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Wu CY, Huang TJ, Hwu YM, Kuo-Kuang Lee R, Lin MH. Comparison of clinical outcomes between conventional in vitro fertilization and intracytoplasmic sperm injection in poor responders with only single oocyte retrieved. Taiwan J Obstet Gynecol 2023; 62:55-58. [PMID: 36720551 DOI: 10.1016/j.tjog.2022.02.052] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2022] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVE To compare the clinical outcomes between conventional insemination (IVF) and intracytoplasmic sperm injection (ICSI) in poor responders with only a single oocyte retrieved. MATERIALS AND METHODS This is a retrospective case-control study. Couples who were treated with assisted reproductive technology (ART) with a single oocyte retrieved in Mackay Memorial Hospital from 1996 to 2016 were recruited. All data were categorized into three groups, according to their fertilization method and semen quality: group A, conventional insemination with non-male factor (IVF-NMF, n = 115), group B, ICSI with male factor (ICSI-MF, n = 30), and group C, ICSI with non-male factor (ICSI-NMF, n = 49). RESULTS No statistically significant difference was observed between IVF and ICSI groups in pregnancy outcomes, including the chemical or clinical pregnancy rate, miscarriage rate, and live birth rate. Similar fertilization rates per oocyte obtained were observed in IVF and ICSI patients, but significantly lower per mature oocyte in the ICSI group (IVF: 91.5%, ICSI-MF: 75.0%, ICSI-NMF: 77.8%). Although there is no statistical significance, the lower live birth rate is observed in group C than others (A:11.5%, B:25%, C:5%, p = 0.187). CONCLUSION In this study, pregnancy outcomes of conventional in vitro fertilization and ICSI in poor responders with only a single oocyte retrieved were similar. However, the fertilization rate of matured oocytes in ICSI groups is significantly lower than that in the IVF group, indicating that ICSI procedures might cause oocyte damage. Therefore, the choice of fertilization method should be based on semen quality. A randomized controlled trial should be performed to confirm our findings.
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Affiliation(s)
- Chao-Yun Wu
- Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan
| | - Tian-Jeau Huang
- Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan
| | | | - Robert Kuo-Kuang Lee
- Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan; Department of Medical Research, Mackay Memorial Hospital, Taipei, Taiwan
| | - Ming-Huei Lin
- Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan; Department of Medical Research, Mackay Memorial Hospital, Taipei, Taiwan; Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan; Mackay Medical College, New Taipei City, Taiwan.
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Effect of Sperm Morphology in Intrauterine Insemination: Analysis of 115 Cycles and Literature Review. Obstet Gynecol Surv 2021; 76:170-174. [PMID: 33783546 DOI: 10.1097/ogx.0000000000000871] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Importance The value of morphology as a sperm parameter remains uncertain. Many studies have addressed the importance of morphology to predict the success of intrauterine insemination (IUI), but with conflicting results. Objective The aims of this study were to review the current literature, to query our own clinical experience via a retrospective, descriptive study, and to determine whether the diagnosis of isolated teratozoospermia influences pregnancy rate after IUI. Results We identified a large number of studies addressing this question. All were retrospective and most used different criteria to assess sperm morphology. Further complicating matters, the cutoff for normal morphology decreased from 15% to 4%. In our patient population, we found 12 cases of isolated teratozoospermia (10.43%). Only one of these produced an ongoing pregnancy and live birth. In all other cases, alteration of other sperm parameters coexisted (89.57%). These cycles produced a pregnancy rate of 13%, a nonsignficant difference. Pregnancy rates also were analyzed according to the percentage of normal morphology: 35.71% for less than 4%, 50% for 5% to 9%, and 14.29% for 10% to 14%. These rates did not differ significantly. Conclusions and Relevance No consistent effect of sperm morphology on pregnancy rate was found in either the published literature or our own clinical experience. Larger and prospective studies are needed to identify any subtle effects of morphology on IUI outcomes that might exist.
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Wang R, Pan W, Jin L, Li Y, Geng Y, Gao C, Chen G, Wang H, Ma D, Liao S. Artificial intelligence in reproductive medicine. Reproduction 2019; 158:R139-R154. [PMID: 30970326 PMCID: PMC6733338 DOI: 10.1530/rep-18-0523] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 04/10/2019] [Indexed: 12/16/2022]
Abstract
Artificial intelligence (AI) has experienced rapid growth over the past few years, moving from the experimental to the implementation phase in various fields, including medicine. Advances in learning algorithms and theories, the availability of large datasets and improvements in computing power have contributed to breakthroughs in current AI applications. Machine learning (ML), a subset of AI, allows computers to detect patterns from large complex datasets automatically and uses these patterns to make predictions. AI is proving to be increasingly applicable to healthcare, and multiple machine learning techniques have been used to improve the performance of assisted reproductive technology (ART). Despite various challenges, the integration of AI and reproductive medicine is bound to give an essential direction to medical development in the future. In this review, we discuss the basic aspects of AI and machine learning, and we address the applications, potential limitations and challenges of AI. We also highlight the prospects and future directions in the context of reproductive medicine.
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Affiliation(s)
- Renjie Wang
- Department of Obstetrics and Gynecology, Cancer Biology Research Center, Tongji Hospital, Tongji Medical College of HUST, Wuhan, Hubei, People’s Republic of China
| | - Wei Pan
- School of Economics and Management, Wuhan University, Wuhan, Hubei, People’s Republic of China
| | - Lei Jin
- Department of Obstetrics and Gynecology, Cancer Biology Research Center, Tongji Hospital, Tongji Medical College of HUST, Wuhan, Hubei, People’s Republic of China
| | - Yuehan Li
- Department of Obstetrics and Gynecology, Cancer Biology Research Center, Tongji Hospital, Tongji Medical College of HUST, Wuhan, Hubei, People’s Republic of China
| | - Yudi Geng
- Department of Obstetrics and Gynecology, Cancer Biology Research Center, Tongji Hospital, Tongji Medical College of HUST, Wuhan, Hubei, People’s Republic of China
| | - Chun Gao
- Department of Obstetrics and Gynecology, Cancer Biology Research Center, Tongji Hospital, Tongji Medical College of HUST, Wuhan, Hubei, People’s Republic of China
| | - Gang Chen
- Department of Obstetrics and Gynecology, Cancer Biology Research Center, Tongji Hospital, Tongji Medical College of HUST, Wuhan, Hubei, People’s Republic of China
| | - Hui Wang
- Department of Obstetrics and Gynecology, Cancer Biology Research Center, Tongji Hospital, Tongji Medical College of HUST, Wuhan, Hubei, People’s Republic of China
| | - Ding Ma
- Department of Obstetrics and Gynecology, Cancer Biology Research Center, Tongji Hospital, Tongji Medical College of HUST, Wuhan, Hubei, People’s Republic of China
| | - Shujie Liao
- Department of Obstetrics and Gynecology, Cancer Biology Research Center, Tongji Hospital, Tongji Medical College of HUST, Wuhan, Hubei, People’s Republic of China
- Correspondence should be addressed to S Liao;
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Tan SY, Lee YX, Chan C, Tzeng CR. Prognostic Factors to Achieve Higher Pregnancy and Live Birth Rate in Intrauterine Insemination Among Subfertile Women. FERTILITY & REPRODUCTION 2019. [DOI: 10.1142/s2661318219500105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background: The purpose of this study was to evaluate the prognostic factors that could affect the clinical pregnancy rate (CPR) and live birth rate (LBR) among subfertile women undergoing intrauterine insemination (IUI). Methods: A retrospective analysis study of a total of 2186 cycles of IUI among 1784 subfertile women between 2012 and 2017 at the infertility clinic in Taipei Medical University Hospital was conducted. Social demographics, CPR, and LBR were measured. Eleven prognostic factors were analysed with multivariable logistic regression. Results: Of the 2186 cycles, 569 became pregnant (26.0%), resulting in 454 live births. The LBR per cycle and per patient were 20.8% and 24.6%, respectively. Eight factors were found to significantly predict the obstetric outcome among the women who underwent IUI (p [Formula: see text] 0.05). Age, [Formula: see text] 35.0 years old; serum anti-Müllerian hormone (AMH) level, [Formula: see text] 1.2 ng/mL; delayed sperm insemination, [Formula: see text] 36.0 hour following human chorionic gonadotropin (HCG) injection; serum estradiol level, [Formula: see text] 500 pg/mL; endometrial thickness, [Formula: see text] 7.0 mm on the day of HCG administration; and post-wash total motile sperm count (TMSC), [Formula: see text] 5 million/mL were found to be prognostic factors in determining the CPR and LBR (p [Formula: see text] 0.05). However, duration of subfertility and the presence of urine luteinizing hormone surge during the day of the HCG trigger inversely affected the LBR (p = 0.006 and p = 0.033, respectively) but not the CPR (p [Formula: see text] 0.05). The type of infertility, total antral follicle count, and pre-wash TMSC were not able to predict pregnancy outcome (p [Formula: see text] 0.05). Conclusions: Six out of 11 factors were identified as strong prognostic factors for successful pregnancies and live births: age, serum AMH and serum estradiol levels, endometrial thickness, post-wash TMSC, and delayed sperm insemination after HCG injection.
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Affiliation(s)
- Shiuan Yee Tan
- Division of Infertility, Department of Obstetrics and Gynaecology, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Obstetrics and Gynaecology, Seberang Jaya Hospital, Ministry of Health Malaysia, Malaysia
| | - Yi-Xuan Lee
- Division of Infertility, Department of Obstetrics and Gynaecology, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan
| | - Cindy Chan
- Division of Infertility, Department of Obstetrics and Gynaecology, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan
| | - Chii-Ruey Tzeng
- Division of Infertility, Department of Obstetrics and Gynaecology, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan
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Abstract
The objective of this study was to identify sperm score thresholds to achieve satisfactory intrauterine insemination (IUI) success rates according to the response to stimulation with clomiphene citrate (CC). To minimize the confounding effect of female age, we included only CC/IUI cycles of women ≤35 years old. A total of 1,194 CC/IUI cycles were included. Semen volume, concentration, and motility influenced the clinical pregnancy rate (CPR). Normal morphology (≥4%) was associated with a comparable CPR with 3%, 2%, and 1% normal forms (15.6%, 16.1%, 18.1%, and 13.1%, respectively). A combination of the total number of motile spermatozoa in the ejaculate before semen preparation (TM) at a threshold ≥20 × 106 was associated with a CPR of 17.8% compared to 4.6% for a threshold <20 × 106 (p < .001). Interestingly, the TM threshold to achieve satisfactory outcomes was lower (10 × 106) in patients who had an optimal response to CC (≥2 dominant follicles with an endometrial thickness ≥7 mm) compared to 40 × 106 for those who had a suboptimal response (one dominant follicle with an endometrial thickness <7 mm). In conclusion, the response to superovulation with CC determines each patient's TM threshold required for satisfactory outcomes. Couples whose TM is below the threshold may benefit from a superovulation with gonadotropins or in vitro fertilization.
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Affiliation(s)
- Mohamad Irani
- a The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine , Weill Cornell Medicine , New York , NY , USA
| | - Stephen Chow
- a The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine , Weill Cornell Medicine , New York , NY , USA
| | - Derek Keating
- a The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine , Weill Cornell Medicine , New York , NY , USA
| | | | - Zev Rosenwaks
- a The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine , Weill Cornell Medicine , New York , NY , USA
| | - Gianpiero Palermo
- a The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine , Weill Cornell Medicine , New York , NY , USA
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Gatimel N, Moreau J, Parinaud J, Léandri RD. Sperm morphology: assessment, pathophysiology, clinical relevance, and state of the art in 2017. Andrology 2017; 5:845-862. [DOI: 10.1111/andr.12389] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 05/05/2017] [Accepted: 05/11/2017] [Indexed: 12/26/2022]
Affiliation(s)
- N. Gatimel
- Department of Reproductive Medicine; Paule de Viguier Hospital; Toulouse University Hospital; Toulouse France
- EA 3694 Human Fertility Research Group; Paule de Viguier Hospital; Toulouse University Hospital; Toulouse France
| | - J. Moreau
- Department of Reproductive Medicine; Paule de Viguier Hospital; Toulouse University Hospital; Toulouse France
- EA 3694 Human Fertility Research Group; Paule de Viguier Hospital; Toulouse University Hospital; Toulouse France
| | - J. Parinaud
- Department of Reproductive Medicine; Paule de Viguier Hospital; Toulouse University Hospital; Toulouse France
- EA 3694 Human Fertility Research Group; Paule de Viguier Hospital; Toulouse University Hospital; Toulouse France
| | - R. D. Léandri
- Department of Reproductive Medicine; Paule de Viguier Hospital; Toulouse University Hospital; Toulouse France
- EA 3694 Human Fertility Research Group; Paule de Viguier Hospital; Toulouse University Hospital; Toulouse France
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7
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Dehghanpour F, Tabibnejad N, Fesahat F, Yazdinejad F, Talebi AR. Evaluation of sperm protamine deficiency and apoptosis in infertile men with idiopathic teratozoospermia. Clin Exp Reprod Med 2017; 44:73-78. [PMID: 28795045 PMCID: PMC5545222 DOI: 10.5653/cerm.2017.44.2.73] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 02/28/2017] [Accepted: 05/17/2017] [Indexed: 11/18/2022] Open
Abstract
Objective Sperm morphology plays an important role in infertility, especially in cases of defects in the heads of spermatozoa. Tapered-head or elongated-head spermatozoa are examples of morphological abnormalities. The aim of this study was to compare the semen parameters, levels of protamine deficiency, and frequency of apoptosis between patients with normozoospermia and those with teratozoospermia with tapered-head spermatozoa. Methods Fifty-two semen samples (27 patients with tapered-head sperm and 25 fertile men) were collected and semen analysis was performed according to the World Health Organization criteria for each sample. Protamine deficiency and the percentage of apoptotic spermatozoa were evaluated using chromomycin A3 (CMA3) staining and terminal deoxynucleotidyl transferase dUTP nick-end labelling (TUNEL) assays, respectively. Results Sperm concentration, motility, and normal morphology in the tapered-head spermatozoa (cases) were significantly lower than in the normozoospermic samples (controls). CMA3-reactive spermatozoa (CMA3+) in the case group were more common than in the controls. Apoptotic spermatozoa (TUNEL-positive) were significantly more common in the cases than in the controls. Conclusion This analysis showed that tapered-head spermatozoa contained abnormal chromatin packaging and exhibited a high rate of apoptosis, which can be considered to be an important reason for the impaired fertility potential in teratozoospermic patients with tapered-head spermatozoa.
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Affiliation(s)
- Fatemeh Dehghanpour
- Medical Biotechnology Research Center, Ashkezar Branch, Islamic Azad University, Ashkezar, Yazd, Iran
| | - Nasim Tabibnejad
- Department of Andrology, Research and Clinical Center for Infertility, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Farzaneh Fesahat
- Department of Andrology, Research and Clinical Center for Infertility, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Fatemeh Yazdinejad
- Department of Andrology, Research and Clinical Center for Infertility, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Ali Reza Talebi
- Department of Andrology, Research and Clinical Center for Infertility, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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8
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Thijssen A, Creemers A, Van der Elst W, Creemers E, Vandormael E, Dhont N, Ombelet W. Predictive value of different covariates influencing pregnancy rate following intrauterine insemination with homologous semen: a prospective cohort study. Reprod Biomed Online 2017; 34:463-472. [DOI: 10.1016/j.rbmo.2017.01.016] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 01/27/2017] [Accepted: 01/27/2017] [Indexed: 10/20/2022]
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9
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Chang V, Garcia A, Hitschfeld N, Härtel S. Gold-standard for computer-assisted morphological sperm analysis. Comput Biol Med 2017; 83:143-150. [DOI: 10.1016/j.compbiomed.2017.03.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 01/31/2017] [Accepted: 03/01/2017] [Indexed: 10/20/2022]
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10
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Pocate-Cheriet K, Heilikman I, Porcher R, Barraud-Lange V, Sermondade N, Herbemont C, Wolf JP, Sifer C. Predicting the clinical outcome of ICSI by sperm head vacuole examination. Syst Biol Reprod Med 2016; 63:29-36. [DOI: 10.1080/19396368.2016.1261203] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
| | - Ilan Heilikman
- Jean Verdier University Hospital, IVF Laboratory Unit, Bondy, France
| | - Raphael Porcher
- Saint-Louis University Hospital, Bio-statistical analysis unit, Paris, France
| | | | | | | | - Jean Philippe Wolf
- Cochin-Port Royal University Hospital, IVF Laboratory Unit, Paris, France
| | - Christophe Sifer
- Jean Verdier University Hospital, IVF Laboratory Unit, Bondy, France
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11
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Lemmens L, Kos S, Beijer C, Brinkman JW, van der Horst FA, van den Hoven L, Kieslinger DC, van Trooyen-van Vrouwerff NJ, Wolthuis A, Hendriks JC, Wetzels AM, Kos S, Beijer C, Brinkman JW, van der Horst FA, van den Hoven L, Kieslinger DC, van Trooyen-van Vrouwerff NJ, Wolthuis A, Wetzels AM. Predictive value of sperm morphology and progressively motile sperm count for pregnancy outcomes in intrauterine insemination. Fertil Steril 2016; 105:1462-8. [DOI: 10.1016/j.fertnstert.2016.02.012] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 01/14/2016] [Accepted: 02/03/2016] [Indexed: 11/30/2022]
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12
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The impact of sperm morphology on the outcome of intrauterine insemination cycles with gonadotropins in unexplained and male subfertility. Eur J Obstet Gynecol Reprod Biol 2016; 197:120-4. [DOI: 10.1016/j.ejogrb.2015.12.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 10/03/2015] [Accepted: 12/10/2015] [Indexed: 11/22/2022]
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13
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Lockwood GM, Deveneau NE, Shridharani AN, Strawn EY, Sandlow JI. Isolated abnormal strict morphology is not a contraindication for intrauterine insemination. Andrology 2015; 3:1088-93. [PMID: 26384603 DOI: 10.1111/andr.12098] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2015] [Revised: 07/16/2015] [Accepted: 07/23/2015] [Indexed: 11/28/2022]
Abstract
This study sought to investigate whether isolated abnormal strict morphology (<5% normal forms) and very low strict morphology (0-1% normal forms) affects pregnancy rates in intrauterine insemination (IUI). This was a retrospective study performed at an Academic Medical Center/Reproductive Medicine Center. Four hundred and eight couples were included for 856 IUI cycles. 70 IUI cycles were performed in couples with abnormal strict morphology and otherwise normal semen parameters. Outcomes were measured as clinical pregnancy rate per IUI cycle as documented by fetal heart activity on maternal ultrasound. Clinical pregnancy rate did not significantly differ between the group with abnormal strict morphology [11/70 (15.7%)] and the normal morphology group [39/281 (13.9%)]. Additionally, there was no significant difference between the pregnancy rate in the abnormal morphology group compared to that of our overall institutional IUI pregnancy rate [145/856 (16.9%)]. Furthermore, there was no significant difference between pregnancy rate in the very low morphology group [3/14 (21.4%)] compared to those with normal morphology or the overall IUI pregnancy rate. Patients with isolated abnormal strict morphology have clinical pregnancy rates similar to those with normal morphology for IUI. Even in those with very low normal forms, consideration of IUI for assisted reproduction should not be excluded.
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Affiliation(s)
- G M Lockwood
- Department of Urology, Froedtert Hospital, Medical College of Wisconsin Affiliated Hospitals, Milwaukee, WI, USA
| | - N E Deveneau
- Department of Obstetrics and Gynecology, Froedtert Hospital, Medical College of Wisconsin Affiliated Hospitals, Milwaukee, WI, USA
| | - A N Shridharani
- Department of Urology, Froedtert Hospital, Medical College of Wisconsin Affiliated Hospitals, Milwaukee, WI, USA
| | - E Y Strawn
- Department of Obstetrics and Gynecology, Froedtert Hospital, Medical College of Wisconsin Affiliated Hospitals, Milwaukee, WI, USA
| | - J I Sandlow
- Department of Urology, Froedtert Hospital, Medical College of Wisconsin Affiliated Hospitals, Milwaukee, WI, USA
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Impact of sperm morphology on the likelihood of pregnancy after intrauterine insemination. Fertil Steril 2014; 102:1584-90.e2. [DOI: 10.1016/j.fertnstert.2014.09.016] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Revised: 09/11/2014] [Accepted: 09/11/2014] [Indexed: 11/22/2022]
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15
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Gatimel N, Leandri RD, Marino L, Esquerre-Lamare C, Parinaud J. Sperm vacuoles cannot help to differentiate fertile men from infertile men with normal sperm parameter values. Hum Reprod 2014; 29:2359-67. [DOI: 10.1093/humrep/deu206] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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16
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Abstract
Assisted reproductive technologies (ART) encompass fertility treatments, which involve manipulations of both oocyte and sperm in vitro. This chapter provides a brief overview of ART, including indications for treatment, ovarian reserve testing, selection of controlled ovarian hyperstimulation (COH) protocols, laboratory techniques of ART including in vitro fertilization (IVF), and intracytoplasmic sperm injection (ICSI), embryo transfer techniques, and luteal phase support. This chapter also discusses potential complications of ART, namely ovarian hyperstimulation syndrome (OHSS) and multiple gestations, and the perinatal outcomes of ART.
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Semen quality and prediction of IUI success in male subfertility: a systematic review. Reprod Biomed Online 2013; 28:300-9. [PMID: 24456701 DOI: 10.1016/j.rbmo.2013.10.023] [Citation(s) in RCA: 94] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Revised: 10/25/2013] [Accepted: 10/31/2013] [Indexed: 01/11/2023]
Abstract
Many variables may influence success rates after intrauterine insemination (IUI), including sperm quality in the native and washed semen sample. A literature search was performed to investigate the threshold levels of sperm parameters above which IUI pregnancy outcome is significantly improved and/or the cut-off values reaching substantial discriminative performance in an IUI programme. A search of MEDLINE, EMBASE and Cochrane Library revealed a total of 983 papers. Only 55 studies (5.6%) fulfilled the inclusion criteria and these papers were analysed. Sperm parameters most frequently examined were: (i) inseminating motile count after washing: cut-off value between 0.8 and 5 million; (ii) sperm morphology using strict criteria: cut-off value ⩾5% normal morphology; (iii) total motile sperm count in the native sperm sample: cut-off value of 5-10 million; and (iv) total motility in the native sperm sample: threshold value of 30%. The results indicate a lack of prospective studies, a lack of standardization in semen testing methodology and a huge heterogeneity of patient groups and IUI treatment strategies. More prospective cohort trials and prospective randomized trials investigating the predictive value of semen parameters on IUI outcome are urgently needed. It is generally believed that intrauterine insemination (IUI) with homologous semen should be a first-choice treatment to more invasive and expensive techniques of assisted reproduction in cases of cervical, unexplained and moderate male factor subfertility. The rationale for the use of artificial insemination is to increase gamete density at the site of fertilization. Scientific validation of this strategy is difficult because literature is rather confusing and inconclusive. Many variables may influence success rates after IUI treatment procedures. It seems logical that sperm quality has to be one of the main determinants to predict IUI success. Clinical practice would benefit from the establishment of threshold levels for sperm parameters above which IUI pregnancy outcome is significantly improved and below which a successful outcome is unlikely. We performed a literature search to investigate if such threshold levels are known. Most striking were the lack of standardization in semen-testing methodology and the huge heterogeneity of patient groups and IUI treatment strategies. The four sperm parameters most frequently examined were: (i) inseminating motile count after washing: cut-off value between 0.8 and 5 million; (ii) sperm morphology using strict criteria: cut-off value >4% normal morphology; (iii) total motile sperm count in native sperm sample: cut-off value of 5-10 million; and (iv) total motility in native sperm sample: threshold value of 30%. This review identified an urgent need for more and better prospective cohort trials investigating the predictive value of semen parameters on IUI pregnancy rate.
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Is intracytoplasmic morphologically selected sperm injection effective in patients with infertility related to teratozoospermia or repeated implantation failure? Fertil Steril 2013; 100:62-8. [DOI: 10.1016/j.fertnstert.2013.02.048] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Revised: 02/25/2013] [Accepted: 02/28/2013] [Indexed: 11/22/2022]
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19
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Sun Y, Li B, Fan LQ, Zhu WB, Chen XJ, Feng JH, Yang CL, Zhang YH. Does sperm morphology affect the outcome of intrauterine insemination in patients with normal sperm concentration and motility? Andrologia 2012; 44:299-304. [PMID: 22335521 DOI: 10.1111/j.1439-0272.2012.01280.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2011] [Indexed: 12/01/2022] Open
Abstract
The aim of this study was to assess the correlation of sperm morphology with the intrauterine insemination (IUI) outcome in patients with normal sperm concentration and motility. About 412 couples who underwent 908 IUI cycles were involved in the present study. A total of 110 clinical pregnancies were achieved with a pregnancy rate of 12.11% per cycle. The pregnancy rates per cycle were 7.60%, 12.67%, 13.62% and 13.13% in patients with <5%, 5-9%, 10-14% and >14% normal forms, respectively. The lowest pregnancy rate (7.60%) was obtained in the group with normal forms below 5%. However, this rate was not significantly different from other subgroups. Moreover, no pregnancies occurred in women >35 years old with normal sperm forms below 5%, in comparison with that in other subgroups of the same age. For women younger than 35 years old, no significant difference in pregnancy rate was observed in terms of different level of morphologically normal sperm. Our results show that for patients with normal sperm concentration and motility, IUI is recommended for first-line treatment when the woman is younger than 35 years, or morphologically normal sperm is ≥ 5%. IVF/ICSI should be performed when the normal forms are <5% and female age is > 35 years.
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Affiliation(s)
- Y Sun
- Reproductive Medical Center, The Third Affiliated Hospital of Guangzhou Medical College, Key Laboratory for Major Obstetric Diseases of Guangdong Province, Guangzhou, China
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The potential use of intrauterine insemination as a basic option for infertility: a review for technology-limited medical settings. Obstet Gynecol Int 2011; 2009:584837. [PMID: 20011061 PMCID: PMC2778500 DOI: 10.1155/2009/584837] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2008] [Accepted: 01/15/2009] [Indexed: 11/17/2022] Open
Abstract
Objective. There is an asymmetric allocation of technology and other resources for infertility services. Intrauterine insemination (IUI) is a process of placing washed spermatozoa transcervically into the uterine cavity for treatment of infertility. This is a review of literature for the potential use of IUI as a basic infertility treatment in technology-limited settings. Study design. Review of articles on treatment of infertility using IUI. Results. Aspects regarding the use of IUI are reviewed, including ovarian stimulation, semen parameters associated with good outcomes, methods of sperm preparation, timing of IUI, and number of inseminations. Implications of the finding in light of the needs of low-technology medical settings are summarized. Conclusion. The reviewed evidence suggests that IUI is less expensive, less invasive, and comparably effective for selected patients as a first-line treatment for couples with unexplained or male factor infertility. Those couples may be offered three to six IUI cycles in technology-limited settings.
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Tug N, Altunkaynak ME, Aktas RG, Kilic U, Yilmaz B, Cam C, Karateke A. Does erythropoietin affect motility of spermatozoa? Arch Gynecol Obstet 2009; 281:933-8. [PMID: 19937447 DOI: 10.1007/s00404-009-1289-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2009] [Accepted: 11/02/2009] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Erythropoietin, which is a hematopoietic growth factor, has been found to play a role in various physiologic processes within the body including testicular steroidogenesis and spermatogenesis. However, it is not known whether erythropoietin is also essential for the normal physiology of mature sperm cells. In this study, the effects of recombinant human erythropoietin beta (rEPO) on sperm motility were investigated. MATERIALS AND METHODS Samples of 37 volunteers (with total motile sperm count>5x10(6)/ml and a total motility of >50% according to WHO criteria) were collected by masturbation following a 3-5 days period of abstinence. After morphometric analysis before and just after washing, samples were either used as control or treated with rEPO at concentrations of 0.1, 1, 10 or 100 mIU/ml, respectively. Control and treated tubes were incubated for 4 h at 37 degrees C. RESULTS Total motility, total progressive motility, slow forward and nonmotile sperm counts of 1, 10 and 100 mIU/ml rEPO groups were significantly improved. This effect was dose independent. CONCLUSION No significant effect was found at 0.1 mIU/ml concentration. These results suggest that supplementation of media used for sperm preparation techniques with erythropoietin might be beneficial. Further studies are needed to clarify the mechanism of action of erythropoietin on mature sperm cells.
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Affiliation(s)
- Niyazi Tug
- Obstetrics and Gynecology Department, Zeynep Kamil Hospital, and Department of Medical Biology, Faculty of Medicine, Yeditepe University, Istanbul, Turkey.
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La tératozoospermie à l’heure de l’intracytoplasmic morphologically selected sperm injection (IMSI). ACTA ACUST UNITED AC 2009; 37:552-7. [DOI: 10.1016/j.gyobfe.2009.03.029] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2009] [Accepted: 03/18/2009] [Indexed: 11/18/2022]
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Sermondade N, Vialard F, Bergere M, Hammoud I, Cavelot P, Selva J, Albert M. Evaluation de l’apport de la méthode d’observation des spermatozoïdes à fort grossissement en ICSI. ACTA ACUST UNITED AC 2007. [DOI: 10.1007/bf03040730] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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van Weert JM, Repping S, Van Voorhis BJ, van der Veen F, Bossuyt PMM, Mol BWJ. Performance of the postwash total motile sperm count as a predictor of pregnancy at the time of intrauterine insemination: a meta-analysis. Fertil Steril 2004; 82:612-20. [PMID: 15374704 DOI: 10.1016/j.fertnstert.2004.01.042] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2003] [Revised: 01/28/2004] [Accepted: 01/28/2004] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To assess the performance and clinical value of the postwash total motile sperm count (postwash TMC) as a test to predict intrauterine insemination (IUI) outcome. DESIGN Meta-analysis of diagnostic tests. SETTING Tertiary fertility center. PATIENT(S) Patients undergoing IUI. INTERVENTION(S) None. RESULT(S) We detected 16 studies that reported on postwash TMC at insemination and IUI outcome. Summary receiver operating characteristics (ROC) curves indicated a reasonable predictive performance toward IUI outcome, and, at cut-off levels between 0.8 to 5 million motile spermatozoa, the postwash TMC provided a substantial discriminative performance. At these cut-off levels, the specificity of the postwash TMC, defined as the ability to predict failure to become pregnant, was as high as 100%; the sensitivity of the test, defined as the ability to predict pregnancy, was limited. CONCLUSION(S) The postwash TMC at insemination could potentially be used in counseling patients for either IUI or IVF. However, to enable patient counseling before the start of treatment, further studies are needed to establish the accuracy of a postwash TMC during the fertility workup rather than at insemination.
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Affiliation(s)
- Janne-Meije van Weert
- Center for Reproductive Medicine, Division of Obstetrics and Gynecology, Academic Medical Center, Meibergdreef 9, 1100 AZ Amsterdam, The Netherlands.
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Tanphaichitr N, Haebe J, Leader A, Carmona E, Harris JD, da Silva SM, Antunes TT, Chakrabandhu K, Léveillé MC. Towards a more precise assay of sperm function in egg binding. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2003; 25:461-70. [PMID: 12806448 DOI: 10.1016/s1701-2163(16)30308-5] [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: 11/18/2022]
Abstract
Historically, the treatment of severe male factor infertility has relied on donor sperm insemination. A decade ago the option of treating severe male factor infertility with partner sperm became a viable alternative. With the introduction of intracytoplasmic sperm injection (ICSI) in conjunction with in vitro fertilization (IVF), only men who produce no sperm are denied the option of fathering their own children. The use of ICSI has been extended to couples with mild male factors. Despite the known genetic risks (both inherent and de novo) of ICSI to offspring, couples with male factors as part of their infertility problem often prefer ICSI to standard IVF, due to apprehension that their sperm might not otherwise succeed in fertilization. This apprehension would be alleviated if an assay for the egg binding capability of human sperm were available. We examine here the possibility that recombinant human zona pellucida 3 (rec hZP3), the primary sperm receptor sulfoglycoprotein of the egg zona pellucida (ZP), be used as a human ZP surrogate for assessing sperm ability to bind to the ZP. Unlike human eggs, which cannot be obtained for this purpose, rec hZP3 can be produced in quantity. An efficient assay can be established by incubating sperm with rec hZP3 coated to a microwell plate. Infertile men with sperm having ability to bind to rec hZP3 can be advised to select standard IVF or intrauterine insemination, which have fewer genetic and medical risks.
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Affiliation(s)
- Nongnuj Tanphaichitr
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, ON, Canada
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Ombelet W, Deblaere K, Bosmans E, Cox A, Jacobs P, Janssen M, Nijs M. Semen quality and intrauterine insemination. Reprod Biomed Online 2003; 7:485-92. [PMID: 14656412 DOI: 10.1016/s1472-6483(10)61894-9] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
There is good evidence in literature that intrauterine insemination (IUI) is the best first line treatment and most cost-effective procedure for moderate male factor subfertility. It seems very difficult to identify individual semen parameters predicting the likelihood of pregnancy after IUI. This can be explained by a lack of standardization of semen analysis, but many other methodological variables may also influence IUI success rates such as the patient selection, type of ovarian stimulation and number of inseminations per cycle. A review of the literature confirmed that sperm morphology using strict criteria and the inseminating motile sperm count (IMC) after sperm preparation are the two most important sperm parameters to assess the real impact of semen quality on IUI outcome. A universal threshold level above which IUI can be performed with acceptable pregnancy rates has not been determined yet, although IUI success seems to be impaired with <5% normal spermatozoa and an IMC of <1 x 10(6). Until now, no method of sperm preparation has been shown to be superior with regard to pregnancy rate after IUI. Whether supplementation of culture media with substances such as antioxidants and platelet activating factor may improve the results remains the subject of further research.
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Affiliation(s)
- Willem Ombelet
- Genk Institute for Fertility Technology, Schiepse Bos 6, 3600 Genk, Belgium.
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