Number Of Top-quality Embryos Research Articles

Reduced ovarian response to controlled ovarian stimulation is associated with increased oxidative stress in the follicular environment

Serum estradiol (E2) level is routinely used to monitor the ovarian response during controlled ovarian hyperstimulation (COH) and the concentration of serum E2 may influence the oocyte quality and pregnancy outcome. However, the knowledge on the association between COH induced serum E2 level, oocyte quality and embryo development is limited. Therefore we investigated the association between serum E2 level, oxidative stress in the follicular fluid and granulosa cells (GCs) response to elucidate the association between E2 level and embryological outcome. In this study, patients (n = 30) undergoing ART were categorized as ‘normal responders’ (NR, n = 10), ‘poor responders’ (PR, n = 10) and hyper responders (HR, n = 10). The follicular fluid malondialdehyde (MDA) level was determined. The total RNA extracted from GCs was subjected to analyse the relative abundance of transcripts of stress response genes (P53, caspase 3,8-oxoguanine DNA glycosylase, OGG1 and heat shock protein 70; HSP70) and embryological outcome was noted. Follicular fluid MDA level was significantly higher in PR (p < 0.01) compared NR and HR whereas number of top-quality embryos were significantly lower in PR and HR compared to NR (p < 0.01). The relative expression of P53, HSP70, and OGG1 in GCs was significantly elevated in PR (p < 0.05−0.01). An inverse relationship was established between serum E2 level vs follicular MDA level (r = −0.45; p < 0.01) and follicular MDA level vs. number of top-quality embryos (r = −0.45; p < 0.01). Hence, patients with low serum E2 had elevated oxidative stress in their follicular environment and poor quality embryos implicating the risk of oxidative stress in patients with poor ovarian response.

Does the presence of AGG interruptions within the CGG repeat tract have a protective effect on the fertility phenotype of female FMR1 premutation carriers?

While FMR1 premutation carriers (CGG 55-200) were shown to have reduced success with IVF treatment (lower oocyte yield), studies reporting on the association between the number of CGG repeats and patients' response to controlled ovarian hyperstimulation (COH) are inconsistent. In the present study, we aim to explore whether the number of CGG repeats in women with premutation in FMR1 gene, undergoing COH for IVF, correlates with COH variables and whether the number of AGG interruptions may function as a "protective factor" by improving the ovarian response to COH. Retrospective study, in an academic IVF-PGD unit. Fifty-seven consecutive FMR1 premutation carriers who underwent 285 IVF treatment cycles were included. The numbers of CGG repeats and AGG interruptions were retrieved and correlated to the demographics and COH variables. There were no significant association between the numbers of CGG or the AGG interruptions and the number of oocyte retrieved or the peak estradiol levels. The lack of association was also observed when including all the IVF treatment cycles or only the first or last IVF treatment cycle. Moreover, no associations were found between the number of CGG repeats or AGG interruptions and other COH variables, i.e., duration of stimulation, the total dose of gonadotropin used, or the number of top-quality embryos. No associations were observed between the number of CGG repeats or AGG interruptions and any of the COH variables. Further studies are required to identify early biomarkers of POI to empower FMR1 premutation carriers with risk assessment tools to consider procedures such as fertility preservation.

Impact of maternal ethnicity on pregnancy outcome in infertile women with polycystic ovarian syndrome

Polycystic ovarian syndrome (PCOS) is the most prevalent endocrine pathology seen among women of reproductive age. The objective of the study is to investigate the impact that ethnic background has on pregnancy outcomes, including live birth rates in infertile women with PCOS going through IVF compared to women without PCOS. Retrospective cohort study in an academic IVF center. This study used a coded REDCap data set of 486 women, 18-45 years of age who underwent IVF and embryo transfer between 1/1/2010 and 12/31/2015 at an academic IVF Center after IRB approval (IRB 2015-0623). Patients underwent their 1st IVF cycle following progestogen withdrawal (norethindrone acetate) using GnRH agonist or antagonist protocols with mixed gonadotropins and demographic data, including race and ethnicity was obtained. Data collected during the IVF process included peak estradiol, number of mature oocytes, fertilization rate, number of top quality embryos on Day 3 of development, number of embryos transferred, implantation rate, clinical pregnancy rate, live birth rate, clinical miscarriage rate, and ectopic pregnancy rate. In women, whose pregnancy resulted in a live birth, additional maternal and neonatal variables were collected, including estimated gestational age (EGA) at delivery, mode of delivery, and weight at birth. Using R analytics software, data was analyzed using logistic regression and linear models. For logistic regression, the estimated coefficient was the log-odds-ratio. A significant p value was considered <0.05. Of the 486 initial women, 360 women were included in the final analysis. Only women with known/reported ethnicity were included. Not Hispanic is the referent cohort for ethnicity and non-PCOS is the referent group when comparing PCOS status. There was no significant difference found for implantation rate (p=0.53) and pregnancy rate (p=0.99) when comparing women without PCOs with the women with PCOS. When taking into account the ethnicity factor in PCOS and the women who conceived and had a live birth, there was no significant difference between being Hispanic with PCOs and the referent non-Hispanic group. However, when evaluating women who started the IVF cycle, women with PCOS are less likely to have a pregnancy that leads to a live birth compared to women without PCOS (p=0.046). Being Hispanic by itself does not seem to affect live birth (p= 0.81). Hispanic women with PCOS have the same probability of having a vaginal delivery compared to the referent group (p=0.935). Women with PCOS are more likely to deliver ∼2 weeks earlier than non-PCOS patients (p=0.038). Being Hispanic and having PCOS did not affect the EGA at delivery (p= 0.83) or affected fetal weight compared to the referent group (p=0.58). This pilot study did not find a significant difference in most of the variables studied comparing Hispanic PCOS women with non-Hispanic women without PCOS. However, further studies with a larger number of subjects are needed to assess the impact of ethnicity and PCOS on IVF pregnancy outcomes.

Should ICSI be implemented during IVF to all advanced-age patients with non-male factor subfertility?

BackgroudIn order to maximize In vitro fertilization (IVF) success rates in advanced- age patients, it has been suggested to favor the use of intracytoplasmic sperm injection (ICSI) over conventional insemination (CI), with the notion that ICSI would serve as a tool to overcome interference in sperm oocyte interaction and sperm oocyte penetration issues that can be related to maternal age and are not due to sperm abnormalities. We therefore aim to evaluate the role of ICSI in the treatment of non-male factor infertile patients aged ≥35 in terms of fertilization and top-quality embryo rates.MethodsIn this retrospective cohort study, data were collected and analyzed for all patients with non-male factor infertility, aged ≥35 treated, undergoing their first IVF cycle attempt with 6 or more oocytes yield, in whom a 50% ICSI-CI division was performed.ResultsFive hundreds and four oocytes were collected from 52 eligible patients. Overall, 245 oocytes underwent ICSI and 259 oocytes underwent CI. The fertilization rate was 71.0% following ICSI, compared to 50.1% in the CI treated oocytes (P < 0.001). The top quality embryo rate was 62.8% following ICSI compared to 45.5% following CI (P < 0.001). Subdividing the study population to two age groups revealed that the above differences remained significant in patients aged 35–39 yrs., whereas in those aged 40–45 yrs., the differences were non-significant but still inclined in favor of ICSI.ConclusionsThis study favors the use of ICSI in the older IVF population in order to increase both the fertilization rate and the number of top quality embryos that result per IVF cycle. Further studies are needed to establish our observations and use ICSI as the preferred approach to overcome egg sperm abnormal interactions related to advanced maternal age.

Melatonin and Myoinositol: A Foreword Step Toward IVF Success, a Prospective Clinical Trial

Many subfertile couples, who failed to conceive naturally, seek help by means of artificial reproduction techniques such as in vitro fertilization (IVF) to achieve pregnancy. It is clear that oocyte and embryo quality depression are widely considered to be the main challenge of IVF in assisted reproduction. The aim of the study was to assess the effect and the role of melatonin combined with myoinositol on oocyte quality and to investigate its correlation with pregnancy outcome. A total of 315 patient, aged between 30-40, in a 12 month study period from Jan. 2017 to Dec. 2017, with history of one or multiple unsuccessful IVF cycles due to poor oocyte quality were included in this study. The study group (group 1, n=166) was treated with melatonin combined with myoinositol (Seidivid plus, SEIDLAB) for 3 months prior to a new IVF cycle and the control group (group 2, n =149) just received a standard IVF cycle without melatonin and myoinositol. IVF outcomes were compared between the two groups. Primary endpoint was the number of morphologically mature oocytes retrieved (MII oocytes). Secondary endpoints were fertilization rate per number of mature oocytes, embryo quality and pregnancy rate. After treatment, the number of mature oocytes, the fertilization rate, the number of top-quality embryos transferred and pregnancy rate were statistically higher compared to the previous IVF cycle, while there was no difference in the number of retrieved oocyte. The mean number of oocytes retrieved differ between the two groups being (11.56) in group 1 and (10.9) in control one (1920 vs. 1629) and the percentage of mature oocytes was significantly higher in melatonin-treated group (77.03% vs. 69.1%). Concurrently, the mean number of immature oocytes (germinal vesicles) was reduced (22.9% vs. 39.9%). Furthermore, the melatonin –myoinositol treated group showed an increase in fertilization rate (80.2% vs. 77.7%) and the mean number of grade one embryos resulted was also higher (60.05% vs. 49.5%). Clinical pregnancy rate was in tendency higher in the group treated with melatonin and myoinositol (48.3% vs. 40.8%), In the current study It was concluded that Melatonin and myoinositol treatment is likely to become a significant option for improving oocyte and embryo quality in women who cannot become pregnant because of poor oocyte quality.

Effect of GOLPH3 on cumulus granulosa cell apoptosis and ICSI pregnancy outcomes

Previous studies have shown that GOLPH3 mediates cell growth, proliferation and differentiation and inhibits cell apoptosis; however, the role of GOLPH3 in cumulus granulosa cells and the value of GOLPH3 in predicting ICSI pregnancy outcomes remain unknown until now. Our findings showed higher positive expression rate, score of staining intensity, and immunohistochemical score of GOLPH3 in the cumulus granulosa cells of the pregnant women relative to non-pregnant women, and a higher apoptotic rate of cumulus granulosa cells was detected in non-pregnant women than in pregnant women. Pearson correlation analyses revealed that pregnancy correlated negatively with GOLPH3 expression and apoptosis of cumulus granulosa cells, and positively with the number of follicles punctured, number of grade III oocytes, number of eggs retrieved for ICSI, number of zygotes, number of cleavage-stage embryos, number of top-quality embryos, number of blastocysts, number of top-quality blastocysts, and number of frozen embryos. GOLPH3 may be involved in the apoptosis of cumulus granulosa cells, which may correlate with oocyte maturation and egg development. GOLPH3 expression in cumulus granulosa cells may facilitate the selection of top-quality eggs and embryos, the prediction of the clinical pregnancy outcomes of ICSI, and the increase of the pregnancy rate.

Circular RNA expression profiling of human granulosa cells during maternal aging reveals novel transcripts associated with assisted reproductive technology outcomes.

Circular RNAs (circRNAs) are a unique class of endogenous RNAs which could be used as potential diagnostic and prognostic biomarkers of many diseases. Our study aimed to investigate circRNA profiles in human granulosa cells (GCs) during maternal aging and to uncover age-related circRNA variations that potentially reflect decreased oocyte competence. CircRNAs in GCs from in vitro fertilization (IVF) patients with young age (YA, ≤ 30 years) and advanced age (AA, ≥ 38 years) were profiled by microarray, and validated in 20 paired samples. The correlation between circRNAs expression and clinical characteristics was analyzed in additional 80 samples. Chip-based analysis revealed 46 up-regulated and 11 down-regulated circRNAs in AA samples (fold change > 2.0). Specifically, circRNA_103829, circRNA_103827 and circRNA_104816 were validated to be up-regulated, while circRNA_101889 was down-regulated in AA samples. After adjustment for gonadotropin treatment, only circRNA_103827 and circRNA_104816 levels were positively associated with maternal age (partial r = 0.332, P = 0.045; partial r = 0.473, P = 0.003; respectively). Moreover, circRNA_103827 and circRNA_104816 expressions in GCs were negatively correlated with the number of top quality embryos (r = -0.235, P = 0.036; r = -0.221, P = 0.049; respectively). Receiver operating characteristic (ROC) curve analysis indicated that the performance of circRNA_103827 for live birth prediction reached 0.698 [0.570–0.825], with 77.2% sensitivity and 60.9% specificity (P = 0.006), and that of circRNA_104816 was 0.645 [0.507–0.783] (P = 0.043). Bioinformatics analysis revealed that both circRNAs were potentially involved in glucose metabolism, mitotic cell cycle, and ovarian steroidogenesis. Therefore, age-related up-regulation of circRNA_103827 and circRNA_104816 might be potential indicators of compromised follicular micro-environment which could be used to predict IVF prognosis, and improve female infertility management.

Does Bariatric Surgery Improve Assisted Reproductive Technology Outcomes in Obese Infertile Women?

Little is known about the impact of bariatric surgery on obese infertile women seeking an assisted reproductive technology. All obese women with a history of assisted reproductive technology (ART) failure that underwent ART treatment cycles both prior to and following bariatric surgery were included. ART outcomes were compared evaluating the duration and dose of gonadotrophins used; the measurement of day 3 FSH; the anti-mullerian hormone dosage; the number of follicles >15mm; the number of retrieved and fertilized oocytes; the number of metaphase II, metaphase I and germinal vesicle oocytes; the number of embryos obtained; the number of top-quality oocytes and embryos; the number of transferred embryo; the pregnancy rate and the live birth rate. Forty women were included. The total number of gonadotropin units required and in the length of stimulation following bariatric surgery decreased (p=.001), with an increase of the number of follicles ≥15mm (p=.005), of retrieved oocytes (p=.004), of top-quality oocytes (p=.001) and metaphase II oocytes (p=.008). More oocytes were fertilized (4.2±1.7 vs 5.3±2.4; p=.02). After surgery, we have registered also a better number of top-quality embryos (0.5±0.6 vs 1.1±0.9; p=.003). Pregnancy rate following the bariatric surgery increased to 15/40 (37.5%) (p<.001), and live birth rate (LBR) increased to 14/40 (35%) in the post-surgery group (p<. 001). Although additional research would be useful to draw definitive conclusion, our results appear to be encouraging enough to suggest the use of bariatric surgery in obese infertile women seeking an ART treatment.

Anti-Müllerian hormone dynamics during GNRH-antagonist short protocol for IVF/ICSI in women with varying ovarian reserve levels.

Data on variations in anti-Müllerian hormone (AMH) levels according to ovarian reserve are scant. The aim of this study was to investigate changes in AMH levels during controlled ovarian hyperstimulation with a GnRH-antagonist protocol for in vitro fertilization (IVF). Prospective, observational study of 46 women. The subjects were divided into three cohorts according to ovarian reserve levels: polycystic ovary syndrome (PCOS; N.=19), low ovarian reserve (LOR; N.=11), and normoreserve (NR; N.=16). Serum AMH concentration was measured at baseline (cycle day 2-3 before follicle stimulating hormone [FSH] administration) and just prior to GnRH-antagonist and human chorionic gonadotropin (hCG) administration. AMH concentration in follicular fluid (FF) was assessed on the day of oocyte retrieval. AMH serum concentration decreased significantly (P<0.001) and progressively in all three groups from baseline (initiation of stimulation) to all subsequent assessments. Serum AMH levels were significantly higher in the PCOS group at all determinations: (AMH1: 8.18±6.26ng/mL, AMH2: 5.3±3.97ng/mL, AMH3: 2.19±1.31ng/mL) versus the NR group (AMH1: 2.94±1.53ng/mL, AMH2: 1.44±0.77ng/mL, AMH3: 0.71±0.57ng/mL) and LOR group (AMH1: 0.63±0.42ng/mL, AMH2: 0.58±0.4ng/mL, AMH3: 0.31±0.2ng/mL). No significant between-group differences were observed for AMH levels in FF (PCOS: 3.56±3.19ng/mL, NR: 4.06±5.44ng/mL, LOR: 1.31±0.47ng/mL) nor for fertilization rate, number of top quality embryos, or clinical pregnancy rates. Serum AMH levels gradually decrease during GnRH-antagonist protocol for IVF. This decrease starts at the beginning of the follicular phase and continues up to the day of hCG administration. These results underscore the important role that AMH plays in the process of folliculogenesis and dominant follicle selection.

Gonadotropin-releasing hormone agonist trigger in oocyte donors co-treated with a gonadotropin-releasing hormone antagonist: a dose-finding study

To determine the optimal GnRH agonist dose for triggering of oocyte maturation in oocyte donors. Single-center, randomized, parallel, investigator-blinded trial. IVFMD, My Duc Hospital, Ho Chi Minh City, Vietnam. One hundred sixty-five oocyte donors (aged 18-35 years, body mass index [BMI] <28 kg/m(2), antimüllerian hormone level >1.25 ng/mL, and antral follicle count ≥6). Ovulation trigger with 0.2, 0.3, or 0.4 mg triptorelin in a GnRH antagonist cycle. The primary end point was number of metaphase II oocytes. Secondary end points were fertilization and cleavage rates, number of embryos and top-quality embryos, steroid levels, ovarian volume, and ongoing pregnancy rate (PR) in recipients. There were no significant differences between the triptorelin 0.2, 0.3, and 0.4 mg trigger groups with respect to number of metaphase II oocytes (16.0 ± 8.5, 15.9 ± 7.8, and 14.7 ± 8.4, respectively), embryos (13.2 ± 7.8, 11.7 ± 6.9, 11.8 ± 7.0), and number of top-quality embryos (3.8 ± 2.9, 3.6 ± 3.0, 4.1 ± 3.0). Luteinizing hormone levels at 24 hours and 36 hours after trigger was significantly higher with triptorelin 0.4 mg versus 0.2 mg and 0.3 mg (9.8 ± 7.1 IU/L vs. 7.3 ± 4.1 IU/L and 7.2 ± 3.7 IU/L, respectively; 4.6 ± 3.2 IU/L vs. 3.2 ± 2.3 IU/L and 3.3 ± 2.1 IU/L, respectively. Progesterone level at oocyte pick-up +6 days was significantly higher in the 0.4-mg group (2.2 ± 3.7 ng/ml) versus 0.2 mg (1.1 ± 1.0 ng/ml) and 0.3 mg (1.2 ± 1.6 ng/ml). One patient developed early-onset severe ovarian hyperstimulation syndrome (OHSS). No significant differences between triptorelin doses of 0.2, 0.3, and 0.4 mg used for ovulation trigger in oocyte donors were seen with regard to the number of mature oocytes and top-quality embryos. NCT02208986.

Low-dose growth hormone supplementation increases clinical pregnancy rate in poor responders undergoing in vitro fertilisation

Poor ovarian response (POR) often means low success rates after in vitro fertilisation (IVF). We aim to study the impact of a low-dose growth hormone (GH) supplementation in pregnancy rates in poor responders in a prospective, self-controlled study of 64 poor responders to previous IVF cycles, who failed to achieve pregnancy and were supplemented with low-doses of GH in a subsequent cycle using the same gonadotropin dose and protocol. Our primary endpoint was the clinical pregnancy rate (CPR), considering secondary endpoints, the number of retrieved oocytes, embryos, embryo quality and the proportion of cycles with embryo transfer. CPR in the GH group was 34.4%. Significant differences were observed for the GH group both in the number of top quality embryos (0.64 ± 0.88 versus 1.03 ± 1.17, p < 0.05) and cryopreserved embryos (0.3 ± 0.81 versus 0.85 ± 1.49, p < 0.05). This is, to our knowledge, the first clinical trial to use a low dose of GH as a supplement for IVF in POR patients. Despite this low dose, we achieved excellent success rates in patients with a very poor prognosis, at a reasonable cost and without side effects, which makes this a safe and cost-effective alternative.

Co-administration of GnRH-agonist and hCG, for final oocyte maturation (double trigger), in patients with low proportion of mature oocytes

Objective: Human chorionic gonadotropin (hCG) is usually used at the end of controlled ovarian hyperstimulation (COH), as a surrogate LH surge, to induce final oocyte maturation and resumption of meiosis. Recently, the co-administration of GnRH agonist and hCG for final oocyte maturation – 40 and 34 h prior to OPU, respectively (double trigger) was suggested to improve IVF outcome in patient with genuine empty follicle syndrome. In the present study, we aim to evaluate whether the double trigger might improve the proportions of metaphase-II (MII) oocytes in patients with low proportion of mature oocytes (<66%) per number oocytes retrieved.Patients and methods: We compared the stimulation characteristics of 12 IVF cycles, which include the cycle with the double trigger to the same patients' previous IVF attempt, triggered with hCG-only.Results: Patients who received the double trigger (study group) had a significantly higher number of mature oocytes – MII (6.5 versus 3.6 p < 0.008), number of embryos transferred (2.4 versus 1.1 p < 0.03), a significantly higher proportions of MII oocytes per number of oocytes retrieved (69.7% versus 47.1% p < 0.03) and a higher number of top quality embryos (3.1 versus 1 p < 0.02), as compared to their previous control cycles (hCG-only trigger). Six pregnancies were recorded in the study group and none in the control group.Conclusions: Co-administration of GnRH-agonist and hCG for final oocyte maturation, 40 and 34 h prior to OPU, respectively (double trigger) improves IVF outcome in patients with high proportion of immature oocytes.

Understanding reproducibility of human IVF traits to predict next IVF cycle outcome.

Evaluating the failed IVF cycle often provides useful prognostic information. Before undergoing another attempt, patients experiencing an unsuccessful IVF cycle frequently request information about the probability of future success. Here, we introduced the concept of reproducibility and formulae to predict the next IVF cycle outcome. The experimental design was based on the retrospective review of IVF cycle data from 2006 to 2013 in two different IVF centers and statistical analysis. The reproducibility coefficients (r) of IVF traits including number of oocytes retrieved, oocyte maturity, fertilization, embryo quality and pregnancy were estimated using the interclass correlation coefficient between the repeated IVF cycle measurements for the same patient by variance component analysis. The formulae were designed to predict next IVF cycle outcome. The number of oocytes retrieved from patients and their fertilization rate had the highest reproducibility coefficients (r = 0.81 ~ 0.84), which indicated a very close correlation between the first retrieval cycle and subsequent IVF cycles. Oocyte maturity and number of top quality embryos had middle level reproducibility (r = 0.38 ~ 0.76) and pregnancy rate had a relative lower reproducibility (r = 0.23 ~ 0.27). Based on these parameters, the next outcome for these IVF traits might be accurately predicted by the designed formulae. The introduction of the concept of reproducibility to our human IVF program allows us to predict future IVF cycle outcomes. The traits of oocyte numbers retrieved, oocyte maturity, fertilization, and top quality embryos had higher or middle reproducibility, which provides a basis for accurate prediction of future IVF outcomes. Based on this prediction, physicians may counsel their patients or change patient's stimulation plans, and laboratory embryologists may improve their IVF techniques accordingly.

Effect of preovulatory progesterone elevation and duration of progesterone elevation on the pregnancy rate of frozen–thawed embryo transfer in natural cycles

To assess the incidence of P elevation (PE) in natural cycles and evaluate its effect on frozen-thawed embryo transfer cycles performed in natural cycles (FET-NC). Retrospective analysis. A tertiary assisted reproductive unit. Subfertile woman who did not conceive in their stimulated IVF cycle and underwent the first FET-NC cycle. Achieved serum samples were assayed for P concentrations from the day of LH surge up to 3 days before the surge. The cutoff level of PE was defined as 5 nmol/L. Clinical and ongoing pregnancy rates. The incidence of PE in natural cycles was 173 of 610 (28.4%). There were no significant differences in both clinical and ongoing pregnancy rates (39.0% vs. 37.3% and 32.5% vs. 31.7%) between those with vs. without PE on the day of LH surge. If PE lasted for 2 days or more, there was a significant reduction in the clinical pregnancy rate (39.4% vs. 20.7%). Using multivariate logistic regression, women's age, PE for 2 days or more, and the number of top-quality embryos were the significant factors for clinical pregnancy rates in FET-NC. The incidence of PE in FET-NC was similar to that in stimulated cycles. Progesterone elevation for 2 days or more before the LH surge impaired the clinical pregnancy rate of FET-NC, whereas PE on the day of LH surge only did not have such an adverse effect.

A prospective randomized study to evaluate the effect of hyaluronic acid sperm selection on the intracytoplasmic sperm injection outcome of patients with unexplained infertility having normal semen parameters

Sperm quality plays an important role in determining embryo development and intracytoplasmic sperm injection (ICSI) outcome. Selection of competent sperm based on its ability to bind to hyaluronic acid (HA) has been suggested as one of the methods to assess sperm quality. The aim of the present study was to examine whether injection of HA bound sperm helps in improving outcome in patients undergoing ICSI with unexplained infertility having normal semen parameters. Patients with unexplained infertility having normal semen parameters in accordance with WHO 2010 criterion, undergoing their first IVF-ICSI cycle were enrolled during the course of the study.156 patients were prospectively randomized after oocyte retrieval and were assigned to either the ICSI group, where sperm selection for injection was based on visual assessment, or the PICSI group, where sperm were selected based on their ability to bind to HA. Only fresh embryo transfers were included in the analysis. There was no difference in the fertilization rates, number of top quality embryos and clinical pregnancy rates between the ICSI and PICSI groups (65.7 % vs 64.7 %; 45.8 % vs 43.6 % and 35 % vs 35.2 % respectively). However, a higher pregnancy loss rate was observed in the ICSI group (25 % vs 12 %; P = 0.227) as compared to the PICSI group, but the difference was not statistically significant. Implantation rates were 22.03 % and 18.84 % in the PICSI and ICSI groups respectively. There were 22 (31 %) live births in the PICSI group and 21(26.3 %) live births in the ICSI group. Patients with unexplained infertility having normal semen parameters may constitute a patient group which does not benefit from this sperm selection method. A larger study may be necessary to establish a relationship between PICSI and pregnancy loss rate in patients undergoing IVF with unexplained infertility.

Luteal phase support does not improve the clinical pregnancy rate of natural cycle frozen-thawed embryo transfer: a retrospective analysis

ObjectiveTo evaluate pregnancy outcomes with and without use of luteal phase support (LPS) in frozen-thawed embryo transfer (FET) performed in natural cycles (NC). Study designRetrospective analysis. Before 1st July 2009, two doses of 1500IU intramuscular human chorionic gonadotrophin were given on the day of FET and 6 days after the transfer. Such practice was stopped after 1st July 2009. The pregnancy outcomes of NC FET with and without LPS were compared. ResultsA total of 408 NC FET cycles were analysed. Demographic data, embryo quality, clinical pregnancy rates and miscarriage rates were comparable with and without LPS. By univariate logistic regression, the only significant factors predicting the clinical pregnancy rate were the women's age, the number of embryos transferred, the number of top quality embryos before and after cryopreservation, and the average number of blastomeres after thawing. Only the women's age (OR 0.944, 95%C.I. 0.893–0.998, p=0.044) remained to be a significant predictor of clinical pregnancy rate by multivariate logistic regression. ConclusionThe pregnancy outcomes of NC FET were similar with or without LPS. The women's age was the significant factor affecting the clinical pregnancy rate. A randomised trial should be carried out to confirm the results.

Sperm head vacuolization affects clinical outcome in ICSI cycle. A proposal of a cut-off value

To evaluate the relationship between sperm nuclear vacuoles and sperm morphology and to investigate the influence of the rate of spermatozoa with head vacuolization (SVR) in a seminal sample on the clinical outcomes in couples undergoing intracytoplasmic sperm injection. 26 patients undergoing infertility investigations were included and were divided in two groups according to an SVR ≤ 20,28 % (Group A) or > 20,28 % (Group B), and were investigated to verify the influence of SVR on the fertilization rate, embryo quality, pregnancy and implantation rates. Abnormal spermatozoa with nuclear vacuoles were significantly higher (p < 0.001) than the percentage of normal spermatozoa with nuclear vacuoles. Patients in group A had a percentage of abnormal sperm with nuclear vacuole significantly lower compared to group B (p < 0,001), but there was no difference in the percentage of normal sperm with nuclear vacuoles. Fertilization rates and the number of top quality embryos did not differ between the two groups. The pregnancy and implantation rates were significantly higher in Group A compared to Group B (respectively p < 0,05 and p < 0.001). For the first time, we propose a cut off value in the proportion of sperms with nuclear vacuolization on the total of sperm in seminal samples, and demonstrate a relationship between SNV and clinical outcomes after ICSI. The SNV rate could be introduced as an easy diagnostic evaluation prior to perform an ICSI cycle.

Are the annexin V microbeads, a real solution to sperm DNA fragmentation?

ObjectiveThe aim of our study was to assess the effect of annexin V microbeads on cycles with abnormal sperm DNA fragmentation (>20%), in fertilization, embryo quality and success rate.DesignAnalytic Retrospective Observational study.Materials and MethodsWe analyzed 88 cycles of Assisted Reproduction treatments.All patients had abnormal sperm DNA fragmentation and previously had undergone one or more unsuccessful cycles of IVF/ICSI.The cycles were divided into two groups:Group 1: unsuccessful cycles of IVF/ICSI.Group 2: cycles with sperm sorting with annexin V columns (36 cycles) from these same partners.The sperm DNA fragmentation was assessed by TUNEL (terminal deoxynucleotidyl transferase dUTP nick end labeling).The embryos were evaluated according to criteria of the Spanish Association for Reproductive Biology (ASEBIR). The transfer was performed on day 3 of embryo development.ResultsNo significant differences were found between groups or age, nor in the rates of fertilization (P>0.05). However, embryo quality did show statistically significant differences, being higher the number of top quality embryos (A, P=0.004. A+B, P=0.02) in group 2.ConclusionThe results suggest that the use of annexin V columns improves embryo quality in couples with previous failure in IVF/ICSI. So it could be used, as a useful tool, in patients with previous IVF failures. The fertilization rate shows no significant differences. This may be because sperm with fragmented DNA were capable of fertilizing the egg as effectively as sperm without DNA fragmentation. ObjectiveThe aim of our study was to assess the effect of annexin V microbeads on cycles with abnormal sperm DNA fragmentation (>20%), in fertilization, embryo quality and success rate. The aim of our study was to assess the effect of annexin V microbeads on cycles with abnormal sperm DNA fragmentation (>20%), in fertilization, embryo quality and success rate. DesignAnalytic Retrospective Observational study. Analytic Retrospective Observational study. Materials and MethodsWe analyzed 88 cycles of Assisted Reproduction treatments.All patients had abnormal sperm DNA fragmentation and previously had undergone one or more unsuccessful cycles of IVF/ICSI.The cycles were divided into two groups:Group 1: unsuccessful cycles of IVF/ICSI.Group 2: cycles with sperm sorting with annexin V columns (36 cycles) from these same partners.The sperm DNA fragmentation was assessed by TUNEL (terminal deoxynucleotidyl transferase dUTP nick end labeling).The embryos were evaluated according to criteria of the Spanish Association for Reproductive Biology (ASEBIR). The transfer was performed on day 3 of embryo development. We analyzed 88 cycles of Assisted Reproduction treatments.All patients had abnormal sperm DNA fragmentation and previously had undergone one or more unsuccessful cycles of IVF/ICSI.The cycles were divided into two groups: Group 1: unsuccessful cycles of IVF/ICSI. Group 2: cycles with sperm sorting with annexin V columns (36 cycles) from these same partners. The sperm DNA fragmentation was assessed by TUNEL (terminal deoxynucleotidyl transferase dUTP nick end labeling).The embryos were evaluated according to criteria of the Spanish Association for Reproductive Biology (ASEBIR). The transfer was performed on day 3 of embryo development. ResultsNo significant differences were found between groups or age, nor in the rates of fertilization (P>0.05). However, embryo quality did show statistically significant differences, being higher the number of top quality embryos (A, P=0.004. A+B, P=0.02) in group 2. No significant differences were found between groups or age, nor in the rates of fertilization (P>0.05). However, embryo quality did show statistically significant differences, being higher the number of top quality embryos (A, P=0.004. A+B, P=0.02) in group 2. ConclusionThe results suggest that the use of annexin V columns improves embryo quality in couples with previous failure in IVF/ICSI. So it could be used, as a useful tool, in patients with previous IVF failures. The fertilization rate shows no significant differences. This may be because sperm with fragmented DNA were capable of fertilizing the egg as effectively as sperm without DNA fragmentation. The results suggest that the use of annexin V columns improves embryo quality in couples with previous failure in IVF/ICSI. So it could be used, as a useful tool, in patients with previous IVF failures. The fertilization rate shows no significant differences. This may be because sperm with fragmented DNA were capable of fertilizing the egg as effectively as sperm without DNA fragmentation.

Correlations between antral follicle count and ultrasonographic ovarian parameters and clinical variables and outcomes in IVF cycles

Aims: To assess the correlation between the antral follicle count (AFC) and other ultrasonographic parameters and clinical variables in in vitro fertilization (IVF) cycles. Methods: Pretreatment ultrasonographic evaluation included AFC (total), large (5–10 mm) and small (2–4 mm) antral follicles, ovarian volume, and ovarian Doppler indices. Data were prospectively uploaded and subsequently analysed in relation to IVF cycle results. Results: The study included 128 women (128 cycles). Analysis of body mass index (BMI) yielded a weak significant correlation with large (5–10 mm) AFC but not with other sonographic variables. AFC was significantly correlated with patient age, ovarian volume, number of retrieved oocytes, total dose of used gonadotropins, peak estradiol, number of top-quality embryos, and number of frozen embryos and marginally correlated with number of aspirated immature oocytes. Lower large (5–10 mm) AFC was the only ovarian parameter associated with oral contraception pretreatment compared to nontreatment, even after adjustment for age and BMI. There was no difference in any of the parameters between short and long IVF cycles. Conclusions: BMI is only weakly correlated with AFC. Pretreatment with oral contraceptives may be associated with lower AFC. Pretreatment with gonadotropin-releasing hormone agonist (long protocol) does not alter the ultrasonographic ovarian parameters.

Symmetry in number of retrieved oocytes between two ovaries: a possible predictor of in vitro fertilization outcome

Objective. To examine the relationship between the ratio of difference in number of retrieved oocytes from the two ovaries to total number of oocytes (difference ratio, |NRO−NLO|/NTOTAL) and in vitro fertilization (IVF) outcome.Methods. Retrospective review of medical record for infertility patients with intact two ovaries who had undertaken controlled ovarian stimulation (COS) and IVF cycles in Seoul National University Hospital was conducted. Characteristics and IVF outcomes were compared according to the difference ratio (|NRO−NLO|/NTOTAL) using student t-test and χ2 test. To adjust for the effect of confounding factors, binary logistic regression test was performed.Results. When the study population was divided according to the difference ratio by cut-off value of 0.4, patients with difference ratio less than 0.4 showed significantly higher pregnancy rate (25.7% vs. 17.1%, p = 0.021). A significant correlation was noted between the difference ratio and achievement of pregnancy after adjustment for patient's age and total number of top quality embryos transferred (adjusted OR = 0.40, 95% CI 0.19–0.83, p = 0.014).Conclusions. The difference ratio of retrieved oocytes in patients with intact two ovaries was observed to have prognostic value in IVF cycles.