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Naji O, Moska N, Dajani Y, El-Shirif A, El-Ashkar H, Hosni MM, Khalil M, Khalaf Y, Bolton V, El-Toukhy T. Early oocyte denudation does not compromise ICSI cycle outcome: a large retrospective cohort study. Reprod Biomed Online 2018; 37:18-24. [PMID: 29673730 DOI: 10.1016/j.rbmo.2018.03.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 03/10/2018] [Accepted: 03/14/2018] [Indexed: 11/30/2022]
Abstract
This retrospective cohort study of 2051 consecutive fresh non-donor intracytoplasmic sperm injection (ICSI) cycles investigated whether time from oocyte retrieval to denudation, precisely measured and recorded by an operator-independent automated radiofrequency-based system, affected cycle outcome. ICSI cycles were divided into two groups: group I (denudation within <2 h of oocyte retrieval, n = 1118) and group II (denudation 2-5 h after oocyte retrieval, n = 933). Univariate analysis by two-sample t-test or Mann-Whitney test was used, as appropriate. Both groups were comparable with regards to mean number of oocytes retrieved and fertilized normally after ICSI. The mean number of embryos transferred and surplus embryos cryopreserved at the blastocyst stage were similar. There was no significant difference in fertilization, embryo implantation, pregnancy, clinical pregnancy or live birth rates between the groups. Analysis of group I ICSI outcome after subdivision into immediate (up to 30 min) and early (31-119 min) denudation showed no statistically significant differences between the two subgroups. In conclusion, early oocyte denudation within <2 h after retrieval does not appear to compromise ICSI cycle outcome, permitting more efficiency and flexibility in scheduling laboratory workload. As this was a retrospective observational study, further prospective studies are required to confirm the findings.
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Affiliation(s)
- Osama Naji
- Assisted Conception Unit, Guy's and St Thomas' Foundation Trust, Guy's Hospital, London, UK.
| | - Natalie Moska
- Assisted Conception Unit, Guy's and St Thomas' Foundation Trust, Guy's Hospital, London, UK
| | - Yaser Dajani
- Assisted Conception Unit, Guy's and St Thomas' Foundation Trust, Guy's Hospital, London, UK
| | - Awatuf El-Shirif
- Assisted Conception Unit, Guy's and St Thomas' Foundation Trust, Guy's Hospital, London, UK
| | - Hassan El-Ashkar
- Assisted Conception Unit, Guy's and St Thomas' Foundation Trust, Guy's Hospital, London, UK
| | - Mohamed M Hosni
- Assisted Conception Unit, Guy's and St Thomas' Foundation Trust, Guy's Hospital, London, UK
| | - Mohamed Khalil
- Assisted Conception Unit, Guy's and St Thomas' Foundation Trust, Guy's Hospital, London, UK
| | - Yacoub Khalaf
- Assisted Conception Unit, Guy's and St Thomas' Foundation Trust, Guy's Hospital, London, UK; King's College London, London, UK
| | - Virginia Bolton
- Assisted Conception Unit, Guy's and St Thomas' Foundation Trust, Guy's Hospital, London, UK; King's College London, London, UK
| | - Tarek El-Toukhy
- Assisted Conception Unit, Guy's and St Thomas' Foundation Trust, Guy's Hospital, London, UK; King's College London, London, UK
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Moura BRLD, Gurgel MCA, Machado SP, Marques PA, Rolim JR, Lima MCD, Salgueiro LL. Low concentration of hyaluronidase for oocyte denudation can improve fertilization rates and embryo quality. JBRA Assist Reprod 2017; 21:27-30. [PMID: 28333029 PMCID: PMC5365197 DOI: 10.5935/1518-0557.20170008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Objective Hyaluronidase enzyme is an extremely important factor for the process of
oocyte denudation, but little is known about its negative effects. Methods This prospective randomized study analyzed the results of using different
concentrations of hyaluronidase (Diluted: 8IU/mL and Normal: 80IU/mL) used
for denudation of sibling-oocytes for 22 women undergoing treatment for
assisted reproduction by ICSI. A total of 192 oocytes were injected, being
104 for group I (diluted) and 88 for group II (normal). We analyzed
fertilization rate, cleavage, embryo quality at 48 and 72 hours and number
of transferred embryos in each group. Results The diluted enzyme group showed better results in fertilization rates (92.3%
vs. 80.6%), mean cleavage (4.18 ± 2.57 vs. 3.09 ± 1.90), in
48-hour embryos A and A + B (60.9% vs. 44.1% and 90.2% vs. 82.3%) and at 72
hours (45.6% vs. 36.8% and 77.1% vs 66.2%), and number of embryos selected
for transfer (61.8% vs. 38.1%). The overall pregnancy rate was 59.1%. Conclusion This study demonstrates that the use of 8 IU/mL of hyaluronidase, according
to the following protocol, is beneficial and can be successfully used for
oocyte denudation, and it is also economically advantageous to the
laboratory
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Affiliation(s)
- Bernardo R L de Moura
- Clínica Fértilis de Medicina Reprodutiva, Sorocaba, SP, Brazil.,Universidade Anhembi Morumbi, São Paulo, SP, Brazil
| | | | | | | | - Juliana R Rolim
- Clínica Fértilis de Medicina Reprodutiva, Sorocaba, SP, Brazil
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3
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Bárcena P, Rodríguez M, Obradors A, Vernaeve V, Vassena R. Should we worry about the clock? Relationship between time to ICSI and reproductive outcomes in cycles with fresh and vitrified oocytes. Hum Reprod 2016; 31:1182-91. [DOI: 10.1093/humrep/dew070] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 03/08/2016] [Indexed: 11/12/2022] Open
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Assisted reproductive technologies: a systematic review of safety and effectiveness to inform disinvestment policy. Health Policy 2011; 102:200-13. [PMID: 21868120 DOI: 10.1016/j.healthpol.2011.07.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2011] [Revised: 06/09/2011] [Accepted: 07/21/2011] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Health policy relating to assisted reproductive technologies (ART) has been variably informed by clinical evidence, social values, political and fiscal considerations. This systematic review examined key factors associated with specific benefits and harms of ART to inform the development of a model for generating policy recommendations within an Australian disinvestment research agenda. METHODS Six databases were searched from 1994 to 2009. Included articles contained data on safety and/or effectiveness of in vitro fertilisation (IVF) or IVF with intracytoplasmic sperm injection with reference to female age, male age or cycle rank. Narrative descriptions of key outcomes (live birth, miscarriage) were constructed alongside tabular summaries. RESULTS Sixty-eight studies and one registry report were included. There was substantial heterogeneity present within the evidence-base which limited the strength and scope of conclusions that could be drawn. However, this review does affirm the differential effectiveness associated with the ageing of ART patients with regard to live birth and miscarriage. CONCLUSION From the available evidence, it was not possible to determine an explicit age or cycle rank that could be used to formulate defensible policy responsive to identified differential effectiveness. Stakeholder interpretation of this evidence-base may assist in developing policy that can incorporate uncertainty and reflect social values.
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Parlakgumus HA, Haydardedeoglu B, Simsek E, Bulgan Kilicdag E, Bagis T. Are serum markers altered in first trimester screening in poor ovarian reserve patients? J Obstet Gynaecol Res 2011; 37:1582-7. [PMID: 21733033 DOI: 10.1111/j.1447-0756.2011.01578.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM To investigate whether serum biochemical markers were altered during first trimester screenings in patients who have diminished ovarian reserve. METHODS One hundred and fifty-one women who conceived after intracytoplasmic sperm injection were enrolled during the 11- to 14-week scan between June 2006 and July 2008. The normoresponders (Group 1: 125 patients) had >6 oocytes and the poor responders (Group 2: 26 patients) had ≤6 oocytes in oocyte retrieval. The means of the multiples of the median (MoM) of pregnancy-associated plasma protein A (PAPP-A), free β-human chorionic gonadotropin (β-hCG) and nuchal translucency of the poor responder and normoresponder groups were compared and a potential relationship between serum markers and poor ovarian reserve was investigated. Data were analyzed with the Student's t-test, χ2-test and Mann-Whitney two sample test (unpaired, nonparametric). P < 0.05 was considered significant. RESULTS The means of the MoMs of the poor responders and normoresponders were 1.16 ± 0.45 and 1.04 ± 0.32 (P = 0.111) for nuchal translucency, 0.92 ± 0.48 and 0.89 ± 0.61 (P = 0.399) for PAPP-A, and 1.08 ± 0.40 and 1.21 ± 0.95 (P = 0.831) for β-hCG, respectively. CONCLUSION There was no statistically significant difference between the groups in serum biochemical markers, nuchal translucency means and screen positive rates during the first trimester screening.
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Affiliation(s)
- Huriye A Parlakgumus
- Department of Obstetrics and Gynecology, Başkent University School of Medicine, Ankara, Turkey.
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6
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Geyter CD, Geyter MD, Behre HM. Assisted Reproduction. Andrology 2010. [DOI: 10.1007/978-3-540-78355-8_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Kaminsky A, Salamon B, Katzorke T, Rübben H, Sperling H. [Testicular sperm extraction and intracytoplasmic sperm injection : Are there useful predictors of pregnancy and take home baby rate?]. Urologe A 2009; 48:886-93. [PMID: 19458932 DOI: 10.1007/s00120-009-2005-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Among married couples in Germany, 3-9% suffer from infertility. Due to the tremendous changes in reproductive medicine, several successful approaches including ICSI after operative sperm retrieval are available.The age of the woman has a positive predictive value for the ICSI outcome, but for the male partner no predictive value for any parameter before TESE and ICSI has been demonstrated. Therefore we investigated whether there is a parameter before TESE that will elucidate the question of success of assisted reproduction after successful sperm retrieval.The outcome of 108 married couples that were treated consecutively for infertility with one or more TESE were investigated to determine whether the man's age, FSH concentration or testicular volume has a significant influence on the success of this therapy. None of the parameters had a positive predictive value about the outcome that could enhance the counselling of these couples before operative sperm retrieval.
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Affiliation(s)
- A Kaminsky
- Klinik für Urologie, Kliniken Maria Hilf GmbH, Mönchengladbach, Deutschland.
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8
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Carizza C, Abdelmassih V, Abdelmassih S, Ravizzini P, Salgueiro L, Salgueiro PT, Jine LT, Nagy P, Abdelmassih R. Cabergoline reduces the early onset of ovarian hyperstimulation syndrome: a prospective randomized study. Reprod Biomed Online 2009; 17:751-5. [PMID: 19079957 DOI: 10.1016/s1472-6483(10)60401-4] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Prophylactic use of cabergoline has been associated with a decrease in the severity of ovarian hyperstimulation syndrome (OHSS). A prospective randomized study was designed to evaluate the potential of cabergoline to decrease the incidence of OHSS in high-risk patients undergoing assisted reproductive technology treatment; 166 patients with oestradiol concentrations over 4000 pg/ml on the day of human chorionic gonadotrophin (HCG) administration were evaluated. They all received 20 g routine preventive intravenous human albumin on the day of oocyte retrieval. They were then randomized into two groups: group A (n = 83) received 0.5 mg oral cabergoline per day for 3 weeks beginning on the day after oocyte retrieval, and group B (n = 83) received no medication. 'Early' OHSS was defined as being when the onset of the syndrome was initiated during the first 9 days after HCG administration, and 'late' OHSS was defined as being when the onset of the syndrome was initiated from 10 days after HCG administration. In group A, no patients progressed to 'early' OHSS and nine patients (10.8%) developed 'late' OHSS; in group B, 12 patients (15.0%) progressed to 'early' OHSS and three (3.8%) to 'late' OHSS. Although the risk of 'early' OHSS decreased significantly (P < 0.001), the risk of 'late' onset OHSS did not. The two groups presented no changes in pregnancy, implantation or miscarriages rates.
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Affiliation(s)
- Carlos Carizza
- Roger Abdelmassih Human Reproduction Clinic and Research Centre, Avenida Brasil, 1085, São Paulo, SP, Brazil.
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Ravizzini P, Carizza C, Abdelmassih V, Abdelmassih S, Azevedo M, Abdelmassih R. Microdissection testicular sperm extraction and IVF-ICSI outcome in nonobstructive azoospermia. Andrologia 2008; 40:219-26. [PMID: 18727731 DOI: 10.1111/j.1439-0272.2008.00846.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
We evaluated the efficiency of microdissection testicular sperm extraction (MicroTESE) in patients with nonobstructive azoospermia (NOA) and their pregnancy outcomes in a programme based on in vitro fertilisation (IVF)/intracytoplasmic sperm injection (ICSI). Fifty-six MicroTESE procedures were performed in 53 patients with NOA. Pre-operative levels of luteinising hormone, follicle-stimulating hormone (FSH), testosterone and prolactin were obtained and a Doppler sonography examination was conducted. Sperm retrieval rate, mean age of female partner, mean ICSI and fertilisation rate, number and quality of embryos transferred, implantation, pregnancy and miscarriage rates were calculated. Samples for testicular histological analysis were taken trans-operatively in every case. Sperm retrieval rate, mean ICSI per case and fertilisation rate were 57.1%, 7.4% and 58.4% respectively. A significant difference in pre-operative testicular volume (P = 0.001), serum FSH (P = 0.008) and total testosterone levels (P = 0.021) was found in patients from whom sperm could be retrieved. Mean 1.9 type A embryos were transferred per cycle. Implantation, clinical pregnancy and miscarriage rates were 20%, 40% and 18.7% respectively. It is concluded that MicroTESE is a viable option for men with NOA, offering excellent results in couples undergoing IVF-ICSI. Pre-operative serum FSH, testicular volume and total testosterone levels may have a prognostic value, although more data are needed to determine their significance and whether or not patients should be excluded from an initial sperm retrieval attempt.
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Affiliation(s)
- P Ravizzini
- Clínica e Centro de Pesquisa em Reprodução Humana Roger Abdelmassih, São Paulo, Brazil.
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Dozortsev D, Nagy P, Abdelmassih S, Oliveira F, Brasil A, Abdelmassih V, Diamond M, Abdelmassih R. The optimal time for intracytoplasmic sperm injection in the human is from 37 to 41 hours after administration of human chorionic gonadotropin. Fertil Steril 2004; 82:1492-6. [PMID: 15589848 DOI: 10.1016/j.fertnstert.2004.09.002] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2004] [Revised: 09/08/2004] [Accepted: 09/08/2004] [Indexed: 10/26/2022]
Abstract
Fertilization rates increased continuously with the time elapsed after administration of hCG, reaching a peak of 84% when intracytoplasmic sperm injection (ICSI) was performed >41 hours after hCG administration. However, the highest implantation rate, 24%, was achieved when ICSI was performed 37-41 hours after hCG administration.
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Affiliation(s)
- Dmitri Dozortsev
- Clinica e Centro de Pesquisa em Reproducao Humana Roger Abdelmassih, São Paulo, Brazil.
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11
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Avrech OM, Orvieto R, Pinkas H, Sapir-Rufas O, Feldberg D, Fisch B. Inclusion of standard and low-dose gonadotropin releasing hormone-analog (short protocol) in controlled ovarian hyperstimulation regimens in normogonadotropic patients aged 40-48 years who are undergoing in vitro fertilization. Gynecol Endocrinol 2004; 19:247-52. [PMID: 15726912 DOI: 10.1080/09513590400019288] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
We aimed to compare the efficiency of three controlled ovarian hyperstimulation protocols in achieving superovulation in normogonadotropic patients aged 40 years or more, who were undergoing in vitro fertilization (IVF) treatment. This was a prospective randomized clinical study, carried out in the Infertility and IVF Unit of an academic tertiary hospital. A total of 219 normogonadotropic patients (serum follicular stimulating hormone level < 15 mIU/ml) aged 40-48 years, with regular menstrual cycles, were randomly allocated to one of three short follicular protocols: menotropins only (group A), menotropins plus a mini-dose of gonadotropin releasing hormone (GnRH)-analog (600 microg/ day) (group B), or menotropins plus a standard dose (900 microg/day) of a GnRH-analog (group C). Those cycles that reached the stage of oocyte retrieval (67, 70 and 71 cycles, respectively) were analyzed. The mean daily dose of menotropins needed for ovarian stimulation was higher when GnRH-analog was used (groups B and C) (p < 0.02; ANOVA), although there was no significant difference in the time of human chorionic gonadotropin injection (average: cycle day 11). Peak estradiol levels (p < 0.02), number of oocytes retrieved (3.9, 5.4 and 5.5 oocytes/cycle, respectively, p < 0.02) and number of embryos transferred (1.6, 1.8 and 2.1 embryos/cycle, respectively, p < 0.05) were higher when GnRH-analog was included in the controlled ovarian hyperstimulation protocol. The IVF treatment resulted in 19 pregnancies (9.1% implantation rate), with a similar distribution among all three groups (11.9%, 8.6% and 7.0%). However, a higher miscarriage rate was noted in the menotropins-only group (67.5% vs. 33.3% and 40.0% of pregnancies). No differences were observed in any of the aforementioned variables between the mini-dose and standard dose GnRH-analog groups (groups B and C). In conclusion, controlled ovarian hyperstimulation before IVF treatment in normogonadotropic patients aged 40 years or more is more effective when a GnRH-analog (short protocol) is included in the treatment regimen. In this selected group of patients, reducing the daily dose of GnRH-analog does not improve the treatment results.
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Affiliation(s)
- O M Avrech
- Department of Obstetrics and Gynecology, Rabin Medical Center, Beilinson Campus, Petah Tiqva, Israel
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12
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Oliveira FG, Abdelmassih VG, Diamond MP, Dozortsev D, Melo NR, Abdelmassih R. Impact of subserosal and intramural uterine fibroids that do not distort the endometrial cavity on the outcome of in vitro fertilization–intracytoplasmic sperm injection. Fertil Steril 2004; 81:582-7. [PMID: 15037406 DOI: 10.1016/j.fertnstert.2003.08.034] [Citation(s) in RCA: 172] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2003] [Revised: 08/07/2003] [Accepted: 08/07/2003] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To further evaluate the effects of intramural and subserosal uterine fibroids on the outcome of IVF-ET, when there is no compression of the endometrial cavity. DESIGN Retrospective, matched-control study from January 2000 to October 2001. SETTING Private IVF center. PATIENT(S) Two hundred forty-five women with subserosal and/or intramural fibroids that did not compress the uterine cavity (fibroid group) and 245 women with no evidence of fibroids anywhere in the uterus (control group). INTERVENTION(S) In vitro fertilization-intracytoplasmic sperm injection (IVF-ICSI) cycles. MAIN OUTCOME MEASURE(S) The type of fibroid (intramural, subserosal), number, size (cm), and location of intramural leiomyomas (fundal, corpus) were recorded. Outcomes of IVF-ICSI cycles were compared between the two groups. RESULT(S) There was no correlation between location and number of uterine fibroids and the outcomes of IVF-ICSI. Patients with subserosal or intramural fibroids <4 cm had IVF-ICSI outcomes (pregnancy, implantation, and abortion rates) similar to those of controls. Patients with intramural fibroids >4.0 cm had lower pregnancy rates than patients with intramural fibroids <or=4.0 cm. There were no statistical differences related to delivery rates (31.5% vs. 32%, respectively) between all patients with fibroids and controls. Premature delivery rates for singleton gestations were 10% vs. 8%, respectively, in all patients with fibroid and controls. CONCLUSION(S) Patients having subserosal or intramural leiomyomas of <4 cm not encroaching on the uterine cavity have IVF-ICSI outcomes comparable to those of patients without such leiomyomas. Therefore, they might not require myomectomy before being scheduled for assisted reproduction cycles. However, we recommend caution for patients with fibroids >4 cm and that such patients be submitted to treatment before they are enrolled in IVF-ICSI cycles. Whether or not women with fibroids > 4 cm would benefit from fibroid treatment remains to be determined.
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Affiliation(s)
- Flávio Garcia Oliveira
- Clínica e Centro de Pesquisa em Reprodução Humana "Roger Abdelmassih," São Paulo, Brazil.
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Orvieto R, Bar-Hava I, Yoeli R, Ashkenazi J, Rabinerson D, Bar J, Fisch B. Results of in vitro fertilization cycles in women aged 43-45 years. Gynecol Endocrinol 2004; 18:75-8. [PMID: 15195498 DOI: 10.1080/09513590310001651849] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Our objective was to evaluate the results of in vitro fertilization (IVF) cycles in the elderly (43-45 years old) female population. All consecutive women aged 43-45 years admitted to our IVF unit from January 1996 to December 2001 were enrolled in the study. Ovarian stimulation characteristics, number of oocytes retrieved, number of embryos transferred and pregnancy rate were assessed. Seven hundred and eight consecutive IVF cycles in 276 patients were evaluated. Two hundred and seven cycles were cancelled (cancellation rate 29.2%). Forty-seven patients achieved a clinical pregnancy (pregnancy rate 6.6% per cycle and 9.4% embryo transfer) with a 30% live birth rate. In patients who underwent embryo transfer, there were no differences between conception and non-conception cycles in patient's age, number of gonadotropin ampules used, length of ovarian stimulation, number of oocytes retrieved, fertilization rate or cleavage rate. However, the conception cycles were associated with a significantly lower peak estradiol level (p < 0.04) and higher number of total (p < 0.03) and good-quality (p < 0.005) embryos transferred, in addition to a lower ratio of estradiol level/number of follicles > 14 mm on day of human chorionic gonadotropin administration and of estradiol level/number of oocytes retrieved. We conclude that, although older female age is a major contributor to IVF failure, successful IVF cycles can be expected in patients aged 43-45 years in the presence of low ratios of peak estradiol to either number of follicles > 14 mm on day of human chorionic gonadotropin administration or number of oocytes retrieved that reach the stage of embryo transfer with at least two good-quality embryos.
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Affiliation(s)
- R Orvieto
- Department of Obstetrics and Gynecology, Rabin Medical Center, Petah Tiqva, Israel
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14
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Oliveira FG, Abdelmassih VG, Diamond MP, Dozortsev D, Nagy ZP, Abdelmassih R. Uterine cavity findings and hysteroscopic interventions in patients undergoing in vitro fertilization–embryo transfer who repeatedly cannot conceive. Fertil Steril 2003; 80:1371-5. [PMID: 14667871 DOI: 10.1016/j.fertnstert.2003.05.003] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To assess hysteroscopic findings in patients undergoing IVF-ET who repeatedly failed to conceive despite transfer of good-quality embryos. DESIGN Prospective, observational study. SETTING Clinical research unit for reproductive medicine in a private clinic. PATIENT(S) Fifty-five patients with a normal uterine cavity on hysterosalpingography before the initial IVF-ET cycle and two previous failed IVF-ET attempts despite transfer of a minimum of two good-quality embryos on each occasion. INTERVENTION(S) Standard transvaginal ultrasonography and diagnostic and therapeutic hysteroscopy. MAIN OUTCOME MEASURE(S) Endometrial findings on transvaginal ultrasonography and hysteroscopy and outcome of the cycles after surgical hysteroscopy and antibiotic therapy. RESULT(S) Twenty-five (45%) patients had abnormal endometrial findings and underwent treatment to correct the lesions. All patients underwent a third IVF-ET cycle. Pregnancy (50% vs. 20%) and implantation (19% vs. 5.5%) rates were significantly higher in patients who were treated for uterine abnormalities than in patients who had normal uterine cavities on hysteroscopy. CONCLUSION(S) The incidence of pathologic findings on hysteroscopy is high in patients with repeated failures of IVF-ET. Evaluation of endometrial integrity by hysteroscopy is highly valuable and should be applied to all such cases.
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Affiliation(s)
- Flávio G Oliveira
- Clínica e Centro de Pesquisa em Reprodução Humana Roger Abdelmassih, São Paulo, SP, Brazil.
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15
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Abdelmassih V, Balmaceda JP, Nagy ZP, Abdelmassih S, Abdelmassih R. ICSI and day 5 embryo transfers: higher implantation rates and lower rate of multiple pregnancy with prolonged culture. Reprod Biomed Online 2003; 3:216-220. [PMID: 12513858 DOI: 10.1016/s1472-6483(10)62039-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
This retrospective review study, carried out in a private IVF clinic, compared pregnancy and implantation rates with day 3 versus day 5 embryo transfers in a selected group of patients. Participants were patients who failed to achieve pregnancy in at least one previous attempt with embryo transfer on days 2 or 3, and had more than five oocytes fertilized. A total of 296 patients who had undergone day 3 (group A) transfers were compared with 154 who had undergone day 5 transfers (group B). Interventions were intracytoplasmic sperm injection (ICSI), day 3 and day 5 embryo transfer. Outcome measures were pregnancy, implantation, multiple gestation and blastocyst formation rates. Overall, 86.4% of embryos were at the six- to eight-cell stage at 72 h and 30% developed to blastocyst by day 5. The mean number of embryos transferred was 4.0 on day 3 and 3.0 on day 5. Pregnancy and implantation rates were 34.8 and 11.5% in group A, versus 45.3 and 18.5% in group B. Multiple gestation rate was 47.1% in group A and 28.5% in group B. Prolonging embryo culture in vitro to day 5 improved embryo selection and implantation rates. A significant decrease in high order gestations was achieved by reducing the number of embryos transferred, without compromising the pregnancy rates.
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Affiliation(s)
- Vicente Abdelmassih
- Clínica e Centro de Pesquisa em Reprodução Humana Roger Abdelmassih, São Paulo SP, Brazil
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16
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Commenges-Ducos M. [What medical intervention in the late desire for a child?]. GYNECOLOGIE, OBSTETRIQUE & FERTILITE 2002; 30:834-8. [PMID: 12478995 DOI: 10.1016/s1297-9589(02)00447-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Therapeutical decisions in case of unsuccessful late child wish in a woman aged more than 35, must take into account several issues. In a context where time cannot be considered as "therapeutical" in the sense that the probability of onset of a pregnancy per cycle can not increase with time, the moment of check-up for infertility can be fixed at 6 months of sexual intercourse, assumed to be possibly fecundant. The assessment of ovarian age allows to formulate a double prognosis, that of therapeutical efficacy for obtaining onset of pregnancy and that of the quality of possible conceptus. The choice of treatment from the etiological check-up will not go from the simplest to the more sophisticated as is done for younger women. This is an important issue since the remaining time of possible fertility is short.
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Affiliation(s)
- M Commenges-Ducos
- Fécondation in vitro, maternité Pellegrin, CHU de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France.
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Haebe J, Martin J, Tekepety F, Tummon I, Shepherd K. Success of intrauterine insemination in women aged 40-42 years. Fertil Steril 2002; 78:29-33. [PMID: 12095486 DOI: 10.1016/s0015-0282(02)03168-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine how advancing female age decreases successful outcomes of intrauterine insemination (IUI) alone or combined with ovarian stimulation. DESIGN Retrospective review. SETTING Academic fertility center. PATIENT(S) Infertile men and women. INTERVENTION(S) Intrauterine insemination alone or combined with ovarian stimulation. MAIN OUTCOME MEASURE(S) Pregnancy rates, miscarriage rates, and live birth rates per insemination cycle according to female age. RESULT(S) The 1,117 cycles of IUI resulted in 217 pregnancies, for an overall pregnancy rate for all female ages of 19.4% and a live birth rate of 12.9% per cycle inseminated. The overall live birth rate per insemination declined with advancing maternal age. CONCLUSION(S) Advancing female age decreases successful outcomes with IUI. The live birth rate with IUI for women 40-42 years old (n = 82) was 9.8% per insemination and may demonstrate that IUI is an appropriate treatment for this age group of women.
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Affiliation(s)
- Jeffrey Haebe
- Fertility Centre, Civic Hospital-Parkdale Clinic, The University of Ottawa, Ontario, Ottawa, Canada.
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18
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Abdelmassih V, Balmaceda JP, Tesarik J, Abdelmassih R, Nagy ZP. Relationship between time period after vasectomy and the reproductive capacity of sperm obtained by epididymal aspiration. Hum Reprod 2002; 17:736-40. [PMID: 11870128 DOI: 10.1093/humrep/17.3.736] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND It is not well defined whether the elapsed time after vasectomy has any influence on the outcome of IVF-ICSI using epididymal sperm. We analysed retrospectively the results of 151 ICSI cycles in which sperm of vasectomized men were used at different time periods after vasectomy. METHODS Oocytes were obtained after a desensitizing ovarian stimulation protocol using GnRH agonist in association with recombinant FSH and HCG. Sperm were retrieved by percutaneous epididymal sperm aspiration. The cycles were split into three groups: < or =10 years after vasectomy (group 1, n = 47), 11-19 years after vasectomy (group 2, n = 79), and > or =20 years after vasectomy (group 3, n = 25). RESULTS As might be expected, the mean age of men differed in the three groups (group 3 > group 2 > group 1), and the mean age of the women was also significantly higher in group 3 than in groups 1 and 2, although no differences were described between groups 2 and 3. All other laboratory and clinical parameters were similar in the three groups. Ongoing pregnancy and implantation rates (34, 25, 8% and 22, 15, 6% respectively) decreased significantly from group 1 to group 3. CONCLUSION Pregnancy and implantation rates after ICSI with sperm from vasectomized men are negatively correlated with the time interval from vasectomy, which cannot be explained purely by male or female ageing.
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Affiliation(s)
- Vicente Abdelmassih
- Clínica e Centro de Pesquisa em Reproduçião Humana Roger Abdelmassih, Rua Maestro Elias Lobo 805, Jardim Paulista, Cep: 01433-000, São Paulo SP, Brazil
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19
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De Geyter C, De Geyter M, Meschede D, Behre HM. Assisted Fertilization. Andrology 2001. [DOI: 10.1007/978-3-662-04491-9_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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20
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Bar-Hava I, Ferber A, Ashkenazi J, Dicker D, Ben-Rafael Z, Orvieto R. Natural-cycle in vitro fertilization in women aged over 44 years. Gynecol Endocrinol 2000; 14:248-52. [PMID: 11075294 DOI: 10.3109/09513590009167689] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Women who are 44 years of age or more are usually denied infertility treatment because of their low response to ovarian stimulation and the extremely low pregnancy rate that can be achieved. The object of this study was to assess the place of natural-cycle in vitro fertilization (IVF) in this population. From January 1996 to September 1997, all consecutive women aged 44-47 years who approached our unit seeking infertility treatment with their own oocytes were enrolled in the study. After a counselling session in which the advantage of egg donation was discussed, women who still wished to try to conceive by utilizing their own oocytes were treated according to the following protocol. Ultrasound and hormonal surveillance was carried out starting 5 days prior to the presumed ovulation day, based on previous menstrual history. Ovum pick-up was timed either by detection of the luteinizing hormone surge or by human chorionic gonadotropin administration. In total, 48 treatment cycles were conducted in 20 women. Oocyte retrieval was successful in 22 cycles. Fertilization and cleavage rates of 48% and 100%, respectively, were detected. Nine of the 12 embryos transferred were defined as grade A. One chemical and one ongoing pregnancy were achieved. We conclude that, despite the fact that high-quality embryos can be obtained in this population, the likelihood of pregnancy is low.
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Affiliation(s)
- I Bar-Hava
- Department of Obstetrics and Gynecology, Rabin Medical Center, Petah Tiqva, Israel
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21
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Moon SY, Kim SH, Jung BJ, Jee BC, Suh CS, Lee JY. Influence of female age on pregnancy outcome in in vitro fertilization and embryo transfer patients undergoing intracytoplasmic sperm injection. J Obstet Gynaecol Res 2000; 26:49-54. [PMID: 10761332 DOI: 10.1111/j.1447-0756.2000.tb01201.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE To determine the influence of female age on the outcomes of ICSI in IVF-ET patients. METHODS One hundred and seventy-five couples underwent 352 cycles of ICSI. The quality of oocytes and embryos, fertilization rate, and pregnancy outcomes were retrospectively evaluated according to female age; < 30 years in Group A (49 cycles), 30-34 in Group B (177 cycles), 35-39 in Group C (97 cycles), and > or = 40 in Group D (29 cycles). RESULTS The fertilization rates were not significantly different among the age groups. Significant negative linear correlations were observed between female age and the numbers of oocytes retrieved and embryos transferred, and cumulative embryo score. Clinical pregnancy rates were significantly decreased and spontaneous abortion rate increased with advancing age. CONCLUSIONS Female age may be a prognostic indicator in ICSI program.
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Affiliation(s)
- S Y Moon
- Department of Obstetrics and Gynecology, College of Medicine, Seoul National University, Korea
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22
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Jacob S, Spillane H, Keane D, Waite K, McSorley G, Harrison RF. Initial experiences of a testicular sperm extraction programme for assisted reproduction in Ireland. Ir J Med Sci 2000; 169:26-9. [PMID: 10846853 DOI: 10.1007/bf03170479] [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: 11/30/2022]
Abstract
BACKGROUND The technique aspirating spermatozoa from the testis is a new development in male infertility treatment. It is appropriate for infertile couples where the male has azoospermia but is still producing live motile spermatozoa in the testes. AIM To describe the initial experiences of a testicular sperm extraction programme (TESE) coupled with intracytoplasmic sperm injection (ICSI) in 18 men during 1998. METHODS Spermatozoa were obtained by direct aspiration from the testes using a 16 gauge needle with cannula and negative suction under local anaesthetic. All samples obtained were to be cryopreserved for use in a subsequent ICSI cycle. RESULTS All five men with congenital bilateral absence of the vas deferens to be carriers of cystic fibrosis gene mutations. No gene deletions were found in their wives. No other cyto or molecular genetic abnormalities were otherwise found. Twenty one procedures were carried out. The mean number of aspirations was 1.72. Eleven samples from 10 men had sperm suitable for ICSI post-freeze. Post-procedure pain was the universal side-effect. Eight couples had a single attempt at ICSI, two couples two each. Fertilisation rate was 71.4%. Two pregnancies were achieved. CONCLUSION TESE may give hope in selected cases of azoospermia of fathering a child without the involvement of a third party.
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Affiliation(s)
- S Jacob
- Human Assisted Reproduction Ireland (HART) Unit, Rotunda Hospital, Dublin
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23
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Bar-Hava I, Ferber A, Ashkenazi J, Orvieto R, Kaplan B, Bar J, Peleg D, Ben-Rafael Z. Does female age affect embryo morphology? Gynecol Endocrinol 1999; 13:371-4. [PMID: 10685329 DOI: 10.3109/09513599909167582] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Deteriorating oocyte quality is commonly believed to be the primary determinant of the decreased implantation potential in older women. We assessed the influence of age on embryo morphology in standard in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) modalities. All 6350 consecutive embryos (2990 IVF, 3360 ICSI) obtained in our Assisted Reproductive Technology Unit from January 1996 through June 1997 were included. High quality embryos were defined as those with equal-sized blastomeres and < 10% fragmentations and a cleavage rate of four cells on day 2 or eight cells on day 3 transfers. The results were analyzed for the standard IVF group, the ICSI group, and the ICSI subgroup with severe male factor infertility (< or = 1 x 10(6) total motile spermatozoa in the ejaculate). For standard IVF, a positive association was observed between female age and increased proportion of good quality embryos. No such association was detected for the ICSI cycles (whole group or subgroup). We conclude that in standard IVF, embryo quality, as reflected by embryo morphology, does not deteriorate with increased maternal age.
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Affiliation(s)
- I Bar-Hava
- Department of Obstetrics and Gynecology, Rabin Medical Center, Petah Tiqva, Israel
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24
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Ludwig M, Strik D, Al-Hasani S, Diedrich K. No transfer in a planned ICSI cycle: we cannot overcome some basic rules of human reproduction. Eur J Obstet Gynecol Reprod Biol 1999; 87:3-11. [PMID: 10579610 DOI: 10.1016/s0301-2115(99)00071-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Since intracytoplasmic sperm injection (ICSI) has been introduced in the techniques for the non-causal treatment of severe male factor infertility failure of conventional in-vitro fertilisation and subsequent embryo transfer due to failed oocyte-fertilisation has become rare in these cases. Nonetheless, even in ICSI cycles cases occur where no transfer can be performed for several reasons. The contribution of sperm-, oocyte- and other factors are reviewed in this article. 78 (5.4%) out of 1433 ICSI cycles, performed from 1.1.1995 up to 31.5.1997, in which no transfer could be done, despite a performed follicular puncture, were used as an example. 30 cycles with no fertilisation, 17 with no oocytes, 8 with only degenerated oocytes retrieved, 17 with no injectable sperms, 4 with no normal fertilisation, and 2 with no cleavage after normal fertilisation were identified. In more than two thirds of the cases an oocyte factor, identified by a high FSH, low response to the hormonal stimulation or no fertilization despite the presence of motile sperms, was present. The other cases were attributed to a sperm factor or other causes. After one failed ICSI cycle - i.e. a cycle with no embryo transfer - the chance to conceive is very low in a subsequent cycle. Only 1 out of 24 cycles was successful in terms of an established and ongoing pregnancy.
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Affiliation(s)
- M Ludwig
- Department of Gynaecology and Obstetrics, Medical University of Lübeck, Germany
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25
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Ebner T, Moser M, Yaman C, Feichtinger O, Hartl J, Tews G. Elective transfer of embryos selected on the basis of first polar body morphology is associated with increased rates of implantation and pregnancy. Fertil Steril 1999; 72:599-603. [PMID: 10521094 DOI: 10.1016/s0015-0282(99)00315-5] [Citation(s) in RCA: 98] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To determine the relationship between first polar body morphology and implantation rate and pregnancy rate (PR), to facilitate decision making concerning elective ET. DESIGN Prospective, randomized study. SETTING Fertility center. PATIENT(S) One hundred fifty-eight consecutive patients (173 intracytoplasmic sperm injection cycles) resulting in embryo transfers. INTERVENTION(S) In our study group, priority in ET was given to embryos derived from well-shaped first polar bodies, whereas selection of embryos for transfer in the control group was based exclusively on the degree of embryo fragmentation. MAIN OUTCOME MEASURE(S) Total numbers of implantations and pregnancies, PR and implantation rate, and rates of multiple pregnancy and miscarriage. RESULT(S) In the study cohort, 212 embryos were transferred. In the control group, 313 embryos were transferred. The implantation rate and PR were significantly lower in the control group than in the study cohort. In addition, the rate of multiple pregnancy was significantly higher in the study group. CONCLUSION(S) Elective transfer of embryos selected on the basis of first polar body morphology results in higher implantation and pregnancy rates. Multiple pregnancy can be avoided by transferring a reduced number of embryos selected on the basis of first polar body morphology.
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Affiliation(s)
- T Ebner
- In Vitro Fertilization Unit, Women's General Hospital, Linz, Austria.
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26
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Bar-Hava I, Orvieto R, Ferber A, Ashkenazi J, Dicker D, Ben-Rafael Z. Standard in vitro fertilization or intracytoplasmic sperm injection in advanced female age--what may be expected? Gynecol Endocrinol 1999; 13:93-7. [PMID: 10399053 DOI: 10.3109/09513599909167539] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This study was conducted to evaluate the current results of standard in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) in the elderly (> or = 40 years of age) female population. Oocyte recovery, fertilization, embryo transfer, pregnancy and cumulative pregnancy rates were assessed. The results were analyzed for: the entire elderly population; the standard IVF group (group 1); all those in the ICSI group (group 2); and ICSI for severe male-factor category (group 3). A total of 330 IVF and 158 ICSI treatment cycles were carried out in 249 women. Forty-five (9.2%) clinical pregnancies were achieved. This rate was not statistically different from those achieved for groups 1, 2 and 3 (9.1%, 9.5% and 6.8%, respectively). The cumulative pregnancy rate for a total of five cycles was 19.2% and 26.4% for groups 1 and 2, respectively. For those who started their treatments at > or = 40 years, the cumulative pregnancy rate for three cycles was 26.5% and 36.5% in groups 1 and 2, respectively. These results clearly demonstrate that female age is a major success determinant, with similar influence on both standard IVF and ICSI therapy modalities.
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Affiliation(s)
- I Bar-Hava
- Department of Obstetrics and Gynecology, Rabin Medical Center, Petah Tikva, Israel
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27
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Affiliation(s)
- C Schmidt-Sarosi
- NYU Medical Center, Department of Obstetrics and Gynecology, NY 10016, USA
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28
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Mercan R, Oehninger S, Muasher SJ, Toner JP, Mayer J, Lanzendorf SE. Impact of fertilization history and semen parameters on ICSI outcome. J Assist Reprod Genet 1998; 15:39-45. [PMID: 9493065 PMCID: PMC3468197 DOI: 10.1023/a:1022578322024] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
PURPOSE The objectives of this study were (1) to investigate intracytoplasmic sperm injection (ICSI) outcome according to its indications, i.e., a history of failed or poor fertilization and unsuitable sperm parameters for conventional IVF, and (2) to examine the impact of a female's age, sperm concentration, motility, morphology, presence of antisperm antibodies, and hemizona assay (HZA) results on overall outcome. METHODS Two hundred seventy-nine ICSI cycles performed in 207 couples were retrospectively evaluated. RESULTS Clinical pregnancy and delivery rates were 36.8 and 29.8% for patients with prior failed fertilization, 23.2 and 17.8% for patients who had prior poor fertilization, and 28.6 and 21.3% for patients with unsuitable sperm parameters. The differences among all groups were found to be insignificant. There was a significant, negative correlation between a female's age and pregnancy results. No difference was found in the three basic sperm parameters between those patients who produced and those who did not produce a pregnancy, but the fertilization rate was significantly higher in patients with more adequate sperm parameters. Although there was a trend toward a better fertilization rate in patients with a hemizona index (HZI) greater than 30 (indicative of a superior sperm-zona pellucida binding capacity) than in those with a HZI less than 30, the difference was not significant. There were no differences in fertilization rate according to the presence or absence of antisperm antibodies. CONCLUSIONS Fertilization history in a conventional IVF cycle has no effect on success rates following ICSI, and there is no correlation among the basic sperm parameters, the presence of antisperm antibodies, and pregnancy rates.
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Affiliation(s)
- R Mercan
- Howard and Georgeama Jones Institute for Women's Health, Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk 23507, USA
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29
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Abstract
OBJECTIVE To describe methods of sperm retrieval for intracytoplasmic sperm injection (ICSI) in patients with male factor infertility and to review the clinical results using sperm from the different sources. DESIGN The literature on sperm-obtaining methods and ICSI was reviewed. Studies related to this topic were identified through MEDLINE. RESULTS(S) This review describes the evolution of sperm retrieval methods. Sperm can be obtained by microepididymal sperm aspiration (MESA), percutaneous sperm aspiration (PESA), and testicular sperm extraction (TESE), from patients with congenital absence of the vas deferens or acquired vas obstruction. When ICSI is performed with ejaculated, epididymal, or testicular sperm, good fertilization and pregnancy rates are achieved without significant differences among the various sperm sources. The original percutaneous sperm aspiration method has been modified slightly and yields successful results. CONCLUSION(S) Viable pregnancies can be achieved with ICSI by using not only ejaculated sperm, but also epididymal and testicular sperm. Microepididymal sperm aspiration, percutaneous sperm aspiration, modified percutaneous sperm aspiration, and testicular sperm extraction can be considered standard procedures to treat male factor infertility.
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Affiliation(s)
- K Y Cha
- Infertility Medical Center, Cha General Hospital, Seoul, Korea
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30
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Poe-Zeigler R, Nehchiri F, Hamacher P, Boyd C, Oehninger S, Muasher S, Lanzendorf SE. Effects of sperm viability on fertilization and embryo cleavage following intracytoplasmic sperm injection. J Assist Reprod Genet 1997; 14:277-81. [PMID: 9147241 PMCID: PMC3454722 DOI: 10.1007/bf02765829] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
PURPOSE In the human, intracytoplasmic sperm injection is typically performed using "viable" sperm which has been mechanically rendered nonmotile. The purpose of the present study was to determine the ability of nonviable sperm to fertilize human oocytes and the early developmental normalcy of the resulting embryos. METHODS In this study, immature, prophase I oocytes from a total of 27 consenting patients were matured in vitro and then randomized into two groups: injection with a viable human sperm or injection with a sperm rendered nonviable by freeze-thawing in liquid nitrogen. The rates of fertilization and cleavage were compared between the two groups. RESULTS The results demonstrated a significantly higher two-pronuclear fertilization rate when oocytes were injected with viable sperm (62.2%) compared to when oocytes were injected with nonviable sperm (16.2%). Oocytes injected with viable sperm also demonstrated a higher cleavage rate (91 vs 33%). CONCLUSIONS These findings suggest that while the intracytoplasmic injection of nonviable human sperm can result in normal fertilization, it does so at a much reduced rate compared to viable sperm and may not result in normally cleaving embryos.
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Affiliation(s)
- R Poe-Zeigler
- Jones Institute for Reproductive Medicine, Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk 23507, USA
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31
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Gordon AC, Harrison RF, McMahon A, Fawzy M. Establishing an intracytoplasmic sperm injection (ICSI) programme for the treatment of male factor infertility in Ireland. Ir J Med Sci 1997; 166:65-9. [PMID: 9159983 DOI: 10.1007/bf02944188] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
This paper chronicles the introduction and initial experiences of Intra Cytoplasmic Sperm Injection (ICSI) as a treatment for severe male factor infertility in Ireland. Following initial development of the technique using a bovine model, therapy was offered clinically from September 1995. Up to March 1996 a total of 60 couples underwent the procedure. Fertilisation and embryo transfers were achieved in 50 of these (83.3 percent). Fourteen (23 percent) became clinically pregnant per cycle commenced, 28 percent per embryo transfer. Despite a drop in the total number of oocytes available, fertilisation rates rose over the 6 months of the study from 22 percent to 54 percent. There were 2 miscarriages (14.2 percent) and the multiple pregnancy rate was 28.5 percent. Eight singletons, 2 twins and 2 triplet sets have been successfully delivered. Provided there is proper patient selection, ICSI should prove a valuable addition to treatment options available to infertile couples in Ireland.
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Affiliation(s)
- A C Gordon
- Human Assisted Reproduction, Rotunda Hospital, Dublin
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32
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Stolwijk AM, Zielhuis GA, Sauer MV, Hamilton CJ, Paulson RJ. The impact of the woman's age on the success of standard and donor in vitro fertilization. Fertil Steril 1997; 67:702-10. [PMID: 9093198 DOI: 10.1016/s0015-0282(97)81370-2] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To study the effect of the age of the woman who provides the oocytes or who receives the embryos on results of IVF-ET. DESIGN Historical cohort study. Multivariate regression analysis was used to study the age effect continuously and after adjustment for confounding. SETTING Patients of the University of Southern California, Los Angeles, California. PATIENT(S) Couples who underwent standard (n = 277) or donor IVF-ET (n = 294) between January 1991 and July 1995. INTERVENTION(S) One cycle of standard or donor IVF-ET. MAIN OUTCOME MEASURE(S) Successive IVF outcomes from number of oocytes to ongoing pregnancy and several measures of pregnancy loss. RESULT(S) The number of oocytes decreased with aging of the oocyte provider. More women who received oocytes from donors aged 20 to 23 years had at least one good embryo transferred than women who received oocytes from older donors. The age of the woman who received the embryos had no effect on IVF outcomes. In women > 40 years who underwent standard IVF, the probability of pregnancy decreased. No such relationships were observed for donor IVF, but all the oocyte donors were younger. CONCLUSION(S) An age effect for ongoing pregnancy was only found in women > 40 years who underwent standard IVF independent of the lower number of oocytes and suggests decreasing oocyte quality.
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Affiliation(s)
- A M Stolwijk
- University of Nijmegen, Bosch Medicenter, Den Bosch, The Netherlands
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33
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Boldt J, Schnarr P, Ajamie A, Ketner J, Bonaventura L, Colver R, Reuter L, Jarrett J. Success rates following intracytoplasmic sperm injection are improved by using ZIFT vs IVF for embryo transfer. J Assist Reprod Genet 1996; 13:782-5. [PMID: 8986589 DOI: 10.1007/bf02066498] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE The purpose of this study was to analyze whether the mode of embryo transfer (ZIFT vs IVF) affected the outcome in intracytoplasmic sperm injection (ICSI) cycles. METHODS AND RESULTS Eighty-two ICSI cycles (42 ZIFT and 40 IVF) were analyzed. Several variables, including patient age and weight, numbers of mature eggs collected, injected, and fertilized, fertilization rate, number of fertilized eggs obtained per cycle, numbers of zygotes/embryos transferred, clinical pregnancy rate, and implantation rate, were compared. Mean patient age and weight were identical. The mean number of mature eggs collected and injected and fertilization rate were significantly higher in the ZIFT group, however, the mean numbers of zygotes/embryos transferred were identical. The clinical pregnancy and implantation rates in ZIFT cycles (52.3 and 23.2% respectively) were significantly higher than in IVF cycles (17.5 and 9.7%). CONCLUSIONS These data suggest that ZIFT is the more appropriate method for transfer of ICSI-derived embryos.
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Affiliation(s)
- J Boldt
- Midwest Reproductive Medicine, Indianapolis, Indiana 46260, USA
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