IVF-ICSI Outcome Research Articles

The effects of decreased ovarian reserve on in vitro fertilization outcome

Objective: In this study, we aimed to compare the effects of microdose and antagonist regimens on IVF-ICSI outcome. 
 Material and Methods: The study was conducted at the XXXX University Medical Faculty Training and Research Hospital IVF Clinic during the period of 2018 and 2022. The files of the patients were reviewed retrospectively and age, duration of infertility, basal FSH level, body mass index, antral follicle number (AFC), antimullerian hormon (AMH) level, retrieved oocyte number, metaphase 2 oocyte number, fertilization and pregnancy rates were evaluated. The patients in Group 1 (n=124) were treated by using gonadotropin releasing hormone (GnRH) microdose protocol and in Group 2 (n=136) were treated by using antagonist protocol. 
 Results: There was no significant difference between the groups in terms of the characteristics of the patients such as age, infertility duration, basal FSH level body mass index, AFC and AMH level. The retrieved oocyte number, metaphase 2 oocyte number, fertilization rates and pregnancy rates were also similar.
 Conclusion: Our results demonstrated that microdose and antagonist regimens have similar effect in poor reponder women on IVF-ICSI outcome.

O-249 The impact of semen parameters on ICSI and pregnancy outcomes in egg recipient cycles with PGT-A

Abstract Study question To assess the effect of male factor on ICSI and pregnancy outcomes in egg recipient cycles combined with preimplantation aneuploidy testing Summary answer In egg donor cycles where sperm was obtained from azoospermic men there was a significant effect on ART and clinical outcomes. What is known already The increased incidence of chromosomal problems in men with azoospermia and its correlation with chromosomally abnormal embryos and with adverse pregnancy outcomes has been shown by multiple studies. Nevertheless, few studies in the literature outline the impact of non-obstructive azoospermia in the subgroup of couples who opt to use donated eggs. The egg donation model offers an opportunity to isolate the male factor and evaluate its impact on IVF-ICSI and pregnancy outcomes. The aim of our study was to study the effect of non-obstructive azoospermia(NOA) on ICSI outcomes compared with oligoasthenozoospermia(OATS) and moderate male factor(MMF) infertility, from ART parameters to clinical outcomes. Study design, size, duration This is a retrospective longitudinal cohort study involving 1,594 ICSI cycles using donor eggs performed between January 2016 and May 2020. The cohort was divided into three groups according to the male partner’s sperm parameters: couples with NOA accounting for 479 cycles (30%); couples with OAT-S (sperm number <5 x 106/ml), accounting for 442 cycles (27.8%); couples with moderate male factor, with sperm number >_5 x 106/ml and <15 x 106/ml, accounting for 673 cycles (42.2%). Participants/materials, setting, methods Participants: Subfertile couples who opted to use donor eggs. Donor eggs were utilized, due to history of severe female infertility, including low ovarian reserve, poor response to ovarian stimulation, repeated IVF failures or premature ovarian failure. Setting: Private IVF Unit Intervention: ICSI with ejaculated/surgically retrieved sperm, blastocyst culture, PGT-A and frozen-thawed euploid embryo transfer. Outcomes: The primary outcomes were live birth, fertilization, blastocyst development and euploidy rates; the secondary outcomes were clinical pregnancy, miscarriage rates, preterm labour and SGA. Main results and the role of chance The fertilization rate was significantly reduced in the NOA group as compared to the OATS and the MMF group: 30.3% versus 63% and 77.3%. Logistic regression analysis adjusted for confounders highlighted NOA as a negative predictor of obtaining an euploid blastocyst per inseminated oocyte. When the analysis was performed per obtained blastocyst, no correlation between male factor and euploidy rate was observed. The clinical pregnancy rates were similar in the MMF and OATS group, but significantly lower in the NOA group (38.2% versus 36.3% and 29.5% respectively). The miscarriage rate in the NOA group was 11.8%; higher than the OATS and MMF group (7% and 2.7%). The live birth rate per ET was significantly lower in the NOA group compared to the OATS and the MMF group (20.4% vs 30.3% and 35.4%,p<0.05). The live birth rate was significantly lower in the OATS group compared to the MMF group(p < 0.05). The risk of preterm labour was significantly higher in the NOA group, compared to the OATS and MMF group (55.1% versus 46.8 and 16.1%,p<0.001) and a higher number of babies born with a birth weight <2.5kg came from the NOA group, compared to the OATS and MMF group (34% versus 19.8% and 12.2%, p < 0.001). Limitations, reasons for caution The present study is limited by its retrospective design and the fact that the confounding factors of advanced maternal age, endometrial ageing and uterine factors cannot be fully evaluated. However, the study was controlled for female and male partner's age. Neonatal outcomes were not available. Wider implications of the findings Non-obstructive azoospermia can impair early embryonic potential and reduce live birth rates. Our study also shows an association between NOA and preterm birth. Future research should focus on prospective collection of data and long-term follow up of babies born by fathers with non-obstructive azoospermia. Trial registration number Not applicable

Stimulation Duration in Patients with Early Oocyte Maturation Triggering Criteria Does Not Impact IVF-ICSI Outcomes.

Results from studies reporting the optimal stimulation duration of IVF-ICSI cycles are inconsistent. The aim of this study was to determine whether, in the presence of early ovulation-triggering criteria, prolonged ovarian stimulation modified the chances of a live birth. This cross-sectional study included 312 women presenting triggering criteria beginning from D8 of ovarian stimulation. Among the 312 women included in the study, 135 were triggered for ovulation before D9 (D ≤ nine group) and 177 after D9 (D > nine group). The issues of fresh +/− frozen embryo transfers were taken into consideration. Cumulative clinical pregnancy and live-birth rates after fresh +/− frozen embryo transfers were similar in both groups (37% versus 46.9%, p = 0.10 and 19.3% versus 28.2%, p = 0.09, respectively). No patient characteristics were found to be predictive of a live birth depending on the day of ovulation trigger. Postponing of ovulation trigger did not impact pregnancy or live-birth rates in early responders. A patient’s clinical characteristics should not influence the decision process of ovulation trigger day in early responders. Further prospective studies should be conducted to support these findings.

Influence of sperm morphology in ICSI cycle outcomes: a retrospective study

Aim: To determine whether sperm morphology has any influence on the assisted reproductive technique (ART) outcome in in vitro fertilization (IVF)-intracytoplasmic sperm injection (ICSI) cycles. Objectives: To assess whether sperm morphology affects IVF-ICSI outcome. Method: This study was a retrospective analysis of data from 1000 couples who had undergone ART cycle at Southend Fertility & IVF, Delhi between January 2016 and January 2021. The recruited patients were divided into two groups: Group A: Group A was the study group, and included 600 patients with an abnormal sperm morphology (morphology of <4%); Group B: Group B was the control group, and included 400 patients with a normal sperm morphology (morphology of >4%). The two groups were compared in terms of fertilization rate, embryo development rate, grade A embryo development rate, grade B embryo development rate, grade C embryo development rate, cleavage rate, embryo discarded or damage rate, and pregnancy rate. Results: Of the total 1000 ART-ICSI cycles analyzed the baseline characteristics, such as age, type of infertility, and semen parameters such as volume, count, motility, debris, agglutinations, grade A motility, grade B motility, total progressive (A+B) motility, morphology assessments, and type of protocol used for stimulation were comparable between the two groups. In the 1000 patients analyzed, a total of 6871 oocytes were injected at ICSI, of which 4049 oocytes belonged to group A and 2822 oocytes belonged to group B of the 6871 oocytes injected, 6275 got fertilized, giving a fertilization rate of 91.3%. On comparing the fertilization rate of the two groups, a fertilization rate of 90.1% (3650/4049) was observed in group A and 93.01% (2625/2822) was observed in group B, which was statistically different (P < 0.001). Of the various outcome parameters, a statistically significant difference was reported in the fertilization rate, cleavage rate, embryo development rate, grade A embryo development rate, and grade C embryo development rate in the two groups. No statistically significant difference was observed in the pregnancy rate. It was also observed that once fertilization occurred, embryo quality was good for all types of abnormal spermatozoa (grade A, good- to excellent-quality embryos), except for spermatozoa with broken necks, with which only good to excellent quality, or poor quality grade B and group C embryos were obtained. Conclusion: Sperm morphology influences the fertilization rate, cleavage rate, and the embryo development rate but there is no significant influence of sperm morphology on pregnancy rate.

RCT TO STUDY THE EFFECT OF VAGINAL SILDENAFIL IN IMPROVING ART OUTCOME IN WOMEN WITH RECURRENT IMPLANTATION FAILURE UNDERGOING IVF-ICSI CYCLES

The objective of this study was to evaluate the effect of vaginal sildenafil in improving the IVF-ICSI outcome in patients with Recurrent implantation failure due to thin endometrium undergoing IVF-ICSI cycles. 52 patients with Recurrent implantation failure and a thin endometrium (Endometrial-thickness less than 7mm) were randomized into two groups. Group A patients self-administered sildenafil citrate vaginal suppositories 25mg four times a day, starting from the fifth day of menstrual cycle till the embryo transfer day. Group-B patients did not receive vaginal sildenafil. Endometrial thickness and spiral artery RI & PI were assessed using trans-vaginal spectral ultrasound Doppler in the sub-endometrial zone before embryo-transfer in both the groups of patients. The primary outcomes measured were the maximum endometrial thickness prior to embryo transfer, implantation rate and the clinical pregnancy rate. The secondary outcome measured was the abortion rate. Statistically significant improvement of endometrial thickness and endometrial blood flow with significant reduction of RI & PI were detected in Group-A patients (Study group). Implantation rate and pregnancy rate were also significantly higher in patients in the sildenafil group as compared to patients in the non-sildenafil group. (14% vs 6%) & (23% vs 11%) respectively. Abortion rate was also higher in non-sildenafil group. Vaginal sildenafil may conceivably improve Clinical pregnancy rates in thin endometrium patients suffering from recurrent implantation failure in IVF-ICSI cycles. Further randomized clinical trials using vaginal sildenafil with a higher sample size are recommended.

High-Dose Supplementation of Folic Acid in Infertile Men Improves IVF-ICSI Outcomes: A Randomized Controlled Trial (FOLFIV Trial).

Dietary supplementation is commonly used in men with male infertility but its exact role is poorly understood. The aim of this multicenter, randomized, double-blind, placebo-controlled trial was to evaluate the impact of high-dose folic acid supplementation on IVF-ICSI outcomes. 162 couples with male infertility and an indication for IVF-ICSI were included for one IVF-ICSI cycle. Male partners of couples wishing to conceive, aged 18–60 years old, with at least one abnormal spermatic criterion were randomized in a 1:1 ratio to receive daily supplements containing 15 mg of folic acid or a placebo for 3 months from Day 0 until semen collection for IVF-ICSI. Sperm parameters and DNA fragmentation before and after the treatment and the biochemical and clinical pregnancy rates after the fresh embryo transfer were analyzed. We observed an increase in the biochemical pregnancy rate and a trend for a higher clinical pregnancy rate in the folic acid group compared to placebo (44.1% versus 22.4%, p = 0.01 and 35.6% versus 20.4%, p = 0.082, respectively). Even if no changes in sperm characteristics were observed, a decrease in DNA fragmentation in the folic acid group was noted (8.5 ± 4.5 vs. 6.4 ± 4.6, p < 0.0001). High-dose folic acid supplementation in men requiring IVF-ICSI for male infertility improves IVF-ICSI outcomes.

Do midkine levels in serum and follicular fluid affect IVF-ICSI outcome?

Objective: Current studies have demonstrated that midkine (MK) inhibits the apoptosis in granulosa cells and is responsible for follicular angiogenesis. The aim of this study was to investigate the relation of MK levels and ART outcome.Material and Method: The study included a total of 99 patients who underwent IVF-ICSI at Ondokuz Mayis University between February 2019 and April 2019. Of 99 patients, no embryo development was formed in 1 patient, no oocytes were obtained by oocyte pick up (OPU) in 14 patients and the oocyte cryopreservation was established in 17 patients. In total, 67 patients underwent fresh embryo transfer after IVF-ICSI. On the day of OPU, the level of midkine in serum and follicular fluids were examined. The primary outcome was determined as pregnancy and secondary outcome was determined as blastocyst‐stage embryos. Results: The level of midkine in serum and follicular fluid was found to be higher in pregnant women compared with non-pregnant women (p=0.042 and p=0.01 respectively). Midkine levels in follicular fluid and serum lead to an increase in blastocyst development.Conclusion: Midkine levels in follicular fluid and serum may lead to an increase in blastocyst development. The level of midkine is higher in pregnant subjects than in non-pregnant subjects.

The ReceptIVFity cohort study protocol to validate the urogenital microbiome as predictor for IVF or IVF/ICSI outcome

BackgroundDuring the last decade, research has shown that besides the known predictive factors, such as duration of subfertility, a women’s age, the body mass index, also the microbiome might affect fertility. Micro-organisms together with their genetic information and the milieu in which they interact are called the microbiome. Studies have shown that the presence of certain microbiota during assisted reproductive technology (ART) has a positive impact on the outcome. However, the potential role of using the microbiome as a predictor for outcome of ART has not yet been investigated.MethodsIn a prospective study, 300 women of reproductive age and with an indication for in-vitro Fertilization (IVF) with or without Intra Cytoplasmic Sperm Injection (ICSI) treatment will be included. Prior to the IVF or IVF-ICSI treatment, these women provided a midstream urine sample and a vaginal swab. The composition of the urinary and vaginal microbiome will be analysed with both Next Generation Sequencing and the IS-pro technique. The endpoints of the study are pregnancy achieved after fresh embryo transfer (ET) and within the subsequent year after inclusion. External validation of the findings will take place in an additional cohort of 50 women with an IVF or IVF-ICSI indication.DiscussionIn the proposed study, the predictive accuracy of the composition of the urinary and vaginal microbiome for IVF or IVF-ICSI outcome will be only validated for fresh ET. Follow-up has to show whether the predictive accuracy will be similar during the consecutive frozen ET’s as part of the IVF or IVF-ICSI treatment or for subsequent stimulated or natural cycles. In addition, external validation will take place in another cohort and hospital. Predictive knowledge of the microbiome profile may enable couples to make a more substantiated decision on whether to continue treatment or not. Hence, the unnecessary physical and emotional burden of a failed IVF or IVF-ICSI treatment can be avoided.Trial registrationISRCTN ISRCTN83157250. Registered 17 August 2018. Retrospectively registered.

Assisted reproductive technology in Beijing, 2013-2015.

Why are comprehensive and detailed reports of local or national utilization outcomes of assisted reproductive technology (ART) lacking in China? Retrospective collection of data on intrauterine insemination (IUI) and IVF and intracytoplasmic sperm injection (ICSI) in Beijing, including all 12 registered institutions with cycles, started between 1 January 2013 and 31December 2015. Clinical pregnancy rates (CPR) per aspiration and fresh embryo transfer were 39.1% and 43.2% in 2013, 40.1% and 45.4% in 2014, and 37.8% and 44.5% in 2015; live birth rates (LBR) per aspiration and per fresh embryo transfer were 31.7% and 35.0%, 32.3% and 36.6%, and 30.3% and 35.6%, respectively. In frozen embryo transfer (FET) cycles, the CPR per thawed transfer was 43.4%, 47.2% and 46.2%, respectively, resulting in LBR of 34.3%, 37.4% and 36.5%. The prevalence of multiple pregnancies was 28.0-31.3% for fresh embryo transfer, and 23.5-25.9% for FET. The LBR was 8.8-9.1% after IUI with husband or partner's semen (IUI-H), and 16.7-19.7% after IUI with donor semen (IUI-D). The birth defect rate among live born infants was 1.52%, 0.42% and 0% after IUI-H, 1.05%, 0.39% and 0.66% after IUI-D, 0.71%, 0.56% and 0.46% after fresh embryo transfer, and 0.73%, 0.20% and 0.18% after FET in 2013, 2014 and 2015, respectively. In Beijing over 3 years, the number of IVF-ICSI cycles has increased and the number of IUI cycles has decreased; IVF-ICSI outcomes are better and safer. Further effort should be made to lower the multiple pregnancy rates. A Chinese nationwide ART registry should be promoted.

Effect of male body mass index on assisted reproduction treatment outcome: an updated systematic review and meta-analysis

Men with a body mass index (BMI) of 30 or over are more likely to have reduced fertility and fecundity rates. This systematic review and meta-analysis evaluated the effect of male BMI on IVF and intracytoplasmic sperm injection (ICSI) outcome. An electronic search for published literature was conducted in MEDLINE and EMBASE between 1966 and November 2016. Outcome measures were clinical pregnancy rates (CPR) and live birth rates (LBR) per IVF or ICSI cycle. Eleven studies were identified, including 14,372 cycles; nine reported CPR and seven reported LBR. Pooling of data from those studies revealed that raised male BMI was associated with a significant reduction in CPR (OR 0.78, 95% CI 0.63 to 0.98, P = 0.03) and LBR (OR 0.88, 95% CI 0.82 to 0.95, P = 0.001) per IVF-ICSI treatment cycle. Male BMI could be an important factor influencing IVF-ICSI outcome. More robust studies are needed to confirm this conclusion using standardized methods for measuring male BMI, adhering to the World Health Organization definitions of BMI categories, accounting for female BMI, IVF and ICSI cycle characteristics, including the number of embryos transferred and embryo quality, and use the live birth rate per cycle as primary outcome.

IVF outcome in azoospermic cancer survivors

ObjectiveTo assess clinical outcome among infertile couples treated by in vitro fertilization (IVF) and intra cytoplasmic sperm injection (ICSI) using testicular sperm from azoospermic cancer survivors. Study designThis clinical retrospective study included infertile couples treated in a single tertiary referral center between 1996 and 2013. All male partners were cancer survivors who were diagnosed with azoospermia due to previous gonadotoxic treatments and referred to testicular sperm extraction (TESE). Retrieved sperm was used for IVF-ICSI among patients’ spouses. Sperm retrieval rate and IVF-ICSI outcome were evaluated. ResultsSperm was successfully retrieved in 12 out of 36 patients (33.3%) on initial TESE, with an overall sperm retrieval rate of 38.6% (17 of 44). Female patients were 29.8±5.1 years old. The average number of retrieved oocytes was 14.0±4.0 per cycle, with clinical pregnancy and live birth rates per successful TESE of 64% (11 of 17) and 58.8% (10 of 17), respectively. Age, serum FSH, testicular volume and time from chemotherapy to TESE were not significantly different between patients with successful TESE to those without. Patients suffering from seminomas had significantly higher sperm retrieval rate, as compared to patients who had Hodgkin’s lymphoma (P=0.024). ConclusionsPost-chemotherapy azoospermia can be successfully treated with TESE and ICSI, and should be offered to azoospermic cancer survivors who did not cryopreserve sperm prior to their gonadotoxic treatments.

Ethnicity is an independent predictor of IVF-ICSI outcome: a study of 5,549 cycles in Spain and India

Aim: To determine the role of ethnicity on IVF/ICSI outcomes between Indian and white Caucasian women.Settings and design: Retrospective cohort study.Materials and methods: White Caucasian and Indian women undergoing IVF/ICSI treatment cycles. Total 5549 self, non-donor, fresh IVF cycles conducted from January 2014 to March 2015, out of which, 4227 were white Caucasian and 1322 were Indian. Data were collected on baseline characteristics, IVF cycle parameters and outcomes. Ongoing pregnancy rate (OPR) was measured as main outcome.Results: Indian women differed significantly from white Caucasian women in baseline characteristics like age (30.6 ± 0.2 versus 37.6 ± 0.1 years; p < 0.001), BMI (22.3 ± 0.2 versus 26.6 ± 1.0 kg/m2; p < 0.05), duration of infertility (6.9 ± 3.0 versus 2.5 ± 0.1 years; p < 0.001) and antral follicle count (AFC) (8.9 ± 0.4 versus 7.5 ± 0.2; p < 0.001). Indian women had lower implantation rate (30.1% versus 39.6%: p < 0.001) and OPR (35.1% versus 41.7%: p < 0.001) compared with white Caucasian women. Regression analysis proved independent effect of ethnicity on OPR (OR 0.944; 95% CI 0.928–0.961: p < 0.001)Conclusions: OPR was significantly lower among Indian ethnic group following IVF/ICSI suggest that ethnicity, like age, is a major and an independent predictor of IVF outcome.

Correlation of serum estradiol level on the day of ovulation trigger with the reproductive outcome of intracytoplasmic sperm injection.

BACKGROUND:Serum estradiol (E2) levels are measured in in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI), to assess the ovarian response and to predict ovarian hyperstimulation syndrome. The impact of peak E2 levels on IVF-ICSI outcome was found to be inconsistent in the previous studies.AIM:To evaluate the impact of the serum E2 levels on the day of ovulation trigger with the reproductive outcome of ICSI.SETTINGS AND DESIGN:Retrospective observational study. ART Center, at a Tertiary Care University Teaching Hospital.SUBJECTS AND METHODS:Eighty-nine infertile women, who underwent ICSI with fresh embryo transfer over a period of 3 years, were included in the study. The study subjects were grouped based on the serum E2 level on the day of ovulation trigger:- Group I - <1000 pg/ml, Group II - 1000–2000 pg/ml, Group III – 2000.1-3000 pg/ml, Group IV – 3000.1–4000 pg/ml, and Group V >4000 pg/ml. The baseline characteristics and controlled ovarian hyperstimulation (COH) outcome were compared among the study groups.STATISTICAL ANALYSIS USED:Chi-square test, Student's t-test, ANOVA, and logistic regression analysis.RESULTS:The study groups were comparable with regard to age, body mass index, ovarian reserve. Group V had significantly higher number of oocytes retrieved than I and II (18.90 vs. 11.36 and 11.33; P = 0.009). Group IV showed significantly higher fertilization rate than I, III, and V; (92.23 vs. 77.43, 75.52, 75.73; P = 0.028). There were no significant differences in the implantation rates (P = 0.368) and pregnancy rates (P = 0.368).CONCLUSION:Higher E2 levels on the day of ovulation trigger would predict increased oocyte yield after COH. E2 levels in the range of 3000–4000 pg/ml would probably predict increased fertilization and pregnancies in ICSI cycles.

The association between anti-Mullerian hormone and IVF-ICSI outcome in poor responder patients performing long protocol

Purpose of investigation: Ovarian reserve reflects the capacity of the ovaries for a successful pregnancy. Anti-Mullerian hormone (AMH) could be a useful marker to predict ovarian reserve and to adjust controlled ovarian stimulation. The aim of this study was to assess the relationship between AMH and intracytoplasmic sperm injection-in vitro fertilization (IVF-ICSI) outcome in poor responder women. Materials and Methods: This study was conducted prospectively for a period of 12 months. Inclusion criteria were FSH value > 15 iu/l or antral follicle number nd day of cycle. All patients underwent GnRH agonist stimulation with long protocol. Serum AMH levels were measured in the treatment cycle just before the stimulation. After the treatment, patients who were pregnant formed the study group and patients who were not pregnant formed the control group. Serum AMH level was the main outcome measure. Results: The study and control group consisted of 34 and 70 patients, respectively. No significant difference was found in duration of infertility, antral follicular count, basal E2 and FSH levels. The mean serum AMH level was significantly higher in study group (p = 0.005). The retrieved oocyte number, metaphase 2 oocyte number, and fertilization rate were also significantly higher in the study group. Discussion: Evaluation of serum AMH seems to be a useful marker to predict IVF-ICSI outcome in poor responder patients.

The value of HCG serum concentrations after trigger in predicting pregnancy and live birth rates in IVF–ICSI

The aim of this study was to determine if an association existed between serum human chorionic gonadotrophin (HCG) level at 12 h after trigger and IVF and intracytoplasmic sperm (ICSI) treatment outcomes. Women undergoing initial IVF–ICSI and embryo transfer treatment using the long luteal phase gonadotrophin-releasing hormone agonist protocol between April 2012 and March 2013 for tubal factor were included (n = 699). In the clinical pregnancy group, HCG after trigger was significantly elevated (276.0 ± 5.1 versus 198.5 ± 6.1 mIU/mL; P < 0.001). The optimal cut-off value proposed by the receiver operating characteristic analysis (area under curve = 0.730) for HCG was 201.2 mIU/ml. Compared with the lower HCG group, the clinical pregnancy rate in the higher HCG group was increased in obese and non-obese patients (77.8% versus 57.3%, P < 0.05; 85.6% versus 53.0%, P < 0.01, respectively). Adjusted for age and body mass index, an increase of HCG was associated with a better IVF–ICSI treatment outcome (OR 4.39, 95% CI 2.99 to 6.45). Clinical pregnancy rate was significantly higher across increasing quartiles of HCG. An elevated level of serum HCG at 12 h after trigger was associated with a better IVF–ICSI outcome.

Assessment of follicular fluid leptin levels and insulin resistance as outcome predictors in women undergoing in vitro fertilization–intracytoplasmic sperm injection

To analyze follicular fluid leptin (FFL) levels, abdominal obesity, and insulin resistance as predictors of invitro fertilization (IVF)-intracytoplasmic sperm injection (ICSI) outcome. Observational study. Academic medical center. A sample of 130 infertile women aged 26-40years without polycystic ovary syndrome. Measurement of FFL levels in controlled ovarian hyperstimulation cycles with an antagonist and agonist protocol for IVF-ICSI. Live birth rate. Mean FFL values were significantly higher in pregnancies not ending in a live birth, even after adjustment for waist circumference and insulin resistance. A multivariable model obtained with the use of logistic binary regression analysis showed that waist circumference and insulin resistance had no influence over IVF-ICSI outcomes, but a higher number of follicles, lower serum progesterone levels on the day before α-hCG administration, and lower FFL concentrations were significantly associated with a higher probability of having a live birth. The multivariate model reached a sensitivity of 87% and a specificity of 71% for predicting the possibility of pregnancy ending in a live birth. High FFL levels were associated with abdominal obesity, insulin resistance, and a lower live birth rate after IVF-ICSI. Further investigations are warranted to define the precise roles of leptin, obesity, and insulin resistance on IVF-ICSI outcomes.

MP68-09 EULERIAN VIDEO MAGNIFICATION: A NOVEL TECHNIQUE FOR IMPROVED SPERM SELECTION IN MEN WITH SEVERE OLIGOASTHENOSPERMIA

You have accessJournal of UrologyInfertility: Evaluation1 Apr 2014MP68-09 EULERIAN VIDEO MAGNIFICATION: A NOVEL TECHNIQUE FOR IMPROVED SPERM SELECTION IN MEN WITH SEVERE OLIGOASTHENOSPERMIA Gavin Langille, James Dupree, Jason Kovac, Ranjith Ramasamy, Dolores Lamb, and Larry Lipshultz Gavin LangilleGavin Langille More articles by this author , James DupreeJames Dupree More articles by this author , Jason KovacJason Kovac More articles by this author , Ranjith RamasamyRanjith Ramasamy More articles by this author , Dolores LambDolores Lamb More articles by this author , and Larry LipshultzLarry Lipshultz More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.2188AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The absence of sufficient motile sperm in samples used for in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) can present a serious clinical problem for infertility specialists wishing to select viable sperm. Identification of optimal quality sperm can be especially challenging in men with oligoasthenospermia. Eulerian Video Magnification (EVM) is a technique that provides an opportunity to detect subtle movements in video feeds not appreciable to the unaided human eye. EVM is a computational algorithm that uses spatial and temporal variations present in video sources to enhance, in a spatially-multiscale manner, the variation of individual pixel values over time. In patients whose semen samples demonstrate significantly impaired motility by traditional light microscopy, EVM could be used to select viable motile sperm that would have been otherwise identified as non-motile using traditional light microscopic visualization. METHODS Using traditional light microscopy with 400x magnification, semen analysis (SA) samples from men demonstrating severe oligoasthenospermia (density < 1 million/ml and motility < 20%) were investigated. A high definition (HD) video camera was used to record video footage from three high-powered fields (HPF) per SA. Each video recording was scored twice for motility, first using the raw HD footage, and second after the video was processed using EVM previously developed at the Massachusetts Institute of Technology (http://people.csail.mit.edu/mrub/vidmag). Quantitation of motile sperm in each video recording was compared between the raw and EVM-enhanced images. RESULTS Video from eleven SA samples with three recordings each were analyzed. A total of 442 sperm were recorded across all samples. After processing with EVM, the number of additionally recognized motile/viable sperm increased by 14% (p<0.05). CONCLUSIONS EVM is a novel technique to identify viable sperm that would not have been recognized using traditional light microscopy. Using a micro-locator and micro-pipette, these sperm can then be retrieved for IVF-ICSI. Our data suggests that an additional 14% of retrieved ova can then be inseminated. Further studies are underway to refine this technique and to test the efficacy of the additional EVM-identified sperm in improving IVF-ICSI outcomes for the oligoasthenospermic patient. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e801 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Gavin Langille More articles by this author James Dupree More articles by this author Jason Kovac More articles by this author Ranjith Ramasamy More articles by this author Dolores Lamb More articles by this author Larry Lipshultz More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Beneficial Effect of an Oral Antioxidant Supplementation (Fertimax2) on IVF-ICSI Outcomes: A Preliminary Clinical Study

Background: Considerable evidence points towards a significant role of oxidative stress (OS) in the pathogenesis of sperm dysfunction. OS as a result of an inappropriate balance between oxidants and antioxidants in the semen can cause DNA damage and lipid peroxidation leading to failure of conception, miscarriage or potentially even childhood cancer. The objective of this study was to investigate whether a male antioxidant therapy can improve semen parameters and the results of in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI). Methods: A total of forty eight infertile couples were considered. Male participants were administrated Fertimax2 antioxidant treatment for at least two months prior to their partner’s IVF-ICSI cycle. Sperm parameters (volume, concentration, progressive motility) and the IVF-ICSI outcomes were compared before and after the antioxidant treatment. The primary outcome measures were oocyte fertilization, cleavage and good embryo quality rates; the secondary outcomes were biochemical pregnancies, clinical pregnancies and implantation rates. Results: The principal finding that emerged from this study was that antioxidant therapy resulted in significant improvements in fertilization (p = 00.2), cleavage (p = 0.004) and good-embryo quality (p = 0.002) rates accompanied by a marked increase in clinical pregnancy (18.7% versus 2.5%) and implantation (11.8% versus 1.02%) rates. No significant changes in routine sperm parameters were observed. Conclusion: The Fertimax2 antioxidant therapy appears to influence favorably chances of conception in couples undergoing assisted reproduction treatment (ART).

Is dehydroepiandrosterone (DHEA) supplementation really effective on IVF-ICSI outcome in patients with poor ovarian reserve?

Is dehydroepiandrosterone (DHEA) supplementation really effective on IVF-ICSI outcome in patients with poor ovarian reserve?

In Vitro Fertilization Outcomes in Treated Hypothyroidism

Levothyroxine has been shown to enhance pregnancy outcomes in women with hypothyroidism requiring in vitro fertilization (IVF). However, the precise magnitude of these benefits remains to be determined. In particular, it has yet to be clarified whether levothyroxine may fully overcome the detrimental effects of hypothyroidism or, conversely, whether affected women remain at reduced prognosis for pregnancy outcomes. Patients who underwent IVF-intracytoplasmic sperm injection (ICSI) over a 3-year period were reviewed. Cases were deemed eligible if they were diagnosed with clinical or subclinical hypothyroidism and were receiving levothyroxine. Controls were two subsequently age-matched euthyroid women for every case. Both cases and controls were selected only if serum thyrotropin was ≤2.5 mIU/L. In total, 137 women with treated hypothyroidism and 274 controls were included. Baseline characteristics of the two study groups were similar with the exception of body mass index, which was slightly higher among the cases (22.9±3.9 vs. 21.9±3.3 kg/m2, p=0.013). Most IVF-ICSI cycle outcome variables were also similar, with the exception of a higher rate of cancellation for poor response (3.6% vs. 0.7%, p=0.04), a longer duration of stimulation (10.9±2.2 vs. 10.1±2.0 days, p=0.001), a higher proportion of women failing to obtain viable embryos (17% vs. 7%, p=0.006), and a lower fertilization rate (75% vs. 86%, p=0.017) among cases. Conversely, the clinical pregnancy rate per started cycle, the implantation rate, and the live birth rate per started cycle did not differ; they were 36% and 34% (p=0.93), 28% and 22% (p=0.11), and 30% and 27% (p=0.50) in cases and controls, respectively. Subgroup analyses comparing women with (n=79) and without (n=58) thyroid autoimmunity and comparing women who were diagnosed with overt hypothyroidism (n=70) or subclinical hypothyroidism (n=67) failed to identify relevant differences. In our population, IVF-ICSI outcome was not significantly hampered in women with adequately treated hypothyroidism. The magnitude of the detected differences in cycle outcome was mild, and we failed to document any differences for the most relevant outcomes, i.e., pregnancy rate, implantation rate, and delivery rate. In conclusion, adequate levothyroxine treatment maintaining thyrotropin serum levels below 2.5 mIU/L may overcome the detrimental effects of hypothyroidism.