Intracytoplasmic Sperm Injection Fertilization Rate Research Articles

Hashimoto’s Thyroiditis Negatively Influences Intracytoplasmic Sperm Injection Outcome in Euthyroid Women on T4 Substitution Therapy: A Retrospective Study

Objective: The objective of this study was to analyze the impact of thyroid autoimmunity (TAI) on reproductive outcome parameters of intracytoplasmic sperm injection (ICSI) cycles as compared to TAI-negative ICSI cycles. Design: In this single in vitro fertilization (IVF) center retrospective study, 86 infertile women with elevated thyroid peroxidase or TGAb levels, but euthyroid after thyroxine replacement (study group), were compared to 69 female patients with no thyroid abnormalities (controls). Following ICSI treatment fertilization rate (FR), clinical pregnancy rate (CPR), miscarriage rate (MR), and live birth rate (LBR) were analyzed. Materials, Setting, Methods: All subjects with various infertility factors were treated with ICSI in university-based IVF center. Patients in the study group received thyroxine replacement and were euthyroid at IVF treatment. Before the IVF cycles, endocrinological parameters were uniformly assessed: thyroid function and antibodies, reproductive hormones (anti-Müllerian hormone [AMH], follicular stimulating hormone [FSH], luteinizing hormone, E2, PRL, testosterone, DHEAS, 17-OHP, AD) and OGTT (0–60–120 min glucose and insulin). Following descriptive comparison of laboratory parameters, age-adjusted analyses of FR, CPR, MR, and LBR were performed. Results: TAI-positive women were older (mean age 35.31 ± 4.95 vs. 32.15 ± 4.87 years; p = 0.002), had higher FSH (8.4 ± 3.4 vs. 7.4 ± 2.32 U/L; p = 0.024), higher E2 (53.94 ± 47.61 vs. 42.93 ± 18.92 pg/mL; p = 0.025) levels, while AMH (2.88 ± 2.62 vs. 3.61 ± 1.69 ng/mL; p = 0.0002) was lower. There were no differences in TSH levels (1.64 ± 0.96 vs. 1.66 ± 0.65 µIU/mL; p = 0.652) between the two groups. FT3 (2.63 ± 0.58 vs. 2.98 ± 0.55 pg/mL; p = 0.002) was lower and FT4 (1.3 ± 0.29 vs. 1.13 ± 0.21 ng/dL; p = 0.0002) was higher in the TAI-positive group, reflecting clinically irrelevant differences. Egg cell counts (6 ± 3.8 vs. 7.5 ± 3.95; p = 0.015) were lower in TAI and remained so following age adjustment. Although the overall ICSI FR did not differ (62.9% vs. 69.1%, p = 0.12), it was lower for patients under 35 with TAI showing decreasing differences in line with age. The CPR (36.04% vs. 69.56%; p < 0.001) and LBR (23.25% vs. 60.86%; p < 0.001) were lower, the MR (35.48% vs. 12.5%; p = 0.024) was higher in the TAI group, and these differences remained after age adjustment. Limitations: Since the higher age of the study group may interfere with the effect of TAI, age adjustment calculations were necessary to perform to eliminate this confounding factor. Conclusion: Despite optimal thyroid supplementation in clinical or subclinical hypothyroidism, the presence of TAI negatively influences CPR and is connected to a higher MR, thus resulting in a lower LBR after ICSI. Decreased FR with ICSI in TAI patients may also contribute to poorer outcomes, especially in younger women.

Defects in phospholipase C zeta cause polyspermy and low fertilization after conventional IVF: not just ICSI failure.

Phospholipase C zeta (PLCζ) is a key sperm-borne oocyte-activating factor that triggers Ca 2+ oscillations and the subsequent block to polyspermy following gamete fusion. Mutations in PLCZ1 , the gene encoding PLCζ, cause male infertility and intracytoplasmic sperm injection (ICSI) fertilization failure; and PLCζ expression and localization patterns are significantly correlated with ICSI fertilization rate (FR). However, in conventional in vitro fertilization (cIVF), whether and how sperm PLCζ affects fertilization remain unclear. Herein, we identified one previously reported and two novel PLCZ1 mutations associated with polyspermy in vitro that are characterized by excessive sperm-zona binding and a delay in pronuclei (PN) formation. Immunofluorescence staining and oocyte activation testing revealed that virtually all spermatozoa from patients lacked functional PLCζ and were thus unable to evoke Ca 2+ oscillations. ICSI with an artificial oocyte activation treatment successfully rescued the polyspermic phenotype and resulted in a live birth. Furthermore, we analyzed PLCζ in an additional 58 males after cIVF treatment in the Reproductive and Genetic Hospital of CITIC-Xiangya (Changsha, China) between February 2019 and January 2022. We found that the proportion of spermatozoa that expressed PLCζ was positively correlated with both 2PN rate and total FR. The optimal cutoff value below which males were likely to experience low FR (total FR ≤30%) after cIVF was 56.7% for the proportion of spermatozoa expressing PLCζ. Our study expands the mutation and the phenotypic spectrum of PLCZ1 and further suggests that PLCζ constitutes a promising biomarker for identifying low FRs cases in cIVF due to sperm-related oocyte activation deficiency and that sperm PLCζ analysis may benefit the wider male population and not only men with ICSI failure.

P-058 Defects in phospholipase C zeta cause polyspermy and low fertilization after conventional IVF: not just ICSI failure

Abstract Study question How does sperm phospholipase C zeta (PLCζ) affect fertilization in conventional in vitro fertilization (cIVF)? Summary answer Absence of PLCζ causes polyspermy, and a decline in the proportion of sperm expressing PLCζ is correlated with a low fertilization rate (FR) after cIVF. What is known already PLCζ is a key sperm-borne factor that triggers Ca2+ oscillations and the subsequent oocyte activation following gamete fusion. Mutations in PLCZ1, the gene encoding PLCζ, cause male infertility and intra-cytoplasmic sperm injection (ICSI) fertilization failure; and PLCζ expression and localization patterns are significantly correlated with ICSI FR. However, few studies have been published on the relationship between PLCζ and cIVF, an insemination procedure involving several key events that are bypassed in ICSI, e.g., sperm-zona binding and penetration, as well as polyspermy blocking. It is possible that sperm PLCζ may affect fertilization in a different manner from that in ICSI. Study design, size, duration Sixty couples who underwent cIVF treatments were recruited from the Reproductive and Genetic Hospital of CITIC-Xiangya between February 2019 and January 2022. Participants/materials, setting, methods We performed whole-exome sequencing in two unrelated males who exhibited infertility and polyspermy in cIVF. Immunofluorescence staining and oocyte-activation testing were employed to evaluate the effects of the candidate variants on PLCζ protein. Subsequent PLCζ analysis was performed in additional 58 males who underwent cIVF. The Pearson correlation coefficient was performed to evaluate the relationships between PLCζ and FRs. The receiver operating characteristic curve and Youden’s index analysis were used to indicate the cutoff value. Main results and the role of chance We identified one previously reported and two novel PLCZ1 variants in two males that were associated with male infertility and polyspermy characterized by excessive sperm–zona binding and a delay in pronuclear (PN) formation. In vitro functional analyses revealed that virtually all sperm from patients lacked functional PLCζ and were thus unable to evoke the physiologic pattern of Ca2+ oscillations. ICSI with an artificial oocyte-activation treatment successfully rescued the polyspermic phenotype and resulted in a live birth. Subsequent PLCζ analysis were performed in additional 58 males, who were allocated to three groups according to fertilization outcomes: a multiple pronuclear (MPN) group (no. of PN ≥ 3, MPN rate ≥ 50%, n = 9) and low fertilization (LF, total FR ≤ 30%, n = 18) and normal fertilization groups (NF, 2PN ≥ 50%, 1PN + MPN &amp;lt; 30%, n = 31). We found that the proportion of sperm that expressed PLCζ was positively correlated with both 2PN rate (P = 0.0005) and total FR (P = 0.0008) after cIVF, and that the optimal cutoff value below which males were likely to experience low FR (total FR ≤ 30%) after cIVF was 56.7% (area under the ROC curve, 0.705; P = 0.0176). Limitations, reasons for caution Precise mechanisms that underly the roles of PLCζ in cIVF outcomes are still uncovered. Follow-up studies with larger numbers of patients are required to validate the sensitivity, specificity, and accuracy of PLCζ as a diagnostic biomarker in cIVF outcomes. Wider implications of the findings Our study identified PLCZ1 as a novel causative gene of polyspermy in humans,highlighting the potential value of PLCζ as a fertility marker for cIVF outcomes. Trial registration number nor applicable

P-278 What are the effects of ICSI procedure time intervals on in vitro fertilization outcomes?

Abstract Study question Do time intervals between oocyte pick-up (OPU), oocyte denudation (OD), and Intra-cytoplasmic Sperm Injection (ICSI) impact ICSI outcomes? Summary answer ICSI time intervals impact oocyte maturation, blastulation and pregnancy rates. There is no effect on fertilization and cleavage rates. What is known already Cytoplasmic and nuclear oocyte maturation are crucial for the success of in vitro fertilization and embryo development. Cumulus cells enhance oocyte maturation. Therefore, prolonged oocyte culture prior to denudation may induce oocyte apoptosis. There is no consensus for optimal time intervals between different ICSI procedures and their effects on fertilization, embryo and blastocyst, development and pregnancy rates. Study design, size, duration A retrospective analysis of 794 ICSI fresh cycles was performed at the Alyssa Fertility Group Center, between Juin 2021 and December 2022. Participants/materials, setting, methods ICSI cycles were performed on women aged ≤40 years, with at least 3 mature oocytes. Semen partner concentrations greater than 1million/mL were included. Time intervals between OPU, OD, and ICSI were recorded. We evaluate the effects of these timing intervals on oocyte maturation, fertilization, embryo development and pregnancy rates. Statistical analysis was performed using SPSS 22.0. Kolmogorov–Smirnov, Student t, Pearson tests, and ROC curve analysis were used. Level of signification p-value &amp;lt;0.05. Main results and the role of chance The mean women’s age was 33,2 years (SD 4,4). Mean times in hours for OPU/OD, OD/ICSI, and OPU/ ICSI were respectively: 01:28(SD 00:37); 02:35(SD 01:01); 04:03(SD 01:08). Positive correlations were seen between maturation rate and OPU/OD; OPU/ICSI intervals respectively (r = 0,217, p = 0,002; r = 0,193, p = 0,005).There were no significant correlation between ICSI time intervals, fertilization and cleavage rates. Top quality embryos rates were positively associated with OPU/OD time interval (r = 0,136: p = 0,049). The blastulation rate was positively associated with OPU/OD, OD/ICSI, and OPU/ICSI time intervals respectively(r = 0,183: p = 0,008; r = 0,211: p = 0,002; r = 0,279: p &amp;lt; 0,001).Pregnancy rates were positively correlated to OD/ICSI and OPU/ICSI respectively: (r = 0,158: p = 0,022; r = 0,188: p = 0,006). The ROC curves analysis revealed that the cut off value of time intervals between: OPU/OD was 01:10 (AUC = 0,554; IC 95% 0,476-0,632), p = 0,185; OD/ICSI was 02:20 (AUC = 0,600; IC 95% 0,516-0,669), p = 0,023 and for OPU/ICSI: 03:50, (AUC = 0,600; IC 95% 0,524-0,676), p = 0,014. Limitations, reasons for caution Trigger time is an important factor for oocyte maturation that should be noted. This study is limited by its retrospective nature. Potential unmeasured confounding factor cannot be excluded Wider implications of the findings Time intervals between all the ICSI procedures affect reproductive outcomes. According to our findings, excessive oocyte incubation time before denudation should be avoided. ICSI should be performed 2 hours after OD. Time intervals should be adjusted according to laboratory practice to improve ICSI outcomes. Trial registration number Not applicable

P-206 An evaluation of the incidence of total failed fertilization (TFF) following conventional IVF (cIVF) and the outcome of subsequent intracytoplasmic sperm injection (ICSI) cycles

Abstract Study question What is the incidence of TFF following conventional IVF (cIVF) and the chance of live birth in subsequent ICSI treatment cycles after TFF? Summary answer The incidence of TFF might be higher than previously reported and establishment of in-house benchmarks are recommended. Treatment continuation results in acceptable live birth rates. What is known already TFF following a cIVF is a devastating outcome for patients and physicians. The fear of this unfortunate event is assumable one of the main drivers for overutilizing ICSI. The incidence of TFF after cIVF should be less than 5 % of stimulated cycles based on ESHREs recommended performance indicators. Data on TFF of an unselected population is indeed however only available from an era when ICSI was not in use and showed a higher rate. We investigated the incidence of TFF and evaluated the chance of live birth following of such event at the first cycle. Study design, size, duration A single center, retrospective chart review for the time period of 2010-2021 was done to identify all cycles where cIVF did not result in at least one oocyte with ≥ 2 pronuclei. Also, patients who had more than 2 oocytes retrieved in their first cycle and continued their treatment using ICSI as a fertilization method in their upcoming cycles were selected. Participants/materials, setting, methods A total of 5772 initiated IVF cycles were identified in the electronic database for the examined time period. Criterion for cIVF was normozoospermia and applied as fertilization method in 1001 (17.3%) cycles. All the cases where TFF was noted following cIVF were retrieved and the number of oocytes, the rank of the cycle, female age and the result of upcoming cycles if any were recorded. Data was analyzed using Chi-Square test, p &amp;lt; 0.05 was considered significant. Main results and the role of chance A total of 125 TFF cycles were identified out of the 1001 cIVF cycles (12.49% failed fertilization rate per cIVF). A significantly higher frequency of TFF was seen in cycles where less than 3 oocytes were retrieved compared to those with more than two oocytes (38/99 [38.38%] vs. 87/902 [9.65%], p &amp;lt; 0.001). No statistical difference was detected between the risk of TFF occurring at the first, second or the third rank cIVF cycle (87/664 [13.10%], 30/224 [13.39%], 5/75 [6.67%] respectively; p &amp;gt; 0.05). The differences remained non-significant when only cycles with more than 2 oocytes were analyzed (67/608 [11.02%], 16/199 [8.04%], 4/68 [5.88%] respectively; p &amp;gt; 0.05). Also, different age groups showed similar incidence of TFF (16/157 [10.19%], 41/362 [11.33%], 54/381 [14.17%] and 14/101 [13.86%] in &amp;lt; 30, 31-35, 36-40 and &amp;gt;40 years of age respectively; p &amp;gt; 0.05). A total number of 56 patients were identified who continued their treatment using ICSI as fertilization method in their upcoming cycles. These patients completed 101 cycles resulting in 3 TFF cases (3%) and a fertilization rate of 75.1% (524/698) which was significantly higher to our baseline ICSI fertilization rate (70.9% [25231/35568]; p &amp;lt; 0.05). Nineteen of these 56 patients (33.9%) ended up giving at least one live birth following treatment continuation. Limitations, reasons for caution Selection criteria, e.g. patient characteristics and treatment type such as PGT-A, for choice of fertilization method are probably a source of variation in TFF incidence between centers. It is recommended that laboratories establish their own benchmark values based on their own data for the incidence of TFF. Wider implications of the findings Previous studies identified serum luteinizing hormone and progesterone levels at trigger and the number of oocytes as critical predictors for TFF. The similar chance of TFF after previous successful fertilization suggests more involvement of female factors in TFF. Acceptable live birth rates can be achieved following treatment continuation. Trial registration number not applicable

The Association of Sperm DNA Fragment and Assisted Reproductive Outcomes: A Meta-Analysis.

Objective To analyze the effect of sperm DNA fragmentation index (DFI) on the outcomes of in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI). Methods Literature search was conducted on English databases PubMed, Cochrane, and Embase to obtain eligible studies. Results A total of 11 cohort studies were included and analyzed using the random effects model. The results illustrated that the IVF fertilization rate (RR = 0.94, 95% CI: 0.77-1.14, P = 0.61), pregnancy rate (RR = 0.83, 95% CI: 0.57-1.21, P = 0.32), and live birth rate (RR = 0.53, 95% CI: 0.16-1.80, P = 0.31) in the high DFI group were statistically insignificant with those in the low FI group. The correlations between DFI and ICSI fertilization rate (RR = 0.79, 95% CI: 0.52-1.18, P = 0.25), pregnancy rate (RR = 0.89, 95% CI: 0.74-1.06, P = 0.18), and live birth rate (RR = 0.89, 95% CI: 0.70-1.14, P = 0.36) were also not statistically significant. Conclusion This study has observed no significant correlation between sperm DFI and assisted reproductive outcomes. Multicenter large-sample clinical trials are required to conclusively determine the impact of DNA damage on the clinical outcomes of assisted reproduction.

Impact of Living in Different Altitudes on Intracytoplasmic Sperm Injection (ICSI) Outcomes for Infertile Couples in Southwestern Region of Saudi Arabia, a Retrospective Study

Objective: The aim of this study was to determine the effect of different altitudes in the Southwestern region of Saudi Arabia on ICSI outcomes, fertilization rate, embryo quality, pregnancy rate, and miscarriage rates for infertile couples. Materials and Methods: This is a retrospective study on 551 infertile couples carried out in the Assisted Reproductive Technology unit at the Maternity and Childern Hospital in Abha, Saudi Arabia between 2018 and 2019 to compare ICSI outcomes in different altitudes. Low altitude (205 patients), mild altitude (86 patients) and high altitude (260 patients). Main result measurements: fertilization rates, embryo quality, clinical pregnancy and miscarriage rates at different altitudes. Results: The data showed that there were no significant differences (P&gt;0.67) in fertilization rates and the number of good-quality embryos between different altitudes. Importantly, clinical pregnancy rates were similar between groups and there was no significant difference in the miscarriage rates between high, mild and low altitudes. Conclusions: This study demonstrates that there is now increased risk of miscarriage or low pregnancy rates with different altitudes in Southwestern region of Saudi Arabia. This suggests that altitude changes has no obvious risk on pregnancy rate and pregnancy outcome.

Correction: Decreased Sperm Motility Retarded ICSI Fertilization Rate in Severe Oligozoospermia but Good-Quality Embryo Transfer Had Achieved the Prospective Clinical Outcomes

[This corrects the article DOI: 10.1371/journal.pone.0163524.].

Decreased Sperm Motility Retarded ICSI Fertilization Rate in Severe Oligozoospermia but Good-Quality Embryo Transfer Had Achieved the Prospective Clinical Outcomes.

IntroductionSpermatozoa motility is the critical parameter to affect the treatment outcomes during assisted reproductive technologies (ART), but its reproductive capability remains a little informed in condition of severe male factor infertility. This retrospective cohort study aimed to evaluate the effects of reduced sperm motility on the embryological and clinical outcomes in intra-cytoplasmic sperm injection (ICSI) treatment of severe oligozoospermia.Patients and Methods966 cycles (812 couples) of severe oligozoospermia diagnosed by spermatozoa count ≤ 5 × 106/mL and motile spermatozoa ≤ 2 × 106/mL were divided into four groups in according to the number of motile spermatozoa in one ejaculate on the day of oocyte retrieval (Group B—E). The control (Group A) was 188 cycles of moderate oligozoospermia with spermatozoa count > 5 × 106/mL and motile spermatozoa > 2 × 106/mL. All female partners were younger than 35 years of age. Logistic regression analyzed embryological outcomes (the rates of fertilization, cleavage and good-quality embryo) and clinical outcomes (the rates of pregnancy, implantation, early miscarriage and live birth). Quality of embryo transfer (ET) was divided into three classes as continuous factor to test the effects of embryo quality on clinical outcomes.ResultsThe reduction in the number of motile sperm in four groups of severe oligozoospermia gave rise to comparable inability of the fertilization (p < 0.001) and a decreased rate of good-quality embryo at Day 3 (p < 0.001) by compared to the control. The cleavage rate of the derived zygotes was similar to the control. ET classes significantly affected the clinical outcomes (p < 0.001). Class I ET gave rise to similar rates of clinical outcomes between five groups, but Class II and Class III ET retarded the rates of pregnancy, implantation and live birth and this particularly occurred in Group C, D and E. The rate of early miscarriage was not comparably different between groups. Overall rates in all groups were 41.26% clinical pregnancy, 25.74% implantation and 36.32% live birth, which gave live birth to 252 girls and 252 boys.ConclusionsThe reduction of motile spermatozoa in severe oligozoospermia decreased the rates of fertilization and good-quality embryo. Obtaining and transfer of good-quality embryos was the good prognostic to achieve prospective clinical outcomes regardless of the severity of oligozoospermia.

Use of testicular versus ejaculated sperm for intracytoplasmic sperm injection among men with cryptozoospermia: a meta-analysis

To examine outcomes of intracytoplasmic sperm injection (ICSI) using testicular versus ejaculated sperm among men with cryptozoospermia. Meta-analysis. Not applicable. Men with cryptozoospermia undergoing consecutive ICSI cycles using ejaculated or testicular sperm. A systematic search was performed using PubMed (inception to August 2015). Inclusion criteria were studies comparing ICSI outcomes among men with cryptozoospermia using ejaculated and testicular sperm. Primary outcomes included ICSI fertilization or pregnancy rates (PRs). Secondary analysis included number of retrieved oocytes, maternal and paternal ages. Meta-analysis of weighted data using a random effects model was performed. Results are reported as relative risk or weighted mean differences (WMD) with 95% confidence intervals (CI). Five cohort studies were included, encompassing 272 ICSI cycles and 4,596 injected oocytes. There were no differences in ICSI PRs (relative risk [RR] 0.53, 95% CI 0.19-1.42, I(2) = 67%) or fertilization rates (RR 0.91, 95% CI 0.78-1.06, I(2) = 73%) between testicular and ejaculated sperm groups. There was a significant trend toward increasing maternal age (WMD 1.69years, 95% CI -2.71 to -0.66) and paternal age (WMD 2.61years, 95% CI -4.73 to -0.48) with testicular sperm. There was no difference between numbers of oocytes retrieved (WMD 0.95, 95% CI -0.15 to 2.05). Post-hoc power analysis revealed pβ <20% for PR analysis and pβ <10% for fertilization rate analysis. The existing literature does not support a recommendation for men with cryptozoospermia to use testicular sperm in preference over ejaculated sperm for ICSI.

Use of testicular versus ejaculated sperm for intracytoplasmic sperm injection among men with cryptozoospermia: a meta-analysis

The question of whether or not to proceed with intracytoplasmic sperm injection (ICSI) using ejaculated or testicular sperm among men with cryptozoospermia remains unanswered. Our aim was to examine the relationship between sperm source in men with cryptozoospermia--ejaculated versus testicular--and ICSI outcomes. Meta-analysis. A systematic search was performed in PubMed (inception to March 2015). Search terms included variations on: ‘cryptozoospermia’, ‘severe oligozoospermia’, ‘oligo-astheno-teratozoospermia’, ‘ejaculated’, and ‘testicular’. Inclusion criteria included human studies comparing ICSI outcomes among men with cryptozoospermia who underwent consecutive ICSI cycles using either testicular or ejaculated sperm. Primary outcomes included fertilization rate or pregnancy rate. The secondary outcome was maternal age at time of ICSI. Meta-analysis of weighted data was performed using RevMan 5.3 and a random effects model was employed, due to clinical heterogeneity among the studies. Results are reported as odds ratio (OR) or weighted mean differences (WMD) with 95% confidence interval. A total of 773 studies were identified, of which five cohort studies were included for analysis.(1-5) The included studies examined either pregnancy or fertilization rates, encompassing 272 ICSI cycles and 2547 injected oocytes, respectively. There were no differences in the ICSI pregnancy rates (OR 0.44, 95% CI: 0.12-1.64, p=0.22, I2=69%) or fertilization rates (OR 0.84, 95% CI: 0.63-1.11, p=0.22, I2=69%). A non-significant trend toward increasing maternal age at the time of ICSI with testicular sperm was noted (WMD 3.03, 95% CI: -.04-6.09). Post-hoc power analysis revealed pβ <20% for pregnancy rate analysis and pβ<10% for fertilization rate analysis. Thus, the risk of Type II error was low. Among men with cryptozoospermia, the use of testicular sperm was shown to have no advantage in regard to ICSI fertilization or pregnancy rates as compared to ejaculated sperm. Thus, men should be encouraged to proceed with ICSI cycles using ejaculated sperm preferentially over invasive surgically-extracted testicular sperm.

Intracytoplasmic Sperm Injection Fertilization Rate Does Not Depend on the Proportion of Round-headed Sperm, Small-acrosomal Sperm, or Morphologically Normal Sperm in Patients with Partial Globozoospermia.

Background:Generally, intracytoplasmic sperm injection (ICSI) may be the preferable method to treat partial globozoospermia, but whether there exist some correlations between ICSI fertilization rate and the proportion of round-headed sperm or morphologically normal sperm remains open. This study was to explore the correlation between ICSI fertilization rate and the sperm morphology in patients with partial globozoospermia.Methods:Thirty-four patients diagnosed with partial globozoospermia accepted the following assisted fertilization treatments – 2 cases accepted in-vitro fertilization (IVF) alone, 26 cases accepted ICSI alone, and 6 accepted split IVF/ICSI. Detailed morphological characteristics were described using Diff-Quik rapid staining. Sixty cases accepting IVF or ICSI treatment in our reproductive center were considered as the control group after being matched by relevant criteria. Fertilization rate, embryo quality, embryo implantation rate and clinical pregnancy rate were calculated.Results:Besides very high proportion of round-headed sperm, partial globozoospermia also showed very high proportion of small-acrosomal sperm and very low proportion of morphologically normal sperm. Fertilization rate of IVF (IVF alone plus split IVF) was very low in partial globozoospermia (25.4% ± 17.4%), but ICSI (ICSI alone plus split ICSI) achieved satisfying fertilization rate compared with the control group (66.2% ± 22.5% vs. 68.8% ± 29.4%, P > 0.05). In patients with partial globozoospermia, there were no correlations between ICSI fertilization rate and the proportion of round-headed sperm, small-acrosomal sperm, or morphologically normal sperm.Conclusions:There was high proportion of small-acrosomal sperm in partial globozoospermia. For patients with partial globozoospermia, ICSI is more preferable than IVF. ICSI fertilization rate does not depend on the proportion of round-headed sperm, small-acrosomal sperm, or morphologically normal sperm.

Total levels, localization patterns, and proportions of sperm exhibiting phospholipase C zeta are significantly correlated with fertilization rates after intracytoplasmic sperm injection

To study the relationship of total levels, localization patterns, and proportions of sperm exhibiting phospholipase C zeta, with fertilization rates after in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI). Laboratory study; controls vs. patients after IVF (n = 27) or ICSI (n = 17) treatment. Fertility center. A total of 44 semen samples, subjected to either IVF or ICSI treatment. Oocyte collection, ICSI or IVF, determination of sperm concentration and motility, and immunocytochemical analyses of phospholipase C zeta (PLCζ). None. Percentages of sperm exhibiting PLCζ. Significant positive correlation between ICSI fertilization rates and total levels, localization patterns, and the proportion (percentage) of sperm exhibiting PLCζ. Total levels, localization patterns, and the proportion of sperm exhibiting PLCζ are correlated with fertilization rates for ICSI, but not for IVF. Evaluating total levels, localization patterns, and proportions of PLCζ may represent a useful diagnostic tool for clinical purposes in men for whom IVF is not advised or has previously failed. This clinical study further supports the fundamental role of PLCζ in the oocyte activation process.

Depression of HspA2 in human testis is associated with spermatogenic impairment and fertilization rate in ICSI treatment for azoospermic individuals.

Heat shock protein A2 (HspA2) expression was quantitatively measured in human testis and its relationship with the spermatogenetic status and laboratory outcomes of intracytoplasmic sperm injection (ICSI) was investigated. Testicular tissues of azoospermia men were divided into four groups according to histopahtology: normal spermatogenesiss, hypospermatogenesis, maturation arrest and Sertoli cell-only syndrome (SCOS). HspA2 immunostaining was measured by Image Pro-Plus (IPP) and laboratory outcomes were calculated. The regression analysis between HspA2 expression and Johnsen score of as well as fertilization, cleavage and high quality embryo rate was performed. HspA2 was strongly present in the cytoplasm of spermatocytes and spermatides in normal testis. However, hypospermatogenesis and maturation arrest testicular tissues demonstrated light staining and no staining for SCOS. Quantitative image analysis showed that there were significant differences among groups (P = 0.000 & P = 0.001). HspA2 exspression was founded significantly correlated spermatogenetic status (R(2) = 0.726, P = 0.000) as well as fertilization rate in ICSI (R(2) = 0.569, P = 0.000). The fertilization rate with ICSI is associated with HspA2 expression in the testis from which sperm retrieved and the alteration of HspA2 expression has been involved in spermatogenic impairment.

The impact of examining the meiotic spindle by polarization microscopy on assisted reproduction outcomes

To examine the effect of submitting oocytes to polarization microscopy (PM) before intracytoplasmic sperm injection (ICSI). Retrospective observational study. University hospital in Brazil. Couples undergoing ICSI. PM before ICSI (PM group) compared with no PM before ICSI (No-PM group) Fertilization and cleavage rates, formation of top-quality embryos (TQEs), and implantation, clinical pregnancy, miscarriage, and live-birth rates. The PM group consisted of 1,000 consecutive oocytes from 201 couples submitted to PM during the year of 2008. The No-PM group consisted of 1,400 oocytes from 249 couples: 700 consecutive oocytes were retrieved before we started using PM and 700 consecutive oocytes were retrieved after we stopped using PM. In the PM group, we observed an increased fertilization rate (79.7% vs. 72.5%, PM group vs. No-PM group, respectively) but reduced cleavage rate (86.2% vs. 92.5%) and TQE formation (33.1% vs. 49.9%). Implantation (18.7% vs. 20.6%), clinical pregnancy (31.8% vs. 33.3%), miscarriage (21.9% vs. 15.7%), and live-birth (24.9% vs. 28.1%) rates were not significantly different between groups. Use of PM was associated with increased fertilization rate but reduced cleavage rate and TQE formation; no significant difference was observed for implantation, clinical pregnancy, or live-birth rates.

Triggering with GnRH agonist in oocyte-donation cycles: oestradiol monitoring is not necessary during ovarian stimulation

This prospective observational study evaluated the efficacy and safety of oocyte-donation cycles triggered with a gonadotrophin-releasing hormone (GnRH) agonist without monitoring oestradiol concentrations during ovarian stimulation. A total of 97 oocyte donors received recombinant FSH (150–225/day) and GnRH antagonists (0.25 mg/day). Oocyte maturation was triggered with 0.2 mg triptorelin s.c. Donors aged 25.4 ± 4.1 years were stimulated for 8.8 ± 0.9 days and underwent 2.9 ± 0.5 (2–4) ultrasound assessments. Total FSH dose was 1703.4 ± 304.7 IU, antagonists were administered for 4.3 ± 1.0 days, 14.7 ± 8.8 oocytes were retrieved and there were no cases of ovarian hyperstimulation syndrome. Recipients ( n = 123) aged 40.3 ± 3.4 years received 10.9 ± 4.3 oocytes, 88.7% of which were metaphase II. Intracytoplasmic sperm injection fertilization rate was 79% and 2.18 ± 0.6 (1–3) embryos were transferred. The pregnancy, clinical pregnancy and twin pregnancy rates were 64.2%, 57.7% and 19.7%, respectively. In conclusion, given the high efficacy and safety of the GnRH-antagonist protocol triggered with a GnRH agonist, the monitoring of oestradiol concentrations is not necessary. Ultrasound monitoring is enough for an adequate follow up of the stimulation cycle in oocyte donors.

Split ICSI/Insemination in Mild Male Factor Infertility: a Randomized Controlled Trial

Introduction: Intracytoplasmic sperm injection (ICSI) is a widely used adjunct to in vitro fertilization (IVF) for male-factor infertility when fertilization failure is suspected. In patients with borderline semen, the decision to choose either IVF or ICSI is critical because the chance of total fertilization failure after a conventional IVF or of performing an unnecessary ICSI procedure is hard to predict. Objective: The purpose of this study was to assess the value of the allocation of some eggs to ICSI and others to conventional insemination (Split ICSI/insemination) in IVF cycles in which semen parameters are subfertile. Design: It is prospective study. Materials and methods: Between August 2007 and April 2010, 190 patients had half of their eggs inseminated with ICSI and the other half inseminated with conventional IVF. Results: In this study, 76.3% of patients were fertilized by both IVF and ICSI, 21.6% of patients were fertilized only by ICSI while 2.1% of patients were not fertilized either by IVF or ICSI. Fertilization rate was significantly higher in oocytes injected by ICSI (63.7%) compared to oocyte inseminated by IVF (44.3%). In patients fertilized by both IVF and ICSI, although ICSI fertilization rate was higher (65.9%) than IVF fertilization rate (57.3%), yet there is no significant differences were observed. High grade embryos were significantly higher in oocytes injected by ICSI (75.9%) compared to oocyte inseminated by IVF (56.4%). Also, significantly more type 1 and 2 embryos developed after ICSI compared with IVF (77.3% vs. 56.4%) in the group of patients with fertilization after both IVF and ICSI. Conclusion: According to our findings, implementation of ICSI in couples with mild male factor infertility could improve fertilization rates and decrease the risk of complete fertilization failure. Additionally, split ICSI procedure provides valuable clinical information about fertilization potential for the couple and unnecessary use of ICSI procedure can be avoided in future cycles for patients who have achieved good fertilization in both IVF and ICSI.

Split ICSI/Insemination in Mild Male Factor Infertility: a Randomized Controlled Trial

Introduction: Intracytoplasmic sperm injection (ICSI) is a widely used adjunct to in vitro fertilization (IVF) for male-factor infertility when fertilization failure is suspected. In patients with borderline semen, the decision to choose either IVF or ICSI is critical because the chance of total fertilization failure after a conventional IVF or of performing an unnecessary ICSI procedure is hard to predict. Objective: The purpose of this study was to assess the value of the allocation of some eggs to ICSI and others to conventional insemination (Split ICSI/insemination) in IVF cycles in which semen parameters are subfertile. Design: It is prospective study. Materials and methods: Between August 2007 and April 2010, 190 patients had half of their eggs inseminated with ICSI and the other half inseminated with conventional IVF. Results: In this study, 76.3% of patients were fertilized by both IVF and ICSI, 21.6% of patients were fertilized only by ICSI while 2.1% of patients were not fertilized either by IVF or ICSI. Fertilization rate was significantly higher in oocytes injected by ICSI (63.7%) compared to oocyte inseminated by IVF (44.3%). In patients fertilized by both IVF and ICSI, although ICSI fertilization rate was higher (65.9%) than IVF fertilization rate (57.3%), yet there is no significant differences were observed. High grade embryos were significantly higher in oocytes injected by ICSI (75.9%) compared to oocyte inseminated by IVF (56.4%). Also, significantly more type 1 and 2 embryos developed after ICSI compared with IVF (77.3% vs. 56.4%) in the group of patients with fertilization after both IVF and ICSI. Conclusion: According to our findings, implementation of ICSI in couples with mild male factor infertility could improve fertilization rates and decrease the risk of complete fertilization failure. Additionally, split ICSI procedure provides valuable clinical information about fertilization potential for the couple and unnecessary use of ICSI procedure can be avoided in future cycles for patients who have achieved good fertilization in both IVF and ICSI.

Influence of sperm chromatin anomalies on assisted reproductive technology outcome

To evaluate the influence of DNA fragmentation, DNA methylation, and protamine deficiency as indicators of chromatin status on assisted reproductive technology outcome, and also to assess the relation between these parameters. Prospective study. Royan Institute and Isfahan Fertility and Infertility Center. Semen samples from 92 infertile couples undergoing intracytoplasmic sperm injection (ICSI) and IVF were assessed during this study. Semen analysis was carried out according to World Health Organization criteria. Protamine deficiency, DNA methylation, and DNA fragmentation were assessed by chromomycin A3 (CMA3), immunostaining, and sperm chromatin dispersion, respectively. Chromomycin A3 positivity, DNA methylation, DNA fragmentation and assisted reproductive technology outcome. Chromomycin A3 positivity shows a significant correlation with DNA fragmentation and fertilization rate. Furthermore, unlike in IVF patients, DNA fragmentation showed a significant negative correlation with fertilization rate in ICSI. A significant negative correlation was observed between DNA methylation and DNA fragmentation. In addition, no correlation was found between fertilization rate and DNA methylation in both IVF and ICSI patients. The results reveal that in ICSI procedure DNA fragmentation, and CMA3 positivity affect the fertilization rate, whereas none of these parameters affect postfertilization development. Furthermore, both CMA3 positivity and DNA methylation affect DNA fragmentation, independently of each other. Thus, it can be concluded that these parameters may play an early role in initiation of development.

Sperm chromatin structure assay parameters are not related to fertilization rates, embryo quality, and pregnancy rates in in vitro fertilization and intracytoplasmic sperm injection, but might be related to spontaneous abortion rates

To investigate the relationship between sperm chromatin structure assay (SCSA) parameters, DNA fragmentation index (DFI) and high DNA stainability (HDS), and outcomes of IVF and intracytoplasmic sperm injection (ICSI). Retrospective review and prospective study. Academic human reproduction laboratory. Two hundred twenty-three couples undergoing conventional IVF (n = 137) and ICSI (n = 86). Testing with SCSA on a semen aliquot taken from ejaculate used for assisted reproductive technology (ART). Conventional semen parameters, DFI, HDS, outcomes of IVF and ICSI. There were no significant differences in IVF and ICSI fertilization rate, good embryo rate, and pregnancy rate (PR) between high, moderate, and low DFI or HDS groups. Men with HDS >15% had significantly higher IVF abortion rates. There was a statistically insignificant trend toward an increased abortion rate in the high DFI (>27%) group. The DFI correlated negatively with sperm motility, and HDS correlated negatively with sperm morphology and concentration. Neither DFI nor HDS scores can provide independent information about embryo quality, fertilization, and PRs for infertility patients undergoing ART. Sperm DNA fragmentation probably affects sperm motility. The relationship between HDS and IVF abortion rates provides preliminary evidence that ICSI may be indicated for men with HDS >15%. The potential adverse effect of sperm DNA damage on the quality of postimplantation embryo and spontaneous abortion should be a concern.