Good-quality Embryo Rate Research Articles

When semen viscosity was overcome, it did not afeect the clinical outcomes of fresh embryo transfer cycles regardless of insemination methods

To evaluate the influence of overcome semen viscosity (SV) on clinical outcomes according to two types of insemination method (i.e., conventional in vitro fertilization or intracytoplasmic sperm injection) in fresh embryo transfer cycles. Retrospective cohort study of 681 IVF/ICSI cycles from January 2013 to October 2017. Cycles were divided into 4 groups according to the presence of SV and the types of insemination method (IVF: SV, n = 51 vs. no SV, n = 77 and ICSI: SV, n = 255 vs. no SV, n = 298). Cycles with poor responder, advanced maternal age (≥38 years), frozen sperm, and surgically retrieved sperm were excluded. Semen parameters were evaluated according to the WHO 2010. SV (length of ≥2 cm) was checked by gentle aspiration of liquefied semen into a 5-mL serological pipette and then allowing the semen to drop by gravity and observing the length of any thread. To overcome semen viscosity, a sterile 5-mL syringe fitted with a sterile 18G needle was used. The semen was gently drawn into the syringe and expelled slowly back into the tube and repeated. Semen was treated by swim-up method. Patients’ characteristics between SV and no SV in the IVF or the ICSI group were not statistically significant difference (p > 0.05). We observed similar rates of fertilization and good-quality embryos on day 3 between SV and no SV in IVF or the ICSI group, respectively. Moreover, the rates of biochemical pregnancy, clinical pregnancy, ongoing pregnancy, miscarriage, and implantation per cycle also did not significantly differ between SV and no SV in the IVF or the ICSI group (p > 0.05).Tabled 1Table 1. Clinical outcomes in SV versus no SV according to insemination methodIVF-SVIVF-no SVp-valueICSI-SVICSI-no SVp-valueCycles (n)5177255298Oocytes fertilized rate (%)84.7 (533/629)83.1 (726/874)0.38673.7 (2238/3037)73.6 (2503/3401)0.931Good quality embryos rate (%)18.6 (99/533)21.8 (158/726)0.16514.3 (319/2238)15.8 (396/2503)0.132Biochemical pregnancy rate (%)60.8 (31/51)50.6 (39/77)0.25949.8 (127/255)48.3 (144/298)0.728Clinical pregnancy (%)51.0 (26/51)36.4 (28/77)0.10139.6 (101/255)37.2 (111/298)0.569Ongoing pregnancy (%)41.2 (21/51)33.8 (26/77)0.39532.9 (84/255)34.2 (102/298)0.749Abortion (%)19.2 (5/26)7.1 (2/28)0.24316.8 (17/101)8.1 (9/102)0.053Implantation (%)36.2 (38/105)25.5 (41/161)0.06123.7 (129/544)21.3 (132/621)0.316 Open table in a new tab When SV was overcome, it did not affect the clinical outcomes of fresh embryo transfer cycles regardless of insemination methods.

Outcomes of Preimplantation Genetic Diagnosis Cycles by Fluorescent In situ Hybridization of Infertile Males with Nonmosaic 47,XYY Syndrome.

Background:The 47,XYY syndrome could result in fertility problems. However, seldom studies reported comprehensive researches on the embryonic development and pregnancy outcomes of these patients. This study aimed to evaluate the clinical outcomes of nonmosaic 47,XYY patients performed with fluorescent in situ hybridization (FISH) and preimplantation genetic diagnosis (PGD) treatment.Methods:This was a retrospective study. Between January 2012 and May 2017, 51 infertile males with nonmosaic 47,XYY syndrome underwent FISH-PGD were included in the study. According to sex chromosomal FISH results, embryos were classified as normal signal, no nuclei fixed, no signal in fixed nuclei, suspensive signal, and abnormal signal groups, respectively. The incidence of each group, the fixation rate, and hybridization rate were calculated. Embryonic development and pregnancy outcomes were also analyzed. The measurement data were analyzed with Student's t-test. The comparison of categorical data was analyzed with the Chi-square test and Fisher's exact test when expected cell count was <5.Results:The 53 PGD cycles with 433 embryos were analyzed. The fixation rate was 89.6%, while the hybridization rate was 96.4%. There were 283 embryos with two sex chromosomal signals with clear diagnosis (65.4%). The numbers of no nuclei fixed, no signal in fixed nuclei, suspensive signal, and abnormal signal groups were 45 (10.4%), 14 (3.2%), 24 (5.5%), and 67 (15.5%), respectively. Embryos with abnormal signals were abandoned. The number of good-quality embryos was 210 (57.4%), including implanted embryos on day 4/day 5 and cryopreserved. The rates of good-quality embryos in the no nuclei fixed (22.2%), no signal in fixed nuclei (28.6%), and suspensive signal groups (33.3%) were comparable (P > 0.05), and were significantly lower than the normal signal group (66.4%, P < 0.001). The clinical pregnancy rates of fresh and frozen embryos transferred cycles were 70.6% and 85.7%, respectively.Conclusions:Among embryos with a clear diagnosis of sex chromosome, about one-fifth showed abnormal signals. Embryos with two sex chromosomal signals are more likely to develop into good-quality ones. The application of the PGD by FISH may help to improve the clinical outcomes.

Application of testicular spermatozoa cryopreservation in assisted reproduction.

To evaluate the efficiency of spermatozoa cryopreservation and to compare the clinical pregnancy outcomes in intracytoplasmic sperm injection (ICSI) using fresh versus cryopreserved spermatozoa collected by testicular sperm aspiration (TESA). A retrospective study was performed to compare the outcomes of men who accepted frozen-spermatozoa-based TESA-ICSI with those of men who underwent TESA-ICSI using fresh spermatozoa between January 1, 2015, and December 30, 2016. The groups were matched for age. The rates of fertilization, good-quality embryos, blastocyst formation, and clinical pregnancy outcomes were obtained from clinical records and were compared between the groups. There were no significant differences between the frozen TESA group (n=79) and the fresh TESA group (n=194) in the rates of fertilization (71.4% vs 73.4%), good-quality embryos (55.3% vs 54.5%), blastocyst formation (60.9% vs 60.1%), clinical pregnancy (61.7% vs 55.1%), and live delivery (51.1% vs 45.7%) (P>0.05 for allcomparisons). Freezing low-count sperm collected by TESA with a cryoprotectant was an efficient method in the treatment of male factor infertility.

Effect of Progestin-primed Ovarian Stimulation Protocol on Outcomes of Aged Infertile Women Who Failed to Get Pregnant in the First IVF/ ICSI Cycle: A Self-controlled Study.

This study aimed to explore the outcomes of progestin-primed ovarian stimulation protocol (PPOS) in aged infertile women who failed to get pregnant in the first IVF/ICSI-ET cycles with GnRH-a long protocol. A self-controlled study was conducted to retrospectively investigate the clinical outcomes of 104 aged infertile patients who didn't get pregnant in the first IVF/ICSI-ET treatment by stimulating with GnRH-a long protocol (non-PPOS group), and underwent PPOS protocol (PPOS group) in the second cycle between January 2016 and December 2016 in the Center for Reproductive Medicine, Renmin Hospital of Wuhan University. The primary outcomes included clinical pregnancy rate of frozen-thawed embryos transfer (FET) in PPOS group, and good-quality embryo rate in both groups. The secondary outcomes were fertilization rate, egg utilization rate and cycle cancellation rate. The results showed that there were no significant differences in basal follicle stimulating hormone (bFSH), antral follicle count (AFC), duration and total dosage of gonadotropin (Gn), number of oocytes retrieved, intracytoplasmic sperm injection (ICSI) rate, fertilization rate, and cycle cancellation rate between the two groups (P>0.05). However, the oocyte utilization rate and good-quality embryo rate in PPOS group were significantly higher than those in non-PPOS group (P<0.05). By the end of April 2017,62 FET cycles were conducted in PPOS group. The clinical pregnancy rate and embryo implantation rate were 22.58% and 12.70%, respectively. In conclusion, PPOS protocol may provide better clinical outcomes by improving the oocyte utilization rate and good-quality embryo rate for aged infertile patients who failed to get pregnant in the first IVF/ICSI-ET cycles.

Testicular sperm is superior to ejaculated sperm for ICSI in cryptozoospermia: An update systematic review and meta-analysis

Intracytoplasmic sperm injection (ICSI) is well established and provides patients with severely impaired sperm quality with an opportunity to father a child. However, previous studies do not clearly indicate whether male with cryptozoospermia should use testicular sperm or ejaculated sperm for ICSI. The newest systematic review of this topic also gave a controversial conclusion that was based on incorrect pooling result. Moreover, two clinical studies published after the systematic review. In the present update systematic review and meta-analysis, a comprehensive citation search for relevant studies was performed using the Cochrane library databases, Embase, Ovid MEDLINE, PubMed, ScienceDirect, Scopus, and Web of Science up to September 2017. The search returned 313 records, in which six studies were included in quantitative synthesis. These studies involved 578 male infertility patients who had undergone 761 ICSI cycles. The risk ratios favour fresh testicular sperm for good quality embryo rate (1.17, 95% CI 1.05–1.30, P = 0.005), implantation rate (95% CI 1.02–2.26, P = 0.04), and pregnancy rate (RR = 1.74, 95% CI 1.20–2.52, P = 0.004). In conclusion, the existing evidence suggests that testicular sperm is better than ejaculated sperm for ICSI in male with cryptozoospermia.

Outcomes of poor responders following growth hormone co-treatment with IVF/ICSI mild stimulation protocol: a retrospective cohort study.

No research has studied the effect of GH co-treatment in mild stimulation protocol for poor responders. We therefore conducted this retrospective analysis to assess the outcome of IVF/ICSI cycles after the adjunct GH use to the mild stimulation protocol in poor responders. 132 poor responders who received mild stimulation protocol at Reproductive Medicine Center of Changzheng Hospital from January 2014 to December 2016 were included in this study. Good-quality embryo rate, clinical pregnancy rate, and live birth rate were compared between the GH group (n=61) and control group (n=71). IVF good-quality embryo rate (68.1 versus 51.5%; P=0.008*) and ICSI good-quality embryo rate (53.9 versus 36.7%; P=0.045*) was significantly higher in the GH group. Though the clinical outcomes did not reach a statistically significant difference between the two groups due to the limited sample size, there was a trend of higher rate in GH group in the aspect of clinical pregnancy rate (52.4 versus 47.1%; P=0.609) and live birth rate (35.7 versus 27.5%; P=0.392). The results suggested that the adjuvant GH treatment in mild stimulation protocol for poor responders could significantly improve good-quality embryo rate, and might therefore improve the clinical outcomes.

Patients with acephalic spermatozoa syndrome linked to SUN5 mutations have a favorable pregnancy outcome from ICSI.

Are Sad1 and UNC84 domain containing 5 (SUN5) mutations associated with the outcomes of ICSI in patients with acephalic spermatozoa syndrome (ASS)? Despite highly abnormal sperm morphology, ASS patients with SUN5 mutations have a favorable pregnancy outcome following ICSI. ASS is a rare cause of infertility characterized by the production of a majority of headless spermatozoa, along with a small proportion of intact spermatozoa with an abnormal head-tail junction. Previous studies have demonstrated that SUN5 mutations may cause ASS. Several studies showed that ICSI could help patients with ASS father children. This retrospective cohort study included 11 infertile ASS males with SUN5 mutations. Five of them underwent five ICSI cycles. Their ICSI results were compared to men with ASS without SUN5 mutations (n = 3) and to men with multiple morphological abnormalities of the sperm flagella (MMAF) (n = 9). All ICSI treatments were completed between Jan 2011 and May 2017. Sanger DNA sequencing was used to detect mutations in SUN5. Clinical and biological data were collected from patients at the fertility center. Sanger sequencing validated 11 patients with SUN5 mutations. Three novel mutations in SUN5 (c.829C>T [p.Q277*]; c.1067G>A [p.R356H]; c.211+1 insGT [p.S71Cfs11*]) were identified in three patients. The rates of fertilization, good-quality embryos and pregnancy for five patients with SUN5 mutations following ICSI were 81.5%, 81.8% and 100%, respectively. The rates of fertilization and good-quality embryos in patients with MMAF were significantly lower compared with ASS patients (65.6 versus 82.4%, P = 0.039 and 53.6 versus 85.2%, P = 0.031, respectively). There were no differences in ICSI results between ASS patients with and without SUN5 mutations. Only a small number patients with SUN5 mutations was available because of its rare incidence. Patients with ASS can be effectively treated with ICSI. SUN5 mutations may be one of the genetic causes of ASS. This study was supported by the National Natural Science Foundation of China (81401251, 81370754, and 81170559), the Jiangsu Province Special Program of Medical Science (BL2012009, ZX201110, FXK201221) and a project funded by PAPD of the Priority Academic Program Development of Jiangsu High Education Institutions (JX10231802). None of the authors have any competing interests.

Effects of growth hormone plus gonadotropins on controlled ovarian stimulation in infertile women of advanced age, poor responders, and previous in vitro fertilization failure patients

ObjectiveTo investigate the effects of growth hormone (GH) cotreatment in ovarian stimulation in infertile women of advanced age, poor responders, and patients with one or more previous IVF treatment failures. Materials and methodsWe conducted a retrospective observational study of 436 patients undergoing GH cotreatment in ovarian stimulation. The first arm included 134 infertile women of advanced age. The second arm included 236 patients with one or more IVF previous treatment failures, and the third arm included 66 younger poor responders. Main outcome measures were the number of oocytes and embryos, quality of embryos, and implantation and pregnancy rates. ResultsIn infertile women of advanced age, GH plus ovarian stimulation yielded no statistical differences in the numbers of oocytes and embryos, quality of embryo, and rates of implantation and pregnancy. In the second arm, the mature oocyte number (8.2 vs. 6.8), implantation rate (16.1% vs. 0%), and pregnancy rate (33.9% vs. 0%) in the GH cotreatment group differed significantly from those in the control group; the rate of good-quality embryos in the GH cotreatment group improved from 35.5% ± 31.1%–41.4% ± 30.6% in this arm. Similar results were observed in the third arm; in this arm, the clinical pregnancy rate was 30.3% in the GH cotreatment group and 6.1% in the control group. ConclusionNo significant differences were observed in infertile women of advanced age, which may be due to the low GH dose. The GH adjuvant therapy for patients with one or more previous IVF treatment failures and for poor responders significantly improved the oocyte and embryo numbers as well as implantation and pregnancy rates.

Bilaterality of ovarian endometriomas does not affect the outcome of in vitro fertilization/intracytoplasmic sperm injection in infertile women after laparoscopic cystectomy

BackgroundTo assess whether the unilateral or bilateral lesions can affect ovarian reserve and pregnancy outcome in in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) in infertility patients underwent laparoscopic cystectomy. MethodsA total of 148 IVF/ICSI cycle in patients who had undergone laparoscopic cystectomy for unilateral or bilateral endometriomas were reviewed retrospectively. There were 103 cycles where laparoscopic cystectomy had been carried out for unilateral endometriomas and 45 cycles after bilateral-side surgery. Primary outcome measures were ovarian reserve and ovarian response. Secondary outcome measures were the implantation rate, clinical pregnancy rate, and live birth rate. ResultsThe number of dominant follicle on the day of human chorionic gonadotropin (hCG) administration (5.2 ± 3.1 vs. 4.2 ± 2.7; p = 0.048), and oocytes retrieved (10.0 ± 6.9 vs. 7.6 ± 6.6; p = 0.047) were significantly lower in the bilateral-side group compare with the unilateral-side group. However, the mean number of antral follicle count, metaphase II oocytes, the doses of gonadotropin used, fertilization rate, the rate of good quality embryos transferred, implantation rate and clinical pregnancy, live-birth rate and miscarriage rate were similar between the two groups. ConclusionThere were no associations among the bilaterality of ovarian endometriomas, ovarian reserve and pregnancy outcomes in IVF/ICSI cycles. However, bilateral ovarian endometriomas after laparoscopic cystectomy may impair ovarian response as compared to unilateral ovarian endometrioma.

A new insight into male fertility preservation for patients with completely immotile spermatozoa

BackgroundSperm cryopreservation is the most effective method to preserve male fertility but this is normally used for motile spermatozoa. Thus, only motile spermatozoa are used for cryopreservation in most reproductive medicine centers worldwide. The immotile spermatozoa from some problematic patients are usually discarded, resulting in a missed opportunity of sterility cryopreservation for future assisted reproductive treatments. Many studies have shown that successful fertilization can be obtained after selection of viable sperm from the completely immotile spermatozoa before ICSI. Whether the completely immotile spermatozoa are worth of freezing has not been realized The aim of this study is to explore the clinical value of cryopreservation of immotile spermatozoa.MethodsCompletely immotile spermatozoa were collected and frozen, and subsequently viable but immotile frozen-thawed spermatozoa were selected by laser plus for ICSI. Main outcomes included spermatozoa survival index, fertilization rate and good quality embryo rate.ResultsAfter identification by laser, the fresh samples of spermatozoa presented with a mean survival rate of 54.86% and 26.05%, and this was reduced to 44.13% and 18.13% in frozen-thawed spermatozoa samples, which showed a frozen-thawed spermatozoa survival index of 0.80 and 0.70 in the testicular and ejaculate sperm, respectively. There were no statistically differences in fertilization rate (80% vs80.51%, 75.00% vs 81.48%), cleavage rate (95.45% vs 98.95%, 100.00% vs 95.45%) and good quality embryo rate (40.48% vs 52.13%, 33.33%vs38.10%) between the frozen-thawed immotile spermatozoa group and the routine fresh immotile spermatozoa ICSI group in both testicular and ejaculate sperm, respectively.ConclusionsThe results of the study show that completely immotile spermatozoa can be frozen in order to preserve male fertility as long as viable spermatozoa are present. This procedure provides a further possibility for fertility preservation for patients with completely immotile spermatozoa.

Correlation between the number of cultured human embryos and embryo development in the wow culture dish system

The WOW dish (LinKIDTM culture dish; DNP, Japan) has 25 microwells that allows group culture under a single drop of medium. Through its design, it is possible to manage embryos separately whilst in group culture. Due to paracrine effects associated with group culture, embryo culture results have been reported to be improved in animal species such as the cow and mouse. However, there is scant information on group culture, and any subsequent effects of the WOW dish used for human embryo culture. Therefore, in order to clarify the group effect of WOW culture in human embryos, we investigated whether there is any relationship between the number of cultured embryos and subsequent embryo development. 7039 embryos from 936 IVF cycles (from September 2014 to October 2015) where blastocyst culture was performed in WOW dish or 15μl droplet were analyzed. 814 WOW cycles and 122 droplet cycles were each divided into 5 experimental groups according to number of cultured embryos (4-5, 6-10,11-15,16-20 and 21-25 embryos). The rates of good quality embryos on culture day3 and day5 (defined as ≥3BB, Gardner's score) were analyzed and compared between WOW and droplet groups. 2PN embryos which were obtained from either ICSI or conventional IVF were cultured in WOW (group culture with 60μl single step medium) or a droplet system (single embryo culture with 15μl single step medium) for up to 7 days. The culture medium was exchanged on day3 and day5 in the droplet groups, but not in the WOW groups. Chi-square and Cochran-Armitage tests were used for statistical analysis. The rates of good quality embryos on Day 3 in groups 4-5, 6-10,11-15,16-20 and 21-25 between WOW and droplet groups were 22.8% versus 23.9%, 22.2% versus 17.3%, 25.4% versus 18.3%, 33.7% versus 23.8%, and 33.8% versus 13.1%, respectively. The rates of good quality blastocysts on Day 5 in groups 4-5, 6-10,11-15,16-20 and 21-25 between WOW and droplet groups were 35.5% versus 37.5%, 37.3% versus 35.4%, 39.7% versus 39.4%, 45.5% versus 36.3%, and 48.2% versus 31.1% respectively. The differences between WOW and droplet groups in the 21-25 embryos group were significant (p<0.05) for the two parameters on day3 and day5 respectively. Furthermore, a positive correlation was observed between the number of cultured embryos and embryo development in WOW culture (p<0.01; the Cochran-Armitage Test), but not in droplet culture. A positive correlation was confirmed between the number of cultured embryos and embryo development in WOW culture. In the WOW culture system, increasing the number of cultured embryos, potentially causes elevations in the concentration of paracrine factors. These findings in a human embryo culture system are in line with previous reports from animal species and support the positive role of group culture for human embryo development.

Clinical evaluation of two generations of time lapse imaging systems

Time lapse monitoring of embryos during culture is being used increasingly to achieve optimal culture conditions, improved embryo selection, quality control, and more efficient workflow in the laboratory. Since 2015, two EmbryoScope™ (ES-D) devices, each with a capacity to monitor up to 12 embryos from 6 patients have been used in our clinic. In order to allow for time lapse monitoring during the entire incubation period for all our patients, we installed five units of the new EmbryoScope+™ (ES+) device in 2017. One ES+ unit can monitor up to 16 embryos from a total of 15 patients simultaneously. Due to the increased capacity of the ES+, the number of “door” openings of the incubator have increased compared to the ES. However, the ES+ incubator has also been re-configured so that only the embryo slides taken out of the incubator are ejected from the controlled environment, leaving remaining slides concealed inside the incubator. One additional difference between the two systems is that the embryos in the dish for ES+ share media overlay, whereas, the embryos in the ES dish are completely isolated from each other. In this study, we compared outcomes between the two incubator types as we migrated from the ES-D to the ES+. A prospective study We targeted 776 mature ova in 73 cycles from which at least six oocytes were retrieved between January and February 2017 for investigation. After insemination, embryos from each patient were allocated to two groups and incubated in an ES-D (ES group) or an ES+ (ES+ group). We compared fertilization rate, cleavage rate, Day-3 good-quality embryo rate, Day-5 blastocyst formation rate, Day-5 good-quality blastocyst rate, and Day-6 blastocyst formation rate between the ES-D and ES+ groups. Our findings revealed for the ES-D versus the ES+ group a fertilization rate of 85.8% versus 83.0%, cleavage rate 100% versus 97.5%, Day-3 good-quality embryo rate 70.6% versus 74.5%, Day-5 blastocyst formation rate 62.2% versus 69.4%, Day-5 good-quality blastocyst rate 37.5% versus 44.2%, and Day-6 blastocyst formation rate 9.8% versus 5.6%, respectively. There was no significant difference between the two groups in these parameters. The outcomes with the two time-lapse incubation and imaging systems showed no statistical difference in the present study; even though, the new ES+ device tended to yield higher blastocyst formation than the ES-D. The ES+ provides an incubation environment that is at least equivalent or superior to that of the ES-D, ES-D occupied area per patient was 562.8 cm2 per patient and , ES + was 220.0 cm2 per patient, and has more than double the capacity of the ES-D. Thus, the ES+ is shown to be a highly attractive upgrade for a busy lab such as ours.

Effect of oxygen concentration on outcome of in-vitro fertilization-embryo transfer

To investigate the effect of low and high oxygen concentration on embryo development, pregnancy outcome and birth defects of in vitro fertilization-embryo transfer (IVF-ET). According to the oxygen concentration of in vitro culture environment, the IVF-ET performed in the Women's Hospital, Zhejiang University School of Medicine during 2013 and 2015 were divided into low oxygen concentration group (n=2036, 5% O2) and high oxygen concentration group (n=4617, 20% O2). The rate of fertilization, good quality embryo, clinical pregnancy, ectopic pregnancy, abortion and birth defect were compared between two groups. The good quality embryo rate was significantly higher in the low oxygen concentration group (P<0.05). However, no significant differences were found between two groups in the rate of fertilization, clinical pregnancy, ectopic pregnancy, abortion and birth defect (all P>0.05). Low oxygen environment may improve the potential of embryonic development, but its impact on pregnancy outcome and birth defect is not significant.

Clinical outcome analysis of mild-stimulation in poor ovarian responders

Objective To explore the clinical outcomes of different mild-stimulation in poor ovarian responders in vitro culture/intracytoplasmic injection (IVF/ICSI) to provide the evidence for clinical treatment, and investigate clinical parameters including pre-ovulation rate, rate of oocytes retrieved, fertilization rate, good quality embryo rate, and pregnancy rate per cycle. Methods The clinical date of a total 180 IVF cycles of infertile patients undergone from Jan 2013 to May 2016 in medical reprodution center of Xiang Tan Central Hospital. According to the different methods of controlled ovarian hyperstimulation (COH), the cycles were divided into 3 groups: group A with 60 cycles of early five days using clomiphene, group B with 60 cycles of persistent using clomiphene, and group C with 60 cycles using artificial luteal-phase ovarian stimulation protocol. Results The basic situations in three groups were no significant difference ( P>0.05). Compared to groups B and C, the pre-ovalution rate was more in group A (P<0.05), and the rate of oocytes retrieved, fertilization rate, good quality embryo rate, and preganacy rate per cycle were higher in groups B and C (P<0.05). The rate of oocytes retrieved, fertilization rate, good quality embryo rate, and preganacy rate per cycle were no significant difference among gourps B and C. The good quality embryo rate and preganacy rate per cycle in groups B and C were higher than group A, and group B was higher than group A (P<0.05). Conclusions Persistent using clomiphene or persistent using clomiphene in COH could decrease the rate of pre-ovalution, and get more rate of oocytes retrieved, good quality embryo rate, and preganacy rate per cycle. Key words: Ovulation induction; Ovarian diseases/DT

Time-lapse imaging reveals differences in growth dynamics of embryos after in vitro maturation compared with conventional stimulation

To study the impact of invitro maturation (IVM) on embryonal development with the use of time-lapse imaging. Retrospective case-control study. University hospital. In total, 294 embryos were cultured after intracytoplasmic sperm injection treatment of three groups: patients with polycystic ovary syndrome (PCOS) and IVM (n = 105; group 1 [G1]), patients after conventional stimulation without PCOS (n = 115; G2) and with PCOS (n = 74; G3). In total, 171 embryos were finally analyzed (57 G1, 65 G2, and 49 G3). Data of 23 PCOS patients (30 IVM cycles) from January 2012 to July 2015 were matched according to age and number of oocytes to patients after conventional stimulation without PCOS (n = 30; 30 cycles) and with PCOS (n = 16; 19 cycles). Markers of embryo development were analyzed at different time points. Pregnancy rates (PRs) and live birth rates (LBRs) were recorded. Morphokinetic differences in embryo development after IVM compared with conventional stimulation with or without PCOS. The rate of good-quality embryos was significantly lower in G1. Embryo development in G1 was significantly accelerated to the time of appearance of two pronuclei but slowed down by the time of reaching 6-cell stage and remained slower compared with embryos of G2 and G3. PRs as well as LBRs did not differ significantly among the study groups. Although growth dynamics of embryos from G1 differ from G2 and G3 and the rate of good-quality embryos was lower in IVM embryos, PRs and LBRs did not differ significantly.

The application value of sperm nuclear DNA integrity and sperm morphology in the treatment of ICSI

Objective To investigate the effects of sperm DNA fragmentation (SDF) and sperm morphology on the fertilization and embryo development in ICSI. Methods SDF and sperm morphology were detected in the meanwhile of taking eggs in 145 ICSI treatment cycle.On the basis of SDF index (DFI) divided into group A (DFI≤30%) and group B (DFI>30%). According to the normal sperm morphology divided into group C (NMSR≥4%), group D (1%≤NMSR 30% and NMSR<4%). Statistically analyzed ICSI outcome of research group: fertilization rate, embryo utilization rate, good quality embryo rate, implantation rate and clinical pregnancy rate. Results (1)The normal fertilization rate, embryos utilization rate, good quality embryo rate, implantation rate in group A were significantly higher than those in group B (χ2=6.96, 8.95, 5.49, 3.92, all P 0.05). (2) The normal fertilization rate was statistically significant in group C, group D, group E (χ2=34.5, 65.8, 11.8, all P 0.05). (3)The normal fertilization rate, embryo utilization rate, good quality embryo rate, implantation rate and clinical pregnancy rate in group F were significantly higher than those in group G, and normal fertilization rate, embryos utilization rate, good quality embryo rate had statistically significant differences (χ2=37.5, 11.0, 4.3, all P<0.05). Conclusion Sperm abnormal morphology has negative effect on fertilization, and the high DNA fragments have negative effects on fertilization and embryo development. Key words: DNA fragmentation rate; Sperm morphology; ICSI; Embryo

Influence of the insemination method on the outcomes of elective blastocyst culture

ObjectiveThe aim of this study was to explore the effects of the insemination method on the outcomes of elective blastocyst culture.MethodsWe retrospectively analyzed the outcomes of elective blastocyst culture performed between January 2011 and December 2014.ResultsThere were 2,003 cycles of conventional in vitro fertilization (IVF) and 336 cycles of intracytoplasmic sperm injection (ICSI), including 25,652 and 4,164 embryos that underwent sequential blastocyst culture, respectively. No significant differences were found in the female patients' age, basal follicle-stimulating hormone level, basal luteinizing hormone level, body mass index, number of oocytes, maturity rate, fertilization rate, or good-quality embryo rate. However, the blastocyst formation rate and embryo utilization rate were significantly higher in the conventional IVF group than in the ICSI group (54.70% vs. 50.94% and 51.09% vs. 47.65%, respectively, p<0.05). The implantation/pregnancy rate (IVF, 50.93%; ICSI, 55.10%), miscarriage rate (IVF, 12.57%; ICSI, 16.29%), and live birth rate (IVF, 42.12%; ICSI, 44.08%) were similar (p>0.05). No cycles were canceled due to the formation of no usable blastocysts.ConclusionAlthough the fertilization method had no effect on clinical outcomes, the blastocyst formation rate and embryo utilization rate in the ICSI group were significantly lower than those observed in the conventional IVF group. Therefore, more care should be taken when choosing to perform blastocyst culture in ICSI patients.

Predicting the clinical outcome of ICSI by sperm head vacuole examination

ABSTRACTTo assess whether high magnification sperm head vacuole examination (SHVE) and/or standard sperm morphology assessment can predict ICSI outcomes in terms of fertilization, embryo quality, and delivery rates, a prospective observational bicentric study was conducted in two publicly funded assisted reproductive technology (ART) units in France between January and July of 2012. A total of 111 ICSI cycles for exclusively male infertility factors were included. A Spearman’s correlation test was performed to validate SHVE reproducibility between the ART units. The normal morphology rate and SHVE performed on selected spermatozoa were respectively determined according to David’s and Vanderzwalmen’s classifications used for motile sperm organelle morphology examination (MSOME) on the day of the ICSI. Receiver Operating Characteristic (ROC) curve analysis was performed to determine thresholds associated with the occurrence of a delivery. There was an excellent correlation between the two operators (r=0.98), thus validating the study’s SHVE data. Percentages of normal morphology grade spermatozoa using the standard classification and first-best morphology grade spermatozoa determined by SHVE were not significantly associated with (i) delivery (p=0.58; 0.90 /area under curve (AUC) =0.532; 0.507), (ii) fertilization (p=0.88; 0.90), (iii) top-quality embryos (p=0.27; 0.98), and (iv) good quality embryo rates (p=0.73; 0.98), respectively. In conclusion, high magnification SHVE and standard sperm morphology assessment cannot predict clinical or biological ICSI outcomes.Abbreviations: ART: assisted reproductive technology; HBV: hepatitis B virus; HCV: hepatitis C virus; HIV: human immunodeficiency virus; ICSI: intra-cytoplasmic sperm injection; IVF: in vitro fertilization; LNVs: large nuclear vacuoles; MSOME: motile sperm organelle morphology examination; SHVE: sperm head vacuole examination; WHO: World Health Organization

Influence of chromosomal polymorphisms on the clinical outcome of patients undergoing in vitro fertilization embryo transfer

To explore the influence of chromosome polymorphisms on the outcome of in vitro fertilization embryo transfer (IVF-ET). Patients who completed the first cycle of in vitro fertilization fresh embryo transfer were retrospective studied. Patients with the chromosome polymorphisms were classified as to the study group (200 treatment cycles), all patients with normal chromosomes at the same period were classified as the control group (4777 treatment cycles). No significant difference was found between the chromosome polymorphisms and the control groups in terms of clinical pregnancy rate (44.50% vs. 39.85%, P=0.750), early abortion rate (15.73% vs. 10.79%, P=0.163) and live birth rate per cycle (34.5% vs. 30.73%, P=0.437) except for fertilization rate (60.94% vs. 64.08%, P=0.001), cleavage rate (95.01% vs. 97.09%, P=0.000) and good quality embryo rate (53.8% vs. 58.2%, P=0.001). Chromosomal polymorphisms appeared to have no adverse influence on the outcome of IVF-ET treatment.

Comparison of the Clinical Outcomes of Intracytoplasmic Sperm Injection Between Spermatozoa Retrieved From Testicular Biopsy and From Ejaculate in Cryptozoospermia Patients

To compare the clinical outcomes of intracytoplasmic sperm injection (ICSI) between spermatozoa retrieved from testicular biopsy and from ejaculate in cryptozoospermia patients. The clinical data of 285 cryptozoospermia patients who underwent ICSI treatment in our center during the period from March 2009 to November 2013 were retrospectively analyzed. Within them, ejaculated sperms were used in 214 cases (group 1), and testicular sperms extracted by testicular sperm aspiration or conventional testis dissection sperm extraction were used in 71 cases (group 2). Good-quality embryo, fertilization, embryo implantation, pregnancy, and birth rates after ICSI were compared between the 2 groups. Comparing the ejaculated sperm group with the testicular sperm group, fertilization rates were 59.6% and 60.6%, good-quality embryo rates were 36.8% and 46.1%, embryo implantation rates were 30.7% and 52.1%, pregnancy rates were 33.3% and 53.6%, and birth rates were 27.1% and 44.6%, respectively. Using testicular sperms can achieve higher rates of embryo implantation, pregnancy, and birth compared with those using ejaculated sperms for ICSI treatment in cryptozoospermia patients.