Take-home Baby Research Articles

Characteristics and clinical outcomes of patients undergoing fertility treatment by double gamete donation

The number of women receiving in vitro fertilization cycles with both oocyte and sperm donation (double donation; DD) has grown globally in the last decade. The aim of this retrospective study, which included 1139 DD cycles, was to describe the characteristics of patients receiving DD and the outcomes of this assisted reproductive treatment. A cluster analysis identified couple ‘status’ as the main variable in dividing patients into categories. Three such status groups were identified for further analysis: (i) single women (SW), that is women without a partner either male or female; (ii) women with a male partner (MP); (iii) women with a female partner (FP). SW were significantly older (43.9) than patients with a MP (40.4) and a FP (41.3). Women with a male or FP comprised fewer patients with no previous assisted reproductive technology cycles (18.4% and 25.7%, respectively) compared to SW (43.5%). The proportion of patients without children before treatment was significantly different between SW (94.7%) and women with a MP (87.2%). There were no differences in clinical outcomes among the three groups studied. Biochemical pregnancy rate was 58.2% in SW, 58.4% in women with a MP and 64.9% in women with a FP. For the same groups, clinical pregnancy rates were 50.2%, 49.4% and 55.4%, while ‘take-home baby’ rates were 36.6%, 38.9% and 40.3%. Multiple birth and caesarean section rates were not different among the groups, with twinning rates 21.1%, 30.4% and 36%, and caesarean section rates 25.6%, 24% and 26.4% for SW, women with MP and women with FP, respectively.

XM17 Follitropin Alfa (Ovaleap(®)): A Review in Reproductive Endocrine Disorders.

The subcutaneous recombinant human follicle-stimulating hormone XM17 follitropin alfa (Ovaleap(®)) is approved in the EU as a biosimilar of follitropin alfa (Gonal-f(®)) for use in all indications for which the reference product is approved, including as a multifollicular stimulant in women undergoing superovulation for assisted reproductive technology (ART) treatment. In a nonblind, phase I study in healthy female volunteers, the pharmacokinetic profile of XM17 follitropin alfa was bioequivalent to that of reference follitropin alfa following single dosing. Moreover, in a multinational, phase III study, the efficacy of XM17 follitropin alfa as a multifollicular stimulant was equivalent to that of reference follitropin alfa in terms of the number of retrieved oocytes (primary endpoint) in women undergoing controlled ovarian stimulation for ART treatment. There were no clinically relevant differences in oocyte quality between XM17 follitropin alfa and reference follitropin alfa, with biochemical, clinical and ongoing pregnancy rates and take-home baby rates not significantly differing between the treatment groups. XM17 follitropin alfa was generally well tolerated in this patient population, with its tolerability profile generally similar to that of reference follitropin alfa and with no new unexpected tolerability concerns identified. Thus, XM17 follitropin alfa is an effective treatment option in patients requiring follitropin alfa therapy for various reproductive endocrine disorders, providing a useful alternative to reference follitropin alfa.

Blastocyst development in single medium with or without renewal on day 3: a prospective cohort study on sibling donor oocytes in a time-lapse incubator

To evaluate the efficiency of using a continuous (one-step) protocol with a single medium for the culture of human embryos in a time-lapse incubator (TLI). Prospective cohort study on sibling donor oocytes. University-affiliated in vitro fertilization (IVF) center. Embryos from 59 patients. Culture in a TLI in a single medium with or without renewal of the medium on day-3. Embryo morphology and morphokinetic parameters, clinical pregnancy, take-home baby rate, and perinatal outcomes. The blastocyst rates (68.3 vs. 66.8%) and the proportion of good-quality blastocysts (transferred plus frozen) obtained with the two-step (80.0%) protocol were statistically significantly similar to those obtained in the one-step protocol (72.2%). Similarly, morphokinetic events from early cleavage until late blastocyst stages were statistically significantly equivalent between both groups. No differences were found either in clinical pregnancy rates when comparing pure transfers performed with embryos selected from the two-step (75.0%), one-step (70.0%, respectively), and mixed (57.1%) groups. A total of 55 out of 91 embryos transferred implanted successfully (60.4%), resulting in a total of 37 newborns with a comparable birth weight mean among groups. Our findings support the idea that in a TLI with a controlled air purification system, human embryos can be successfully cultured continuously from day 0 onward in single medium with no need to renew it on day-3. This strategy does not affect embryo morphokinetics or development to term and offers more stable culture conditions for embryos as well as practical advantages and reduced costs for the IVF laboratory.

Relationship of paternal age with outcome of percutaneous epididymal sperm aspiration–intracytoplasmic sperm injection, in cases of congenital bilateral absence of the vas deferens

To assess the relationship between paternal age and the outcome of percutaneous epididymal sperm aspiration-intracytoplasmicsperm injection (ICSI) in patients with congenital bilateral absence of the vas deferens (CBAVD). Prospective cohort study. Invitro fertilization centers. Eighty-five (male) CBAVD patients who underwent percutaneous epididymal sperm aspiration with ICSI were divided into 3 age groups; <30years (n = 27); aged 30-40years (n = 32); and aged >40years (n = 26). History taking, clinical examination, semen analysis, percutaneous epididymal sperm aspiration with subsequent ICSI. Sperm retrieval, clinical pregnancy, and "take-home baby." The number of sperm retrieved by percutaneous epididymal sperm aspiration significantly decreased with advancing age in the studied groups (0.63, 0.31, and 0.18 million, respectively), concomitant with significant decreases in the outcomes of clinical pregnancy (55.5%, 43.7%, and 23.1%, respectively) and "take-home baby" (48.1%, 40.6%, and 11.5%, respectively). Male age was significantly negatively correlated with retrieved sperm count, sperm motility, sperm vitality, and normal sperm morphology. Multiple logistic regression, adjusted for confounding factors, with male age, and sperm count obtained using percutaneous epididymal sperm aspiration, was significant. The receiver operating characteristic curve showed that a sperm count of 0.55 million as a cutoff value could predict clinical pregnancy with an accuracy of 77.4%, with 82.9% sensitivity and 62% specificity, and "take-home baby" with an accuracy of 81.7%, with 93.1% sensitivity and 62.5% specificity. In cases of CBAVD, male age has a negative effect on retrieved-sperm count, motility, vitality, and normal sperm morphology; number of retrieved sperm predicted both clinical pregnancy and "take-home baby" outcomes in subsequent ICSI.

A randomized, controlled trial comparing the efficacy and safety of aqueous subcutaneous progesterone with vaginal progesterone for luteal phase support of in vitro fertilization.

STUDY QUESTIONIs the ongoing pregnancy rate with a new aqueous formulation of subcutaneous progesterone (Prolutex®) non-inferior to vaginal progesterone (Endometrin®) when used for luteal phase support of in vitro fertilization?SUMMARY ANSWERIn the per-protocol (PP) population, the ongoing pregnancy rates per oocyte retrieval at 12 weeks of gestation were comparable between Prolutex and Endometrin (41.6 versus 44.4%), with a difference between groups of −2.8% (95% confidence interval (CI) −9.7, 4.2), consistent with the non-inferiority of subcutaneous progesterone for luteal phase support.WHAT IS KNOWN ALREADYLuteal phase support has been clearly demonstrated to improve pregnancy rates in women undergoing in vitro fertilization (IVF). Because of the increased risk of ovarian hyperstimulation syndrome associated with the use of hCG, progesterone has become the treatment of choice for luteal phase support.STUDY DESIGN, SIZE, DURATIONThis prospective, open-label, randomized, controlled, parallel-group, multicentre, two-arm, non-inferiority study was performed at eight fertility clinics. A total of 800 women, aged 18–42 years, with a BMI of ≤30 kg/m2, with <3 prior completed assisted reproductive technology (ART) cycles, exhibiting baseline (Days 2–3) FSH of ≤15 IU/L and undergoing IVF at 8 centres (seven private, one academic) in the USA, were enrolled from January 2009 through June 2011.PARTICIPANTS/MATERIALS, SETTING, METHODSIn total, 800 women undergoing IVF were randomized after retrieval of at least three oocytes to an aqueous preparation of progesterone administered subcutaneously (25 mg daily) or vaginal progesterone (100 mg bid daily). Randomization was performed to enrol 100 patients at each site using a randomization list that was generated with Statistical Analysis Software (SAS®). If a viable pregnancy occurred, progesterone treatment was continued up to 12 weeks of gestation.MAIN RESULTS AND THE ROLE OF CHANCEUsing a PP analysis, which included all patients who received an embryo transfer (Prolutex = 392; Endometrin = 390), the ongoing pregnancy rate per retrieval for subcutaneous versus vaginal progesterone was 41.6 versus 44.4%, with a difference between groups of −2.8% (95% CI −9.7, 4.2), consistent with the non-inferiority of subcutaneous progesterone for luteal phase support. In addition, rates of initial positive β-hCG (56.4% subcutaneous versus 59.0% vaginal; 95% CI −9.5, 4.3), clinical intrauterine pregnancy with fetal cardiac activity (42.6 versus 46.4%; 95% CI −10.8, 3.2), implantation defined as number of gestational sacs divided by number of embryos transferred (33.2 versus 35.1%; 95% CI −7.6, 4.0), live birth (41.1 versus 43.1%; 95% CI −8.9, 4.9) and take-home baby (41.1 versus 42.6%; 95% CI −8.4, 5.4) were comparable. Both formulations were well-tolerated, with no difference in serious adverse events. Analysis with the intention-to-treat population also demonstrated no difference for any outcomes between the treatment groups.LIMITATIONS, REASONS FOR CAUTIONThe conclusions are limited to the progesterone dosing regimen studied and duration of treatment for the patient population examined in this study.WIDER IMPLICATIONS OF THE FINDINGSSubcutaneous progesterone represents a novel option for luteal phase support in women undergoing IVF who for personal reasons prefer not to use a vaginal preparation or who wish to avoid the side effects of vaginal or i.m. routes of administration.STUDY FUNDING/COMPETING INTERESTSThe study was funded by Institut Biochimique SA (IBSA). CAJ, BC, ST and CJ are employees of IBSA. FH currently consults for IBSA.TRIAL REGISTRATION NUMBERNCT00828191.

Obstetric and neonatal outcomes of delayed interval delivery in cerclage and non-cerclage cases: an analysis of 20 multiple pregnancies.

The aim of study is to compare maternal and fetal outcomes of pregnancies in which cerclage was placed following the loss of first fetus with those without cerclage placement in multiple pregnancies for delayed interval delivery. Records of pregnancies in which the first fetus was lost between 13-26 weeks and delayed delivery experienced for retained fetus(es), were collected retrospectively. A total of 20 patients including 11 twins, seven triplets and two quadruplets were evaluated. Cases with cervical cerclage placed after the first delivery were evaluated as the cerclage group (n = 11) and the cases without cerclage placement were evaluated as the non-cerclage group (n = 9). Median duration of delay was 22 days (range, 3-121) for both groups; 40 days (range, 5-121) in cerclage group and 12 days (range, 3-46) in the non-cerclage group (P = 0.003). Average birthweight of retained fetus(es) in the cerclage group was 850 ± 153.6 g (mean ± standard error [SE]) and 549.5 ± 149.1 g (mean ± SE) in the non-cerclage group (P = 0.04). Delivery week of retained fetus(es), live birth rate, take-home baby rate and chorioamnionitis ratio were not different in between the groups. Cervical cerclage after the first delivery is associated with a longer delivery interval and higher birthweight of retained fetus.

PD24-11 COMPARISON OF INTRACYTOPLASMIC SPERM INJECTION (ICSI) OUTCOMES BETWEEN EJACULATED AND TESTICULAR EXTRACTED SPERMATOZOA IN COUPLES WITH RECURRENT IMPLANTATION FAILURE

You have accessJournal of UrologyInfertility: Therapy1 Apr 2014PD24-11 COMPARISON OF INTRACYTOPLASMIC SPERM INJECTION (ICSI) OUTCOMES BETWEEN EJACULATED AND TESTICULAR EXTRACTED SPERMATOZOA IN COUPLES WITH RECURRENT IMPLANTATION FAILURE Mehmet Murad Basar, Nur Dokuzeylul-Gungor, Mehmet Ali Tufekci, Yesim Kumtepe-Colakoglu, Tugba Senel, and Semra Kahraman Mehmet Murad BasarMehmet Murad Basar More articles by this author , Nur Dokuzeylul-GungorNur Dokuzeylul-Gungor More articles by this author , Mehmet Ali TufekciMehmet Ali Tufekci More articles by this author , Yesim Kumtepe-ColakogluYesim Kumtepe-Colakoglu More articles by this author , Tugba SenelTugba Senel More articles by this author , and Semra KahramanSemra Kahraman More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.2002AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Testicular sperm usage is an alternative method for patients associated with lower fertilization and embryo cleavage rates in their previous ICSI with mature ejaculated sperm. The aim of the present study is to compare ICSI outcomes of couples with recurrent implantation failure after use of ejaculated versus testicular spermatozoa with different cycles in the same centre. METHODS This study included 140 ART cycles in 51 couples. Patients were divided into two groups according to source of spermatozoa. Group 1 included of 76 cycles using ejaculated spermatozoa in our center. If the patients had at least twice ICSI cycle with ejaculated spermatozoa and/or had total severe immotile sperm (no progressive motility), testicular spermatozoa was obtained with testicular sperm aspiration (TeSa) under local anesthesia in 64 cycles of group 2. Fertilization, embryo quality and clinical pregnancy rates were compared between groups. RESULTS Mean age of males and women were 38.2±7 (24-58) and 33.5±5.9 (21-44) years old, respectively. Previous ICSI cycles were 3.2±2.6 in ejaculated spermatozoa used patients and 3.4±2.4 in testicular spermatozoa used patients (p=0.279). In Group 1, total oocyte number and MII oocyte number were 8.9.±7.9 and 6.8±6. These parameters were10.5±7.4 and 8.2±6.1 in group 2, respectively. There were not found statistical difference between two groups according to these parameters (ptotaloocysts = 0.111; pMIIoocyts = 0.078). While fertilization rate was higher with ejaculated spermatozoa (79.3%) than testicular spermatozoa (74.9%) (p=0.103), pregnancy rate was statistically higher with testicular spermatozoa than ejaculated spermatozoa (41.7% vs 21.4%, respectively, p=0.021). Additionaly, ongoing pregnancy rate (OPR) and takehome baby rate (THBR) were higher with testicular spermatozoa than ejaculated spermatozoa (OPR: 26.7% vs 7.1%, p= 0.006; THBR: 24.6% vs 6.0%, p= 0,008). There were observed no complications after TESA in patients such as hematoma, pain etc. CONCLUSIONS ICSI cycle with testicular sperm is one of the best choices in idiopathic male fertility resulting in ICSI cycle failure with ejaculated sperm, and can have marked improvement in outcome. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e734 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Mehmet Murad Basar More articles by this author Nur Dokuzeylul-Gungor More articles by this author Mehmet Ali Tufekci More articles by this author Yesim Kumtepe-Colakoglu More articles by this author Tugba Senel More articles by this author Semra Kahraman More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Eliminating the effect of pathomorphologically formed sperm on resulting gravidity using the intracytoplasmic sperm injection method

The aim of the present study was to test whether it is possible to eliminate a high percentage of morphologically abnormal sperm in male ejaculate by assisted reproduction using the intracytoplasmic sperm injection (ICSI) method. Treatment success was evaluated by comparing fertilization, clinical pregnancy and reproduction rates between males with heavy teratospermia (≤1% morphologically normal spermatozoa) and males with a higher percentage (>1%) of normal sperm. In total, 174 patients who had previously undergone 174 ICSI cycles (1 per each pair) were evaluated retrospectively. In the group of patients with heavily impaired sperm morphology (n=37), the percentage of normal spermatozoa was ≤1%. In the second group, males with >1% normal spermatozoa (n=137) were considered as patients with mildly impaired sperm morphology. The results of partner fertilization in these two groups were compared and a lower number of fertilized oocytes was identified in the patients with heavily impaired sperm morphology (P=0.038). However, neither the gravidity nor the take-home baby rates of the partners differed between the patients with mildly and heavily impaired sperm morphology. Trends opposite to that for fertilization were observed for gravidity and delivery [odds ratio (OR), 0.62; 95% confidence interval (CI), 0.29–1.30; OR, 0.55; 95% CI, 0.26–1.24, respectively]. This indicates that the lower number of fertilized oocytes was not associated with the overall outcome of fertilization and that patients with heavily impaired sperm morphology experience the same benefit from ICSI as patients with mildly impaired sperm morphology.

Microsurgical transverse 2-suture intussusception vasoepididymostomy: effectiveness and rationality

Background 2-Suture longitudinal vasoepididymostomy shows superiority to transverse technique in an animal study; to date, this has not been consistently confirmed in human body. In the present study, we evaluated the effectiveness of 2-suture transverse intussusception vasoepididymostomy and compared the rationality between transverse and longitudinal techniques. Methods From May 2007 to December 2008, we performed 2-suture transverse vasoepididymostomy in 19 consecutive patients, as described by Marmar with modification. Between March 2009 and January 2010, the internal diameter of the vas lumen and the outer diameter of the epididymal tube were measured using microruler (21 patients and 37 sides). Results Three patients lost to follow-up. At the first follow-up period (ranged from 10 to 24 months), the patency rate was 56.3% (9/16) and the natural pregnancy rate was 25% (4/16). At the second follow-up period (ranged from 46 to 63 months), the patency rate was 68.8% (11/16), the natural pregnancy rate was 37.5% (6/16), respectively, and the takehome baby rate was 31.3% (5/16). The diameter of the vas lumen and the outer diameter of the epididymal tubule were (0.512±0.046) mm and (0.572±0.051) mm (P &lt;0.001), respectively. Conclusion Transverse 2-suture intussusception vasoepididymostomy is still an effective technique in treating obstructive azoospermia.

Human oocyte vitrification with corona radiata, in autologous follicular fluid supplemented with ethylene glycol, preserves conventional IVF potential: birth of four healthy babies

The aim of this study was to examine the effects of vitrification with autologous follicular fluid (AFF) supplemented with ethylene glycol (EG) and sucrose on human oocytes with corona radiata. A total of 182 human oocytes with corona radiata from fifteen infertile patients were vitrified using either equilibration solutions (ES) and vitrification solution (VS) consisting of AFF, EG and sucrose (AFF group, n=67) or commercial ES and VS (control group, n=115). All oocytes were thawed in the next cycle, with surviving oocytes being inseminated by conventional IVF. The clinical outcome of vitrified-warmed oocytes by both vitrification methods was analysed retrospectively. In the AFF group, six patients received embryo transfer, with three couples taking four healthy babies home. In the control group, nine patients received embryo transfer, with four couples taking five healthy babies home. There was no significant difference in the survival rate (91.0 vs 92.2%), two pronuclei (2PN) fertilisation rate (73.8 vs 73.6%), cleavage rate (100 vs 100%), top-quality embryo rate (62.2 vs 59.2%), clinical pregnancy rate (50.0 vs 44.4%), implantation rate (33.3 vs 25%) or take-home baby rate (50.0 vs 44.4%) between the AFF group and the control group, respectively. These results show that AFF supplemented with EG and sucrose is an efficient, cost-effective cryoprotectant for human oocyte cryopreservation. A corona radiata on vitrified-warmed oocytes retains the oocytes' fertilisation capability in conventional IVF.

Papel actual de la cirugía conservadora

It is not easy to establish the true impact of fibroids on fertility. Fibroidectomy in sterile patients with subserosal fibroids does not offer the best results for patients with in situ fibroids. Women with intramural fibroids appear to present reduced fertility and increased miscarriage rates, compared with women without fibroids. However, fibroidectomy does not always reverse this effect (does not increase the clinical pregnancy or “take-home baby” rates), but the quality of the studies is still poor. Fibroids with a submucosal component significantly decrease implantation and pregnancy rates with regard to sterile controls. Fibroid exeresis clearly improves fertility results. There is a need for better quality studies aimed at assessing the impact of intramural fibroids, with a special focus on factors such as size, number and proximity to the endometrium.The majority of cases can be treated endoscopically. This procedure needs properly trained teams who monitor their results and who are able to offer the same guarantees that laparotomy affords, both in terms of the surgical technique and the patients’ obstetric future. Laparoscopic fibroidectomy offers results comparable to laparotomy and minimizes the formation of adhesions, blood loss, hospital stay and the time to return to work.For sterile patients, laparoscopic fibroidectomy may be the first choice therapy.

Triplet pregnancies – a three-decade perspective: do we fare better?

ObjectivesTo evaluate the impact of advances in perinatal and neonatal care in the past three decades on the outcome of triplet pregnancies. Study designWe compared the outcome of 29 sets of triplets born in our medical center during 1978–1987 with 34 sets of triplets born in the same medical center during 2001–2011. Data were extracted from maternal and neonatal medical records. ResultsThere were no significant differences in mortality or morbidity in any of the studied outcome measures between the two epochs. Of the 34 women with triplet pregnancies in the present cohort only 28 (82%) took all three born babies home, not different from the 86% found in the early cohort. The overall take-home baby rate was 93% (95/102) in the present cohort, not different than the 86% (74/86) in the early cohort. ConclusionsDespite technological advances in perinatal and neonatal care, there was no significant improvement in the outcome of triplet pregnancies during the past three decades.

Randomised trial of cervical cerclage, with and without occlusion, for the prevention of preterm birth in women suspected for cervical insufficiency

To evaluate the effect of cerclage, with and without cervical occlusion. Multicentre, stratified, randomised controlled trial. Hospital-based multicentre study with 18 tertiary centres from nine countries. Women with a history of cervical insufficiency (prophylactic trial) and women with a short cervix (therapeutic trial) were recruited from August 2006 to August 2011. A centralised telephone randomisation service with a computer system was used to randomise women to cervical cerclage with or without cervical occlusion. Only the analyst performing the interim analyses was blinded. The take-home baby rate (number of infants discharged alive from the hospital), gestational age at delivery, and the number of days in the neonatal intensive care unit (NICU). Women (n = 309) were stratified into the prophylactic trial (n = 213) or the therapeutic trial (n = 96). The trial stopped early due to slow recruitment and an interim analysis showing no benefit of occlusion. Final analysis comprised 197 women in the prophylactic trial and 87 women in the therapeutic trial. No added effect of cervical occlusion was found in terms of the take-home baby rate in the prophylactic trial (92 versus 90%, RR 1.03, 95% CI 0.94-1.12) or in the therapeutic trial (81 versus 85%, RR 0.96, 95% CI 0.79-1.16). No effect of cervical occlusion was found in terms of gestational age at delivery and number of days the neonate spent in the NICU. Cervical occlusion was associated with no harm. Cervical occlusion with cerclage had no significant additional effect.

Retain singleton or twins? Multifetal pregnancy reduction strategies in triplet pregnancies with monochorionic twins

To assess the effectiveness and feasibility of retaining a singleton or twins for multifetal pregnancy reduction (MFPR) in triplet pregnancy with monochorionic twins. This retrospective study was conducted from January 2006 to September 2011 at a university reproductive medical center. Multifetal pregnant patients (n=35) with dichorionic triplets underwent MFPR in the first trimester to reduce one or both monochorionic twins. These cases were divided into two groups: Group A (9 MFPR cases to reduce one monochorionic twin) and Group B (26 MFPR for both monochorionic twins). Control A (for Group A) included another 18 cases of trichorionic triplet reduction to twins; Control B (for Group B) included 35 cases of trichorionic triplet reduction to singletons. MFPR was performed during the same period for all groups. Pregnancy outcomes were compared between groups. Patients were 28-39 years old; the average gestation for fetal reduction was 6-8 weeks. The early abortion rate was lower in Group A than Group B (0 versus 11.5%, p=0.339), but the late abortion rate was significantly higher in Group A. (33.3% versus 0, p=0.000). Groups A and B did not differ significantly in premature labor rate, term birth rate, gestation at delivery and take-home baby rate. The rate of very low and low birth weight was significantly higher in Group A than Group B (50% versus 0, p=0.001), and the average birth weight was significantly lower in Group A (2391.7±318.5 versus 3119.6±523.9, p=0.001). Group A had significantly more low birth-weight newborns than Control A (50% versus 13.3%, p<0.05 [0.024]). Group B (retained singleton) had similar pregnancy outcomes and neonatal conditions as Control B. Retaining a singleton is always the best choice when deciding about using MFPR to improve pregnancy outcomes. For patients having a triplet pregnancy with monochorionic twins and strongly desiring to keep twins, MFPR in one monochorionic twin was feasible by aspirating embryonic parts early in gestation (6-8 weeks) with no drug injection. Pregnancy outcomes are similar with twin reduction in trichorionic triplet pregnancy.

The benefit of artificial oocyte activation is dependent on the fertilization rate in a previous treatment cycle

Following intracytoplasmic sperm injection (ICSI), some patients present low or zero fertilization rates. Artificial oocyte activation has been proposed as a suitable means to overcome this problem. This study applied artificial oocyte activation in patient cohorts with a history of no fertilization (0%, group 1), fertilization between 1 and 29% (group 2) or fertilization between 30 and 50% (group 3) in initial ICSI cycles. In the following treatment cycles, oocytes were activated after ICSI using calcium ionophore. Fertilization, pregnancy and take-home baby rates were compared with the previous cycle without activation. In group 1, fertilization rate was 41.6%, embryos for transfer were available in 82.1% of cycles, giving a clinical pregnancy rate of 18.8% and take-home baby rate of 12.8%. In group 2, despite a lower transfer rate (87.9% versus 100%, P<0.05), there were higher fertilization and clinical pregnancy rates (44.4% versus 19.3% and 31.4% versus 12.8%, respectively, P<0.05) and take-home baby rate was 24.1% versus 12.8%. In group 3, fertilization rates differed (56.1% versus 36.8%; P<0.001) but all other parameters were similar. Artificial oocyte activation has great potential especially in patients showing compromised fertilization rates below 30% after standard ICSI.Following intracytoplasmic sperm injection (ICSI), some patients present very low or even zero fertilization rates after ICSI. Artificial oocyte activation has been proposed as a suitable means to overcome this problem. We applied artificial oocyte activation in patients which presented a history either no fertilization, fertilization between 0 and 30% or fertilization between 30 and 50% in initial ICSI cycles. In the following treatment cycles, oocytes were activated after ICSI using a calcium ionophore. Fertilization, pregnancy and take-home baby rates were compared to the previous cycle without activation. For the groups with previously 0% or 1–29% fertilization, we noted higher fertilization rates and clinical pregnancy rates per embryo transfer. For the group with moderate fertilization, only fertilization rates differed but all other parameters were not significantly different. From these data we conclude that artificial oocyte activation has a great potential especially in patients which show a compromised fertilization rate below 30% in a standard ICSI cycle.

Fetal reduction of triplet pregnancy: one or two?

To review outcomes following reductions in trichorionic triplet pregnancies at our institution. Retrospective analysis of the outcome of trichorionic triamniotic triplets reduced to singletons (group I, n = 44) or twins (group II, n = 136) at 10 and 12 weeks of gestation. Reduction to one or two was based on parent's preference, hence unrelated to any specific obstetrical or maternal issue. Early fetal loss rate (e.g. <24 weeks) was 9.1% in group I versus 5.1% in group II (p = 0.83). In group I, the take-home baby rate was 86.4% versus 91.9% in group II (p = 0.8). In group I, 17.5% of the women gave birth between 33 and 36(+6) weeks of gestation versus 40.6% in group II (p = 0.026). Delivery beyond 37 weeks was 72.5% in group I and 46.9% in group II (p = 0.01). Intrauterine growth restriction rate was 27.0% in group I versus 45.0% in group II (p = 0.049). Reduction to one rather than two fetuses led to significantly higher term delivery rate without significant differences in fetal loss rate or take-home baby rate.

Do weekend oocyte retrievals have an impact on the intracytoplasmic sperm injection cycles outcome?

IntroductionDespite the fact that ovarian stimulation is controlled, it is not always predictable. Because the day of human chorionic gonadotrophin (hCG) injection depends mainly on the patient's ovarian response to gonadotrophins, the day of oocyte retrieval cannot be determined in advance. As a result, oocyte retrievals are often scheduled to occur on weekends, a fact that entails at least one extra working day for the staff, and could lead to physical and psychological stress, especially in embryologists. The aim of this study was to evaluate whether intracytoplasmic sperm injection (ICSI) outcomes are influenced by the day of oocyte retrieval.Material and methodsA total of 327 ICSI cycles, whose retrievals were performed on Wednesdays and Sundays, were analysed in this retrospective study. Cycles were subdivided into two groups according to the day of oocyte retrieval: group W (n = 196), cycles in which oocyte retrieval was performed on Wednesday; and group S (n = 131), cycles in which oocyte retrieval was performed on Sunday. Groups were compared regarding fertilization, implantation, pregnancy and take-home baby rates.ResultsNo significant differences were observed between groups A and B regarding fertilization rate (68.9% and 72.5%; p = 0.1589), implantation rate (21.8% and 24.3%; p = 0.5714), pregnancy rate (29.9% and 31.6%; p = 0.7129) and take-home baby rate (23.6% and 28.1%; p = 0.4351).ConclusionsA well-trained embryologist's group adhering to staff scheduling allows large programmes to ensure a similar outcome independent of the workload or workday on which embryologists perform the manipulation of gametes.

Preimplantation genetic diagnosis for couples with a Robertsonian translocation: practical information for genetic counseling

To evaluate the proportions of abnormal and normal embryos detected by preimplantation genetic diagnosis (PGD) of infertile couples of whom one was a Robertsonian translocation (RT) carrier, and to provide practical information, including details of reproductive outcomes, to aid in genetic counseling of such couples. We retrospectively analyzed all PGD cycles conducted to deal with RT at our center between January 2000 and December 2009. Subject demographic and clinical data were compared with the results of PGD. Employing PGD, we conducted a total of 66 cycles on 34 couples of whom one was an RT carrier, including 24 female and 10 male carriers. Of the 514 blastomeres tested, 161 (31.3%) were normal or balanced. Of the 57 cycles that included embryo transfer, 17 (29.8%) attained positivity for human chorionic gonadotropin (hCG). A total of 17 embryos were implanted and 16 babies, including two sets of twins, were born. The takehome baby rate was 41.2% per couple and the loss rate 6.6%. Receiver operating characteristic curve analysis showed that the proportion of alternate embryos associated with a sensitivity of 70.6% for prediction of clinical pregnancy following PGD was 0.31. Sex of the carrier and type of translocation were not significantly associated with pregnancy outcomes. Couples with RT may benefit from PGD; pregnancy success rate is improved and embryo loss reduced. We found that about 30% of embryos were of normal or balanced chromosomal constitution and that the percentage of normal or balanced embryos was predictive of PGD outcome.

A predictive score for testicular sperm extraction quality and surgical ICSI outcome in non-obstructive azoospermia: a retrospective study

In non-obstructive azoospermia (NOA), testicular sperm extraction (TESE) is successful in ≈ 50% of cases. A parameter for predicting TESE quality and pregnancy rates after ICSI of testicular spermatozoa is still lacking. We retrospectively evaluated the total testicular volume (TTV), hormone levels and TESE quality in 280 patients with NOA. After successful TESE, the characteristics of the ICSI cycles and the take-home baby rates were evaluated. TESE was successful in 149 patients (53.2%). In a multivariate logistic regression analysis, only TTV, FSH and inhibin B were correlated with the TESE outcome. A score including these three parameters was the best predictor of successful TESE (positive likelihood ratio: +3.01). When the score was <18.5, TESE was successful in 77.4% of cases and 'sperm rich' (i.e. yielding >100 spermatozoa) in 91.1% of cases; 42.8% of couples took a baby home. The take-home baby rate did not depend on whether the score was <18.5 or between 18.5 and 3700. If the score was >3700, TESE was successful in 37.8% of cases and 'sperm rich' in 14.3% of cases; only one couple took a baby home (a rate of 7.7 versus 42.8% when the score was <18.5; P< 0.001). Owing to low sperm retrieval on the day of oocyte retrieval, fewer oocytes were injected when the score was >3700 than when <3700. Thanks to better knowledge of TESE quality, the present score could help to improve care and pre-ICSI counseling for patients with NOA.

Editorial commentary: How to predict fatherhood for men with non-obstructive azoospermia opting for TESE-ICSI?

The treatment of male factor infertility, due to non-obstructive azoospermia (NOA), by testicular sperm extraction (TESE)–ICSI is a major breakthrough in assisted reproduction. However, although the first patient series on this approach were published more than 15 years ago (Tournaye et al., 1995), to date, it still remains difficult to provide candidate patients with truthful data about their chances to eventually father their genetically own child. In this issue, Boitrelle et al. (2011) published a study trying to determine predictive parameters to improve patient counselling. Retrieval rates after testicular surgery reported in the literature differ considerably. While in unselected NOA patients, the surgical approach seems to have a limited effect as long as multiple biopsies are taken whenever needed, the extended processing of the wet preparations of the testicular tissue may have a greater impact on sperm recovery. Unfortunately, large well-designed controlled trials to support both assertions are lacking. But sperm retrieval rates are also subject to the (pre)selection of patients and can be biased either by re-allocating successful patients in case series, either by including patients showing almost normal spermatogenesis, e.g. mild-to-moderate hypospermatogenesis, or by inclusion of patients with no testicular histology available. As a result of the above, retrieval rates reported in the literature for NOA men may vary from about 30% to even more than 80%. Larger case studies in well-defined NOA populations report sperm recovery rates after a first TESE attempt around 50%. However, given the invasive character of TESE, NOA patients want to have a better prediction of their chances to retrieve testicular sperm than tossing a coin. Because testicular volume and serum FSH are routinely assessed in azoospermic men, these parameters are often used in studies on prediction either as a stand-alone parameter or in combination with other parameters. Unfortunately, their predictive power remains limited and is subject to the heterogeneity of the population of NOA patients studied. Idem dito for the predictive parameters published in the study by Boitrelle et al. (2011). The positive likelihood ratios for the stand-alone parameters are below 2 and hence not of a great diagnostic value in predicting testicular sperm recovery. With a positive likelihood ratio of 3, a predictive score combining testicular volume, FSH and inhibin-B looks more promising in their setting. But again, is this a robust predictive model applicable to every population of NOA men? All NOA men with all parameters included in the score available were selected in our Brussels database. Although we refrained from assessing inhibin-B routinely, after concluding that this parameter had a poor predictive value (Vernaeve et al., 2002), the score could be calculated in a population of 110 NOA men that had their first TESE attempt and showed neither normal spermatogenesis nor hypospermatogenesis on their testicular histologies. Compared with the study by Boitrelle et al. (2011), our sperm retrieval rates were, respectively, 50.0% compared with 77.4% in men with a score below 18.5 (n 1⁄4 38) and 57.1% compared with 39.7% in men with a score between 18.5 and 3700 (n 1⁄4 72). Our ‘test’ population did not include men with a score higher than 3700. This ‘test’ emphasizes that any blind application of a prediction model on a population of patients, other than the one it originated from, remains difficult due to patient heterogeneity. Whether out-of-routine assessmentsmay improve the prediction of a successful testicular recovery also remains to be proven. Doppler ultrasoundor even invasive assessments such as ‘testicularmapping’ by puncture provide low sensitivities. Since many NOA men do not accept donor insemination as an alternative for their fatherhood and because current predictive tests cannot exclude that any sperm will eventually be retrieved, to date, reliable counselling towards sperm retrieval remains problematic for all TESE candidates suffering from NOA. Counselling becomes even more difficult when an NOA patient would like to know what his chances are to have a child, which in the end is the true outcome of interest to candidate TESE–ICSI patients. At present, only fragmentary data exist either reporting on retrieval rates after TESE or reporting on the outcome of ICSI once testicular spermatozoa were obtained in different subsets of patients. Boitrelle et al. (2011) show that in their setting, the take-home baby rate in patients with a score over 3700 was low (7.7%) compared with lower-score patients (48.8%), a finding that still may suffer from bias because only a subset of patients was included in the subsequent ICSI analysis (89 out of 149 men in which testicular sperm were retrieved, i.e. 59%, eventually proceeded to ICSI). Again, the score can probably not be applied blindly in other TESE–ICSI programmes