (32 in each fertilization group) allowed 7 pregnancies in the IVF group (PR = 22%) as compared to 4 pregnancies in the ICSI group (PR = 12%). The 7 IVF pregnancies ended in 4 deliveries of healthy newborns, 2 miscarriages and one pregnancy still ongoing. In the ICSI group, 1 birth of a healthy newborn and 3 miscarriages were observed. Secondary, thirty-six pregnancies were obtained in the 167 FET cycles. A non significative difference was observed between embryos derived from IVF cycles (PR = 26%) and ICSI cycles (PR = 16%) with respectively 15 and 6 healthy babies born. Two pregnancies in each group are still ongoing. Limitations, reasons for caution The main limitation of this study is that it was a retrospective, single-center study with a relatively small number of births. Wider implications of the findings In conclusion, we observed better outcomes in IVF cycles in comparison to ICSI cycles and our center policy to transfer a good quality embryo developed from 1PN zygotes allowed 26 deliveries of 27 healthy newborns during the period analyzed. Trial registration number not applicable

The impact of oocytes containing smooth endoplasmic reticulum aggregates on assisted reproductive outcomes: a cohort study

BackgroundThe impact of smooth endoplasmic reticulum aggregates (SERa) on assisted reproductive technology (ART) outcomes was still controversial. Our objective is to investigate the impact of the presence of SERa on intracytoplasmic sperm injection (ICSI) outcomes.MethodsThis was a retrospective cohort study. A total of 1,090 fresh ICSI cycles from 944 patients between January 2016 and June 2020 were included. Outcomes from clinical, embryological and neonatal aspects were compared between SERa + and SERa- cycles as well as between SERa + and SERa- oocytes.ResultsThe total gonadotropin (Gn) dose, number of oocytes retrieved, serum estradiol concentration and number of the available embryo were significantly higher in SERa + cycles than in SERa- cycles (P < 0.05). Comparable two pronuclei (2PN) fertilization rate and poly-pronucleus zygote rate were shown in SERa + and SERa- cycles (P > 0.05), but which were higher in SERa + oocytes than in SERa- oocytes (P < 0.05). No statistical difference in blastocyst formation rate was found in SERa + and SERa- cycles as well as in SERa + and SERa- oocytes (P > 0.05). Good-quality embryo rate was statistically higher in SERa- cycles than in SERa + cycles (P < 0.05), but the difference was comparable between SERa + and SERa- oocytes (P > 0.05). No statistical difference in clinical pregnancy rate, spontaneous abortion rate, live birth rate and premature delivery rate were found in SERa + and SERa- cycles as well as in SERa + and SERa- oocytes (P > 0.05). The implantation rate was comparable in SERa + and SERa- cycles (P > 0.05), but it is higher in the group of only SERa- embryo transfer when compared with the group of mixed SERa + and SERa- embryo transfer (P < 0.05). 159 newborns in SERa + cycles and 140 newborns in SERa- cycles were followed up. Comparable newborn malformation rate was observed between SERa + and SERa- cycles and oocytes (P > 0.05). Logistic regression analysis revealed number of oocytes and total dose of Gn were risk factors for SERa occurrence (aOR = 1.05 and 1.55, P < 0.001).ConclusionOocyte's SERa is correlated with a number of oocytes retrieved and higher Gn dose, but it does not affect pregnancy outcomes and increase newborn malformation rate.

O-134 Predictive value of seminal oxidation-reduction potential (ORP) and sperm DNA fragmentation (SDF) analysis for reproductive outcomes of intracytoplasmic sperm injection (ICSI) cycles

Abstract Study question Do seminal oxidation-reduction potential (ORP) and sperm DNA fragmentation (SDF) predict ICSI cycle outcomes? Summary answer Both SDF and seminal ORP have strong prognostic value in predicting good fertilization (≥80%), blastocyst development (≥60%), clinical pregnancy and live birth. What is known already Seminal oxidative stress (OS) has been found to play an important role in various aetiologies of male infertility and is induced by the imbalance between reactive oxygen species (ROS) and antioxidants. OS is a major cause of sperm DNA fragmentation (SDF). It is well established that high levels of seminal OS and SDF are negatively associated with ART outcomes. Previous studies have associated high levels of SDF with an increase risk of miscarriage and a decrease in live birth rate. Study design, size, duration This prospective study included 144 couples who had a fresh autologous ICSI cycle between June 2018 and December 2020. There was no restriction to patients with severe male factor infertility. All cryopreservation and third party assisted reproductive techniques were excluded. Participants/materials, setting, methods This multi-centre study was performed at three ART Clinics in Cape Town, South Africa. All couples included in the study had fresh autologous ICSI cycles with freshly ejaculated semen. Seminal ORP testing was performed using the MiOXSYS system and SDF by means of a fluorescence microscopic TUNEL assay on freshly ejaculated semen samples that were used for ICSI. The ART outcomes evaluated were fertilization rate, blastocyst development rate, clinical pregnancy rate and live birth rate. Main results and the role of chance The study shows that seminal ORP significantly negatively correlates with fertilization rate (r=-0.267; P = 0.0012), blastocyst development rate (r=-0.389; P &amp;lt; 0.0001), pregnancy (r=-0.296; P = 0.0003) and live birth (r=-0.353; P &amp;lt; 0.0001). ROC curve analysis shows significant predictive power for ORP for fertilization (≥80%; AUC=0.652; P = 0.0012), blastocyst development rate (≥60%; AUC=0.762; P &amp;lt; 0.0001), pregnancy (AUC=0.677; P = 0.0002) and live birth (AUC=0.729; P &amp;lt; 0.0001). Comparable results were obtained for SDF. An average cut-off value for ORP of 0.55 mV/106 sperm/mL was calculated. The AUCs between the SDF and ORP results for all reproductive outcome parameters did not differ. For all reproductive outcome parameters, normal sperm morphology shows the lowest predictive power. ORP with male age as confounding factor had significant effects on odds ratios (OR) of fertilization (OR = 0.1446; CI: 0.048-0.430; P = 0.0001) and blastocyst development (OR = 0.2468; CI: 0.095-0.635; P = 0.0029), while it was not significant for pregnancy and life birth. Multivariate logistic regression with fertilization, blastocyst development, pregnancy and live birth as dependent parameters and high/low seminal ORP, primary and secondary infertility, unexplained infertility, polycystic ovaries, endometriosis, tubal factor myomectomy, ovarian insufficiency and advanced maternal age as independent variables showed overall model fits (P &amp;lt; 0.0002) with a significant (P &amp;lt; 0.0084) influence of ORP on all reproductive outcome parameters. Limitations, reasons for caution Since only ICSI patients were included in this study, this might have contributed to the fact the cut-off value of ORP is lower than the published cut-off. A further limitation is the use of a fluorescence microscopic TUNEL assay which drastically limited the number of sperm evaluated. Wider implications of the findings This is the first study showing predictive value of seminal ORP for reproductive outcome including pregnancy and live birth. The method is easy and much quicker than current methods for the determination of SDF. Hence, it can be used a point of care method. Trial registration number Not applicable

Predictive value of seminal oxidation-reduction potential analysis for reproductive outcomes of ICSI

Research questionIs seminal oxidation-reduction potential (ORP) clinically relevant to reproductive outcome? DesignProspective observational study including a total of 144 couples who had an intracytoplasmic sperm injection (ICSI) cycle between June 2018 and December 2020. The study included patients undergoing fresh ICSI cycles with autologous gametes. Cycles that had day 3 embryo transfers and cryopreservation cycles were excluded. There was no restriction on patients with severe male infertility; couples with unexplained infertility and unexplained male infertility were included, those with azoospermia were excluded. Semen analysis, seminal ORP as determined by means of the MiOXSYS system, sperm DNA fragmentation (SDF) and reproductive outcomes (fertilization, blastocyst development, clinical pregnancy and live birth) were determined. ResultsSeminal ORP was significantly negatively correlated with fertilization rate (r = –0.267; P = 0.0012), blastocyst development rate (r = –0.432; P < 0.0001), implantation/clinical pregnancy (r = –0.305; P = 0.0003) and live birth (r = –0.366; P < 0.0001). Receiver operating characteristic curve analysis showed significant predictive power for ORP for fertilization (≥80%; area under the curve [AUC] 0.652; P = 0.0012), blastocyst development rate (≥60%; AUC 0.794; P < 0.0001), implantation/clinical pregnancy (AUC 0.680; P = 0.0002) and live birth (AUC 0.728; P < 0.0001). Comparable results were obtained for SDF (fertilization: AUC 0.678; blastocyst development: AUC 0.777; implantation/clinical pregnancy: AUC 0.665; live birth: AUC 0.723). Normal sperm morphology showed the lowest predictive power for all reproductive outcome parameters. With male age as confounding factor, ORP (cut-off value of 0.51 mV/106 sperm/ml) has significant (P < 0.04667) effects on odds ratios for all reproductive outcome parameters. Multivariate logistic regression to investigate potential seminal and female confounding factors revealed that seminal ORP significantly (P < 0.0039; P < 0.0130) affects reproductive outcome. ConclusionSeminal ORP is relevant for good fertilization, blastocyst development, implantation, clinical pregnancy and live birth.

Early Serum Progesterone Measurement on 9th Day after Oocyte Retrieval can be used as a Predictor of Fresh Intracytoplasmic Sperm Injection Cycle Success

BACKGROUND: In intracytoplasmic sperm injection (ICSI) infertility treatment cycles, measuring serum Progesterone level at day 9 after oocyte retrieval could be used as a predictor of success. METHODS: Sixty-nine women were prospectively included in this study, treated with fresh embryo transfer ICSI cycles. Progesterone analyses were performed on the day of oocyte pick up (day 0) at serum and follicular fluid, then re-assessment at serum on day 9 after oocyte retrieval. The data were compared to evaluate the correlation among hormones measured on day 0 and day 9 with pregnancy rate. RESULTS: Pregnancy rate of Iraqi women was 22% (n = 15), mean serum progesterone on day 9 among pregnant ladies was (mean ± SD, 39.5 ± 13.0) which was significantly higher than that who failed to get pregnant (mean 23.2 ± 11, p = 0.001), then after adjustment of the baseline readings (day 0) estimated mean = 11.1. The differences were still significant, receiver operating characteristic curve area showed that serum Progesterone on day 9 after pick up can differentiate correctly between those who will conceive and those who will not, with a sensitivity = 0.933 and specificity = 0.519, at cut off point = 22.33 and above, (Area under the curve = 0.822, p = 0.001). CONCLUSION: Serum progesterone on day 9 could be one of the predictors of endometrial receptivity and pregnancy, which is actually of great value for both doctors and patients during that stressful period till the date of confirmation, which might negatively affect treatment outcome, as well as the psychosocial and pharmacological impact of medication and limited activity for a failed one.

Stress, anxiety, and depression in infertile couples are not associated with a first IVF or ICSI treatment outcome

BackgroundPsychological distress may exert a negative influence on reproductive function of couples at reproductive age. Couples seeking assisted reproductive technology (ART) treatment may have a higher prevalence of psychological distress than fertile couples. However, whether psychological distress is associated with the outcome of ART treatment remains unknown. We aimed to investigate the association of pre-treatment psychological distress and clinical pregnancy rate among infertility couples undergoing in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) treatment.MethodsThis nested case-control study was conducted based on women who underwent their first fresh IVF or ICSI cycle in the Jiangsu Birth Cohort Study (JBC) between November 2015 and January 2019. A total of 150 women who did not obtain clinical pregnancy after first IVF or ICSI fresh embryo transfer were identified as cases, and a total of 300 age matched women who obtained clinical pregnancy were identified as controls. Conditional logistic regression analyses were used to investigate the association between psychological distress and the outcome of first IVF or ICSI treatment, adjusting for multiple potential confounders.ResultsNo statistically significant association was observed between score of maternal symptoms of psychological distress and clinical pregnancy. Adjusted ORs of logistic regression were 1.00 (95% CI 0.97-1.03) for anxiety, 0.98 (95% CI 0.95-1.02) for depression, and 0.98 (95% CI 0.95-1.01) for perceived stress, respectively. When treat depression and anxiety as categorical variables, 62 (13.8%) were classified as clinical depression, 11 (2.4%) were classified as clinical anxiety, among 450 women in the present study. Psychological distress symptoms were also not associated with clinical pregnancy rate. Adjusted ORs of logistic regression were 0.27 (95% CI 0.03-2.33) for anxiety, 0.88 (95% CI 0.46-1.68) for depression, respectively.ConclusionsOur findings firstly indicated that psychological distress experienced prior to IVF/ICSI treatment was not associated with clinical pregnancy.

SUBTLE ENDOMETRIAL ABNORMALITIES DO NOT AFFECT THE PREGNANCY RATE IN FRESH ICSI CYCLES

The study aimed to determine whether the presence of subtle endometrial abnormalities discovered by office hysteroscopy (OH) affects the pregnancy rate in fresh intracytoplasmic sperm injection (ICSI) cycles. A prospective cohort study included women undergoing their first ICSI cycles was performed in assisted reproductive technology unit. Patients were divided into two groups: patients with subtle endometrial abnormalities diagnosed by OH (group 1, n=78), and patients with normal uterine cavity (group 2, n=122). OH was conducted post-menstrual and subtle abnormalities detected included hypervascularization, petechiae, mucosal elevation, micropolyps, pale endometrium and single adhesion band. The main outcome measures were clinical pregnancy and implantation rates The most common subtle abnormality observed was pale endometrium in 35.9% of cases. Both groups were comparable regarding the baseline clinical data and endometrial thickness. Additionally, total amount of gonadotrophins used, duration of stimulation, peak estradiol concentrations, peak endometrial thickness, number of mature follicles and number of embryos transferred were not significantly different between both groups. The implantation rate was similar in both groups (2.35 ± 0.83 vs. 2.22 ± 0.84, p=0.465). Also, the pregnancy rate was similar in both groups (38.5% vs. 33.6%, p=0.067) Subtle endometrial abnormalities diagnosed by OH do not negatively affect pregnancy and implantation outcomes in fresh ICSI cycles.

Impact of ejaculatory abstinence period and semen characteristic on the reproductive outcomes after intracytoplasmic sperm injection.

ObjectiveThe prognostic of semen characteristics in intracytoplasmic sperm injection (ICSI) outcomes is not clear. Also, there is no evidence-based recommendation for the abstinence period before ICSI. So, we aimed to assess the influence of the abstinence period and semen characteristics on ICSI outcomes.MethodsA total of 1003 fresh ICSI cycles were divided into six groups; group 1 (1-day abstinence), group 2 (2 days abstinence), group 3 (3 days abstinence), group 4 (4 days abstinence), group 5 (5 days abstinence), and group 6 (6-10 days abstinence).ResultsWe showed that semen volume (p=0.0001) and total sperm count (p=0.005) were increased in the groups with higher abstinence periods. Other semen parameters did not significantly associate with the abstinence period. The percentage of progressively motile sperm was associated with fertilization rate (p=0.007), and the sperm morphology was associated with cleavage-stage embryo rate (p=0.036). No influence of abstinence or semen parameters on rates of pregnancies was observed.ConclusionsThe abstinence period before ICSI can influence the semen volume and total sperm count, and possibly fertilization. Although the sperm with the highest quality are selected for ICSI, the percentages of progressively motile and morphologically normal sperm in the ejaculated semen have a predictive value for fertilization and cleavage rates after ICSI, respectively.

Outcome of GnRH antagonist ICSI cycles triggered by GnRH agonist plus Recombinant hCG versus triggered with Recombinant hCG alone in fresh autologous ICSI cycle

To explore whether dual triggering for final oocyte maturation using a low dose of recombinant human chorionic gonadotropin (hCG) plus gonadotropin-releasing hormone agonist (GnRH-a) is as effective as the standard dose of recombinant hCG triggering alone in term of a total number of retrieved oocytes, fertilization and pregnancy rate in fresh autologous antagonist intracytoplasmic sperm injection (ICSI) cycles. 80 infertile women undergoing ICSI, aged ˂ 40 years, 18˂ Body mass index ˂30 Kg/m2 included in fresh autologous antagonist ICSI cycles. 40 women received a Standard dose of recombinant hCG (500 µg) alone and 40 women received GnRH-a (0.2 mg triptorelin plus 250 µg recombinant hCG) were used for final oocytes maturation. This study was conducted at the High Institute for Infertility Diagnosis and Assisted Reproductive Techniques, Al Nahrain University. The mean total number of retrieved oocytes, fertilization, and pregnancy rate were measured. The mean total oocyte number being statistically higher in the dual trigger group. The mean number of fertilized oocytes and clinical pregnancy rates was higher in the dual trigger group than in the control group, but the difference showed borderline statistical significance. Furthermore, fertilization rates show no statistical difference between the control group and the dual trigger group. Results of the study confirm that dual triggers show favorable improvement in fresh autologous antagonist ICSI cycles with the use of GnRH agonists plus hCG compared with hCG alone for triggering of final oocyte maturation.

Impact of changing the ovarian hyperstimulation protocol in the sequental cycle on ICSI outcomes in the same patient population

AimWhether to use the same ovarian stimulation protocol or change it after a failed in vitro fertilization cycle is still a controversial issue. In this study we aimed to investigate the effect of changing the stimulation protocol in the sequental cycle of the same patient population on intracytoplasmic sperm injection (ICSI) outcomes. MethodsThis retrospective study included two sequental fresh ICSI cycles of 941 infertile women attended in a period of one year. Group A was composed of patients who failed to have clinical pregnancy with a GnRH agonist and group B was composed of patients who failed to have clinical pregnancy with a GnRH antagonist protocol cycle. In both groups the study group was composed of patients whose stimulation protocol was changed in the sequential cycle and the control group was composed of patients who proceeded with the same stimulation protocol. The clinical pregnancy and live birth rates were primary outcomes. ResultsIn group A, the clinical pregnancy rates were comparable between the study and the control groups, but the live birth rate was higher in the study group (p=0.03). In group B, there was no difference in terms of clinical pregnancy and live birth rates between the study and control groups (p=0.740 and p=0.842 respectively). ConclusionsChanging the ovarian stimulation protocol after a failed ICSI cycle downregulated with a GnRH agonist increased the live birth rate. After a failed cycle stimulated with a GnRH antagonist protocol, protocol change did not have any impact on the clinical pregnancy and live birth rates.

Performing ICSI within 4 hours after denudation optimizes clinical outcomes in ICSI cycles

BackgroundThe study aimed to investigate whether and how general and partial time intervals between processes, from human chorionic gonadotrophin (HCG) trigger to intracytoplasmic sperm injection (ICSI), affected the laboratory and reproductive outcomes in ICSI cycles.MethodsThis was a retrospective data analysis of 3602 women who underwent ICSI treatment cycles using partner or donor sperms, performed at Reproduction Medicine Center of Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology (Wuhan, China) between October 2016 and September 2018. The clinical pregnancy rate was the major outcome in the study. The fertilization and available embryo rates were secondary outcomes.ResultsData from 3602 consecutive fresh ICSI cycles was analysed. Multivariate linear regression and logistic regression analysis of factors related to fertilization and clinical pregnancy rates showed that fertilization rate (P = 0.001) and clinical pregnancy rate (P = 0.037) were significantly associated with denudation (DN)-ICSI interval. Long DN-ICSI interval was associated with higher rate of fertilization than short DN-ICSI interval but significantly decreased clinical pregnancy rate when the interval is over 4 h (P < 0.05).ConclusionsDN-ICSI time interval can act as an independent predictor for clinical outcomes in ICSI cycles. The optimal time for ICSI is within 4 h after oocyte denudation for excellent laboratory and reproductive outcomes in ICSI cycles.

Is there a pre-retrieval serum human chorionic gonadotrophin (hCG) threshold level for prediction of subsequent retrieval outcomes and pregnancy in fresh ICSI cycles?

Modern ICSI (intracytoplasmic sperm injection) cycles’ outcomes are difficult to predict. Whether human chorionic gonadotrophin (hCG) or luteinizing hormone (LH) serum levels 24 h prior to oocyte retrieval are correlated with retrieval and subsequent cycle results is unclear. An observational historic cohort study of 645 fresh ICSI cycles was conducted. After controlled oocyte stimulation, and 10–12 h after a self-administered trigger, serum levels of hCG (hCG trigger n = 563) and LH (GnRHa trigger n = 82) were measured. Correlations between pre-retrieval hormone levels and cycle results were assessed. No correlation (p > .12) was found between serum pre-retrieval hCG levels or LH levels (in GnRHa-triggered cycles) and total oocytes, M2, M1 + M2 or oocyte maturity rates (OMR) for any of the stimulation protocols. ROC (receiver operator curve) analysis for fertilization rates showed a possible cutoff for LH levels. Pregnancy rates (PR) were higher in rising hCG groups; a cutoff of 117 IU/L was associated with an increase in PR (30.9% to 45.6%) and a moderate sensitivity and specificity (60.6% and 55.0%). However, HCG was not predictive of pregnancy in a logistic regression model. We conclude that preretrieval hCG serum levels are not useful for pre-retrieval estimation of aspiration results but might have a role in prediction of pregnancy.

Comparison and outcomes of nonobstructive azoospermia patients with different etiology undergoing MicroTESE and ICSI treatments.

The purpose of the study was to compare clinical, laboratory, histological features, microdissection testicular sperm extraction (MicroTESE) and intracytoplasmic sperm injection (ICSI) treatment outcomes of nonobstructive azoospermia (NOA) patients of various etiologies, and to investigate ICSI outcomes using fresh and frozen thawed sperms from MicroTESE, so to explore an optimal MicroTESE-ICSI procedure for NOA couples. A retrospective analysis was made in 595 NOA patients undergoing MicroTESE from January 2013 to December 2017. The men were classified into six groups based on etiology. Patients' age, history, hormone profile, testis volume, testicular histology, sperm retrieval, fertile and pregnancy outcomes of ICSI were included for analysis. A total of 595 NOA patients were included in this study, with 446 (75.0%) were idiopathic NOA, 66 (11.1%) were Klinefelter syndrome (KS), 34 (5.7%) with microdeletion of the AZFc, 33 (5.5%) cases had the history of cryptorchidism, 13 (2.2%) had a history of mumps orchitis, and 3 (0.5%) cases underwent chemotherapy. The overall sperm retrieval rate (SRR) was 40.3% (240/595), SRR of the cryptorchidism (84.8%, 28/33) and mumps orchitis (84.6%, 11/13) groups were much higher than that of other groups, the SRR of idiopathic group was the lowest (31.8%, 142/446). One hundred and ninety-eight ICSI cycles utilizing MicroTESE sperm were retrospectively analyzed, including 155 fresh MicroTESE ICSI cycles and 43 frozen-thawed MicroTESE ICSI cycles. Fertilization rate, cleavage rate, and clinical pregnancy rate of fresh sperm group were slightly higher than those in frozen thawed MicroTESE sperm group, but high qualified embryo rate of fresh sperm group was lower than frozen thawed group. The differences were of no statistical meaning. Etiology may be an effective prognostic factor for SRR in NOA patients. NOA of definite etiology, such as cryptorchidism, has high SRR, while idiopathic NOA, the most common type of NOA, has the lowest SRR. Using of frozen thawed sperm from MicroTESE had similar pregnant outcome to that of fresh sperm, so cryopreservation of testicular sperm seems to be more suitable and of great benefit in these cases and good results can also be expected when oocyte retrieval and ICSI are not performed at the same time.

Impact of advanced paternal age on the intracytoplasmic sperm injection (ICSI) outcomes in donor egg cycles.

The purpose of this study is to assess the impact of paternal age on the oocyte-donation outcomes in intracytoplasmic sperm injection (ICSI) cycles. Two hundred and seventy-eight infertile couples were retrospectively involved. Inclusion criteria were: infertility from almost 1 year, normal or sub-fertile seminal parameters, overall oocyte survival rate greater than 85%. Baseline characteristics included male age, recipient age, male body mass index (BMI), smoking, drinking status. Main outcome measures: fertilization rate (FR), cleavage rate (CR), pregnancy rate (PR). Patients were categorized in group 1 ≤45, group 2 >45 years. A total of 1,724 frozen oocytes were included. After warming, 1,642 oocytes survived. Median overall oocyte survival rate was 100% [interquartile range (IQR), 85-100%]. Median male age was 44±5.60 years (IQR, 31-70 years). Median recipients age was 42±3.62 years (IQR, 29-50 years). Group 1 included 166 men, group 2 112 men. Two hundred and seventy-eight fresh ICSI cycle were performed. "Two-pronuclear" (2PN) FR was 72.6%±0.20%, CR 93.0%±0.16%, PR 39.6%. Miscarriage rate was 25.5%. Live birth rate per cycles was 29.5%. Comparison between group 1, group 2 and ICSI outcomes confirmed an association with FR, resulting 80.0% (IQR, 67.0-83.0%) and 67.0% (IQR, 50.0-80.0%), respectively (P<0.01). There were no significant differences between the two groups with respect to seminal parameters. It would be recommended more emphasis on the advancing male age when counselling older couples who undergo egg donation program.

Testicular Fine-Needle Aspiration for Sperm Retrieval in Azoospermia: A Small Step toward the Technical Standardization.

PurposeThe aim was to describe our preliminary experience performing testicular fine-needle aspiration (TEFNA) with a larger needle in infertile patients with obstructive azoospermia, and to provide a systematic literature review of the different testicular sperm aspiration techniques, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement recommendations.Materials and MethodsWe prospectively collected data between March 2017 and June 2018. All men underwent bilateral TEFNA under analgo-sedation, using a larger disposable 18-gauge butterfly needle with 60 mL Luer-Lock syringe attached to it.ResultsThirty consecutive patients were enrolled. Median operative time was 16 minutes (interquartile range [IQR]: 12–30 minutes). No intraoperative complications occurred. Two/thirty patients (6.7%) reported postoperative adverse events: 1 patient had prolonged orchialgia, 1 patient presented scrotal hematoma. Successful sperm retrieval was found in 28/30 cases (93.3%). Median sperm concentration was 0.05 ×106/mL (IQR: 0.001–0.1 ×106/mL). Median total sperm motility was 10% (IQR: 0%–15%). In 20/30 men (66.7%) sperm retrieved was used for fresh intracytoplasmic sperm injection cycle, in 8/30 (26.7%) sperm cryopreservation was necessary, because on the day of sperm retrieval the female resulted not responder to ovarian stimulation. In this cases mean number of 3 (IQR: 1–4) bio system straws was cryopreserved.ConclusionsTEFNA with 18-gauge needle proved to be a feasible, safe and effective treatment, even if future prospective studies will be addressed to clarify what type of azoospermia benefits from this procedure, and if a larger needle permits to improve Assisted Reproductive Technologies (ART) outcomes.

Early serum progesterone and prolactin analysis at day 9 of oocyte retrieval as a predictor of success in fresh ICSI cycles.

ObjectiveTo analyze progesterone and prolactin plasma levels nine days after oocyte retrieval and evaluate their correlation with pregnancy rates in in vitro fertilization cycles. To achieve pregnancy, several factors are analyzed before and during the in vitro fertilization cycle. Progesterone supplementation for adequate luteal phase support is indicated despite the presence of multiple corpus luteum in IVF stimulation cycles because of blockage caused by hypothalamic agonists and antagonists. The dosage of progesterone and prolactin on day 09 after follicular retrieval could function as a predictive marker of success in fertility treatments.MethodsA retrospective study was performed using data from 238 patients submitted to intracytoplasmic sperm injection (ICSI) at a private infertility clinic from January 2013 to December 2015. Hormonal measurements were performed on day 09 after follicular uptake. The data was compared to assess the correlation between prolactin and progesterone dosages and pregnancy rates. ResultsThe ICSI pregnancy rate was 40.8% (n=238). No statistically significant difference was observed when correlating the success of the procedure with the prolactin dosage (p=0.71). However, progesterone showed a significant difference (p=0.021). The cutoff point, indicated by the ROC curve fit according to which gestation would be identified, is 25.95ng/ml of progesterone. The sensitivity of this point is 61.9% and the specificity is 57.4%.ConclusionProgesterone dosage may be one of the indicators of gestation on day 09 after follicular uptake. Such data can help physicians to monitoring and provides suitable early gestational care. More studies are needed to corroborate the data found.

Studija efikasnosti klomifen citrata u poređenju sa GnRH antagonistima u prevenciji skoka LH među pacijentkinjama koje su na stimulaciji jajnika u procesu IVF-ICSI

Abstract: Objective: To determine the efficacy of clomiphene citrate (CC) in preventing luteinizing hormone (LH) surge without adding gonadotropin releasing hormone (GnRH) antagonist or GnRH agonist in stimulated first fresh intracytoplasmic sperm injection cycle by evaluating the outcome of oocytes and embryo quality. Design: Registry cohort study. Settings: Fertility Clinic Registry at Hospital University Kebangsaan Malaysia. Patients: A total of 235 fresh stimulated ICSI cycle for patients aged 18-40 years old using clomiphene citrate plus gonadotropin (n = 117) and GnRH antagonist plus gonadotropin (n = 118) were studied. Intervention: Comparing two different ovarian stimulation protocol. Main outcome measure(s): Social economical demographic, ovarian stimulation response and laboratory outcome. Fertilization rate as our primary outcome and our secondary outcome were oocyte retrieval rate, mature oocyte rate and top quality embryo rate. Result(s):There were no difference in the demographic and hormonal characteristic of the study groups. The primary outcome of fertilization rate has significant difference with p value of 0.003; 73.2% for CC group and 64.2% for GnRH antagonist group. The secondary outcome of OR rate (78.4% ± 17.6% VS 80.3% ± 13.4%, p = 0.368), mature oocyte rate (85.2% ± 19.0 VS 81.7% ± 16.7%, p = 0.130) and top quality embryo rate (79.4% ± 24.2% VS 74.9% ± 22.9%, p = 0.178) were comparable between both groups. There were significant difference between the endometrial thickness on the day of trigger and OHSS risk among both groups (8.5 mm ± 1.0 mm VS 9.4 mm ± 1.1 mm, p &lt; 0.001 and 12.8% VS 44.1% respectively). Discussion: Minimal stimulation protocol with CC and gonadotropin may be the answer to many infertile couples in need of IVF and yet having financial situation deterring them in attempting IVF treatment. GnRH antagonist could be safely replaced by CC by extending to 10 days as this protocol gives better primary outcome and comparable secondary outcomes with less OHSS. CC is recognized to induce thinning of endometrial lining and thus, may impair embryo implantation. However, with advancement of the vitrification system and higher success rate in frozen-thaw embryo transfer worldwide provides an excellent solution for this issue.