Intracytoplasmic Sperm Injection Program Research Articles

Stimulation protocols for Severe Endometriosis- is there any difference?

Endometriosis, being an estrogen-dependent condition, can lead to subfertility in women. Those facing difficulty achieving pregnancy goals may need assistance from assisted reproductive technology (ART). Due to the challenges posed by endometriosis in natural conception, assisted reproductive technologies like IVF and ICSI. Objective of the study: This study aimed to compare ART outcomes in women with endometriosis following the three distinct groups of protocols undergoing various treatment modalities, namely the progestin-primed ovarian Stimulation protocol, GnRH agonist long protocol, and Combined Oral Contraceptives (OCPs). This investigation aims to enhance our understanding of how different stimulation protocols may influence ART outcomes Methodology: This is a cross-sectional study between March 2019 to March 2023. The study collected data from 126 infertile women diagnosed with endometriosis, who were undergoing their first intracytoplasmic sperm injection (ICSI) cycle at MHRT Hospital and Research Center, Hyderabad, Telangana India. Patients in each group were classified into three Protocols ie-GnRH agonist Long Protocol, Progestins primed Ovarian Stimulation, and Combined Oral Contraceptives. The outcomes of the ICSI program were evaluated Result: The findings from our study suggest that women with endometriosis undergoing ICSI experience improved reproductive outcomes when subjected to prolonged downregulation with GnRH agonist long protocol, Progestin primed Ovarian Stimulation and Combined Oral Contraceptives before initiating ovarian stimulation. Notably, the clinical pregnancy rate is notably higher at GnRH agonist long Protocol 57.5% compared to the alternative protocols: PPOS at 34.2 % and Combined Oral Contraceptives at 40.54 %. The groups subjected to extended pituitary downregulation with GnRH agonists long protocol demonstrated superior clinical pregnancy and live birth rates compared to those following the PPOS and Combined Oral Contraceptives. Our segmented IVF approach, including FET cycles, revealed a higher live birth rate in the GnRH agonist protocol compared to the PPOS and Combined Oral Contraceptives. Conclusion: This study demonstrates that GnRH agonists' long protocol demonstrated superior clinical pregnancy and live birth rates compared to those following the PPOS and Combined Oral Contraceptives. Better clinical outcomes were observed in the GnRH agonist long protocol group when compared to the PPOS and Combined Oral Contraceptive group.

Эффективность прайминга мио-инозитолом у пациенток с «бедным» ответом в программе экстракорпорального оплодотворения

Aim. To evaluate the effect of myo-inositol administration in the periconceptional period on the parameters of the stimulated cycle, embryological stage and reproductive outcomes of in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) programs in patients with expected "poor" ovarian response. Design. Рrospective cohort study Materials and methods. The prospective cohort study included 98 women with low ovarian reserve, corresponding to groups 3 and 4 of the POSEIDON classification (number of antral follicles < 5; anti-Mullerian hormone level < 1.2 ng/ml), planning treatment in the IVF program. The participants were divided into two groups using the envelope method. Patients of group 1 (n = 47) took the drug Inofert Forte (ITALFARMACO, Italy) daily for three months before entering the IVF program, the daily dose of which contained 1200 mg of myo-inositol with alpha-lactalbumin and 400 μg of folic acid. Women in group 2 (n = 51) took 400 mcg of folic acid during preparation for the treatment protocol. Results. The total dose of gonadotropins (2250 (2025; 2287) IU) was significantly lower in group 1 patients taking myo-inositol compared to group 2 women (2400 (2250; 2662) IU), p = 0.017. There was a significant difference in the number of oocytes at metaphase II stage (2.61 ± 0.6 vs. 2.19 ± 0.7, p = 0.046), fertilization rate (79% vs. 70%, p = 0.043), and number of zygotes (1.95 ± 0.5 vs. 1.57 ± 0.6, p = 0.030) between group 1 and group 2 patients, respectively. The total number of blastocysts in women taking inositol-containing preparations was statistically significantly higher than in group 2 and amounted to 1.33 ± 0.6 vs. 1.0 ± 0.3 (p = 0.025), with an equal percentage of blastulation (69% and 67%). The number of class A blastocysts in group 1 amounted to 42% of their total number, while in group 2 women this indicator did not exceed 24% (p = 0.174). When analyzing the outcomes of IVF/ICSI programs, there was a tendency to increase the frequency of clinical and progressive pregnancy in the group of myo-inositol priming without achieving statistically significant results compared to the group with standard preparation for the IVF program. Conclusion. The using of myo-inositol in the periconceptional period may be one of the possible variants of the strategy to increase the effectiveness of ART programs in women with expected "poor" ovarian response to stimulation. Key words: in vitro fertilization, infertility, priming, myo-inositol, poor ovarian response.

Correlation between Resistin and Follistatin hormones with pregnancy outcome in samples of Iraqi women undergoing ICSI cycle

Resistin and follistatin levels have been found to be high in polycystic ovarian syndrome (PCOS) patients, that play role in pathophysiology of PCOS and pregnancy status of women having ICSI cycle. This study aimed to determine the relationship between the hormone levels and pregnancy outcome in PCOS and non-PCOS women undergoing intracytoplasmic sperm injection (ICSI) program. The study was done at Higher Institute for Infertility Diagnosis and Assisted Reproductive Technologies from 2022 to 2023. Eighty infertile women participating in the IVF/ICSI treatment. They were split to control (40 non-polycystic ovarian syndrome- PCOS women) and 40 women for PCOS group. They were subdividing to subgroups’ according to body max index (BMI; normal and overweight / obese). ELISA method was used to measure hormone level at day 2 and follicular fluid and serum at day of ova pick up. About 38.8% of study participants were got pregnant. Means of serum resistin and follistatin in day 2 and OPU were significantly higher in patients with PCOS and normal BMI level while follistatin at day 2 and in follicular fluid (FF) were significantly higher in participants who got pregnant. Follistatin level at day 2 > 9.89 ng/ml and in FF > 15.06 ng/ml and might be as a predictor for occurrence of pregnancy after ICSI. The cutoff point of follistatin level in the serum at day two and in FF at the day OPU was found to be a predictor of pregnancy following ICSI, while no correlation was found between resistin and pregnancy outcome.

The efficacy of novel centrifugation-free sperm selection (Io-Lix) on sperm parameters and ICSI reproductive outcomes

Research questionWhat is the effect of a novel non-centrifugation method (Io-Lix) of sperm selection on sperm parameters and intracytoplasmic sperm injection (ICSI) reproductive outcomes? DesignThis pilot study elevated the capacity of the Io-Lix sperm selection protocol to improve sperm parameters (concentration, motility and sperm DNA fragmentation) of the neat ejaculate. Once established, the reproductive outcomes of Io-Lix selected spermatozoa were used for autologous and donor oocyte ICSI programmes and their efficacy compared with those using conventional swim-up. ResultsIo-Lix sperm selection resulted in lower sperm concentration yield (P < 0.001) and sperm DNA fragmentation (P < 0.001) but higher sperm motility (P < 0.001) when compared with spermatozoa in the neat ejaculate. When compared with swim-up sperm selection the Io-Lix protocol resulted in a 14.7% (P = 0.028) increase in pregnancy rate and 16.3% (P = 0.047) reduction in miscarriages in the autologous ICSI programme. A similar comparison of sperm selection procedures employed for a donor oocyte ICSI programme showed no difference in terms of their respective reproductive outcomes. ConclusionsThe Io-Lix sperm selection protocol resulted in improved pregnancy rate and reduction in miscarriage when applied to autologous ICSI, which was attributed to a reduction in the proportion of spermatozoa with DNA damage post-selection. A similar finding was not apparent in the donor oocyte programme, which may be associated with the capacity of the donor oocyte to repair sperm DNA post-syngamy.

Effect of In Vitro Maturation of Human Oocytes Obtained After Controlled Ovarian Hormonal Stimulation on the Expression of Development- and Zona Pellucida-Related Genes and Their Interactions.

In an in vitro fertilization program, approximately 10-15% of oocytes obtained after controlled ovarian stimulation are immature, with germinal vesicles (GVs). These oocytes are usually discarded in clinical practice; however, an in vitro maturation (IVM) procedure can be applied to mature them. There are scarce data in the literature on the effect of IVM on the expression of important development- and zona pellucida (ZP)-related genes in human oocytes; therefore, we wanted to determine this. One hundred nine human oocytes were collected from patients enrolled in an intracytoplasmic sperm injection program. The expression of the BMP4, GDF9, ZP1, ZP2, ZP3, and ZP4 genes was analyzed using RT-qPCR in oocytes matured in vitro with different reproductive hormones in the IVM medium (AMH, FSH + hCG, FSH + hCG + AMH), in in vivo matured oocytes and in immature oocytes with GVs. No statistically significant differences in the expression of selected genes in oocytes were observed among groups with different reproductive hormones in IVM medium. However, several interesting significant correlations were found between BMP4 and GDF9, and ZP1 and ZP4; between GDF9 and ZP1, and ZP2 and ZP4; and between ZP1 and ZP3 and ZP4 in the in vitro matured oocytes, while no such correlations were present in other groups of oocytes. The type of reproductive hormone in the maturation medium does not affect the expression of the analyzed genes in oocytes during the maturation process. However, the in vitro maturation procedure itself generated correlations among analyzed genes that were otherwise not present in in vivo matured and immature oocytes.

Freeze-all policy versus luteal phase support with low dose of human chorionic gonadotrophin for high-responder patients undergoing intracytoplasmic sperm injection on pregnancy outcomes: a retrospective cohort observational study

BackgroundThe literature has always controversies on the use of freeze-all policy in high-responder women performing intracytoplasmic sperm injection. In this article, we discuss the benefits of freeze-all policy on the incidence of pregnancy outcomes and the complications.The main body of abstractFreeze-all policy is applied to the intracytoplasmic sperm injection program by freezing of all embryos and delaying embryo transfer to another subsequent ovarian cycle, to decrease the incidence of ovarian hyperstimulation syndrome, especially in high-responder women. Unfortunately, freeze-all policy is correlated with an increase in the economic costs and more ICSI laboratory effort. Delayed embryo transfer (ET) is correlated with more anxiety among the patients. An alternative strategy is to perform fresh embryo transfer with more intensive luteal phase support to compensate for the negative effect of the GnRH agonist on the endometrial receptivity and luteal phase support.Short conclusionThe freeze-all policy had better pregnancy rates with less incidence of moderate to severe hyperstimulation syndrome compared with original fresh embryo transfer in high-responder women performing intracytoplasmic sperm injection.

The Comparison of the Effect of Recombinant FSH in Antagonist Protocol on Serum and Follicular Fluid Kisspeptin between PCOS and non-PCOS Infertile Women during ICSI

Background: Reproduction is a highly delicate organized process accomplished by the controlled interaction of the higher centers in the brain, the gonads, and different body parts. Kisspeptin is a neuropeptide that acts as a key regulator controlling the hypothalamic-pituitary-gonadal axis and organizing the reproduction process. Gonadotropins treatment used in controlled ovarian hyperstimulation increases the follicular count in an attempt to improve the pregnancy rate. However, one of its drawbacks is the increase in ovarian hyperstimulation syndrome risk. Published data proved that kisspeptin has a fundamental role in regulating follicular growth and maturation at central and peripheral levels highlighting its possible role in diagnosing and treating infertility problems. Objective: To study the influence of gonadotropin (recombinant FSH medication) used in ovarian hyperstimulation program on the level serum and follicular fluid kisspeptin level in PCOS and non-PCOS patients. Subject, Materials, and Method: This is a cross-sectional study performed in the High Institute for Infertility Diagnosis and Assisted Reproductive Technologies, Al-Naharin University, from September 2020 to July 2021. The study includes a sample of (80) infertile Iraqi women aged (18–40 years) scheduled for an intracytoplasmic sperm injection program after being stimulated by GnRH antagonist protocol. On the day of oocytes retrieval, blood and follicular fluid samples were drawn from each participant to measure kisspeptin level using ELIZA technique. Results: In PCOS patients, significant positive correlations were found between recombinant FSH medication with serum and follicular fluid kisspeptin level (p is less than 0.05). Serum kisspeptin was insignificantly higher in the PCOS patient (p = 0.838) while follicular fluid kisspeptin was insignificantly lower in the PCOS women (p = 0.651). There were significant correlations between serum and follicular kisspeptin in the PCOS and the control groups (p = 0.000) and (p = 0.002), respectively. Conclusions: Serum and follicular fluid kisspeptin are positively correlated with the cumulative recombinant FSH medication used by infertile polycystic ovarian syndrome women undergoing ICSI, addressing the possible role of kisspeptin in improving the pregnancy rate in PCOS patients with a lower incidence of ovarian hyperstimulation syndrome.

Assessment of Cortisol Hormonal Level and Relation With Age in Infertile Women With ICSI Outcome

In human-assisted reproduction both partners need to be evaluated during counseling because causes of infertility are due to male factors and female factors. some body hormones play important role in fertile women and cortisol one of these hormones which is essential for normal ovulation, cortisol usually increases during the follicular phase of the menstrual cycle, play a role in the early stages of follicular development by their interaction with aromatase activity and granulose cell functions. To investigate the correlation of cortisol hormonal level in serum and in follicular fluid that relationship with age in women under Intracytoplasmic sperm injection outcome. Its randomized prospective clinical trial study performance conducting in the Higher Institute for Infertility Diagnosis and Assisted Reproductive Technologies / AlNahrain University, Baghdad-Iraq, during the period from November2021to June 2022. a total of Sixty-three Infertile Iraqi women, who planned to inter intrasytoplasmic sperm injection program. The blood sample and follicular fluid sample obtained from all infertile women inter intracytoplasmic sperm injection program to measure cortisol hormonal level at specific days of this study. There was increase in cortisol level in women aged between (30-40) years, So there was significant finding between cortisol level and this age group and there was increase in cortisol level in women aged &lt; 30 years at the same day and no significant difference in cortisol level in women age more than 40. Significant differences in cortisol level appear in group of women age between (30-40) years, also the same result appears in group of women age more than &gt; 40 years and no significant differences in cortisol level in women aged &lt; 30. No significant differences in cortisol level in all age women group (30-40) years, &lt;30 years ,and the women age &gt; 40 years

Relationship between sperm quality and total fertilization failure in intracytoplasmic sperm injection and in vitro fertilization cycles: A cross-sectional study.

BackgroundTotal fertilization failure (TFF) is associated with essential mechanistic and cellular events.ObjectiveThe present study is a comprehensive examination of detrimental effects with well-known assays for predicting TFF in conventional in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) cycles.Materials and MethodsSemen parameters of 90 men, including 60 cases who had experienced IVF/ICSI failure and a control group of 30 individuals, were evaluated. Sperm chromatin/DNA quality assessments were done by aniline blue, toluidine blue, chromomycin A3, and terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) assays. A lipid hydroperoxide (LPO) kit was used to measure the LPO, and JC1 staining was used to evaluate mitochondrial membrane potential (MMP).ResultsThere were statistically significant differences found between the IVF, ICSI and control groups by the toluidine blue (p = 0.01), TUNEL (p = 0.02), and chromomycin A3 (p 0.001) tests, but not by the aniline blue staining. Furthermore, there was a significant difference regarding LPO concentration and high MMP in cases of IVF fertilization failure compared to the control group (p = 0.04, p = 0.02, respectively). The logistic regression model showed that sperm viability was predictive for fertilization failure in the ICSI group. Sperm chromatin and DNA quality assays were not predictors for TFF in either group.ConclusionCellular events such as high DNA fragmentation damage, high levels of reactive oxygen species, and low MMP levels can cause TFF in IVF and ICSI programs. Diagnostic tests, especially in cases with previous fertilization failure, showed significant differences in sperm chromatin and DNA quality between groups but could not predict the risk of TFF.

Holding effect in a commercial OPU-ICSI program: a retrospective study

In vitro embryo production has been rapidly evolved in horses, since the immature oocytes could be viably held overnight and shipped for intracytoplasmic sperm injection (ICSI). However, in facilities where ovum pick-up (OPU) and ICSI are performed in situ, direct in vitro maturation (IVM) can be performed. In a recent study, holding of oocytes followed by extended IVM (36h) resulted in increased embryo development compared to direct IVM for 26 to 28h. Nevertheless, the effect of holding was not evaluated separately in a clinical ovum pick-up (OPU)-ICSI program. Therefore, the current study aimed to determine whether holding oocytes prior IVM could affect their developmental competence. Data from 253 OPU-ICSI sessions at Ghent University (136 mares and 54 stallions) were analysed retrospectively. Collected oocytes were submitted to direct IVM (DM:1152) (TCM-199 Earl's salts (Gibco) containing 10% (v/v) FBS (Gibco), 9.4 µg/mL follicle-stimulating hormone, and 1.88 µg/mL luteinizing hormone (Stimufol, Reprobiol, Ouffet, Belgium)) or kept in commercial holding medium (HM:1371) (Emcare, Agtech, Zulte, Belgium) at room temperature for 17–24 h in a 5 mL Falcon® Test Tube (Corning Europe, Lasne, Belgium) prior to IVM. After an average of 28.4 h of IVM (DM: 28.2; HM: 28.6), oocytes with a polar body werefertilized by piezo-drill ICSI. The zygotes were cultured in DMEM/F-12 (Gibco) with 10% (v/v) FBS under oil (38.2°C, 5% O 2 , 5% CO 2 , and 90% N 2 ). Cleavage was evaluated 2 or 3 days after ICSI, and blastocyst development was monitored daily from day six up to day 13. For statistical analysis, generalized linear model were used to test the effect of holding on maturation, cleavage, and blastocyst rate. Always, the oocyte/ zygote was considered as the unit of interest, and results are expressed as least square means ± standard error. No significant differences were observed between treatments for maturation (DM: 64.9±1.4%; HM: 67.0±1.3; p=0.3), cleavage (DM: 62.7±1.9%; HM: 66.8±1.6; p=0.1), and blastocyst rates (DM: 19.0±1.4%; HM: 17.0±1.2; p=0.3). Likewise, comparable kinetics of embryo development were obtained with 9.08 days in average for DM and 9.33 for HM (p = 0.08). In conclusion, oocyte holding prior to IVM did not affect developmental competence when an average IVM duration of 28h was maintained. Therefore, the observed increased embryo development rates in HM vs DM reported previously primarily resulted from an extended maturation time rather than from the inclusion of an oocyte holding step. Other variables, such as the type of sperm, the effect of the mare, the time of the year could be included in further analyses.

In vitro production of ICSI derived horse blastocysts

In vitro production of horse embryos via intracytoplasmic sperm injection (ICSI) is a useful clinical and research technique. However, current rates of blastocyst production are still sub-optimal. Here, we compared results from our commercial ICSI program to evaluate whether slight modifications in protocols can result in improved blastocyst rates. Firstly, we evaluated the time cumulus oocyte complexes (COCs) can be maintained in holding medium before starting in vitro maturation (IVM) (Group A: 4-10 hours and Group B: overnight). Secondly, we evaluated the effects of using a microfluidic device (Zymöt) for the preparation of sperm samples for ICSI (Group C). This device comprises a microporous membrane that allows to select spermatozoa in base of their motility, avoiding samples centrifugation. This could eventually reduce DNA fragmentation and oxidative stress, which have been associated with conventional sperm preparation protocols. Frozen-thawed cut straws with semen from different stallions were used and prepared either with a gradient and swim-up protocol or with the Zymöt microfluidic device. COCs were recovered from immature follicles using transvaginal ultrasound-guided follicle aspiration (TVA) procedures. After collection, COCs were transferred to holding medium for 4 to 10 hours or maintained in holding medium overnight at room temperature (22–24°C) before starting IVM. In vitro maturation was performed in T-199 Earle's medium supplemented with 5 mU/ml FSH, 50 ng/ml EGF and 10% FBS. After IVM, oocytes were denuded from cumulus and those showing a polar body were subjected to piezo-ICSI (PiezoXpert, Eppendorf). Spermatozoa were first immobilized with strong piezo pulses and then injected individually in the matured oocytes after penetrating the zona pellucida and oolemma with low intensity pulses.The injected oocytes were then cultured in a mix of KSOM-DMEM/F12 medium supplemented with 6% FBS, which was refreshed on Day 5 of development. Embryo culture was performed in humidified benchtop incubators at 6.5% CO2 and 5%O2 at 38.2°C. A Chi-square test was used to compare results.

Varicoceles in Men With Non-obstructive Azoospermia: The Dilemma to Operate or Not.

The knowledge on male reproduction is constantly expanding, especially in treating infertility due to non-obstructive azoospermia (NOA). Varicocele is occasionally diagnosed in a subpopulation of males with NOA. Varicocele repair in NOA-men may contribute to the reappearance of spermatozoa in semen. However, spontaneous pregnancies are observed in only a small percentage of NOA-men post-varicocelectomy. Additionally, it has been reported that the repair of varicocele in NOA-men (before the performance of sperm retrieval techniques) may increase the testicular sperm recovery rate. In addition, it increases the pregnancy rate in intracytoplasmic sperm injection (ICSI) programs in NOA-men without spermatozoa in the semen post-varicocelectomy. In addition, to the improvement in Sertoli cellular secretory function, varicocelectomy may increase the secretory function of Leydig cells, which subsequently results in improved androgen production, raising the probability to negate the need for testosterone replacement therapy in cases of late-onset hypogonadism. On the other hand, the benefit of varicocelectomy in patients with NOA is still debatable. The current review study aims to provide a critical and extensive review of varicocele repair in males with NOA. This study additionally focuses on the impact of varicocele repair on sperm retrieval rates and its influence on the ICSI outcomes for those couples who remain negative for spermatozoa in their semen samples post-varicocelectomy.

Recombinant anti-M\xfcllerian hormone in the maturation medium improves the in vitro maturation of human immature (GV) oocytes after controlled ovarian hormonal stimulation

BackgroundIn vitro maturation (IVM) of oocytes is a laboratory method that allows the maturation of immature (GV) oocytes retrieved from patients enrolled in the in vitro fertilization (IVF) programme. However, this method is still sparsely researched and used in clinical practice, leading to suboptimal clinical results. Anti-Müllerian hormone (AMH) is an important hormone with known effects on human ovaries, especially on follicles (follicular cells) during folliculogenesis. In contrast, the effect of AMH on the human oocyte itself is unknown. Therefore, we wanted to determine whether human oocytes express AMH receptor 2 (AMHR2) for this hormone. Recombinant AMH was added to the IVM medium to determine whether it affected oocyte maturation.MethodsIn total, 247 human oocytes (171 immature and 76 mature) were collected from patients enrolled in the intracytoplasmic sperm injection (ICSI) programme who were aged 20 to 43 years and underwent a short antagonist protocol of ovarian stimulation. The expression of AMHR2 protein and AMHR2 gene was analysed in immature and mature oocytes. Additionally, maturation of GV oocytes was performed in vitro in different maturation media with or without added AMH to evaluate the effect of AMH on the oocyte maturation rate.ResultsImmunocytochemistry and confocal microscopy revealed that AMHR2 protein is expressed in both immature and mature human oocytes. AMHR2 was expressed in a spotted pattern throughout the whole oocyte. The IVM procedure revealed that AMH in maturation medium improved GV oocyte maturation in vitro, as all oocytes were successfully matured in maturation medium containing recombinant AMH only. Furthermore, antagonism between AMH and follicle-stimulating hormone (FSH) during the maturation process was observed, with fewer oocytes maturing when both AMH and FSH were added to the maturation medium. Finally, AMHR2 gene expression was found in immature and in vitro matured oocytes but absent in mature oocytes.ConclusionsThe positive AMHR2 protein and AMHR2 gene expression in human oocytes shows that AMH could directly act on human oocytes. This was further functionally confirmed by the IVM procedure. These findings suggest the potential clinical application of recombinant AMH to improve IVM of human oocytes in the future.

Evaluation of Sperm Parameters and DNA Integrity Following Different Incubation Times in PVP Medium.

Polyvinylpyrrolidone (PVP) is a chemical material used in intracytoplasmic sperm injection (ICSI) program. The aim of this study was to investigate the ideal time that sperm can be safely incubated in PVP with less structure and DNA damage. Thirty-one Oligoasthenoteratospermia (OAT) samples were used. Sperm samples were prepared by discontinuous density-gradients method and incubated in 10% PVP at different time intervals (0, 5, 10, 15, 20, and 30 min). The effect of PVP was assessed on sperm DNA fragmentation and viability via SCD assay and Eosin-nigrosin staining respectively. Data showed there was a significant increase in sperm DNA fragmentation at 10 min compared to 0 min. The viability rate also significantly reduced at 10 min compared to 0 min. As a result, sperm samples could be incubated with PVP for less than 10 min. While prolonged incubation may significantly damage the sperm DNA integrity and viability.

Hormonal markers as noninvasive predictors of sperm retrieval in non-obstructive azoospermia.

Non-obstructive azoospermia (NOA) is one of the leading causes of male factor infertility, which results from impaired spermatogenesis. Currently, the sole feasible therapeutic option for men with NOA to father their biologic children is sperm retrieval by testicular sperm extraction (TESE) approaches followed by an intracytoplasmic sperm injection program. Nevertheless, the rate of sperm retrieval from NOA men following TESE has remained as low as 50%, leading to a significant number of unsuccessful TESE operations. Given that TESE is associated with multiple side effects, the prediction of TESE outcome preoperatively can abolish unnecessary operations and thereby prevent NOA patients from sustaining adverse side effects. As the process of spermatogenesis is under the regulation of hormones, the hormonal profile of serum and/or seminal plasma may contain useful information about spermatogenesis status and can potentially predict the chance of sperm retrieval from NOA patients. A large body of literature is available on the predictive capability of different serum and seminal plasma hormones such as FSH, LH, testosterone, inhibin B, AMH, estradiol, prolactin, and leptin in a stand-alone basis or combinational fashion with respect to the TESE outcome. The present review aimed to evaluate the potential of these hormonal markers as noninvasive predictors of sperm retrieval in men with NOA.

EVALUATION OF OOOCYTE QUALITY IN PATIENTS WITH ENDOMETRIOSIS UNDERGOING INTRACYTOPLASMIC SPERM INJECTION

Endometriosis is a multifactorial disease and its effect on oocyte quality still unclear, several factors has effect on etiology, from other hand the studies of oocyte developmental are limited by ethical constraints on use of human oocytes and embryos for biomedical research also difficult to monitor the embryos transferred to uterus and the factors affected on embryo development and implantation.(96) Also, there are number of studies evaluated the negative impact of endometriosis on oocyte quality by several mechanism such as clinical and biological data in related to different stages of endometriosis: The aim of this study is to Evaluate the quality of oocytes in patients with endometriosis Undergoing ICSI. This was a retrospective cohort analysis of oocytes quality in which 100 infertile ladies with endometriosis compared with 200 infertile ladies without endometriosis were recruited from the infertility clinic of El-Shatby maternity University Hospital and a repro-Fertility Center. All the patients accepted and consented to the intra-cytoplasmic sperm injection program.

Microfluidic sperm selection yields higher sperm quality compared to conventional method in ICSI program: A pilot study

ABSTRACT An appropriate preparation technique, should be capable of isolating highquality spermatozoa for intracytoplasmic sperm injection (ICSI). The aim was to assess sperm quality parameters, DNA integrity, embryo development, and clinical outcomes using a practical and accessible Microfluidic Sperm Sorting (MSS) technique. A total of 95 ICSI cases performed using sperm samples were prepared with our MSS (group 1) or by Direct Swim Up (DSU; control) method (group 2). Both sperm quality parameters and sperm DNA fragmentation (SDF) were compared between the groups. DNA fragmentation was assessed using Sperm Chromatin Dispersion (SCD) test and fine morphology was assessed using Motile Sperm Organelle Morphology Examination (MSOME). Embryo development and clinical outcomes were compared between the groups. In the MSS group, progressive motility and the fraction of Class I sperm morphology sperm were significantly higher compared to DSU group (P < 0.01 and P < 0.001, respectively). Moreover, the rates of DNA fragmentation and immotile spermatozoa were significantly lower in MSS when compared to DSU group (P < 0.001). Also, higher rates of high-quality embryo formation (P < 0.001), implantation (P = 0.04) and pregnancy (P = 0.05) were achieved in the MSS compared to DSU groups. The MSS technique proved to be a noninvasive, disposable, easy to use, and inexpensive method for separation of high-quality spermatozoa. Both laboratory parameters and clinical outcomes were improved with application of MSS for neat sperm collection in ICSI. Abbreviations ICSI: Intracytoplasmic Sperm Injection; MSS: Microfluidic Sperm Sorting; Sperm DNA Fragmentation (SDF); SCD: Sperm Chromatin Dispersion; MSOME: Motile Sperm Organelle Morphology Examination; DGC: Density Gradient Centrifugation; DSU: Direct Swim Up; ROS: Reactive Oxygen Species; ART: Assisted Reproducetive Technology

The Effect of Interleukin-10 And Its Relationship with The Level of White Blood Cells in Women Spontaneous Miscarriage Undergoing Intracytoplasmic Sperm Injection (ICSI) technique

This study was conducted on 84 samples of women subject to the ICSI program . Blood sample was taken tomeasure WBC count , Interleukin-10 and ?-hCG levels . Groups were divided based on the ?-hCG level totwo groups (Pregnant Women Group - Pregnancy Failure Group) and the total of pregnant women dividedinto (Pregnancy Group and spontaneous miscarriage) .The results of the current research showed a significant increase in the level ?-hCG and that the increasein the level of this hormone is evidence of the presence of high success rates for pregnancy in women whoperformed operations IVF, where the success rate at the beginning of the matter reached 61.9%, after whichit decreased to 33.3% after the first three months due to the occurrence of spontaneous miscarriage ofpregnant women due to various immunological and physiological reasons, as well as a positive correlationbetween the level of ?-hCG and other parameters within the study (Interleukin-10 -WBC).The results of the current research also showed a significant difference between the group (pregnancyfailure) and the group (spontaneous miscarriage) compared with the control group (continued pregnancy)in relation to the level of Interleukin-10, Also, The results of the current research showed a significantdifference between the group (pregnancy failure) and the group (spontaneous miscarriage) compared withthe control group (continuation of pregnancy) in relation to the level of WBC, and the present study found apositive relationship between the level of Interleukin-10 and WBC

Evaluation trace minerals and oxidative status in follicular fluid for unexplained infertile female undergoing Intra-cytoplasmic sperm injection program.

Objective: To evaluate the level of zinc and 8-OHdg in follicular fluid and determine the correlation of both with Intracytoplasmic sperm injection outcome.Aim: The aim of this study is. To evaluate the Level of zinc and oxidative stress biomarker 8-OHdg in follicular fluid for unexplained female and compare with male factor. Study the correlation between zinc and 8-OHdg with ICSI outcome. Material and method: eighty eight subfertile couples were involved in this study. They divided into two groups. First group male factor and second group unexplained female factor. Both were interred in ICSI program. Result: The study showed that the mean follicular fluid level of zinc in pregnant group (17.47) and non-pregnant group (16.62). However, not different level of zinc in follicular fluid in both group unexplained female factor and male factor (16.66) and (16.97), respectively. The level of zinc significantly with No. of the oocyte (p=0.004), MII (p=0.033), No. of 2PN (p=0.035), Fertilization rate (p=0.001), Embryo G1 (p=0.044) and Embryo G2 (p=0.026). No significant statistical difference between level of 8- OHdg in follicular fluid in two groups regarding the cause of infertility unexplained female factor and male factor mean (2.20) and (2.25), respectively. But significant with pregnant status in pregnant group mean (1.37) and non pregnant group mean (2.54). The level of 8-OHdg non-significantly with ICSIoutcome. Conclusion: zinc level is statically significant and positively correlated with ICSI outcome, as the number of oocytes, mature oocyte (MII), fertilized oocytes 2PN, fertility rate, embryo G1 and embryo G2.The level of 8-OHdg in follicular fluid statically non- significant with ICSI outcome and not found a correlation between zinc and 8-OHdg.

The impact of late follicular progesterone level on in vitro fertilization-intracytoplasmic sperm injection outcome: Case-control study.

BackgroundStudies have been conducted to improve the pregnancy rate through the in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) program. In recent years, researchers have been focusing on finding impact of high progesterone level on endometrial receptivity. However, data on whether progesterone level also affects the quality of the embryo is still limited.ObjectiveThe aim is to assess the effect of late follicular progesterone level on the outcome of in vitro fertilization-intracytoplasmic sperm injection (IVF-ICSI).Materials and MethodsThis was a case-control of 245 women who underwent in vitro fertilization cycle at Halim Fertility Center, Indonesia. The outcomes assessed were number of oocytes retrieved (OR), maturation rate (MR), fertilization rate (FR), number of good embryos (GE), number of fair embryos (FE), and number of poor embryos (PE). The progesterone (P4) and estradiol (E2) levels were analyzed on the day of human chorionic gonadotropin injection. Serum progesterone level was divided into three groups: 1. low progesterone ( 0.50 ng/ml), 2. normal progesterone (0.51-1.50 ng/ml), and 3. high progesterone ( 1.50 ng/ml). All outcomes were compared amongst the groups.ResultsSignificant differences occurred between progesterone level on the day of human chorionic gonadotropin administration. The number of OR in group 1, 2, and 3 were 8.41 5.88 vs. 12.99 8.51 vs. 17.58 9.52, respectively.ConclusionProgesterone level on the day of human chorionic gonadotropin injection may have an impact on the outcome of IVF-ICSI.