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Ortac MS, Hacioglu A, Uludag SZ, Karaca Z, Unluhizarci K, Kelestimur F, Tanriverdi F. Evaluation of growth hormone deficiency in women with unexplained infertility. Growth Horm IGF Res 2024; 74:101571. [PMID: 38280246 DOI: 10.1016/j.ghir.2024.101571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 01/08/2024] [Accepted: 01/22/2024] [Indexed: 01/29/2024]
Abstract
PURPOSE Growth hormone (GH) has been recognized to play a regulatory role in female reproduction. It has been reported that infertile GH deficient patients regained fertility after GH replacement. The frequency of GH deficiency is not established in patients diagnosed with unexplained infertility. Here, we aim to present the prevalence of GH deficieny in this patient group. METHODS We included patients diagnosed with unexplained infertility throughout 18 months. Insulin tolerance test (ITT) and glucagon stimulation tests (GST) were performed and insufficient response to both tests was required for the diagnosis of GH deficiency. RESULTS Twenty-five patients were included in the study, the mean age was 27.4 ± 4.5 years and the median duration of infertility was 60 months (min:14, max:120). Two patients were GH deficient according to GST and 14 to ITT. Two patients (8%) showed lack of response on both tests and were diagnosed with GH deficiency. CONCLUSION The rate of GH deficiency among women with unexplained infertility was 8% in this preliminary study. There is need for further studies with larger patient groups to verify the results.
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Affiliation(s)
- Mehmet Serif Ortac
- Erciyes University Medical School, Department of Endocrinology, Kayseri, Turkey
| | - Aysa Hacioglu
- Erciyes University Medical School, Department of Endocrinology, Kayseri, Turkey.
| | - Semih Zeki Uludag
- Uskudar University Medical School, Department of Obstetrics and Gynaecology, Istanbul, Turkey
| | - Zuleyha Karaca
- Erciyes University Medical School, Department of Endocrinology, Kayseri, Turkey
| | - Kursad Unluhizarci
- Erciyes University Medical School, Department of Endocrinology, Kayseri, Turkey
| | - Fahrettin Kelestimur
- Yeditepe University Medical School, Department of Endocrinology, Istanbul, Turkey
| | - Fatih Tanriverdi
- Memorial Kayseri Hospital, Department of Endocrinology, Kayseri, Turkey
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Bosselut H, Paulmyer-Lacroix O, Gnisci A, Bretelle F, Perrin J, Courbiere B. [Prognostic factors of live-birth after in vitro fertilization for unexplained infertility: A cohort study]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2021; 49:601-607. [PMID: 33434750 DOI: 10.1016/j.gofs.2021.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES For 15 to 30% of infertile couples, no etiology can be found, leading to the diagnosis of "unexplained infertility". The aim of our study was to identify prognostic factors for live birth following in vitro fertilization (IVF) for these couples. METHODS A retrospective, monocentric study on a cohort of couples undergoing IVF for unexplained infertility with the woman aged≤40 years old. Primary analysis compared couples with a live birth following IVF versus childless couples following IVF. RESULTS Between January 2014 and December 2018, 104 couples were included, 196 transvaginal oocyte pickup were performed, followed by 234 embryo transfers (fresh or cryopreserved) which resulted in 43 deliveries. The cumulative live birth rate was 40.4% per couple. Before IVF attempts, no clinical or paraclinical prognostic factors between the two groups was observed. However, multivariate analysis showed several biological factors of good prognosis in course of treatment, such as a higher number of mature oocytes and better quality embryos in "live birth" group. CONCLUSIONS For a couple, the chances of having a child following IVF unexplained infertility are 40.4%. However, no clinical characteristic enabled us to identify favourable or unfavourable prognosis factors before starting ART. The prognostic factors identified during IVF cycle are interesting to advise or not to pursue IVF.
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Affiliation(s)
- H Bosselut
- Pôle femmes-parents-enfants, centre clinico-biologique d'AMP-CECOS, AP-HM La Conception, 147, boulevard Baille, 13005 Marseille, France.
| | - O Paulmyer-Lacroix
- Pôle femmes-parents-enfants, centre clinico-biologique d'AMP-CECOS, AP-HM La Conception, 147, boulevard Baille, 13005 Marseille, France; Aix Marseille université, département d'histologie et embryologie, Marseille, France
| | - A Gnisci
- Pôle femmes-parents-enfants, centre clinico-biologique d'AMP-CECOS, AP-HM La Conception, 147, boulevard Baille, 13005 Marseille, France
| | - F Bretelle
- Pôle femmes-parents-enfants, centre clinico-biologique d'AMP-CECOS, AP-HM La Conception, 147, boulevard Baille, 13005 Marseille, France; Aix Marseille université, unité de recherche sur les maladies infectieuses tropicales et émergentes, UM 63, CNRS 7278, IRD 198, Inserm 1095, Marseille, France
| | - J Perrin
- Pôle femmes-parents-enfants, centre clinico-biologique d'AMP-CECOS, AP-HM La Conception, 147, boulevard Baille, 13005 Marseille, France; Aix Marseille université, CNRS, IRD, Avignon université, IMBE, Marseille, France
| | - B Courbiere
- Pôle femmes-parents-enfants, centre clinico-biologique d'AMP-CECOS, AP-HM La Conception, 147, boulevard Baille, 13005 Marseille, France; Aix Marseille université, CNRS, IRD, Avignon université, IMBE, Marseille, France
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Satwik R, Kochhar M. Unexplained infertility categorization based on female laparoscopy and total motile sperm count, and its impact on cumulative live-births after one in-vitro fertilization cycle. A retrospective cohort study involving 721 cycles. Reprod Med Biol 2021; 20:190-198. [PMID: 33850452 PMCID: PMC8022093 DOI: 10.1002/rmb2.12368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 12/18/2020] [Accepted: 01/10/2021] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To determine how subcategorizing unexplained infertility based on female laparoscopy and total-motile-sperm-count assessment would impact cumulative live-births after one in-vitro fertilization (IVF) cycle. METHODS Seven hundred twenty one IVF cycles from Jan 2014-April 2019 performed at a single-center were retrospectively analyzed. Couples with unexplained infertility having normal uterine and endometrial morphology were subcategorized into three cohorts, UI (1): those with no tuboperitoneal pathology on laparoscopy and total-motile-sperm-count (TMSC) ≧20 million: n = 103; UI (2): tuboperitoneal pathology on laparoscopy or TMSC <20 million, n = 86; and UI(3): tuboperitoneal status not known: n = 114. Controls were severe male factor, bilateral tubal block, and grade 3/4 endometriosis: n = 418. Primary Outcome was cumulative-live-birth-per-initiated-IVF cycle (CLBR). Odds ratio for live-births were adjusted for confounding factors. RESULTS The CLBR in UI1 cohort was significantly lower than controls (29.1% vs 39; OR = 0.62; 95%CI = 0.39-0.98; P = .04); but similar in UI2 and UI3 vs. controls. (37.2% vs 39.95%; OR = 0.89, 95%CI = 0.55-1.44; P = .89) and (38.6% vs 39.95%; OR = 0.98, 95%CI = 0.64-1.55; P = .98). After adjusting for age, infertility duration, past live-births, and AMH, the adjusted odds for CLBR in UI1 was 0.48 (95%CI = 0.28-0.82; P = .007). CONCLUSIONS Unexplained infertility when defined after a normal laparoscopy and TMSC significantly lowered cumulative-live-births-per-initiated-IVF cycle when compared with traditional diagnosis of tubal, endometriosis, or male factor infertility. In UI subcategory with abnormal laparoscopy or TMSC, CLBR remained unaffected. This information could be useful for counseling couples prior to IVF. Large-scale prospective studies are needed to confirm this observation.
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Affiliation(s)
- Ruma Satwik
- Centre of IVF and Human ReproductionInstitute of Obstetrics and GynaecologySir Ganga Ram HospitalNew DelhiIndia
| | - Mohinder Kochhar
- Centre of IVF and Human ReproductionInstitute of Obstetrics and GynaecologySir Ganga Ram HospitalNew DelhiIndia
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Role of diagnostic intracytoplasmic sperm injection (ICSI) in the management of genetically determined zona pellucida-free oocytes during in vitro fertilization: a case report. ZYGOTE 2020; 28:519-523. [PMID: 32847637 DOI: 10.1017/s0967199420000441] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
PURPOSE To report the utilization of diagnostic intracytoplasmic sperm injection (D-ICSI), an ICSI cycle performed in the natural cycle, to obtain information about embryo development potential after sperm injection into zona pellucida (ZP)-free oocytes. MATERIALS AND METHODS We report the case of a couple with primary unexplained infertility with a history of previous failed, in vitro fertilization intracytoplasmic sperm injection (IVF-ICSI) cycles characterized by the presence of ZP-free oocytes. Whole exome sequencing (WES) was carried out to analyse the possible genetic basis of oocyte abnormality. RESULTS Diagnostic ICSI provided information about the embryo development potential from ZP-free oocytes and allowed better planning of the subsequent ICSI cycle. WES revealed that the absence of ZP was likely to be due to a new (ZP1) mutation. The subsequent ICSI cycle resulted in the delivery of a healthy baby. DISCUSSION To the best of our knowledge, our report is the first to describe the use of D-ICSI to determine the feasibility of embryo development and implantation in a patient with ZP1 mutation, resulting in the subsequent delivery of a healthy baby. We used 'diagnostic' ICSI in the normal menstrual cycle to explore the feasibility of embryo development after sperm injection into ZP-free oocytes. Our results may expand the spectrum of diagnostic procedures associated with unexplained infertility.
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Zhu J, Jiang H, He RB, Yin HQ, Wang CL, Li Y, Du X. Association between etiologic factors in infertile couples and fertilization failure in conventional in vitro fertilization cycles. Andrology 2015; 3:717-22. [PMID: 26097073 DOI: 10.1111/andr.12048] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2015] [Revised: 03/22/2015] [Accepted: 04/08/2015] [Indexed: 10/23/2022]
Abstract
The aim of this study was to investigate the relationship between the etiology of the couples and risk of fertilization failure (FF) in conventional in vitro fertilization (IVF) cycles and the effect of rescue intracytoplasmic sperm injection (ICSI) technique to offspring. A total of 2542 IVF cycles were divided into four groups according to infertile etiology: Group A - primary infertility with normal semen parameters; Group B - secondary infertility with oligoasthenozoospermia; Group C - primary infertility with oligoasthenozoospermia; and Group D - secondary infertility with normal semen parameters. The results showed that there were significant differences in incidence of FF among Group A (16.8%), Group B (20.9%), Group C (48.7%), and Group D (0.9%) (p < 0.001). Logistic regression models demonstrated that primary infertility (OR: 10.898, 95% CI: 4.651-25.583, p < 0.001) and oligoasthenozoospermia (OR: 12.215, 95% CI: 5.903-25.276, p < 0.001) were independent risk factors for FF. There were no significant differences in main outcomes between conventional ICSI and rescue ICSI. In conclusion, the patients with primary infertility and oligoasthenozoospermia might be at higher risk of FF. The rescue ICSI technique is safe and helpful for IVF cycles of FF.
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Affiliation(s)
- J Zhu
- Reproductive Medicine Center, the 105th Hospital of PLA, Hefei, China
| | - H Jiang
- Reproductive Medicine Center, the 105th Hospital of PLA, Hefei, China
| | - R-B He
- Reproductive Medicine Center, the 105th Hospital of PLA, Hefei, China
| | - H-Q Yin
- Reproductive Medicine Center, the 105th Hospital of PLA, Hefei, China
| | - C-L Wang
- Reproductive Medicine Center, the 105th Hospital of PLA, Hefei, China
| | - Y Li
- Reproductive Medicine Center, the 105th Hospital of PLA, Hefei, China
| | - X Du
- Reproductive Medicine Center, the 105th Hospital of PLA, Hefei, China
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Johnson LN, Sasson IE, Sammel MD, Dokras A. Does intracytoplasmic sperm injection improve the fertilization rate and decrease the total fertilization failure rate in couples with well-defined unexplained infertility? A systematic review and meta-analysis. Fertil Steril 2013; 100:704-11. [DOI: 10.1016/j.fertnstert.2013.04.038] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Revised: 04/05/2013] [Accepted: 04/11/2013] [Indexed: 11/17/2022]
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Combelles CMH, Morozumi K, Yanagimachi R, Zhu L, Fox JH, Racowsky C. Diagnosing cellular defects in an unexplained case of total fertilization failure. Hum Reprod 2010; 25:1666-71. [DOI: 10.1093/humrep/deq064] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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Abstract
PURPOSE OF REVIEW A unifying theory of reproductive aging, based on telomere shortening, is proposed. RECENT FINDINGS Telomere shortening may mediate both 'hits' involved in reproductive aging, that is late exit from the fetal production line and long interval to ovulation in the adult. SUMMARY As women age egg dysfunction increases, with meiotic nondisjunction, embryonic arrest, apoptosis, and miscarriage. Egg dysfunction results from two 'hits' - reduced formation of chiasmata during fetal oogenesis, and accumulation of reactive oxygen damage during the prolonged interval until ovulation. Late exit from a production line during oogenesis presumably contributes to the first hit. The later insult also involves meiotic spindle abnormalities. Telomeres, repetitive sequences of DNA, cap chromosome ends and dissipate during divisions. Oocytes do not divide, but oogonia do, and telomerase, the enzyme responsible for maintaining telomere length, is inefficient, and remains inactive in oocytes and embryos until blastocyst stage. Reactive oxygen also shortens telomeres, so the prolonged interval between birth and ovulation would further shorten telomeres from chronic exposure to reactive oxygen. In support of this theory, experimental shortening of telomeres in mice produced a phenotype similar to reproductive aging in women, with abnormal chiasmata, spindles, cell cycles, apoptosis, and genomic instability, and telomere length in human eggs correlated with in-vitro fertilization outcome.
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Affiliation(s)
- David L Keefe
- University of South Florida, Department of Obstetrics and Gynecology, Tampa, Florida 33606, USA.
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Shveiky D, Simon A, Gino H, Safran A, Lewin A, Reubinoff B, Laufer N, Revel A. Sibling oocyte submission to IVF and ICSI in unexplained infertility patients: a potential assay for gamete quality. Reprod Biomed Online 2006; 12:371-4. [PMID: 16569328 DOI: 10.1016/s1472-6483(10)61011-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In order to reduce total fertilization failure in unexplained infertility, sibling oocytes were submitted to both conventional IVF and intracytoplasmic sperm injection (ICSI). Two groups of ICSI embryos were compared in unexplained infertility patients: those derived from ICSI when IVF had failed to fertilize, and those derived from ICSI while their sibling oocytes were fertilized by IVF. The outcome of oocytes fertilized exclusively by ICSI (essential ICSI, n = 749) was compared with those fertilized both by IVF and ICSI (non-essential ICSI, n = 957) in all IVF patients treated for unexplained infertility at the Hadassah Hospital (1999-2002). The latter group was further subdivided into ICSI and IVF embryos. Total fertilization rate was 54%. Fertilization rates by ICSI were lower in the essential ICSI compared with the non-essential ICSI group, at 65 and 73% (P < 0.025). Pregnancy rates per embryo transfer in the essential ICSI group (49%), ICSI derived embryos group (55%) and IVF derived embryos (44%) from the non-essential ICSI group, were similar. Implantation rates were lower in the essential ICSI group as compared with the non-essential ICSI group (21 versus 32% respectively; P < 0.05) and 26% for IVF embryos. In conclusion, essential ICSI was associated with lower fertilization and implantation rates.
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Affiliation(s)
- David Shveiky
- In-Vitro Fertilization Unit, Department of Obstetrics and Gynecology, Hadassah University Hospital, Ein Kerem, Jerusalem 91120, Israel
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Ryley DA, Wu HH, Leader B, Zimon A, Reindollar RH, Gray MR. Characterization and mutation analysis of the human () gene in women with unexplained infertility. Fertil Steril 2005; 83:1363-71. [PMID: 15866570 DOI: 10.1016/j.fertnstert.2004.10.051] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2004] [Revised: 10/28/2004] [Accepted: 10/28/2004] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Formin-2 (Fmn2) mutant mice produce oocytes with meiosis I arrest. Our aim was to describe the human FORMIN-2 (FMN2) gene and to identify DNA sequence polymorphisms in patients with unexplained infertility and multiple failed IVF cycles. DESIGN Institutional review board-approved observational case-control study. SETTING Infertility center and university hospital. PATIENT(S) Sixty-two fertile controls and seven subjects with unexplained infertility. INTERVENTION(S) BLASTP (www.ncbi.nlm.nih.gov) was used to map the genomic DNA and complementary DNA sequence of FMN2. Genomic DNA was extracted from blood leukocyte samples. The polymerase chain reaction was used to amplify FMN2 gene exons for analysis by denaturing gradient gel electrophoresis. MAIN OUTCOME MEASURE(S) Characterization of the FMN2 gene and identification of fragment melting polymorphisms (FMPs). RESULT(S) FMN2 includes 411,960 base pairs (bp) of DNA with 6,204 bp in 18 exons. There was no difference in FMN2 FMP allele frequencies between the controls and subjects. One patient was homozygous for one FMP. CONCLUSION(S) The human FMN2 gene is conserved between evolutionarily diverse vertebrates. It is likely that FMN2 has the same function as Fmn2 in the mouse (i.e., maintenance of the meiotic spindle). Prospective identification of patients with meiosis I arrest is necessary to determine whether FMN2 mutations are a cause of unexplained infertility.
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Abstract
PURPOSE OF REVIEW The purpose of this review is to critically examine the ability of screening tests to predict fertilization failure. RECENT FINDINGS Failed fertilization occurs in 5-10% of in-vitro fertilization cycles and 2-3% of intracytoplasmic sperm injection cycles. Failed fertilization may result from impaired spermatozoa, oocyte deficiencies or defects in the in-vitro sperm/oocyte medium. In the in-vitro fertilization setting most cases are caused by male factor deficiencies, whereas failure of oocyte activation is the most common cause of failed fertilization after intracytoplasmic sperm injection. Although the standard semen analysis has limited ability to predict fertilization failure, strict sperm morphology criteria, sperm-zona binding ratios and zona pellucida induced acrosome reaction tests provide increased capacity to avoid this outcome. The quality of the semen sample on the day of oocyte retrieval and fertilization performance in previous in-vitro fertilization cycles may also guide the appropriate use of intracytoplasmic sperm injection. However, the routine use of the latter technique in cases of non-male factor infertility is contraindicated. SUMMARY The ever improving techniques highlighted in this analysis offer improved ability to predict failed fertilization.
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Affiliation(s)
- Neal G Mahutte
- Department of Obstetrics and Gynecology, Yale University, New Haven, Connecticut 06520-8063, USA
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Kousta E, White DM, Cela E, McCarthy MI, Franks S. The prevalence of polycystic ovaries in women with infertility. Hum Reprod 1999; 14:2720-3. [PMID: 10548608 DOI: 10.1093/humrep/14.11.2720] [Citation(s) in RCA: 73] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Polycystic ovaries (PCO) are highly prevalent in women presenting with hirsutism or recurrent miscarriage but the functional significance of PCO in ovulatory women presenting with infertility remains unclear. We examined the prevalence of PCO, on ultrasonography, among women presenting with infertility. Among 289 couples classified in four main diagnostic categories, PCO were found in 81 (83%) of 98 anovulatory patients, 40 (53%) of 76 patients whose partners had sperm dysfunction, 26 (50%) of 52 patients with tubal disease and in 28 (44%) of 63 patients with unexplained infertility. By comparison, in a control group of 67 parous volunteers, 19 (28%) were found to have PCO. PCO patients with unexplained infertility had higher midfollicular luteinizing hormone and testosterone compared with the group with normal ovaries. The prevalence of PCO was significantly higher in each of the infertility groups than in controls, and a similar tendency (not significant) was observed among women with unexplained infertility. Ovulatory PCO women with infertility had higher testosterone concentrations in comparison with PCO controls. In summary, the prevalence of PCO among ovulatory women with infertility is higher than that in the normal population, suggesting that PCO may, perhaps by virtue of an effect of hyperandrogenaemia, contribute to the causes of subfertility in women with regular menses.
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Affiliation(s)
- E Kousta
- Section of Endocrinology and Metabolic Medicine and Department of Reproductive Science and Medicine, Imperial College School of Medicine, St Mary's Hospital, London W2 1PG, UK
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Silva CP, Kommineni K, Oldenbourg R, Keefe DL. The first polar body does not predict accurately the location of the metaphase II meiotic spindle in mammalian oocytes. Fertil Steril 1999; 71:719-21. [PMID: 10202885 DOI: 10.1016/s0015-0282(98)00530-5] [Citation(s) in RCA: 88] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate how well polar body location predicts spindle localization and to examine spindle morphology. DESIGN Randomized, controlled animal study. SETTING University-affiliated research laboratory. ANIMAL(S) Mature, female golden hamsters. INTERVENTION(S) After superovulation with pregnant mare serum gonadotropin and hCG, metaphase II oocytes were obtained and imaged under digital polarization microscopy. MAIN OUTCOME MEASURE(S) Identify the meiotic spindle in living, unfixed hamster oocytes and determine spindle location relative to the polar body. RESULT(S) Spindles were imaged in 30 oocytes and only in 5 of them could the polar body predict the spindle localization. In the remaining oocytes, the spindles presented a random distribution within the cytoplasm. CONCLUSION(S) These data show that the polar body location is not an accurate predictor for meiotic spindle location in mammalian oocytes.
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Affiliation(s)
- C P Silva
- Department of Obstetrics and Gynecology, Women and Infants Hospital, Brown University School of Medicine, Providence, Rhode Island 02905, USA
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Ziebe S, Andersen AN, Andersen AG, Mikkelsen AL, Lindenberg S. Results of intracytoplasmic sperm injection in relation to indication. Acta Obstet Gynecol Scand 1997; 76:335-9. [PMID: 9174427 DOI: 10.1111/j.1600-0412.1997.tb07988.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Intracytoplasmic sperm injection (ICSI) was first introduced as a treatment to couples that were infertile due to severe male factors. Later, the ICSI technic has also been used on other indications like low or no fertilization in previous IVF cycles. METHODS A total of 262 ICSI cycles performed in 180 patients were reviewed and the results related to the indications. The indications were severely impaired semen quality (182 cycles) or absent or low fertilization in previous IVF attempts (80 cycles). RESULTS A total of 2298 oocytes were aspirated and 1939 oocytes were injected resulting in 1172 fertilized (60%) and 995 cleaved oocytes (51%). Of these, 547 preembryos were transferred in 240 cycles and 287 preembryos were cryopreserved. We obtained 99 pregnancies (41%/transfer) of which 63 were ongoing pregnancies (26%/transfer). The pregnancy rate was significantly lower (p = 0.025) in couples referred for ICSI due to previously failed IVF (29%/ transfer) compared to couples with impaired semen quality (46%/transfer). Seventy-seven children have been born. Forty-eight healthy children were born from singleton pregnancies with a mean gestational age of 39.8 weeks and an average birthweight of 3561 g. Thirteen sets of healthy twins and one set of healthy triplets were born. In 29 of the 63 ongoing pregnancies amniocenteses were performed and all karyotypes were normal. CONCLUSION IVF with ICSI gave good clinical results in couples with severe male factor infertility. The technic can also be used in couples with unexplained fertilization failure, but the pregnancy rate may be lower.
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Affiliation(s)
- S Ziebe
- Fertility Clinics, Rigshospitälet, University of Copenhagen, Denmark
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Reinsemination of one-day-old oocytes by use of intracytoplasmic sperm injection**Supported by grants from the Swedish Medical Research Council (no. 2873, Stockholm, Sweden), the Hjalmar Svensson Foundation (Göteborg, Sweden), and The Anna Ahrenberg Foundation (Göteborg, Sweden). Fertil Steril 1996. [DOI: 10.1016/s0015-0282(16)58397-6] [Citation(s) in RCA: 51] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Hossain AM, Rizk B, Huff C, Helvacioglu A, Thorneycroft IH. Human sperm bioassay has potential in evaluating the quality of cumulus-oocyte complexes. ARCHIVES OF ANDROLOGY 1996; 37:7-10. [PMID: 8827341 DOI: 10.3109/01485019608988495] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Human sperm bioassay is routinely used as a quality control check for the culture media. This is one of the three bioassays chosen by the College of American Pathologists (CAP) for interlaboratory proficiency testing to assess the standards of in vitro fertilization (IVF) and andrology laboratories. This study utilized sperm bioassay to assess the quality of cumulus-oocyte complexes (COCs) retrieved in IVF procedures COCs, harvested from the female partner of IVF couples, undergoing identical ovarian stimulation protocols, were individually inseminated with the sperm of the corresponding male partner. Sperm motility in sperm-COC cocultures were compared. Cocultures were established by inseminating the 103 COCs, retrieved from 18 IVF couples with 1 x 10(5) to 2 x 10(5) sperm of the corresponding male partners of the couples. In all 18 cases, the sperm were prepared identically using the Percoll wash method. The cocultures were maintained for 48 h but the oocytes were removed immediately after the fertilization check (approximately 16 h). The motility of sperm in the cocultures and in the insemination stocks were noted and 17 of 18 sperm stocks used for insemination had similar high preinsemination motility (90.2 +/- 5.0%). At 48 h the sperm motility had significantly decreased in the cocultures compared to the insemination stocks; 52.7 +/- 19.9% versus 67.2 +/- 10.4%. There was no difference in the motility among the small, medium, and large COCs (56.4 +/- 24.6%, 52.5 +/- 17.9%, and 50.8 +/- 20.9%, respectively). In 45% of IVF cases, the motility in cocultures varied widely, falling below as well as above that of their corresponding insemination stocks. Furthermore, the sperm motility varied among the cocultures in both pregnant and nonpregnant patients but the extent of variation appears to be greater in the latter. The inter-COC coculture sperm motility variation most likely is due to the differences in the quality of cumulus-oocyte complexes.
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Affiliation(s)
- A M Hossain
- Department of Obstetrics and Gynecology, University of South Alabama, Mobile 36688, USA
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Windt ML, Franken DR, Kruger TF, Oehninger SC. In vitro fertilization failure: identification of gamete defects by investigation of sperm-zona pellucida binding capacity of unfertilized oocytes. Andrologia 1996; 28:211-5. [PMID: 8844114 DOI: 10.1111/j.1439-0272.1996.tb02785.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
The objective of the study was to determine whether fertilization failure was due to spermatozoal or oocyte factors. Twenty-five unfertilized oocytes from 12 IVF/GIFT couples showing total or partial fertilization failure were evaluated for sperm zona binding potential under hemizonaeassay (HZA) conditions. Hemizonae were separately incubated with a sperm sample from the husband and that of a fertile control. Tight sperm binding to hemizonae was assessed. First, among the 12 patients, results showed a possible zona defect thought to be the cause of fertilization failure in five cases. Second, in two cases, fertilization failure was possibly caused by poor sperm binding potential of spermatozoa. Third, in two cases, fertilization failure was possibly caused by an oocyte defect, and fourth, three cases showed a mixture of possible causes. The results stress the need to develop a sequential analytic programme for those couples with repeated total or partial fertilization failure.
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Affiliation(s)
- M L Windt
- Department of Obstetrics and Gynaecology, University of Stellenbosch, Tygerberg, Republic of South Africa
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Lydic ML, Liu JH, Rebar RW, Thomas MA, Cedars MI. Success of donor oocyte in in vitro fertilization-embryo transfer in recipients with and without premature ovarian failure. Fertil Steril 1996; 65:98-102. [PMID: 8557162 DOI: 10.1016/s0015-0282(16)58034-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To compare the effectiveness of donor oocyte in IVF-ET in patients with premature ovarian failure (POF) versus those (non-POF) with other indications for donor oocyte IVF-ET. DESIGN Retrospective comparative clinical study. SETTING University-based IVF-ET facility. PATIENTS Eighty-six donor oocyte IVF-ET cycles from 32 POF patients (39 cycles) and 38 non-POF patients (47 cycles). INTERVENTIONS Fertile oocyte donors, age 19 to 38 years, were given luteal phase GnRH agonist, gonadotropins, and HCG. Recipients were given transdermal 17 beta-E2 and P in oil. MAIN OUTCOME MEASURES Donor and recipient age, characteristics of controlled ovarian hyperstimulation, oocytes retrieved, embryos frozen and transferred, and percentage with male factor infertility, fertilization rate, implantation rate, and clinical pregnancy rate (PR) per cycle and per transfer. RESULTS Given limitations of sample size, there were no detectable differences in clinical PR per cycle and per transfer, fertilization rate, and implantation rate between POF and non-POF groups despite recognizable differences in recipient age and degree of male factor infertility. CONCLUSIONS Donor oocyte IVF-ET success rates were not different in patients with and without POF. Age-related changes in oocyte quality, rather than uterine senescence, is a major factor for the age-related decline in fertility.
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Affiliation(s)
- M L Lydic
- Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Ohio 45267-0526, USA
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Ducibella T, Dubey A, Gross V, Emmi A, Penzias AS, Layman L, Reindollar R. A zona biochemical change and spontaneous cortical granule loss in eggs that fail to fertilize in in vitro fertilization**Mouse studies were supported by grant HD 24191 (T.D.) and the Center for Reproductive Research (P30 HD 28897) at Tufts University, from the National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland. Fertil Steril 1995. [DOI: 10.1016/s0015-0282(16)57977-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Mitochondrial deoxyribonucleic acid deletions in oocytes and reproductive aging in women**Supported by National Institutes of Health K08 HD01099–01, Bethesda, Maryland and by The American Fertility Society-Ortho Research Award from The American Fertility Society, Birmingham, Alabama (D.K.).††Presented at the 41st Annual Meeting of the Society for Gynecologic Investigation, Chicago, Illinois, March 22 to 26, 1994. Fertil Steril 1995. [DOI: 10.1016/s0015-0282(16)57796-6] [Citation(s) in RCA: 200] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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22
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Sherins RJ, Thorsell LP, Dorfmann A, Dennison-Lagos L, Calvo LP, Krysa L, Coulam CB, Schulman JD. Intracytoplasmic sperm injection facilitates fertilization even in the most severe forms of male infertility: pregnancy outcome correlates with maternal age and number of eggs available. Fertil Steril 1995; 64:369-75. [PMID: 7615116 DOI: 10.1016/s0015-0282(16)57737-1] [Citation(s) in RCA: 77] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To evaluate, in a prospective study, the fertilization and pregnancy rates after intracytoplasmic sperm injection (ICSI) in infertile couples with severe male infertility. DESIGN Intracytoplasmic sperm injection was performed in 229 consecutive IVF cycles on 190 couples with rigorously defined severe male infertility or proven failure of fertilization in prior IVF cycles. Neither male nor female partners were chosen from a waiting list or on any other selective basis, including age, prior or anticipated ovarian response, or oocyte number or quality. There were no upper age limits, in no instance was donor sperm used for ICSI, and cycle cancellation rate was minimal. SETTING Private genetics and fertility center in Fairfax, Virginia. MAIN OUTCOME MEASURES Fertilization, transfer, and pregnancy rates were measured in ICSI-treated couples, and comparisons were made regarding both female age and strictly defined semen categories. RESULTS Two hundred six cycles (90%) resulted in ETs, with initiation of 52 pregnancies (25% per transfer, 23% per cycle). Thirty-eight of 52 (18% per transfer) were clinical pregnancies with established gestational sacs or were ongoing or delivered. Pregnancies were achieved even in older women but were more readily established in younger women producing larger numbers of metaphase II oocytes. The severity of semen abnormalities had some small effect on fertilization rate, but only actual necrospermia was associated with markedly decreased frequency of embryo formation. Pregnancy per transfer was similar across groups. In some cases, pregnancy was initiated with fewer than 100 viable sperm in the ejaculate. CONCLUSIONS Intracytoplasmic sperm injection is a very powerful new treatment for severe male infertility. Paradoxically, egg number and probably egg quality are now the main determinants of success in treating male infertility.
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Affiliation(s)
- R J Sherins
- Genetics & IVF Institute, Fairfax, Virginia 22031, USA
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The results of in vitro fertilization-embryo transfer in couples with unexplained infertility failing to conceive with superovulation and intrauterine insemination. Fertil Steril 1995. [DOI: 10.1016/s0015-0282(16)57661-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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The pregnancy rates of cohorts of idiopathic infertility couples gives insights into the underlying mechanism of infertility. Fertil Steril 1995. [DOI: 10.1016/s0015-0282(16)57662-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Azem F, Yaron Y, Amit A, Yovel I, Barak Y, Peyser MR, David MP, Lessing JB. Transfer of six or more embryos improves success rates in patients with repeated in vitro fertilization failures. Fertil Steril 1995; 63:1043-6. [PMID: 7720915 DOI: 10.1016/s0015-0282(16)57545-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To examine the results of six or more embryos transferred to patients whose IVF-ET cycles repeatedly met with failure. DESIGN Prospective clinical evaluation of pregnancy rates and pregnancy outcome. SETTING IVF-ET Unit. PATIENTS Seventy-two IVF patients who had failed at least four previous IVF cycles. INTERVENTIONS Forty-one patients (group A) received six or more embryos, and 31 patients (group B) chose to receive five embryos. MAIN OUTCOME MEASURES Per embryo implantation rate, pregnancy rate, multiple pregnancies, and outcome were evaluated. RESULTS With the transfer of six or more embryos, the pregnancy rate was significantly higher than with the transfer of five embryos (56% versus 29%, respectively). This was associated with a slight, but insignificant, increase in multiple gestations. No difference in pregnancy outcome was noted among the groups. CONCLUSIONS Patients who have had repeated IVF failures may have higher pregnancy rates if six or more embryos are transferred in subsequent cycles.
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Affiliation(s)
- F Azem
- Tel Aviv Sourasky Medical Center, Serlin Maternity Hospital, Sackler Faculty of Medicine, Tel Aviv University, Israel
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Tsirigotis M, Bennett V, Nicholson N, Khalifa Y, Hogewind G, Yazdani N, Craft I. Experience with subzonal insemination (SUZI) and intracytoplasmic sperm injection (ICSI) on unfertilized aged human oocytes. J Assist Reprod Genet 1994; 11:389-94. [PMID: 7606150 DOI: 10.1007/bf02211724] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE The aim of this study was to assess the fertilizability of unfertilized aged human oocytes from failed in vitro fertilization (IVF) cycles using SUZI and ICSI. METHODS A total of 363 oocytes which showed no fertilization after conventional IVF was subjected to assisted fertilization using SUZI or ICSI. The microinjected oocytes which were derived from 72 patients undergoing their first IVF treatment had an intact polar body and no signs of degeneration. SUZI was carried out in 265 oocytes and ICSI in the remaining 98. RESULTS Significantly more oocytes were damaged after ICSI (9 vs 0.3%, P < 0.01). Normal fertilization rates were higher at 24 hr in both groups and occurred more frequently after ICSI, although the difference did not reach statistical significance. Abnormal fertilization occurred significantly more often after SUZI at 48 hr (P < 0.005), but not at 24 hr. Cleavage rates were significantly higher after ICSI (94.4 vs 57.1%, P < 0.025) at 24 hr, but this was not observed at 48 hr, although the ICSI group still showed better cleavage rates (33.3 vs 19.1%). There was no difference in embryo quality in either group. CONCLUSIONS Our results indicate that micromanipulation rather than reinsemination should be carried out on unfertilized human oocytes from failed IVF attempts. Both techniques can be used to achieve fertilization which occurs more often after ICSI. However, the trauma from the former technique on the microinjected oocytes may impair the potential of the generated embryos to achieve pregnancy compared to SUZI. Prospective randomized trials are necessary to address the problem.
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Affiliation(s)
- M Tsirigotis
- London Gynaecology and Fertility Centre, United Kingdom
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Yaron Y, Botchan A, Amit A, Peyser MR, David MP, Lessing JB. Endometrial receptivity in the light of modern assisted reproductive technologies. Fertil Steril 1994; 62:225-32. [PMID: 8034063 DOI: 10.1016/s0015-0282(16)56868-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To review the different aspects of endometrial receptivity as it is reflected in the various modalities of modern assisted reproductive technologies. DESIGN The importance of endometrial receptivity and the factors that affect it such as the type of treatment, age, and ovarian function are discussed in this review. Novel approaches to determine receptivity such as Doppler ultrasonography and molecular biology are considered; assisted hatching is also discussed. CONCLUSIONS Endometrial receptivity cannot, as yet, be directly assessed. Circumstantial evidence suggests that receptivity declines with age, is adversely affected by controlled ovarian hyperstimulation, and is possibly affected by ovarian function. Future studies will have to focus on molecular cell biology and physiology of the endometrium.
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Affiliation(s)
- Y Yaron
- Vitro Fertilization/Embryo Transfer Unit, Serlin Maternity Hospital, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Israel
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Azem F, Botchan A, Yaron Y, Lessing JB, Har-toov J, Yavetz H, Yovel I, Amit A. Outcome of donor versus husband insemination in couples with unexplained infertility treated by in vitro fertilization and embryo transfer. Fertil Steril 1994; 61:1088-91. [PMID: 8194622 DOI: 10.1016/s0015-0282(16)56761-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To examine the IVF-ET outcome of couples with unexplained infertility treated by husband versus donor sperm. DESIGN A retrospective analysis of the IVF-ET outcome of couples with unexplained infertility treated by either husband or donor sperm and in a subgroup of patients treated simultaneously by husband and donor sperm. SETTING IVF Unit, Serlin Maternity Hospital, Tel Aviv, Israel. PATIENTS Couples diagnosed as having unexplained infertility underwent IVF at our Unit; included were 96 couples treated by husband insemination (group A), 27 couples who received donor insemination because of azoospermia (group B), and 8 couples who sought donor insemination after having previously failed IVF (group C). RESULTS No statistically significant difference was found between groups A and B regarding age of the females, duration of infertility, number of IVF cycles, fertilization rate, number of ETs, and pregnancy rate. Oocytes collected in group C were subdivided further into two groups: 45 were incubated with husband sperm and 46 were incubated with donor sperm. Fertilization rates were 46.6% and 50%, respectively. One pregnancy occurred. CONCLUSION In couples with unexplained infertility who had undergone IVF-ET with husband insemination, the fertilization and pregnancy rates were similar to those of couples who were treated by donor sperm.
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Affiliation(s)
- F Azem
- In Vitro Fertilization/Embryo Transfer Unit, Serlin Maternity Hospital, Tel Aviv Sourasky Medical Center, Israel
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Affiliation(s)
- E Carl Wood
- Department of Obstetrics and GynaecologyMonash University 246 Clayton Road Clayton VIC 3168
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Plachot M, Mandelbaum J, Junca AM, Cohen J, Alvarez S, Salat-Baroux J. A function test to assess the responsibility of oocyte and sperm quality in in vitro fertilization failure. J Assist Reprod Genet 1993; 10:228-34. [PMID: 8400737 DOI: 10.1007/bf01239227] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Affiliation(s)
- M Plachot
- INSERM U173, Hôpital Necker, Paris, France
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Benshushan A, Ezra Y, Simon A, Gordon JW, Laufer N. Subzonal insertion, a possible treatment for "defective oocytes". J Assist Reprod Genet 1993; 10:98-9. [PMID: 8499688 DOI: 10.1007/bf01204449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Affiliation(s)
- A Benshushan
- Department of Obstetrics and Gynecology, Hadassah University Hospital, Ein-Kerem, Jerusalem, Israel
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