Intracytoplasmic Sperm Injection Cycles Research Articles

Laser-assisted selection of immotile spermatozoa has no effect on obstetric and neonatal outcomes of TESA-ICSI pregnancies

BackgroundAzoospermic patients have benefited from both epididymal and testicular spermatozoa intracytoplasmic sperm injection (ICSI) treatment and lasers have been used to identify viable, immotile spermatozoa before the procedure. There are limited studies on the safety of laser-assisted selection of immotile spermatozoa. The aim of this study was to investigate the impact of laser-assisted selection of immotile spermatozoa on the obstetric and neonatal outcomes after ICSI.MethodsA retrospective comparative study was conducted on outcomes of ICSI cycles with testicular spermatozoa from June 2014 to June 2018. Of 132 cycles, 33 were allocated to the test group and oocytes were injected with immotile spermatozoa selected by laser, 99 cycles were allocated as control group.ResultsCompared with the control group, no significant differences were found in the pregnancy, implantation, miscarriage and live birth rates in the test group in either fresh or frozen transfer cycles. The cumulative live birth rate in the test group was 69.70%, which was slightly higher than in the control group (60.61%), but this was not statistically different. There were no differences in the average gestational age, premature birth rate, neonatal birth weight, and the malformation rate between the test and control groups (P > 0.05). In addition, the obstetric outcome between the two groups were not different (P > 0.05).ConclusionsNo negative effect on perinatal and neonatal outcomes was seen by using laser-assisted selection of immotile spermatozoa for TESA-ICSI. This study endorses the use of laser-assisted selection of viable spermatozoa for ICSI cycles.

Cumulative live birth rates in donor oocyte ICSI cycles are not improved by magnetic-activated cell sorting sperm selection

Research questionDoes magnetic-activated cell sorting (MACS) for sperm selection increase cumulative live birth rates (CLBR) or improve clinical parameters of reproductive success in couples undergoing intracytoplasmic sperm injection (ICSI) with donor oocytes? DesignRetrospective multicentre observational study including data compiled from unselected couples who underwent ICSI cycles with donated oocytes in 15 Spanish IVIRMA fertility clinics (January 2008 to February 2020). Patients were divided into reference (standard semen processing, n = 40,157) and MACS (additional sperm selection step by MACS, n = 1,240) groups. CLBR were plotted on Kaplan–Meier curves and compared using the Mantel–Cox test. Proportions were compared with a generalized estimating equation model, and results were adjusted to clinically relevant variables. ResultsThe MACS group showed a 27.1% CLBR after one embryo was transferred and 81.6% after four; the reference group had CLBR of 19.6% and 78.5%, respectively. CLBR in the MACS group was 4.2% after five oocytes were used and 75.5% after 15; for the reference group, CLBR were 7.8% and 78.3%, respectively. Kaplan–Meier curves showed statistically significant differences in CLBR per number of embryos transferred and per number of donated metaphase II oocytes between the two groups (both P < 0.0001), but not for CLBR per embryo transfer. No significant differences between groups were found for classical clinical outcomes such as pregnancy and live birth rates per embryo transfer. ConclusionsAlthough MACS sperm selection slightly increased the CLBR per embryo transferred compared with the reference group, this change was not clinically meaningful. MACS should not be recommended indiscriminately to all infertile patients undergoing ICSI with donated oocytes as a sperm processing add-on.

A decision tree analysis applied to women aged 43–45: who should be referred for ovum donation?

Research questionIn women at the advanced age of 43–45 years undergoing repeated IVF cycles with autologous oocytes, who has the highest chance for birth and who should be referred early to receive donor oocytes? DesignA retrospective cohort study was conducted at a university hospital reproductive centre. The computerized database of 394 women aged 43–45 years undergoing 1528 non-donor IVF or intracytoplasmic sperm injection cycles between 2010 and 2019 was analysed. A decision tree was developed, enabling a comprehensive study of a set of clinical parameters and the expected outcomes. ResultsThe cumulative clinical pregnancy rate was 15.0% (59/394) and the cumulative live birth rate was 8.4% (33/394). The decision tree developed to predict women who should be offered egg donation included age, poor ovarian response to stimulation, the number of top-quality embryos, dominant follicles, previous pregnancy or live birth, fertilized oocytes and body mass index. The model showed that a good ovarian response in the first cycle was the best predictor for live birth (13.3% gave birth). However, among women with poor responses, 7.1% of those who were younger than 43.5 years gave birth, and none of the women who were older than 43.5 years did. ConclusionsWomen over 43.5 years old with fewer than four oocytes collected in their first IVF cycle should be offered ovum donation, since their live birth rate in subsequent cycles is negligible.

Comparison of fresh and frozen ejaculated spermatozoa in sibling oocyte recipient cycles

Research questionDo IVF and intracytoplasmic sperm injection cycles using fresh and frozen ejaculated spermatozoa result in similar pregnancy outcomes in couples with non-male factor infertility? DesignRetrospective cohort study; patients undergoing donor egg recipient cycles, in which oocytes from a single ovarian stimulation were split between two recipients, were reviewed. Two recipients of oocytes from a single donor were paired and categorized based on the type of ejaculated spermatozoa (fresh/frozen). Outcomes included delivery rate, implantation, pregnancy, pregnancy loss and fertilization rates. ResultsOf the 408 patients who received oocytes from a split donor oocyte cycle, 45 pairs of patients used discrepant types of ejaculated spermatozoa and were included in the study. Fertilization rate: fresh (74.8%); frozen (68.6%) (P = 0.13). Pregnancy rate: fresh (76%); frozen (67%); delivery rate: fresh (69%); frozen (44%); implantation rate was significantly higher: fresh (64%); frozen (36%) (P = 0.04). Rate of pregnancy loss was significantly higher in the frozen group compared with the fresh group (33% versus 5.9%, P = 0.013). Adjusted odds for delivery was 67% lower in the frozen group (95% CI 0.12, 0.89). Adjusted odds of pregnancy (adjusted OR 0.67, 95% CI 0.20, 2.27) and implantation (adjusted OR 0.5, 95% CI 0.12, 2.12) were not significantly different between the frozen and fresh sperm groups. ConclusionIn this model that controls for oocyte quality by using paired recipients from the same donor, frozen ejaculated spermatozoa resulted in lower delivery rates than those using fresh spermatozoa

The Effect Of Culture System On Embryonic Development and Aneuploidy Rate For Icsi Cases

Background: Patients undergoing intracytoplasmic sperm injection (ICSI) or in vitro fertilization (IVF)cycles often suffer from recurrent implantation failure (RIF). To ensure live birth and embryonic viability, culture systems should be optimized in all ICSI and IVF cycles. The success of IVF can be affected by the culture systems employed for embryonic development. It has been argued that covering micro drops with oil in culture systems can prevent microbial infection, ensure suitable osmotic and pH conditions, and prevent the evaporation of the medium. Objectives: Comparing the embryonic development, euploidy rate ,and clinical outcome of using GPS Dishes covered with paraffine oil and SPL Dishes with mineral oil for patients with previous RIF. Patients and methods: the study was a prospective randomized controlled trial and the sample size consisted of 174 patients undergoing ICSI cycles at a private fertility center during the period between April 2017 and March 2020. Patients’ embryos were randomly assigned into one of the two of the aforementioned groups. Results: The two groups weren’t statistically significantly different in male age, female age, collected oocyte number, number of mature oocytes, and number of blastocysts undergoing preimplantation genetic diagnosis (PGD-A). For the pre-implantation parameters of the embryos, fertilization, cleavage, and high-quality blastocyst rates were statistically significantly higher in the GPS Dishes with paraffin oil group than in the SPL Dishes covered with mineral oil group (77.5, 80.1, and 79.45%) (p = 0.012, and 0.001). Conclusion: we conclude that embryonic development can be enhanced by using GPS Dishes with paraffin oil overlying.

Improving Implantation Rate in 2nd ICSI Cycle through Ovarian Stimulation with FSH and LH in GNRH Antagonist Regimen.

To investigate whether patients with a previous recombinant follicle stimulating hormone (rFSH)-stimulated cycle would have improved outcomes with rFSH + recombinant luteinizing hormone (rLH) stimulation in the following cycle. For the present retrospective case-control study, 228 cycles performed in 114 patients undergoing intracytoplasmic sperm injection (ICSI) between 2015 and 2018 in an in vitro fertilization (IVF) center were evaluated. Controlled ovarian stimulation (COS) was achieved with rFSH (Gonal-f, Serono, Geneva, Switzerland) in the first ICSI cycle (rFSH group), and with rFSH and rLH (Pergoveris, Merck Serono S.p.A, Bari, Italy) in the second cycle (rFSH + rLH group). The ICSI outcomes were compared among the groups. Higher estradiol levels, oocyte yield, day-3 high-quality embryos rate and implantation rate, and a lower miscarriage rate were observed in the rFSH + rLH group compared with the rFSH group. In patients < 35 years old, the implantation rate was higher in the rFSH + rLH group compared with the rFSH group. In patients ≥ 35 years old, higher estradiol levels, oocyte yield, day-3 high-quality embryos rate, and implantation rate were observed in the rFSH + rLH group. In patients with ≤ 4 retrieved oocytes, oocyte yield, mature oocytes rate, normal cleavage speed, implantation rate, and miscarriage rate were improved in the rFSH + rLH group. In patients with ≥ 5 retrieved oocytes, higher estradiol levels, oocyte yield, and implantation rate were observed in the rFSH + rLH group. Ovarian stimulation with luteinizing hormone (LH) supplementation results in higher implantation rates, independent of maternal age and response to COS when compared with previous cycles stimulated with rFSH only. Improvements were also observed for ICSI outcomes and miscarriage after stratification by age and retrieved oocytes.

Effect of Follicular Fluid Estradiol Level on Oocyte Quality, Fertilization and Pregnancy Outcome in Intracytoplasmic Sperm Injection Cycles

Abstract Background Infertility is the third most serious disease worldwide estimated by the WHO. Despite the worldwide use of ICSI, it still has a low birth rate (30%). Patients and Methods The current study was a prospective study that included 180 women undergoing Intra-cytoplasmic sperm injection (ICSI) procedure. Using Flexible Antagonist protocol; during oocyte retrieval, follicular fluids of mature follicles (&amp;gt;17 mm) aspirated. Results The number of retrieved oocytes ranged from (1 to 33 oocytes) mean number 10±7. Follicular fluid E2 concentration ranged from 246±199 (0 to 700) (ng/ml). Oocyte maturation about 116 were MII (64.4%) of oocytes. And 64 (35.6%) were MI and GV. 107 cases (59.4) had normal fertilization lamos_zzzz@hotmail.com and 73(40%) had abnormal fertilization of MII injected oocytes. Embryo quality 63.9% (115) of fertilized MII oocytes were blastocysts and 65 (blastomere and others) and 60.6% of cases had embryo transfer on day 5 and 39.4 had transfer on day 3. Chemical pregnancy was positive in 85 cases (47.2%) and the clinical pregnancy positive in 66 cases (%). Conclusion Follicular fluid E2 concentration had fair predictive value in oocyte maturation, fertilization, embryo quality, chemical and clinical pregnancy. But it was an independent predictor of MII-grade oocytes production.

Fertilization and early embryonic development of in vitro matured metaphase I oocytes in patients with unexpected low oocyte maturity rate.

To determine the fertilization and embryonic potential of immature metaphase I (MI) oocytes in patients with low oocyte maturity rate in whom the percentage of mature oocytes obtained was less than 75% of the total retrieved ones. In vivo matured metaphase II (MII) oocytes (MII-ICSI, n = 244), and in vitro matured MI oocytes (MI-MII-ICSI, n = 202) underwent an intracytoplasmic sperm injection (ICSI) procedure. Maturation rate, fertilization rate and early embryonic development were compared in both groups. In total, 683 oocytes were collected from 117 ICSI cycles of 117 patients. Among them, 244 (35.7%) were mature MII and 259 (37.9%) were MI after the denudation process. Of those 259 MI oocytes, 202 (77.9%) progressed to MII oocytes after an incubation period of 18-24 h. The maturation rate was 77.9%. Fertilization rate was found to be significantly higher in the rescued in vitro matured MI oocyte group when compared with the in vivo matured MII oocyte group (41.6% vs 25.8%; P = 0.0006). However, no significant difference was observed in terms of cleavage rates on days 2 and 3 between the groups (P = 0.9126 and P = 0.5031, respectively). There may be unidentified in vivo factors on the oocyte maturation causing low developmental capacity in spite of high fertilization rates in the group of patients with low oocyte maturity rate. Furthermore, studies are needed to determine the appropriate culture characteristics as well as culture period and ICSI timing of these oocytes.

Infertility and Intracytoplasmic Sperm Injection (ICSI)

Infertility is generally defined as a Time to pregnancy (TTP) of longer than 12 months among couples who engage in unprotected intercourse in the fertile days of the menstrual cycle, any specific threshold is arbitrary. The prevalence of infertility differs greatly from one country to another, being 15% globally, &gt;30% in some developing countries, and 17-28% in industrialized countries. The term ‘implantation failure’ can be used to describe both patients who have never shown quantifiable signs of implantation such as increased levels of hCG, and those who have increased hCG production without later ultrasound evidence of a gestational sac. Intracytoplasmic sperm injection (ICSI) is a form of assisted reproductive technology in which a single sperm is injected into the cytoplasm of an egg in order to fertilize it. Complete fertilization failure following ICSI is an uncommon occurrence (1–3 percent), although it does occur even when spermatozoa appear to be normal. Furthermore, in some individuals, low to moderate fertilization (30 percent) has been reported in repeated ICSI cycles. Fertilization failure with ICSI is not the same as it is with traditional IVF technique. 60–90 percent of oocytes which showed a fertilization failure in traditional IVF are devoid of sperm nuclei, assuming that sperm ejection or penetration failure is the most common reason for the failure in fertilization process.

Comparison of Cumulative Live Birth Rate Between Aged PCOS Women and Controls in IVF/ICSI Cycles.

The present study aimed to assess whether women with polycystic ovarian syndrome (PCOS) ≥35 years age undergoing in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) cycles experienced a higher cumulative live birth rate (CLBR) over a two-year period compared with age- and body mass index (BMI)-matched patients with tubal factor infertility. Through propensity score matching (PSM) approach, the authors retrospectively analyzed the IVF/ICSI outcomes of 263 PCOS patients (35-46 years of age [mean, 37 years]) and 526 age- and BMI-matched tubal factor controls two years after oocyte retrieval. Multivariate regression analysis was performed to explore factors influencing cumulative live birth. Women with PCOS exhibited better ovarian reserve and response, and higher CLBR in two years compared with age- and BMI-matched controls (CLBR: 55.51% in PCOS vs. 38.02% in control, p<0.001). Multivariate logistic regression analysis revealed that the number of transferable embryos and antral follicle counts were both significant independent factors predicting cumulative live birth after adjusting for female age, female body mass index, percentage of transferred blastocysts, number of embryos transferred per embryo-transfer cycle, diagnosis of PCOS and freeze-all cycles (p<0.001, p=0.045). Women with PCOS ≥ 35 years of age demonstrated a higher CLBR over two years compared with age- and BMI-matched controls. This could be explained by favorable oocyte reserve and more available embryos compared with controls, which overcome the compromised oocyte quality in aged PCOS patients.

Does a Very Short Length of Abstinence Improve Assisted Reproductive Technique Outcomes in Infertile Patients with Severe Oligo-Asthenozoospermia?

In recent years, a growing number of studies seem to support the beneficial effects of a very short abstinence period on sperm parameters, especially in patients with oligo-asthenozoospermia (OA). On this basis, the aim of this study was to evaluate the effects of a short period of abstinence (1 h) on intracytoplasmic sperm injection (ICSI) outcomes in infertile patients with severe OA. We performed a retrospective study on 313 ICSI cycles in which couples were divided into two different groups based on sperm parameters of the male partners. Group 1 included normozoospermic men or male partners with a mild OA (n = 223). Group 2 included male partners with severe OA (n = 90). They were asked to provide a second consecutive ejaculation after 1 h from the first one. The best ejaculate was used to perform ICSI. We found a significant increase of total (p < 0.001) and progressive motility (p < 0.001) in the second ejaculate of patients of Group 2 compared with those of the first one. Spermatozoa of the second ejaculate were chosen for ICSI for all patients in Group 2. We found statistically significant improvement of clinical pregnancy rate (p = 0.001) and embryo quality (p = 0.003) in couples in Group 2 compared to those of Group 1. No statistically significant difference was found in fertilization, implantation, live birth delivery, and miscarriage rates between the two groups. Therefore, a second semen sample collected after a very short time-interval in patients with severe OA allowed us to obtain significantly higher clinical pregnancy rate with improved embryo quality compared to normozoospermic men or patients with mild OA. Fertilization, implantation, live birth delivery, and miscarriage rates were similar between the two groups. The present study shows that a second consecutive ejaculate could represent a simple strategy to obtain better sperm parameters and assisted reproductive technology (ART) outcomes in infertile patients with mild-severe OA.

Maternal lifestyle and nutritional habits are associated with oocyte quality and ICSI clinical outcomes

Research questionDo maternal lifestyle factors influence the incidence of oocyte dimorphisms and outcomes of intracytoplasmic sperm injection (ICSI) cycles? DesignA total of 752 female patients undergoing an ICSI cycle at a private university-affiliated IVF centre from January 2015 to December 2019 were included in this historical cohort study. Before starting ovarian stimulation, participants completed a questionnaire on cigarette smoking habits, consumption of alcoholic beverages, refined sugar, artificial sweeteners, soft drinks, fruits, legumes and vegetables, milk and dairy, and meat, as well as exercise frequency over the past 6 months. Oocyte morphology was evaluated before ICSI. The influence of maternal lifestyle factors on the incidence of oocyte dimorphisms and ICSI outcomes was evaluated by multivariate general linear models and generalized linear models, adjusted for potential confounders. The main outcome measures were the incidence of oocyte dimorphisms per cycle and clinical outcomes. ResultsLifestyle factors and nutritional habits such as cigarette smoking, and the consumption of alcohol, refined sugar and artificial sweeteners, were positively associated with incidence of several oocyte dimorphisms and negatively associated with the response to ovarian stimulation and embryo development. Negative relationships were also observed between these habits and clinical outcomes, apart from miscarriage rate, in which positive relationships were observed. Significant negative dose-dependent relationships between these habits and implantation rates were noted (P < 0.001). Alcoholic beverage consumption also showed inverse dose-dependent relationships with clinical pregnancy and live birth rates. Live birth rate was also negatively associated with cigarette smoking, in a dose-dependent manner. ConclusionsPoor maternal habits were associated with reduced oocyte quality and ICSI outcomes in this study. Many of these associations were shown to be dose-dependent.

A dietary score representing the overall relation of men’s diet with semen quality in relation to outcomes of infertility treatment with assisted reproduction

ObjectiveTo examine the impact of men’s diet on outcomes of infertility treatment with assisted reproductive technology (ART) using an empirical score representing the relation of diet with semen quality.DesignProspective cohort study.SettingFertility center at an academic medical center.Patient(s)We included 296 men (688 semen samples) to identify an empirical dietary pattern and 231 couples (406 ART cycles) to investigate the association of this diet pattern with ART outcomes.Intervention(s)Men’s diet was assessed at baseline using a validated questionnaire. An empirical dietary pattern reflecting the overall relation of diet with semen quality was identified using reduced rank regression.Main Outcome Measure(s)The primary outcome was live birth per treatment cycle. The secondary outcomes were fertilization, implantation, and clinical pregnancy.Result(s)Men had a median baseline age and body mass index of 36.8 years and 26.9 kg/m2, respectively. Although the empirical diet pattern was significantly associated with all semen parameters, the empirical diet score was not related to any clinical outcome of infertility treatment after ART. The adjusted probabilities of relevant clinical outcomes in the lowest and highest quartiles of the empirical score were 0.62 (0.50–0.73) and 0.55 (0.45–0.66) for implantation, 0.57 (0.46–0.69) and 0.50 (0.40–0.61) for clinical pregnancy, and 0.49 (0.37–0.62) and 0.36 (0.25–0.48) for live birth. Analyses excluding couples with a diagnosis of male factor infertility and, separately, excluding intracytoplasmic sperm injection cycles yielded similar results.Conclusion(s)A dietary score representing the overall association of diet with semen quality parameters was not associated with ART outcomes.

MP31-04 DOES INTRACYTOPLASMIC MORPHOLOGICALLY SELECTED SPERM INJECTION IMPROVE LIVE BIRTH RATES COMPARED TO ICSI IN MEN WITH INFERTILITY AND RAISED SPERM DNA FRAGMENTATION?

You have accessJournal of UrologyInfertility: Therapy (MP31)1 Sep 2021MP31-04 DOES INTRACYTOPLASMIC MORPHOLOGICALLY SELECTED SPERM INJECTION IMPROVE LIVE BIRTH RATES COMPARED TO ICSI IN MEN WITH INFERTILITY AND RAISED SPERM DNA FRAGMENTATION? Runzhi Chen, Tharu Tharakan, Channa Jayasena, Sheena Lewis, Jaya Parikh, Meen-Yau Thum, James Nicopoullos, Tet Yap, and Suks Minhas Runzhi ChenRunzhi Chen More articles by this author , Tharu TharakanTharu Tharakan More articles by this author , Channa JayasenaChanna Jayasena More articles by this author , Sheena LewisSheena Lewis More articles by this author , Jaya ParikhJaya Parikh More articles by this author , Meen-Yau ThumMeen-Yau Thum More articles by this author , James NicopoullosJames Nicopoullos More articles by this author , Tet YapTet Yap More articles by this author , and Suks MinhasSuks Minhas More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002035.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: There is conflicting evidence on the role of intracytoplasmic morphologically selected sperm injection (IMSI) in assisted reproductive technology (ART), and whether it increases live birth rates (LBR) compared to conventional intracytoplasmic sperm injection (ICSI). In particular, the role of IMSI on ART outcomes in infertile men with raised sperm DNA fragmentation (SDF) is controversial. METHODS: We performed a retrospective analysis of 2,693 ICSI and 765 IMSI cycles from a single institution. Primary outcome measures included fertilisation rate (FR), clinical pregnancy rate (CPR), miscarriage rate (MR), and live birth rates (LBR). Subgroup analysis was performed on couples who had undergone SDF testing with the Comet assay. Multiple regression analysis was performed to identify variables which may predict LBR in both the overall cohort of patients, and in the subgroup of patients with SDF data. An average Comet score (ACS) of ≥29% was used as the threshold for elevation, as previously defined. RESULTS: The LBR was comparable between ICSI and IMSI cycles in the overall study population; 18.1% and 21.0%, respectively. Subgroup analysis of men with a raised SDF (Table 1) demonstrated a lower MR (40.9% vs. 88.9%, p=0.003) and higher LBR (17.5% vs. 3.2%, p=0.003) in IMSI compared to ICSI cycles. No differences in clinical outcomes were observed between IMSI and ICSI cycles in men with a normal SDF. Multiple regression analysis revealed that IMSI significantly increased the probability of LBR (OR 7.052 [95% CI 1.826–27.237], p=0.005) in men with raised SDF. . . CONCLUSIONS: This study indicates that whilst IMSI may not be beneficial in the general infertile male population undergoing ART, it does improve LBR in men with raised SDF and male factor infertility. Source of Funding: N/A © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e556-e556 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Runzhi Chen More articles by this author Tharu Tharakan More articles by this author Channa Jayasena More articles by this author Sheena Lewis More articles by this author Jaya Parikh More articles by this author Meen-Yau Thum More articles by this author James Nicopoullos More articles by this author Tet Yap More articles by this author Suks Minhas More articles by this author Expand All Advertisement Loading ...

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.

MP31-06 MICRODISSECTION TESTICULAR SPERM EXTRACTION IS AN EFFECTIVE CHOICE TO OPTIMIZE FERTILITY OUTCOMES IN SEVERE OLIGOZOOSPERMIC PATIENTS WHO HAD PRIOR ONE OR MORE ASSISTED REPRODUCTIVE TECHNOLOGY FAILURE

You have accessJournal of UrologyInfertility: Therapy (MP31)1 Sep 2021MP31-06 MICRODISSECTION TESTICULAR SPERM EXTRACTION IS AN EFFECTIVE CHOICE TO OPTIMIZE FERTILITY OUTCOMES IN SEVERE OLIGOZOOSPERMIC PATIENTS WHO HAD PRIOR ONE OR MORE ASSISTED REPRODUCTIVE TECHNOLOGY FAILURE Cheng-Han Tsai, Wei-Jen Chen, I-Shen Huang, Yi-Hsiu Huang, and William J. Huang Cheng-Han TsaiCheng-Han Tsai More articles by this author , Wei-Jen ChenWei-Jen Chen More articles by this author , I-Shen HuangI-Shen Huang More articles by this author , Yi-Hsiu HuangYi-Hsiu Huang More articles by this author , and William J. HuangWilliam J. Huang More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002035.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The aim of this study is to assess the fertility outcomes of intracytoplasmic sperm injection (ICSI) using testicular sperm retrieved by either conventional or microdissection testicular sperm extraction (cTESE or mTESE) in oligozoospermic men who failed to conceive their wives in prior assisted reproductive technology (ART) attempts using ejaculated sperm. METHODS: We retrospectively reviewed the charts of 32 oligozoospermic men who had failed one or more in vitro fertilization (IVF) or ICSI cycles using ejaculated sperm. They were categorized into 3 subgroups according to the sperm concentration: 5-20, 1-5 and <1 million/mL respectively. cTESE was done for all 3 groups. Nine patients in group <1 million/mL failed in the cTESE cycle and proceeded to mTESE. The sperm isolated were all used for ICSI. RESULTS: For these 32 patients, mean age was 38.9±5.4 years. Sperm retrieval rate was 100% in both groups. The female partners showed no difference in all groups. The overall fertilization rate per ICSI cycle was 64.8% and pregnancy rate was 46.9%. For patients underwent cTESE, the pregnancy rates were 75%, 18.2% and 15.4% for the group 5-20, 1-5 and <1 million/mL respectively. In 9 patients of <1 million/mL group, sperm retrieval was done by mTESE and the pregnancy rate was 55.6% (p=0.047, compared to cTESE in the <1 million/mL group). There was no complication occurred after testicular sperm extraction. CONCLUSIONS: Testicular sperm retrieval for ICSI is safe and results in much better pregnancy rates in oligozoospermic men who had prior one or more ART failure using ejaculated sperm. Furthermore, mTESE may be considered an effective choice to optimize ICSI outcomes in severe oligozoospermic patients. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e557-e557 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Cheng-Han Tsai More articles by this author Wei-Jen Chen More articles by this author I-Shen Huang More articles by this author Yi-Hsiu Huang More articles by this author William J. Huang More articles by this author Expand All Advertisement Loading ...

BLASTOCYST FORMATION IS NOT AFFECTED BY FEMALE OBESITY: A MORPHOKINETIC STUDY

To determine whether the embryo cleavage pattern and the rate of blastocyst formation differs between normal weight and obese women undergoing in vitro fertilization (IVF) with ICSI (intracytoplasmic sperm injection). This is a retrospective cohort study performed from January 2016 to May 2020 in IVIRMA-Valencia. A total of 3,316 ICSI cycles from 2,822 women were included, with 1,251 cycles belonging to the Preimplantation Genetic Testing (PGT) program. Patients were grouped according to their body mass index (BMI).Underweight was defined as a BMI < 18.5 kg/m2 (n = 173 cycles from 140 women), normal weight as a BMI of 18.5–24.9 kg/m2 (n= 2,339 cycles from 1,989 women), overweight as a BMI of 25–29.9 kg/m2(n = 643 cycles from 548 women) and obesity as a BMI of >30 kg/m2 (n =161 cycles from 145 women).All embryos were grown in vitro until the fifth or sixth day in a time-lapse system - EmbryoScope, EmbryoScope Plus (Vitrolife) and Geri Plus (GeneaBiomedx) - and its development was assessed on an external computer with a specific software for the purpose. There were no differences in sperm parameters or male age among the four BMI groups. Underweight women were l year or less younger than the other three groups. The percentage of women with polycystic ovary syndrome was higher but not significantly different in the obese group. Indications for PGT do not differ among groups .The number of oocytes retrieved or mature oocytes microinjected was significantly higher in the obese group than in the normal weight group. However, fertilization rates and number of embryos transferred were similar in the four BMI groups. A higher percentage of surplus embryos for freezing was observed in the underweight group when compared to normal weight women. All the embryos were transferred or frozen in blastocyst stage. Despite an initial slower pattern of embryo development, the final blastocyst formation rate in day 5 or in day 5 plus day 6 did not differ in obese women when compared to the other BMI groups. Moreover, embryo quality, based on the evaluation of inner cell mass and trophectoderm in both days of blastocyst development was similar across BMI groups. The same was observed with respect to the pattern of development and arrest up to blastocyst formation and the different categories of full, expanded and hatching blastocysts. Blastocyst formation is not affected by female BMI.

IMPACT OF VITAMIN D DEFICIENCY ON ANEUPLOIDY IN PATIENTS UNDERGOING PREIMPLANTATION GENETIC TESTING

This study seeks to analyze the impact of patient serum vitamin D levels on embryonic aneuploidy for in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) cycles with preimplantation genetic testing for aneuploidy (PGT-A).

Efficacy of three COS protocols and predictability of AMH and AFC in women with discordant ovarian reserve markers: a retrospective study on 19,239 patients

BackgroundRecent studies have consistently shown that AFC and serum AMH are good predictors of ovarian response and have shown strong correlations. However, it is not unusual for reproductive medicine specialists to encounter discordance between them. This is the first study to investigate the efficacies of the different COS protocols when the AFC and AMH levels are discordant. Based on the association between COS protocols and pregnancy outcomes, we attempt to explain the controversial results and clarify the predictive value of AMH and AFC in this context.Methods19,239 patients undergoing their first fresh in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) cycles with GnRH antagonist protocols, GnRH-a long protocols or GnRH-a ultra-long protocols between January 1, 2016, and December 31, 2019, were enrolled and then divided into four groups in accordance with the boundaries for the AFC and serum AMH level provided by the Poseidon Classification. Our study was divided into two parts. Firstly, we retrospectively compared the effects of the three COS protocols in patients with discordant AMH and AFC. Multivariate logistic regression models were conducted in a forward manner to exclude the influence of confounding factors. Afterward, to increase comparability between Group 2 (low AMH and normal AFC) and Group 3 (normal AMH and low AFC), propensity score matching (PSM) analysis was performed based on age, BMI, the number of embryos transferred, and COS protocol. IVF intermediate and reproductive outcomes were compared between Group 2 and Group 3.ResultsFor people with low AMH and normal AFC (Group 2), the number of total oocytes, clinical pregnancy rate (CPR), live birth rate (LBR) and cumulative live birth rate (CLBR) were significantly higher in GnRH-a ultra-long protocol compared with GnRH antagonist protocol. In multivariate logistic regression models, significant associations of COS protocol with fresh LBR and CPR were found after adjusting for age, BMI, AFC, AMH and the number of embryos transferred. Whereas, in patients with normal AMH and low AFC (Group 3), the number of total oocytes, CLBR, LBR and CPR were highest in the long GnRH-a protocol although there was no statistically significant difference. After PSM, the results showed that although oocytes yield and available embryos in patients with normal AMH and low AFC were significantly higher, there was no significant difference in reproductive outcomes between Group 2 and Group 3.ConclusionsWe found that women with normal AFC and low AMH may benefit from the GnRH-a ultra-long protocol. Nevertheless, for women with normal AMH and low AFC, the long GnRH-a protocol seems to be associated with better clinical outcomes. Furthermore, after eliminating the confounding factors including the COS protocol, we found that AMH can only predict the number of oocytes but not the quality of oocytes when there was discordance between AFC and AMH.

Elevated seminal protein carbonyl concentration is correlated with asthenozoospermia and affects adversely the laboratory intracytoplasmic sperm injection (ICSI) outcomes.

Elevated concentrations of reactive oxygen species (ROS) in the semen can lead to oxidative protein damage as they react with the amino acids' side chains in the protein, leading to the generation of carbonyl groups. This study aimed to investigate the effect of protein carbonyl (PC) concentration on sperm motility and the laboratory intracytoplasmic sperm injection (ICSI) outcomes. A total of 150 couples from the ICSI cycle were enrolled in this study and were divided into three groups (G) according to the PC concentration as following, G1 included samples with PC concentrations <0.65nmol/mg, G2 included samples with 0.65≤PC≤2.23nmol/mg and G3 included samples with PC>2.23 (nmol/mg). PC concentrations were measured in all semen samples, and the laboratory ICSI outcomes were evaluated for all injected oocytes. The Kruskal-Wallis p-values for the differences in the medians of sperm motility, fertilisation rate, embryo cleavage score and embryo quality score were <0.05. Furthermore, Dunn's post hoc test showed a significant difference between all groups, p-values <0.05, except for the medians of embryo quality score between G2 and G3. In conclusion, our results showed that sperm motility and laboratory ICSI outcomes are affected negatively by higher concentrations of PC in the semen.