Comparison of clinical outcomes between conventional in vitro fertilization and intracytoplasmic sperm injection in poor responders with only single oocyte retrieved

Intracytoplasmic sperm injection hampers fertilization rate and pregnancy per initiated cycle in patients with extremely poor ovarian response

PURPOSE

To compare the clinical outcomes of extremely poor responders with one or two oocytes who receive in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI).

METHODS

A retrospective study was carried out on 2572 patients with one or two oocytes retrieved from 2013 to 2022, of which 2159 patients were scheduled to receive IVF treatment and 413 patients were scheduled to receive ICSI treatment. The laboratory parameters and clinical outcomes were compared with adjusted multivariate regression and propensity score (PS) matching.

RESULTS

In both matched and non-matched cohorts, The ICSI group had a significantly higher total fertilization failure (TFF) rate and lower multiple fertilization rate than the IVF group (P < 0.05). After matching, the cumulative pregnancy rate per initiated cycle in the IVF group was significantly higher than in the ICSI group (28.7% vs 21.7, P < 0.05). However, the difference in cumulative live births did not reach statistical significance (21.2% vs 17.2%, P > 0.05). The adjusted odds ratios for TFF, cumulative pregnancy, and cumulative live birth comparing ICSI versus IVF in multivariate models were 1.65(95% CI: 1.12, 2.43), 0.65(95% CI: 0.46, 0.91), and 0.76(95% CI: 0.55, 1.04), respectively.

CONCLUSION

In poor responders with one or two oocytes retrieved, ICSI insemination cannot avoid TFF, and it may hamper the cumulative pregnancy rate.

Conventional in vitro fertilisation rather than intracytoplasmic sperm injection when only one oocyte is retrieved: Time to overcome irrational fears

BACKGROUND

The use of intracytoplasmic sperm injection (ICSI) currently extends beyond male factor infertility, notably replacing conventional in vitro fertilisation (IVF) in scenarios like limited oocyte availability, where it is used as a precaution against complete fertilisation failure. While existing studies on the use of conventional IVF in such situations provide some reassurance, the available evidence is somewhat insufficient and ICSI is commonly used.

AIMS

To evaluate whether conventional IVF can be a feasible option when only one oocyte is retrieved.

MATERIALS AND METHODS

A retrospective study was performed to evaluate the fertilisation rate with conventional IVF in women retrieving only one oocyte and whose partner had normal semen. The study aimed at evaluating whether the fertilisation rate was aligned with the threshold indicated by recognized IVF laboratory performance indicators (Vienna Consensus). Clinical pregnancy and live birth rates were secondary outcomes.

RESULTS

Out of 304 cycles with a single oocyte inseminated with conventional IVF, 209 achieved normal fertilisation and 82 did not. Thirteen had no mature oocytes. The fertilisation rate was 69% (95% CI: 63-74%) and increased to 72% (95% CI: 66-77%) when immature oocytes were excluded. The fertilisation rate surpassed the minimum competency threshold of the Vienna Consensus (60%), even if below the benchmark value (75%). Clinical pregnancy and live birth rates per oocyte retrieval were 10% and 8%, respectively. Univariate and multivariate analyses failed to identify any predictive factor of fertilisation.

CONCLUSION

Conventional IVF with one oocyte met Vienna Consensus standards even if it fell short of higher benchmarks.

Autophagy activity is increased in the cumulus cells of women with poor ovarian response

OBJECTIVE

To evaluate the autophagy status of cumulus cells (CCs) in women with poor ovarian response (POR).

MATERIALS AND METHODS

CCs were divided into normal ovarian response (NOR) group and POR group. The ultrastructure of autophagy was analyzed by transmission electron microscopy (NOR: n = 18, POR: n = 26). The mRNA and protein of autophagy markers were detected by Quantitative real-time polymerase chain reaction (NOR: n = 15, POR: n = 19) and Western blotting (NOR: n = 41, POR: n = 38), respectively.

RESULTS

Transmission electron microscopy demonstrated abundant autophagosomes and even autophagic death in the POR group. There were no differences in LC3 and P62 mRNA expression between the two groups (p > 0.05). The BCL2 mRNA expression was lower in the POR group (p < 0.05). Moreover, the LC3 II/I ratio and the P62 protein expression were significantly higher in the POR group (p < 0.05).

CONCLUSIONS

Autophagy in CCs of POR women is activated and the autophagic flux is blocked. The up-regulation of autophagy in CCs may be related to the pathogenesis of POR.

Hypothalamic-Pituitary-Gonadal Axis Disorders Impacting Fertility in Both Sexes and the Potential of Kisspeptin-Based Therapies to Treat Them

Impaired function of the hypothalamic-pituitary-gonadal (HPG) axis can lead to a vast array of reproductive disorders some of which are inherited or acquired, but many are of unknown etiology. Among the clinical consequences of HPG impairment, infertility is quite common. According to the latest report from the World Health Organization, the global prevalence of infertility during a person's lifetime is a staggering 17.5% which translate into 1 out of every 6 people experiencing it. In both sexes, infertility is associated with adverse health events, and if unresolved, infertility can cause substantial psychological stress, social stigmatization, and economic strain. Even though significant advances have been made in the management and treatment of infertility, low or variable efficacy of treatments and medication adverse effects still pose a significant problem. However, the discovery that in humans inactivating mutations in the gene encoding the kisspeptin receptor (Kiss1R) results in pubertal failure and infertility has expanded our understanding of the mechanisms underlying the neuroendocrine control of reproduction, opening up potential new therapies for the treatment of infertility disorders. In this chapter we provide an overview of common infertility disorders affecting men and women, their recommended treatments, and the potential of kisspeptin-based pharmacotherapies to treat them.