Intracytoplasmic Sperm Injection Pregnancies Research Articles

Luteal phase serum progesterone level: a potential predictive marker for pregnancy rate in intracytoplasmic sperm injection.

Background: It is evident that there is a lack of clear consensus on the role of luteal phase serum Progesterone (P) level in the prediction of early pregnancy after controlled ovarian hyperstimulation (COH) protocols in assisted reproductive techniques (ART).Objective: We conducted this study in order to investigate the potential value of luteal phase serum progesterone measurement, in women undergoing ICSI treatment cycles and receiving progesterone supplements, in relation to pregnancy rate.Patients: A total of 68 women aged 20-40 years undergoing their first intracytoplasmic sperm injection (ICSI) cycles in fertility and I.V.F center of Kamal Al samrai hospital.Methods: women consecutively treated by ICSI had Estimation of luteal phase serum Progesterone levels on days 0 and 14 of embryo transfer (ET).Results: 10 pregnancies were achieved (14.7%). Age, basal FSH level, peak E2 level, number of oocytes retrieved, and number of embryos transferred were comparable between pregnant and nonpregnant women. Day-0 and day-14 luteal phase serum Progesterone levels were significantly different between the two groups.Conclusion: Luteal phase serum Progesterone concentration seems to be a promising marker for prediction of early pregnancy in intracytoplasmic sperm injection.

Reduction in sperm aneuploidy levels in severe oligoasthenoteratospermic patients after medical therapy: a preliminary report

The objective of this study was to investigate whether medical therapy can reduce sperm aneuploidy levels and improve the results of intracytoplasmic sperm injection (ICSI) in patients with severe idiopathic oligoasthenoteratospermia (OAT). Thirty-three infertile couples requiring ICSI because of severe idiopathic OAT after at least one unsuccessful ICSI cycle were considered. Semen parameters (concentration, motility and morphology), the percentage of aneuploid sperm and the results of ICSI (the number of oocytes fertilized, embryos transferred, biochemical pregnancies, clinical pregnancies and live births) were compared before and after a 3-month course of treatment with L-carnitine 1 g given twice per day+acetyl-L-carnitine 500 mg given twice per day+one 30-mg cinnoxicam tablet every 4 days. Aneuploidy was assessed using fluorescent in situ hybridisation (FISH) performed on chromosomes X, Y, 13, 15, 16, 17, 18, 21 and 22. The results showed that 22 of the 33 patients had a reduced frequency of aneuploid sperm and improved sperm morphology after treatment (group 1), and 11 showed no change (group 2). The numbers of biochemical pregnancies, clinical pregnancies and live births were significantly higher in group 1 than in group 2. No significant difference was found between the groups regarding the numbers of oocytes fertilized and embryos transferred. The side effects were negligible. The numbers of ICSI pregnancies and live births in severe idiopathic OAT patients improved with a course of L-carnitine, acetyl-L-carnitine and cinnoxicam.

Investigation of confined placental mosaicism by CGH in IVF and ICSI pregnancies

BackgroundAssisted reproductive technologies include in-vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI). It has been shown that embryos derived from ART have higher rates of aneuploidy. Although the majority of ART pregnancies are genetically normal, it is suspected that aneuploid embryos may persist as mosaics and lead to confined placental mosaicism (CPM). Due to the greater risks of sperm aneuploidy in infertile men, CPM may be more prevalent in ICSI than IVF pregnancies. In this report, we investigated the prevalence of CPM in IVF and ICSI pregnancies using comparative genomic hybridization and flow cytometry. MethodsThe placenta and umbilical cord blood were collected after birth. To determine the presence of CPM, karyotypes of umbilical cord blood were compared to the results of placental analyses. For each placenta, multiple villous sites were investigated for DNA gains/losses and polyploidy using comparative genomic hybridization and flow cytometry. Detected abnormalities were further confirmed by fluorescent in-situ hybridization (FISH). ResultsIn total, 134 IVF/ICSI cases were investigated. CPM was detected in five of these cases (5/134) giving an overall rate of 3.73%. CPM was detected in one IVF case (1/31; 3.23%) and four ICSI cases (4/103; 3.88%). The prevalence of CPM in IVF and ICSI pregnancies was not statistically different from each other. CPM was not observed in 13 ICSI and 6 IVF cases that were determined to be small for gestational age (SGA). ConclusionsThe prevalence of CPM in ICSI pregnancies is not greater than IVF pregnancies. In addition, the overall prevalence of CPM in ART pregnancies (IVF and ICSI) is similar to that of the general population. CPM was not observed in the limited cases that were affected by small for gestational age. Our results suggest that ART pregnancies are not at a greater risk for CPM.

Clinical and economic analysis of rescue intracytoplasmic sperm injection cycles

Objective. To identify clinical and embryological factors that may predict success in rescue intracytoplasmic sperm injection (ICSI) cycles (after total fertilization failure has occurred) and to evaluate the cost effectiveness of rescue ICSI strategy. Additionally, follow-up of 20 rescue ICSI pregnancies is reported.Design. Retrospective analysis of total fertilization failure cycles.Setting. University-based tertiary medical center.Material and methods. In total, 92 patients who had undergone conventional in-vitro fertilization (IVF) cycles with total fertilization failure were included. The patients were divided into two subgroups: those who conceived through rescue ICSI and those who did not.Results. The pregnant members of the rescue ICSI subgroup were found to be significantly younger (32.9 ± 4.2 vs. 36.3 ± 4.5, respectively, p = 0.0035,) and to have better-quality embryos than those who did not conceive (cumulative embryo score: 38.3 ± 20.4 vs. 29.3 ± 14.7, p = 0.025). Cost effectiveness analysis showed 25% reduction in the cost per live birth when rescue ICSI is compared to cycle cancellation approach. The pregnancies follow-up did not show adverse perinatal outcome.Conclusions. Rescue ICSI is an option for salvaging IVF cycles complicated by total fertilization failure. Success in rescue ICSI was found to be associated with younger age and higher quality of embryos. Furthermore, the cost effectiveness of rescue ICSI in terms of total fertilization failure was found to be worthwhile.

Comparison of chromosomal abnormality rates in ICSI for non-male factor and spontaneous conception

To compare cytogenetic data of first-trimester missed abortions in intracytoplasmic sperm injection (ICSI) for non-male factor-mediated and spontaneous pregnancies. Using karyotype analysis, we conducted a retrospective cohort trial of missed abortions following ICSI for non-male factor and spontaneous pregnancies. Patients experienced missed abortions during the first 12 weeks of pregnancy. Dilation and curettage procedure was performed followed by cytogenetic evaluations. Two patient groups were created: ICSI (n = 71) and spontaneous pregnancies (n = 81). At least 20 GTG-banded metaphases were analyzed in each case for cytogenetic analyses. Statistical analyses were performed using NCSS 2007 Statistical Program software. The significance level and confidence interval for all analyses were set to p < 0.05 and a 95% confidence interval, respectively. A total of 49.3% (75/152) of the miscarriages were cytogenetically abnormal among the patients. We detected cytogenetically abnormalities in 47.9% (34/71) of the ICSI group and 50.6% (41/81) of the control group, which were not statistically significant differences (p=NS). The sex chromosome abnormalities were similar between the ICSI and control groups (p=NS). The most prevalent abnormalities that were observed in the ICSI and control groups with first-trimester pregnancy loss were trisomy (n = 42; 27.6%), Turner syndrome (45, X0, n = 13; 8.6%), triploidy (n = 13; 8.6%), 48 chromosomes (n = 5; 3.3%), and mixed chromosomal abnormalities (n = 3; 1.2%). In addition, the karyotypes were similar between the ICSI and control groups (p=NS). We observed increases in fetal aneuploidy rates with increased maternal age (<30 years = 23.9% vs. 31-34 years = 37.0% vs. 35-39 years = 82.9% vs. >39 years = 90.9%). However, the observed increases in fetal aneuploidy rates were not statistically significant (p=NS). The aneuploidy rates and sex chromosome anomalies following ICSI for non-male factor were similar to those following natural conception.

Relationships between human sperm protamines, DNA damage and assisted reproduction outcomes

The exchange of histones with protamines in sperm DNA results in sperm chromatin compaction and protection. Variations in sperm protamine expression are associated with male infertility. The aim of this study was to investigate relationships between DNA fragmentation, sperm protamines and assisted reproduction treatment. Semen and spermatozoa prepared by density-gradient centrifugation (DGC) from 73 men undergoing IVF and 24 men undergoing intracytoplasmic sperm injection (ICSI) were included in the study. Nuclear DNA fragmentation was assessed using the alkaline Comet assay and protamines were separated by acid-urea polyacrylamide gels. Sperm DNA fragmentation and protamine content (P1–DNA, P2–DNA, P1 + P2–DNA) decreased in spermatozoa after DGC. Abnormally high and low P1/P2 ratios were associated with increased sperm DNA fragmentation. Couples with idiopathic infertility had abnormally high P1/P2 ratios. Fertilization rates and embryo quality decreased as sperm DNA fragmentation or protamines increased. Sperm DNA fragmentation was lower in couples achieving pregnancies after IVF, but not after ICSI. There was no correlation between protamine content (P1–DNA, P2–DNA, P1 + P2–DNA) or P1/P2 ratios and IVF or ICSI pregnancies. Increased sperm DNA fragmentation was associated with abnormal protamination and resulted in lower fertilization rates, poorer embryo quality and reduced pregnancy rates. During late spermatogenesis, around 85% of the histones in the sperm nucleus are replaced with protamines. This process results in sperm chromatin compaction and also transcription silencing. In the human, protamines are comprised of two types: protamine-1 (P1) and protamine-2 (P2). Variations in sperm protamine expression are associated with male infertility. Similarly, sperm DNA integrity is important for male fertility. The aim of this study was to investigate relationships between DNA fragmentation, sperm protamines and assisted reproduction treatment. Semen and spermatozoa prepared by density-gradient centrifugation (DGC) from 73 men undergoing IVF and 24 men undergoing intracytoplasmic sperm injection (ICSI) were included in the study. Nuclear DNA fragmentation was assessed using the alkaline Comet assay and protamines were separated by acid-urea polyacrylamide gels. Sperm DNA fragmentation and protamine content decreased in spermatozoa after DGC. Abnormally high and low P1/P2 ratios were associated with increased sperm DNA fragmentation. Couples with idiopathic infertility had abnormally high P1/P2 ratios. Fertilization rates and embryo quality decreased as sperm DNA fragmentation or protamines increased. Sperm DNA fragmentation was lower in couples achieving pregnancies after IVF, but not after ICSI. There was no correlation between protamine content or P1/P2 ratios and IVF or ICSI pregnancies. Increased sperm DNA fragmentation was associated with abnormal protamination and resulted in lower fertilization rates, poorer embryo quality and reduced pregnancy rates.

Placental inflammation and oxidative stress in the mouse model of assisted reproduction

Higher rates of low birth weight and prematurity are observed in pregnancies generated with assisted reproduction technologies (ART). Both conditions have been associated with placental inflammation and oxidative stress. Since placental and fetal levels of progesterone, a major anti-inflammatory steroid, are decreased in murine ART, we investigated placental inflammation and oxidative stress in this model as potential mediators of negative birth outcomes. After generating mouse pregnancies by in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) we evaluated the antioxidant defense network and major inflammatory cytokines in maternal, placental and fetal tissues. Additionally, placentas were analyzed for total lipid levels, fibrosis, apoptosis, reactive oxygen species and integrity of intracellular nucleotides. Placentas from ART contained significantly less lipids, with greater levels of apoptosis and degraded nucleotides. Placentas from ICSI pregnancies had lower activities of superoxide dismutase (SOD), thioredoxin reductase (TrxR), xanthine oxidase (XO), catalase, glutathione-S-transferase (GST) glutathione peroxidase, and glutathione reductase (GR). Furthermore, GR, GST and SOD were also lower in fetal livers from ICSI pregnancies. Placentas from IVF pregnancies had decreased levels of SOD, TrxR and XO only. In placentas from both ICSI and IVF pregnancies IL-6 levels were significantly increased. These data suggest that ART is associated with placental inflammation (IL-6), oxidative stress and apoptosis but not fibrosis or remodeling. These effects are markedly greater with the ICSI technique. Since ICSI is ubiquitous, oxidative stress and placental inflammation associated with this method may be a critical factor in negative birth outcomes such as prematurity and low birth weight.

Assisted reproduction technologies alter steroid delivery to the mouse fetus during pregnancy

Assisted reproduction technologies (ART) include in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI), and are common treatments for infertility. Although generally successful, ART warrant further investigations due to emerging perinatal issues, especially low birth weight. Herein we extend our previous work demonstrating higher steroid clearance in murine ART placentas by examining steroid biosynthesis and the directional flow of steroids in the maternal–placental–fetal units. The activities of the major steroidogenic enzymes 3β-hydroxysteroid dehydrogenase (3β-HSD) and cytochrome P450 17-αhydroxylase (CYP17) were assessed in maternal liver and ovaries and fetal livers as were levels of cholesterol, progesterone, estrone (E1), and estradiol (E2) in the maternal, placental and fetal units. No structural abnormalities were found in placentas from ART. Although ART increased 3β-HSD activity in maternal livers, there were no other changes in 3β-HSD- or CYP17-mediated steroidogenesis. Cholesterol levels were significantly lower in maternal livers of ICSI pregnancies and in placentas from both IVF and ICSI pregnancies but not altered in the fetal livers. Progesterone levels were higher in maternal and fetal livers in IVF and ICSI, respectively, but were significantly lowered in ICSI placentas, compared to normal fertilization. For estrogenic hormones, no differences in E1 or E2 levels were observed in maternal livers but ICSI significantly increased both E1 and E2 levels in placentas while both IVF and ICSI significantly lowered E1 but raised E2 levels in fetal livers. In summary, while steroid production was normal, steroid diffusion/flow from mother to fetus was altered in murine pregnancies conceived by ART. This appears to occur, at least in part; through placental mechanisms. Impaired cholesterol and steroid transfer may affect correct regulation of fetal growth and development.

Clinical implications of sperm DNA damage

Traditionally, the diagnosis of male infertility has relied upon microscopic assessment and biochemical assays to determine human semen quality. These tests are essential to provide the fundamental information on which clinicians base their initial diagnosis. However, none of these parameters addresses sperm function and their clinical value in predicting fertility is questionable. The advent of intracytoplasmic sperm injection (ICSI) has further reduced the significance and perceived need for sperm quality tests since ICSI requires only one sperm for the procedure to be successful. Even the conventional measures of sperm quality in terms of normal morphology or motility are not necessary for successful ICSI. Funding of andrological research has been neglected and improvement in assisted reproductive technology (ART) success has suffered as a consequence. Testing of sperm DNA damage shows much promise both as a diagnostic test for male infertility and a prognostic test for ART outcomes. It has been shown to be closely associated with numerous fertility outcomes including negative relationships with fertilization, embryo quality, implantation and positive relationships with miscarriage and childhood diseases. Here we report the relationships between in vitro fertilisation, ICSI pregnancy rates and sperm DNA damage, using the Comet assay to measure DNA fragmentation and also a novel test to measure modified bases, as a indication of oxidative DNA injury.

Preterm delivery in IVF versus ICSI singleton pregnancies: a national population-based cohort

Objectives To assess the risk of spontaneous and iatrogenic preterm delivery in singleton pregnancies when comparing in vitro fertilization (IVF) pregnancies with intracytoplasmic sperm injection (ICSI) pregnancies. Study design A national population-based cohort study using Norwegian Medical Birth Register data during 1999 through 2006 was designed. The cohort included 5824 singleton pregnancies after IVF and ICSI treatment. Multinomial logistic regression analyses were used to calculate risk estimates. Results There were no differences in maternal complicating factors such as pre-eclampsia, hypertension and diabetes between the IVF and ICSI pregnancies. However, IVF pregnancies had a 60% increased risk of moderately (32 + 0 days–36 + 6 days gestational weeks) iatrogenic preterm delivery (OR: 1.6, 95%CI: 1.1–2.2) and a 40% increased risk of iatrogenic preterm delivery <37 weeks (OR: 1.4, 95%CI: 1.02–1.9) compared to ICSI pregnancies. Conclusion IVF pregnancies were at increased risk of moderately iatrogenic preterm delivery when compared to ICSI pregnancies.

The impact of vanishing fetuses on the outcome of ICSI pregnancies

Vanishing fetal twins occurred in 9% (264 out of 2,829) intracytoplasmic sperm injection pregnancies and are associated with a lower fetal loss rate in the first trimester. The live birth rate was higher in pregnancies associated with vanishing fetuses.

N-Acetyl cysteine: could it be an effective adjuvant therapy in ICSI cycles? A preliminary study

This randomized controlled trial tested the hypothesis that addition of N-acetyl cysteine (NAC) can increase the probability of pregnancy in intracytoplasmic sperm injection (ICSI) cycles using the long agonist protocol. Women undergoing ICSI cycles due to male factor were randomly assigned to receive either long protocol (group A, 38 women) or long protocol plus NAC (group B, 38 women). Clinical pregnancy was the primary outcome. Granulosa cell apoptosis, fertilization rate, number of grade-one embryos and ongoing pregnancy were the secondary outcomes. Clinical pregnancy rate was insignificantly higher in NAC group (52.6%) than control (47.4%). Early and late apoptosis were also insignificantly lower in group B than in group A. Irrespective of the used protocol, there was significant negative correlation between both early and late apoptosis and fertilization rate (both P<0.001) and the number of good-quality embryos (P=0.007 and P<0.001, respectively). Pregnant patients had significantly lower early and late apoptosis than those who didn't achieve pregnancy (P<0.001). In conclusion, NAC supplementation did not significantly increase the probability of pregnancy in ICSI cycles using long agonist protocol. It appears that granulosa cell apoptosis may be an important prognosticator for ICSI cycle outcome.

Sperm samples (SS) from infertile patients (IP) undergoing intracytoplasmic sperm injection (ICSI) or intrauterine insemination (IUI) show profound different expression profiles (EP)

OBJECTIVE: Basic SS analysis presents limited predictive power on pregnancy achievement by assisted reproductive techniques (ARTs). Other molecular factors as mRNA present within spermatozoa have recently been described. Our group listed genes differentially expressed (GDE) from SS from pregnant (group P) vs. those non pregnant (group NP) by microarray technology in couples undergoing homologous IUI and ICSI. Our aim is to characterize differential gene EP between SS achieving or not pregnancy in ICSI and IUI cycles. DESIGN: Nested cases and controls study, where 10 SS (5 that achieved pregnancy and 5 failing to conceive) were obtained from IP undergoing IUI with healthy female partners and ICSI cycle with oocytes from young donors. After freezing aliquots of the SS employed for both treatments we compared their respective mRNA expression profiles. Finally 4 microarrays in duplicate were performed with sperm samples from group P vs. NP from both techniques. MATERIALS AND METHODS: SS mRNA was extracted using Trizol, suspended in DEPC-treated water and frozen at -80ºC until the microarray experiments were performed. RNAs were analyzed on Agilent Bioanalyzer 2100 and those genes differentially expressed (GDE) at least twice, with statistically significant differences between P and NP in IUI and ICSI SS were listed and compared. RESULTS: Total number of genes expressed (TNG) in IUI microarray was 19938 and 19229 in ICSI. About 70 % of TNG was common in both procedures. Around 50% of GDE in group P of ICSI group were GDE in group P from IUI group too. There are more GDE (950) in IUI group compared with ICSI group (49). CONCLUSIONS: These data reveals that sperm EP is consistent and molecular features required to pregnant are different in IUI and ICSI procedures. These differences could be potentially employed to detect ICSI and IUI success markers, although it needs to be further explored in order to figure out their biological roles.

Are Tests of Sperm DNA Damage Clinically Useful? Pros and Cons

The advent of assisted reproductive technologies, particularly intracytoplasmic sperm injection (ICSI), has revolutionized the treatment of male-factor infertility. However, there are many unanswered questions regarding the safety of these techniques. These safety concerns are relevant because 1) these technologies often bypass the barriers to natural selection; 2) infertile men, particularly those with severe male-factor infertility, possess substantially more sperm DNA damage than do fertile men; and 3) experimentally, sperm DNA damage has been shown to adversely affect the developing embryo. This review discusses the etiology of sperm DNA damage, describes the individual tests of sperm DNA damage, and explores the relationship between sperm DNA damage and pregnancy outcomes. Based on a systematic review of the literature, sperm DNA damage is associated with lower natural, intrauterine insemination (IUI), and in vitro fertilization (IVF) pregnancy rates, but not with ICSI pregnancy rates. The literature also suggests that that sperm DNA damage is associated with an increased risk of pregnancy loss in those couples undergoing IVF or ICSI. Nonetheless, the true clinical utility of sperm DNA damage tests remains to be established, because the available studies are small and few in number and the study characteristics are heterogeneous. Although current data suggest that impaired sperm DNA integrity may have the greatest effect on IUI pregnancy rates and pregnancy loss by IVF and ICSI, further prospective studies are needed before testing should become a routine part of patient management.

Does luteal estradiol supplementation have a role in long agonist cycles?

To test the hypothesis that the addition of 6 mg estradiol (E2) valerate either orally or vaginally to progesterone (P) for luteal support, can increase the probability of pregnancy in intracytoplasmic sperm injection (ICSI) cycles using the long agonist protocol. Prospective open-labeled randomized controlled trial. Private and university fertility centers. Women undergoing ICSI cycles, with controlled ovarian hyperstimulation using long agonist protocol. On embryo transfer day, participants were randomized to receive, only P (group A, n = 90), P along with 6 mg E(2) valerate either orally (group B, n = 90), or vaginally (group C, n = 90) for luteal support. Clinical pregnancy was the main outcome. luteal serum E(2) and P profiles were the secondary outcomes. Highest pregnancy rate was achieved in group C (45.56%), it was significantly higher than A (relative risk 1.52, 95% CI: 1.03 to 2.24). Day 0 (hCG day) E2 levels were similar in the three groups. Group A had lower E2 levels on days 7, 10, and 13 and a higher magnitude of E2 decline on days 7 and 10. Similar levels of luteal E2 were documented in groups B and C. P levels were similar in the three groups. Addition of 6 mg E(2) valerate to P support may encumber the sharp decline in luteal E(2) level. It may enhance the probability of pregnancy if administered vaginally.

Association of assisted reproductive technology with twinning and congenital anomalies

Recently many reports have been published on the use of intracytoplasmic sperm injection (ICSI) and the increased risk of congenital major malformations or syndromes. We present three cases with Goldenhar syndrome (one of them a twin pair) and one case with Rubinstein-Taybi syndrome (RTS), also a twin pair. All four female cases are derived from ICSI. Goldenhar syndrome with ICSI pregnancy has been reported previously but as far as we know, RTS has not been described in association with assisted reproductive technology (ART). The four new cases reported herein will contribute to a better understanding whether ICSI pregnancy increases congenital malformations.

Semen processing for HIV deletion doesn't affect ICSI's pregnancy rate

The request for assisted reproductive technology (ART) by couples which man is HIV infected, has drastically increased in order to reduce risks of virus transmission to woman and child. The aim of this study was to verify if elimination of viral particles of HIV soropositive men semen impacts on semen quality and in the pregnancy rate following intracytoplasmic sperm injection (ICSI). Retrospective study. This study included 10 HIV seropositive men (HIV+), aging 37.6 ± 5.0 years submitted to ICSI cycles due to serodiscordance. A control group (HIV−) was composed by semen donors (n = 8), aging 32.7 ± 6.8 years. Semen from HIV- group was collected and routine semen analysis was performed according to World Health Organization (WHO), and morphology by Kruger strict criteria before semen cryopreservation. HIV+ patients were submitted to antibiotic therapy (Norfloxacine 400 mg BID for 3 weeks) previously to semen collection, and seminal samples were analyzed as routine, and processed thought current sperm-wash followed by density gradient method. Before cryopreservation, an aliquot were used to detect the presence of HIV-1 thought real time polymerase chain reaction (RT-PCR). Women were submitted to ovarian stimulation and ICSI was performed with thawed and washed sperm samples. For HIV+ samples, ICSI was performed only when no HIV-1 virus was detected. Seminal parameters (concentration, motility, progressive motility and morphology), and pregnancy rate were compared between groups. Sperm concentration in HIV− (52.1 × 106 sperm/mL) had no statistical difference to HIV+ group (59.2 × 106 sperm/mL; P=0.318). The same was observed when the percentile of motile sperm was evaluated (HIV−: 61.7%, HIV+: 61.9%; P=0.117). However, when just progressive motility was compared, it was observed a significant difference between the groups (HIV−: 68%, HIV+: 48%; P=0.022). Morphology differences were not observed among experimental groups (P=0.684) as well as pregnancy rate (P=0.964). After delivery no seroconversion was observed on mother and child. Semen quality of HIV seropositive patients and its treatment before cryopreservation do not affect ICSI's pregnancy rate, and associated to an adequate antiretroviral protocol, semen processing may be a successful toll in providing safe gametes for reproductive management of serodiscordant couples.

Late stages of embryo progression are a much better predictor of clinical pregnancy than early cleavage in intracytoplasmic sperm injection and in vitro fertilization cycles with blastocyst-stage transfer

To define and validate metrics of embryo progression and morphology during extended embryo culture and to compare the effects of early cleavage (EC) vs. blastulation stages on clinical pregnancy. Retrospective observational study. University-affiliated assisted reproduction center. One thousand two hundred ninety-two intracytoplasmic sperm injection and 842 IVF blastocyst-transfer cycles. The embryo progression index (EPI) was calculated as the area under the curve of total cell number (TCN) over time, by using observed TCN for cleavage-stage embryos and estimated blastocyst TCN according to morphology. The EPI from days 1-3 measured early cleavage, and blastulation was assessed by EPI over extended embryo culture. Blastocyst morphology was converted into numerical blastocyst quality scores (BQSs). Receiver operating characteristic curve analysis was used to evaluate predictors for clinical pregnancy. Clinical pregnancy. Per-cycle mean EPI and mean BQS for all embryos developing into blastocysts, as well as mean BQS of the transferred embryos, were significant predictors of clinical pregnancy in intracytoplasmic sperm injection and IVF cycles. Mean EPI for days 1-3 did not predict outcome. Early cleavage is a putative marker of embryo quality. Late-stage embryo development is more sensitive and specific in predicting clinical pregnancy than is early cleavage, supporting the use of extended embryo culture for embryo selection. The embryo progression index and BQS may also be used for this purpose.

Atosiban vs ritodrine used prophylactically with cerclage in ICSI pregnancies to prevent pre-term birth in women identified as being at high risk on the basis of transvaginal ultrasound scan

SummaryOur objective was to compare the effectiveness and safety of atosiban and ritodrine, in pregnancies obtained by intracytoplasmic sperm injection (ICSI) undergoing cervical cerclage. Data from a prospective study were compared with those from a retrospective study. Sixteen ICSI pregnant women, 20 – 24 weeks' gestation and maternal age >18 years, received atosiban (bolus dose 6.75 mg i.v., followed by 300 μg/min i.v. for 3 h and 100 μg/min i.v. for 45 h). Cervical cerclage was performed 3 h after starting atosiban. The control group (group B) of 16 ICSI pregnant women were matched and received ritodrine hydrochloride (100 – 350 μg/min) for 48 h. Cervical cerclage was performed after 24 h. Pre-term rupture of membranes occurred within 48 h of cervical cerclage in one woman receiving atosiban and in four women receiving ritodrine. There was no significant difference in terms of pregnancies not delivered at 48 h (short-term tocolysis) and at 7 days (long-term tocolysis). However, there was a significantly higher incidence of maternal tachycardia with ritodrine compared with atosiban (p < 0.001). The mean gestational age at delivery was significantly higher for atosiban compared with ritodrine (36 vs 33 weeks; p < 0.001). The neonatal outcome was poorer for ritodrine than atosiban, as there were very low birth weight infants (p = 0.008), resulting in lower Apgar scores (p = 0.005) and there were more neonates requiring a long stay in the neonatal intensive care unit (p = 0.005). We conclude that atosiban is associated with a significantly lower incidence of maternal tachycardia and improved neonatal outcome compared with ritodrine.

Success of Testicular Sperm Injection and Intracytoplasmic Sperm Injection in Men with Klinefelter Syndrome

The aim of this study was to report the successful fertility treatment of men with Klinefelter syndrome using testicular sperm extraction (TESE) and intracytoplasmic sperm injection (ICSI). A total of 42 men with Klinefelter syndrome who underwent 54 TESE procedures were identified. Before TESE, patients with serum testosterone levels less than 15.6 nmol/liter were treated with an aromatase inhibitor. Sperm retrieval rates and results of ICSI, including fertilization and clinical pregnancy, were collected. Mean pretreatment FSH and testosterone levels were 33.2 IU/liter and 9.8 nmol/liter. During medical therapy, the mean testosterone level rose to 17.0 nmol/liter (P < 0.01). Spermatozoa were found during 39 microdissection TESE procedures, on the day before, or day of oocyte retrieval during a programmed in vitro fertilization cycle. The sperm retrieval rate was 72% (39 of 54) per TESE attempt, and 29 of the 42 different men (69%) had adequate sperm found for ICSI. Thirty-three in vitro fertilization cycles yielded embryos for transfer in the 39 (85%) cycles with sperm retrieved. Eighteen clinical pregnancies have resulted in 21 live births [18 of 39 (46%)]. All children had a normal karyotype. TESE/ICSI is a successful intervention for the majority of patients with azoospermia and Klinefelter syndrome. Sperm retrieval and ICSI success in men with Klinefelter syndrome are comparable with other men with nonobstructive azoospermia treated at our center.