University-based Assisted Reproductive Technology Research Articles

Comparison of semen quality between university-based and private assisted reproductive technology laboratories

Objective: Obtaining a semen analysis (SA) is an essential step in evaluating infertile men. Despite using standardized procedures for analysis semen quality in the same individual often varies on repeated tests. The objective of this study was to investigate inter-laboratory variation in semen quality between private- and university-based assisted reproductive technology (ART) laboratories.Materials and Methods: IRB approval was obtained to retrospectively evaluate men with a SA at both the private- and university-based ART laboratories. When more than one SA was available from either laboratory, the first at each laboratory was selected for analysis. Comparison of major semen parameters was performed using descriptive statistics and Bland–Altman plots, with differences tested using Wilcoxon-signed rank test.Results: Twenty-eight men aged 33 ± 5 (mean ± SD) years were included in the study. Motility was higher at the private laboratories compared to the university-based laboratory (Median difference −12.5%, 95% confidence interval −20.3%; −5.5%). Percent normal morphology was higher at the university-based laboratory compared to private laboratories (5.0%, 3.6%; 6.9%). No significant differences were found in volume, concentration and total motile sperm count although the Bland-Altman plot bias for concentration was clinically significant (15.9 × 106/ml).Conclusions: In this small series, motility was significantly higher at private laboratories compared to a university-based laboratory but was above WHO reference limits at both places. Normal sperm morphology was significantly lower in semen analyses performed at private laboratories compared to a university-based laboratory and was below WHO reference limits.

Experience With a Patient-Friendly, Mandatory, Single-Blastocyst Transfer Policy

Objective To determine whether a mandatory single-blastocyst transfer (mSBT) algorithm reduced multiple gestation rates without sacrificing clinical pregnancy rates. Design Retrospective review. Setting U.S. university-based assisted reproductive technology (ART) program. Patient(s) All women younger than 38 years undergoing their first ART cycle from 2009 to 2010 with ≥4 high-grade embryos on day 3 oocyte retrieval (patients from 2009 were the group, and patients completing ART under the mSBT policy in 2010 were the after group). Intervention(s) mSBT algorithm. Main Outcome Measure(s) Multiple gestation and clinical pregnancy rates. Result(s) Of the qualified patients, 136 women met inclusion criteria (62 from 2009, 74 from 2010). The baseline demographics were similar between the groups. Statistically significantly fewer blastocysts were transferred per patient in 2010 compared with 2009 (1.5 vs. 1.9). The clinical pregnancy rates before (67.7%) or (63.5%) the mSBT policy were not statistically significantly different. Multiple gestation rates were statistically significantly reduced, from 43.8% (2009) to 14.6% (2010) the mSBT policy was instituted. More patients from 2010 had ≥1 blastocyst cryopreserved compared with 2009 (52.9% vs. 30.6%). Conclusion(s) A novel single-blastocyst transfer algorithm reduced multiple gestation rates and improved cryopreservation rates without compromising clinical pregnancy rates in good-prognosis patients.

Experience with a patient-friendly, mandatory, single-blastocyst transfer policy: the power of one

To determine whether a mandatory single-blastocyst transfer (mSBT) algorithm reduced multiple gestation rates without sacrificing clinical pregnancy rates. Retrospective review. U.S. university-based assisted reproductive technology (ART) program. All women younger than 38 years undergoing their first ART cycle from 2009 to 2010 with ≥4 high-grade embryos on day 3 after oocyte retrieval (patients from 2009 were the "before" group, and patients completing ART under the mSBT policy in 2010 were the "after" group). mSBT algorithm. Multiple gestation and clinical pregnancy rates. Of the qualified patients, 136 women met inclusion criteria (62 from 2009, 74 from 2010). The baseline demographics were similar between the groups. Statistically significantly fewer blastocysts were transferred per patient in 2010 compared with 2009 (1.5 vs. 1.9). The clinical pregnancy rates before (67.7%) or after (63.5%) the mSBT policy were not statistically significantly different. Multiple gestation rates were statistically significantly reduced, from 43.8% (2009) to 14.6% (2010) after the mSBT policy was instituted. More patients from 2010 had ≥1 blastocyst cryopreserved compared with 2009 (52.9% vs. 30.6%). A novel single-blastocyst transfer algorithm reduced multiple gestation rates and improved cryopreservation rates without compromising clinical pregnancy rates in good-prognosis patients.

Effect of vitrification and beta-mercaptoethanol on reactive oxygen species activity and in vitro development of oocytes vitrified before or after in vitro fertilization

To investigate the effect of vitrification and beta-mercaptoethanol (beta-ME) on reactive oxygen species (ROS) activity and in vitro development of oocytes vitrified before or after in vitro fertilization (IVF). Randomized prospective study. University-based assisted reproductive technology laboratory. ANIMALS(S): Abattoir-derived porcine ovaries. Oocytes were vitrified either before or 4 hours after the end of IVF by solid surface vitrification (SSV) without centrifugation and/or delipation procedure. beta-ME was used to inhibit ROS activity. Viability was evaluated by membrane integrity and esterase enzyme activity using fluorescein diacetate staining while ROS activity was assessed by 2',7'-dichlorofluorescein assay. Vitrification increased the ROS activity and decreased the viability and in vitro development of vitrified oocytes. Addition of beta-ME to vitrification and culture medium partially annihilated the ROS activity but did not improve the viability of vitrified-warmed oocytes. Furthermore, beta-ME had no effect on improving the fertilization ability of oocytes vitrified at metaphase II stage but significantly increased their ability to cleave. beta-ME also increased the rate of cleavage and blastocyst formation ability of oocytes vitrified 4 hours after the end IVF. Vitrification increases ROS activity in oocytes that can be partially annihilated by beta-ME to obtain enhanced embryonic development.

Luteal support with intravaginal progesterone increases clinical pregnancy rates in women with polycystic ovary syndrome using letrozole for ovulation induction

To determine the effect of intravaginal micronized P on pregnancy rates in clomiphene citrate and letrozole ovulation induction cycles in women with polycystic ovary syndrome (PCOS). Retrospective chart review. University-based assisted reproductive technology program. Women with PCOS who underwent ovulation induction with either clomiphene citrate (n = 90) or letrozole (n = 31) from January 2002 to December 2008. Clomiphene citrate (50-250 mg x 5 days) or letrozole (5 mg x 5 days) were used for ovulation induction. After either intercourse or IUI, patients received intravaginal micronized P (200 mg twice daily) according to prescribing physician preference. Clinical pregnancy rate. In clomiphene cycles, clinical pregnancies were documented in 15.3% of cycles (19 of 124) in the P group, compared with 12.1% (11 of 91) of the non-P group. In letrozole cycles, clinical pregnancies were documented in 21.1% of cycles (8 of 38) in the P group, compared with none (0 of 13) in the non-P group. Women with PCOS who used letrozole for ovulation induction had higher clinical pregnancy rates when using intravaginal P support. Luteal supplementation with P should be strongly considered in women with PCOS, especially in those using letrozole for ovulation induction.

P-566: The ultrasonographic endometrial thickness and pattern of patients with fibroids is not significantly different than controls at the time of hCG administration in ART cycles

Several studies have shown that patients with uterine fibroids undergoing assisted reproductive technology (ART) have worse pregnancy outcomes. A possible explanation for the reduced success is an alteration in the endometrium. Patterson-Keels et al. demonstrated a reduction in endometrial glands and thickness of the endometrium overlying fibroids. The purpose of this study was to investigate whether the presence of fibroids was associated with altered endometrial thickness or pattern, as assessed by ultrasound, in those undergoing ART at the time of hCG administration. Retrospective case-controlled cohort in a University-based ART center All non-donor, first ART cycles from 01/99 to 12/03 were evaluated. All patients were screened prior to the ART cycle with saline sonography for uterine fibroids or other pathology, and surgically treated as appropriate. The presence and location of fibroids and endometrial thickness/pattern were annotated at baseline ultrasound and during stimulation. A randomly-matched control group of patients was matched by age ± 1 year and treatment date ± 1 year. Patient cycle characteristics and pregnancy outcomes were evaluated between groups. A comparison of endometrial thickness (mm) and ultrasonographic pattern (proliferative/non-proliferative) was performed based on the presence and location of fibroids, impact on endometrial cavity, and diameter of largest fibroid. Student’s t-test, ANOVA and chi-square were used as appropriate. 1,453 ART cycles were evaluated. 219 (15.1%) patients were noted to have a fibroid of any size in any location. There were no submucosal fibroids in our study group due to pre-cycle screening and treatment. Age (36.2 yrs, 95% CI 35.9-36.6), day 3 FSH (7.1 IU/ml, 95% CI 6.9-7.3), gonadotropins used (55.3 ampules, 95% CI 53.8-56.8), oocytes retrieved (15.9, 95% CI 14.3-17.6), and number of embryos transferred (2.8 embryos, 95% CI 2.5-2.8), were not statistically different between groups. There was no statistically significant difference in endometrial thickness or pattern in any group analyzed (Table). When comparing pregnant versus non-pregnant patients there was also no significant difference in endometrial thickness between any of the groups. Post-hoc power analysis revealed that our study was powered to detect a 1 mm difference in endometrial thickness (β=0.998).Tabled 1 Fibroids do not appear to alter the endometrial pattern or thickness during ART stimulation. Consistent with other published findings, the pregnancy rate was significantly reduced in patients with intramural fibroids and in those with fibroids which impact the uterine cavity. The predictable lower pregnancy rate in women with fibroids does not appear to be explained by differences in endometrial thickness or pattern on the day of hCG.

Assessing the reproductive performance of men co-infected with HIV-1 and hepatitis C undergoing assisted reproduction

To assess the reproductive performance of men co-infected with hepatitis C virus (HCV) and human immunodeficiency virus (HIV-1) undergoing assisted reproduction. A retrospective analysis. University-based assisted reproductive technology (ART) center. We reviewed 217 consecutive ART cycles performed on 106 HIV-1 serodiscordant couples between August 1997 and March 2004, in which 28 men (26%) were seropositive for HCV and HIV-1 (group 1). Patient demographics and laboratory testing were compared to reproductive outcomes of men undergoing similar treatment but infected only with HIV-1 (group 2). Co-infected men and their partners were of similar age as men infected only with HIV-1. Comparing group 1 to group 2, like values were noted for HIV-1 viral loads [1,993 +/- 1,140 copies/ml (mean +/- SE) vs. 1,659 +/- 487 copies/ml]; CD4 counts (520 +/- 98 vs. 604 +/- 38 mm(-3)); and semen parameters. IVF performance and outcomes were similar, with fertilization rate (0.68 +/- 0.03 vs. 0.71 +/- 0.02); number of normally cleaving embryos (6.0 +/- 0.5 vs. 5.3 +/- 0.3); embryo implantation rate (0.27 +/- 0.04 vs. 0.2 +/- 0.02); and clinical pregnancy rate (40 vs. 29%). Although the male mortality rate was low in both groups, morbidity among co-infected men was significantly higher. Seven of 28 men (25%) had detectable HCV viral loads, and 14 (50%) had elevated liver function tests. Men co-infected with HCV and HIV-1 do reasonably well undergoing ART to prevent transmission of viruses to their partners and children.

Comparison of assisted reproductive technology utilization and outcomes between Caucasian and African American patients in an equal-access-to-care setting

Racial disparity in assisted reproductive technology (ART) outcomes has been reported but remains controversial. Reasons for the disparity are unclear, and access to care has been suggested as a causative factor. In this study, we sought to examine minority utilization of ART in the Department of Defense (DoD) compared with minority utilization in the U.S. ART population. Outcomes from ART were compared between Caucasian (Cau) and African American (AA) patients, and etiologies of disparity were examined. Retrospective cohort study. University-based ART program. A total of 1,457 patients undergoing first-cycle fresh, nondonor ART. None. Clinical pregnancy rate, live birth rate, implantation rate, spontaneous abortion rate. Within the DoD population, AA women had a fourfold increase in utilization of ART services relative to the U.S. ART population. In this equal-access-to-care setting, AA women experienced a clinically significant decrease in live birth rate that did not reach statistical significance (29.6% vs. 35.8%, risk ratio [RR] 0.83, 95% confidence interval [CI] 0.67-1.02) and a statistically significant increase in spontaneous abortions compared with Cau women (25% vs. 15.9%, RR 1.57, 95% CI 1.05-2.36). This might be explained, in part, by a higher prevalence of uterine leiomyomas in AA women (30.8% AA vs. 10.7% Cau, RR 2.85, 95% CI 2.06-3.95). For both AA and Cau women, the presence of fibroids at baseline ultrasound was associated with reductions in clinical pregnancy rates (35% with leiomyomas vs. 43.2% without leiomyomas, RR 0.74, 95% CI 0.51-0.98), live birth rates (26.2% vs. 36.0%, RR 0.63, 95% CI 0.44-0.90), and implantation rates (25.6% vs. 31.1% RR 0.82, 95% CI 0.69-0.98). Utilization of ART services among AA women increased when access to care was improved. A clinically significant reduction in live birth rate and statistically significant increase in spontaneous abortion rate was observed in AA women compared with Cau women. Leiomyomas were three times more prevalent in AA women and reduced ART success, regardless of race. The persistence of racial differences in an equal-access-to-care environment might be explained, in part, by the increased prevalence of leiomyomas in AA women.

Embryo afterloading: A refinement in embryo transfer technique that may increase clinical pregnancy

Given the importance of ET technique during assisted reproductive technology cycles, we evaluated the effect of embryo afterloading subsequent to placement of the ET catheter on pregnancy rates vs. a standard direct ET. Retrospective cohort analysis. University-based assisted reproductive technology program. Patients undergoing a fresh nondonor day 3 ET by a single provider over a 1-year period. None. Clinical pregnancy. One hundred twenty-seven patients met inclusion criteria, and the overall pregnancy rate was 46.5%. There was no difference between the two groups with respect to age, basal FSH, or number of embryos transferred. The ET method used was at the discretion of the provider. There was no difference between the two groups in the presence of blood on the transfer catheter. However, there were significantly more transfer catheters with mucus contamination in the direct transfer group (25.58% vs. 5.95%). The clinical pregnancy rate in the group with ET using the afterloading technique was higher than in the direct ET group (52.4% vs. 34.9%). There was a trend toward an increase in pregnancy rate when an embryo afterloading technique was used. A prospective randomized trial is needed to examine this issue.

Delaying the initiation of progesterone supplementation results in decreased pregnancy rates after in vitro fertilization: a randomized, prospective study

Objective: To compare IVF outcome between two protocols for luteal phase supplementation, one beginning on day 3 after oocyte retrieval and the other beginning on day 6 after retrieval. Design: Prospective, randomized study. Setting: University-based assisted reproductive technology center. Patient(s): One hundred twenty-six consecutive patients undergoing IVF between January and July 2000. Intervention(s): Patients were randomized to begin luteal phase support using vaginal progesterone beginning either on day 3 after oocyte retrieval or on day 6 after oocyte retrieval. Main Outcome Measure(s): Clinical pregnancy rates and implantation rates. Result(s): All patients randomized underwent transfer. There were no differences in age, oocytes retrieved, or embryos transferred between the two groups. Those patients receiving luteal phase support with progesterone beginning on day 6 after retrieval had a significantly lower clinical pregnancy rate per transfer compared with those beginning support on day 3 after retrieval (44.8% vs. 61.0%, respectively). This difference in pregnancy rates was greater in those patients undergoing a luteal gonadotropin releasing hormone (GnRH) agonist down-regulation protocol (47.5% vs. 71.4%, day 6 vs. day 3, respectively). Beginning support on day 6 also significantly decreased implantation rates in the GnRH agonist group (21.0% vs. 34.0%, day 6 vs. day 3, respectively). Conclusion(s): Pregnancy rates are significantly decreased by initiating luteal-phase progesterone supplementation on day 6 after oocyte retrieval during in vitro fertilization cycles.

Human chorionic gonadotropin levels after blastocyst transfer are highly predictive of pregnancy outcome

Objective: To determine the predictive value(s) of β–hCG serum levels for pregnancy outcome following blastocyst transfer. Design: Retrospective review. Setting: University-based assisted reproductive technology (ART) program. Patients: All ART patients enrolled from January 1998 to December 1999. Intervention(s): None. Main Outcome Measure(s): β–hCG serum levels and pregnancy outcomes. Result(s): Of the 836 ART cycles initiated, 608 embryo transfers met study criteria and were assigned to one of two groups: 248 day 5 blastocyst transfers or 360 day 3 embryo transfers. In the day 5 blastocyst group, 147 pregnancies occurred (59.2%), and day 3 transfers resulted in 165 pregnancies (45.8%). For day 3 and day 5 transfers, mean values of β–hCG on day 16 post-retrieval of spontaneous abortions were lower than ongoing pregnancies ( P<.05). A β–hCG value on day 16 of >300 mIU/mL predicted an ongoing pregnancy for day 5 transfer group in 97% of pregnancies compared with 92% for day 3 embryo transfers. A multiple gestation was observed in 70% of pregnancies with a β–hCG level >400 mIU/mL in the day 5 group compared with 63% for the day 3 group. The incidence of higher-order multiple gestations was significantly lower in the day 5 blastocyst group ( P<.05). Conclusion(s): β–hCG serum levels on day 16 post-retrieval were highly predictive of pregnancy outcome after a blastocyst transfer.

Coexistent hemoconcentration and hypoosmolality during superovulation and in severe ovarian hyperstimulation syndrome: a volume homeostasis paradox

Objective: To investigate the concomitant time courses of the changes in osmolality and calculated blood volume during the genesis of ovarian hyperstimulation syndrome (OHSS). Design: Prospective longitudinal study. Setting: IVF-ET program in a university-based assisted reproductive technology center. Patient(s): Thirty women undergoing superovulation for IVF-ET. Intervention(s): Blood and urine samples were obtained on seven occasions from the start of FSH stimulation until a pregnancy test. Five women with severe OHSS had daily blood and urine tests during hospitalization. Main Outcome Measure(s): Changes in serum and urine osmolality, serum electrolytes, albumin, hemoglobin, and hematocrit. Result(s): Blood volume in women with OHSS decreased significantly by 20% from days hCG +2 to +4, followed by a sustained increase of 30% above baseline from days hCG +8 to +12. There was no statistically significant change in blood volume in women without OHSS. There was a sharp decrease in serum osmolality in women without OHSS between days 0 and hCG +2, which recovered toward baseline from day 4 after hCG. In women with OHSS, there was an unexpected increase in osmolality of 6 mOsm/kg between days hCG −2 and 0, followed by a decrease of 8 mOsm/kg by day hCG +2; this was sustained until day hCG +12. Patients with OHSS demonstrated a concentration and dilution of their urine during the acute and recovery phases of the syndrome, respectively, despite persistence of the hypoosmolar state. Conclusion(s): Decreased osmolality in severe OHSS is maintained despite significant decreases and increases in blood volume, suggestive of fundamental alterations in osmoregulation.

Comparison of two colloidal silica-based sperm separation media with a non–silica-based medium

Objective: To study and compare the effects of three sperm separation media, two silica-based (Percoll; Pharmacia Biotech AB, Uppsala, Sweden, and Isolate; Irvine Scientific, Santa Ana, CA) and one non–silica-based (Ixaprep; Medicult, Copenhagen, Denmark), on the recovery of progressive motile sperm, the percentage of sperm with normal morphology, various sperm motion characteristics determined by computer-aided sperm analysis, and the percentage of acrosome-reacted sperm. Design: Prospective study. Setting: A university-based assisted reproductive technology center. Patient(s): Male partners of couples attending our infertility clinic. Intervention(s): None. Main Outcome Measure(s): Various semen parameters. Result(s): Both Isolate and Ixaprep resulted in enhanced recovery of motile spermatozoa compared with Percoll. The percentage of sperm with forward progressive motility, the percentage of sperm with normal morphology, and various sperm motion characteristics were similar after the use of Percoll and Isolate and were significantly better than after the use of Ixaprep. The same percentage of acrosome-reacted spermatozoa was observed with all three media. Similar results were observed in both normal and subnormal semen samples. Conclusion(s): The use of Isolate and Ixaprep resulted in better recovery of motile spermatozoa. Other semen parameters were similar with the use of Isolate and Percoll, whereas the use of Ixaprep was associated with lower sperm velocities and fewer morphologically normal spermatozoa.

Successful pregnancy in a 63-year-old woman

Abstract Objective: To report the occurrence of an unusual case of successful pregnancy achieved by oocyte donation in a woman >60 years of age. Design: Case report. Setting: University-based assisted reproductive technology program. Patient(s): Sixty-three-year old nulligravida, married for 16 years to her 60-year-old husband. Throughout her infertility treatment, the patient was believed to be 10 years younger, as she claimed. She revealed her true age of 63 only upon being referred for obstetric care at 13 weeks of gestational age. Intervention(s): Oocyte donation, IVF, embryo cryopreservation, and ET. Main Outcome Measure(s): Attainment of pregnancy and subsequent delivery. Result(s): The patient underwent two cycles of oocyte donation. During the second attempt, the fresh transfer resulted in a clinical miscarriage at approximately 8 weeks of gestational age. A subsequent transfer of three frozen-thawed embryos resulted in an ongoing singleton gestation. The pregnancy was complicated by gestational diabetes (controlled by diet) and mild pregnancy-induced hypertension. Delivery by cesarean section at 38 weeks of gestational age resulted in the birth of a healthy female infant weighing 2,844 g with Apgar scores of 9 and 9. Conclusion(s): This case demonstrates that the uterus is capable of supporting nidation and subsequent gestation for many years beyond natural menopause. It shows that other aspects of human physiology are capable of adapting to the stresses and changes of pregnancy sufficiently well to achieve a normal birth at the age of 63 years. This case also exemplifies the difficulty in attempting to regulate the age of recipients in oocyte donation. As in other aspects of human life, when age limits are applied to the provision of certain services, human beings whose age falls outside of these limits become motivated to deceive the providers of those services to avail themselves of the services.

Successful Pregnancy in a 63-Year-Old Woman

Abstract Objective: To report the occurrence of an unusual case of successful pregnancy achieved by oocyte donation in a woman >60 years of age. Design: Case report. Setting: University-based assisted reproductive technology program. Patient(s): Sixty-three-year old nulligravida, married for 16 years to her 60-year-old husband. Throughout her infertility treatment, the patient was believed to be 10 years younger, as she claimed. She revealed her true age of 63 only upon being referred for obstetric care at 13 weeks of gestational age. Intervention(s): Oocyte donation, IVF, embryo cryopreservation, and ET. Main Outcome Measure(s): Attainment of pregnancy and subsequent delivery. Result(s): The patient underwent two cycles of oocyte donation. During the second attempt, the fresh transfer resulted in a clinical miscarriage at approximately 8 weeks of gestational age. A subsequent transfer of three frozen-thawed embryos resulted in an ongoing singleton gestation. The pregnancy was complicated by gestational diabetes (controlled by diet) and mild pregnancy-induced hypertension. Delivery by cesarean section at 38 weeks of gestational age resulted in the birth of a healthy female infant weighing 2,844 g with Apgar scores of 9 and 9. Conclusion(s): This case demonstrates that the uterus is capable of supporting nidation and subsequent gestation for many years beyond natural menopause. It shows that other aspects of human physiology are capable of adapting to the stresses and changes of pregnancy sufficiently well to achieve a normal birth at the age of 63 years. This case also exemplifies the difficulty in attempting to regulate the age of recipients in oocyte donation. As in other aspects of human life, when age limits are applied to the provision of certain services, human beings whose age falls outside of these limits become motivated to deceive the providers of those services to avail themselves of the services.

Successful pregnancy in a 63-year-old woman

Objective: To report the occurrence of an unusual case of successful pregnancy achieved by oocyte donation in a woman >60 years of age. Design: Case report. Setting: University-based assisted reproductive technology program. Patient(s): Sixty-three-year old nulligravida, married for 16 years to her 60-year-old husband. Throughout her infertility treatment, the patient was believed to be 10 years younger, as she claimed. She revealed her true age of 63 only upon being referred for obstetric care at 13 weeks of gestational age. Intervention(s): Oocyte donation, IVF, embryo cryopreservation, and ET. Main Outcome Measure(s): Attainment of pregnancy and subsequent delivery. Result(s): The patient underwent two cycles of oocyte donation. During the second attempt, the fresh transfer resulted in a clinical miscarriage at approximately 8 weeks of gestational age. A subsequent transfer of three frozen-thawed embryos resulted in an ongoing singleton gestation. The pregnancy was complicated by gestational diabetes (controlled by diet) and mild pregnancy-induced hypertension. Delivery by cesarean section at 38 weeks of gestational age resulted in the birth of a healthy female infant weighing 2,844 g with Apgar scores of 9 and 9. Conclusion(s): This case demonstrates that the uterus is capable of supporting nidation and subsequent gestation for many years beyond natural menopause. It shows that other aspects of human physiology are capable of adapting to the stresses and changes of pregnancy sufficiently well to achieve a normal birth at the age of 63 years. This case also exemplifies the difficulty in attempting to regulate the age of recipients in oocyte donation. As in other aspects of human life, when age limits are applied to the provision of certain services, human beings whose age falls outside of these limits become motivated to deceive the providers of those services to avail themselves of the services.

Spermatozoal characteristics from fresh and frozen donor semen and their correlation with fertility outcome after intrauterine insemination

To determine if conventional sperm parameters, specific characteristics of sperm motion determined by computer-aided semen analysis (CASA), sperm penetration assay (SPA), and/or spontaneous acrosome reaction assay could best predict fertility outcome after intrauterine insemination (IUI) from frozen donor sperm. A retrospective analysis of 2,245 cycles of therapeutic donor IUIs were initially studied; 1,147 cycles that met selection criteria were used in this report. A university-based assisted reproductive technology center. All IUIs were performed on women with documented patency of at least one fallopian tube, ovulatory cycles, and who did not receive human menopausal gonadotropins. Sperm donors had to be used for at least four different recipients (mean of 15) and at least 14 different cycles of insemination (mean of 41). None. Pregnancy. Statistical comparisons were made between donors of different relative fertility by using the Mann-Whitney test, Spearman's rank correlation, and multiple regression analysis. These analyses demonstrated that the most significant predictors of the fertility of frozen-thawed donor sperm were curvilinear velocity, straight line velocity, and the total number of motile sperm inseminated. The number of sperm with spontaneous acrosome reactions negatively correlated with fertility outcome, and SPA provided no predictive value. Our study supports the hypothesis that the study of sperm motion characteristics using CASA after thawing and washing of cryopreserved sperm is a better predictor of fertile outcome after IUI than analysis of fresh semen.