Gamete Retrieval Research Articles

Endoscopic surgery and diagnosis in infertility management and assisted reproductive techniques

Objective To describe the role of diagnostic laparoscopy, salpingoscopy, surgical laparoscopy, and diagnostic and surgical hysteroscopy in infertile patients, with special attention to techniques of assisted reproduction. Design A personal review. Setting The Regional Center for Ambulatory Surgery and Infertility, Florence, Italy. Subjects Infertile patients undergoing assisted reproduction procedures. Interventions Diagnostic laparoscopy, salpingoscopy, surgical laparoscopy, diagnostic and surgical hysteroscopy. Main outcome measures and results Diagnostic laparoscopy was considered mandatory in infertile patients when there was suspected tubal, ovarian or peritoneal disease interfering with the capacity to reproduce. The value of other methods as alternatives to laparoscopy and dye insufflation in the management of infertile patients was also evaluated. Salpingoscopy was also reviewed, with the conclusion that this technique is very important in the infertility work up because it allows a prognosis concerning the possibility of conception according to the status of the mucosal folds. Diagnostic hysteroscopy was evaluated. This technique is an extremely reliable outpatient procedure in infertility diagnosis and it allows savings in health costs, even though, unfortunately, it is not yet widely used. The indications for and results of hysteroscopic surgery were also reviewed. Hysteroscopic operations, compared with traditional surgery, involve reduced risk, shortened hospitalization, reduced costs and better results. Considering endoscopic techniques in relation to assisted reproduction, the importance of laparoscopy and hysteroscopy in the selection and preparation of infertile patients was evaluated. However, the direct involvement of endoscopic techniques in gamete retrieval and transfer was considered to give inconsistent results. Conclusion There are clear advantages in using endoscopic surgical techniques, and many traditional surgical approaches can be replaced by operative laparoscopy and hysteroscopy. Considering assisted reproduction and endoscopic techniques, we should emphasize the importance of laparoscopy and hysteroscopy in the selection and preparation of infertile patients.

Procreation after death or mental incompetence: medical advance or technology gone awry?

To review our experience with semen retrieval in men who are incompetent or dead and to formulate general medical, legal, and ethical guidelines for practitioners. Case series and literature review. Academic. Seven incompetent or neurologically dead individuals in whom sperm retrieval was requested. Electroejaculation. Seminal emission was induced in the two men who underwent electroejaculation. Sperm suitable for cryopreservation was obtained in one of these men. Review of the legal and ethical implications of such procedures led to development of general guidelines for determining whether gamete retrieval should be performed when requested. Issues of procreational autonomy, consideration of the decedent's wishes, and assurance of the well-being of any new life created were considered most strongly in the formation of these guidelines. Although the retrieval of sperm from deceased or incompetent individuals may be achieved readily, it is incumbent upon the practitioner to consider the legal and moral implications of these procedures before proceeding.

Feline reproduction and artificial breeding technologies

Increased interest in the domestic cat, both as a companion animal and as a model for rare felid species, has led to augmented research focusing on reproductive processes in this species. In the male, primary attention has been aligned to investigations of gamete retrieval and cryopreservation. Epididymal sperm cells obtained from reproductive tracts after neutering (simulating posthumous collection) do capacitate, as evidenced by attachment to homologous zonae with 30 min and maximum attachement after 4 h. Following cryopreservation, motility is observed, but is attenuated compared with pre-freeze values by 30–40%. However, this information does not correlate with fertilizing ability, as an average of less than 20% of the acrosomes remain intact post-thaw and fertilization rates are less than 2%. Investigations of non-invasive endocrine techniques have centered on the female and new methods for monitoring fecal steroids have been described and adapted to species such as the cheetah, lion, tiger, bobcat and serval. The most intense area of research has been development of artificial breeding techniques. Recently, a 50% success rate with laparoscopic artificial insemination has been demonstrated if semen deposition occurs after ovulation, whereas pregnancy rates are severely attenuated when insemination is performed before the ovulatory process. This technique now has been adapted to the leopard cat, cheetah, tiger and puma, with the birth of one offspring from each species. In vitro fertilization also has received much attention and results in 84–85% fertilization rates using Ham's F-10 medium with PMSG/hCG-stimulated cocytes (84 h between injections). Adaptation to non-domestic felids has resulted in the birth of one litter of tiger cubs and Indian desert cat. Salvage of female gametes by in vitro oocyte maturation and fertilization is a recently exploited area of research for the domestic cat. Approximately 50% of all oocytes placed in culture develop to the metaphase II stage, with gonadotropin-supplemented medium providing superior conditions for maturation. These oocytes are capable of undergoing fertilization (range, 11–36%), and embryos derived completely from male and female rescued gametes have been produced (fertilization rate, approximately 20%). Because of the enormous progress made with domestic cat artificial reproduction, the developed methods (e.g. semen cryopreservation, artificial insemination, in vitro fertilization, gamete salvage) will undoubtedly serve as important tools for strategic management of endangered species populations.