Assessment of interlaboratory and intralaboratory sperm morphology readings with the use of a Hamilton Thorne Research integrated visual optical system semen analyzer

OBJECTIVE

To evaluate the level of variance produced in a multicenter study with the use of a computer-assisted sperm morphology analyzer.

DESIGN

A multicenter, prospective, blinded study.

SETTING

Assisted reproduction research laboratories.

PATIENT(S)

Semen samples produced for assisted reproductive procedures.

INTERVENTION(S)

Hamilton Thorne Research (Beverly, MA) integrated visual optical system semen analyzers were used at five different centers to evaluate the same set of 30 slides that were prepared and numerically coded at Tygerberg Hospital in Tygerberg, South Africa.

MAIN OUTCOME MEASURE(S)

The percentage of normal sperm.

RESULT(S)

Interlaboratory coefficients of variation (CVs) ranged between 16.31% and 23.09%. One of the participating laboratories produced an approximately 14% (-6.5-7.7) limits of agreement analysis, with a CV of 11.36%, for its duplicate readings. The use of a 10% normal sperm morphology cutoff point to determine discordance levels produced rates ranging between 10% and 23.3% for the interlaboratory and intralaboratory readings. This level of discordance equates with < or = 7 of the corresponding readings from two laboratories falling into a different normal sperm morphology group (< or = 10% or >10%).

CONCLUSION(S)

The magnitudes of variation produced by the readings performed in our study reached the same level as for the manual evaluation of sperm morphology. A < 10% CV can be obtained if the correct quality control measures are implemented.

Induction of labor with intravaginal misoprostol versus intracervical dinoprostone

Sixty five pregnant women who had the indication for labor induction were randomized in a clinical trial to receive 100 micrograms intravaginal misoprostol or intracervical gel of 0.5 mg dinoprostone. The mean time from induction to delivery for the misoprostol group was 7.6 +/- 1.9 versus 8.2 +/- 5.9 (hours +/- SD) for the dinoprostone group. There were no significant differences between groups in gestational age, induced labor rates, type of delivery, fetal outcome and maternal complications. We found that intravaginal misoprostol tablet is as effective as intracervical dinoprostone for inducing second and third trimester labor.

Clinical significance of human sperm-zona pellucida binding

OBJECTIVE

To assess the relationship between sperm morphology and motion parameters and sperm-zona pellucida (ZP) binding capacity under hemizona assay (HZA) conditions and to determine the discriminatory power of the HZA for the prediction of in vitro sperm fertilizing ability.

DESIGN

Prospectively designed study.

SETTING

Academic tertiary centers.

PATIENT(S)

One hundred ninety-six couples undergoing IVF therapy participated in this study.

INTERVENTION(S)

Hemizona assay and IVF results were determined for each couple.

MAIN OUTCOME MEASURE(S)

Computerized sperm motion analysis, sperm morphology (strict) criteria), and HZA results were correlated with fertilization outcome.

RESULT(S)

Among sperm parameters from the original ejaculates, morphology was the best predictor of sperm-ZP binding ability; hyperactivated motility was the best predictor of HZA results after swim-up separation of the motile sperm fractions. The HZA index provided the highest discriminatory power for fertilization success/failure, with an overall accuracy of 86%.

CONCLUSION(S)

Sperm morphology and hyperactivated motility showed a high correlation with the capacity of sperm to achieve tight binding to the ZP. The excellent positive and negative predictive values of the HZA for fertilization outcome provide additional support for the use of this functional bioassay in the decision-making process within the assisted reproduction setting.

Radionuclide hysterosalpingography with radiolabeled spermatozoa

OBJECTIVE

To evaluate the efficiency of radionuclide hysterosalpingography (HSG) by using 99mTc hexamethyl propyleneamine oxime (HMPAO)-labeled human spermatozoa in the assessment of fallopian tube patency in infertile couples.

DESIGN

Fifteen infertile female patients were inseminated with their husbands' radiolabeled spermatozoa immediately after cessation of menses.

SETTING

University-based academic hospital.

MAIN OUTCOME MEASURE(S)

The time course of radioactivity and scintigraphic images of the uterus and the parauterine tissues implying tubal patency were evaluated and compared by using laparoscopy and HSG.

RESULT(S)

We demonstrated Tmax (time to peak radioactivity at periovarian sites) for right and left tubes to be 6.74 +/- 2.66 and 5.91 +/- 2.93 minutes (means +/- SD), respectively. We also found 72% sensitivity and 75% specificity of spermatozoa labeled radionuclide HSG compared with laparoscopic findings for tubal patency.

CONCLUSION(S)

Radionuclide HSG with the husband's spermatozoa seems to be a potentially useful method of assessing patency of the fallopian tubes. The safety dose of this procedure is comparable to conventional HSG. However, more comparative studies are needed to evaluate advantages and disadvantages of this technique.

The influence of sperm/zona pellucida collision rates on zona binding

The satisfying success rates reported with intra-cytoplasmic sperm injection (ICSI) urged clinicians and scientists to re-address the emphasis in the management of the male factor patient towards gamete manipulation in order to circumvent the underlying problem causing fertilization failure. We have designed a study to (i) calculate the collision rate of a sperm population with the human zona pellucida, using a mathematical hypothesis and (ii) use the calculated collision rate to evaluate subsequent zona binding results obtained under hemizona assay conditions. Microdroplets were used to co-incubate sperm and human oocytes in order to evaluate zona binding. Using microvolumes, the track followed by sperm, as well as the maximum distance travelled were employed to calculate the collision rate of sperm and zona pellucida. The sperm concentrations of swim up samples were adjusted to 4 x 10(6) and 0.8 x 10(6) sperm ml-1. Five separate droplets each of 20 microliters containing 4 x 10(6) sperm ml-1 (80,000 motile sperm) and 200 microliters containing 0.8 x 10(6) sperm ml-1 (160,000 motile sperm), respectively, were prepared. Both volumes were incubated for 18 h at 37 degrees C. The mean (+/-SD) number of spermatozoa tightly bound to hemizona, incubated in 20 microliters and 200 microliters sperm droplets, was 2444 +/- 612 and 548 +/- 315, respectively (P = 0.0001). The results can be used as a guideline to calculate the optimum insemination concentration needed for a specific sperm population to ensure the maximum collision rates with the oocyte.

A prospective study on the predictive value of normal sperm morphology as evaluated by computer (IVOS)

OBJECTIVE

To evaluate the IVOS (Hamilton Thorne Research Version 2.1 Dimension Program, Beverly, MA) system's ability to predict fertilization in vitro in a prospective study.

DESIGN

Hospital-based academic ART program.

PATIENTS

Eighty patients from the IVF-GIFT program were evaluated. The same semen sample was analyzed on a day-to-day basis by both laboratory (manual method) and the computerized system for percentage normal morphology, concentration/mL, motility, and forward progression. Only patients with two or more metaphase II (MII) oocytes available were allowed into the study and excluded where the male partner had antisperm antibodies or qualified for intracytoplasmic sperm injection (<500,000 motile spermatozoa obtained after glass wool separation).

STATISTICAL ANALYSIS

Logistic regression analysis was used to study predictors of fertilization in vitro.

RESULTS

Three hundred thirty-eight oocytes were obtained from 80 patients of which 239 fertilized. The logistic regression analysis of the manual method (percentage normal morphology) and IVOS indicated that both were predictors of fertilization. Sperm morphology as evaluated by IVOS in patients with <10 x 10(6) motile spermatozoa/mL retrieved after swim-up was a significant predictor of fertilization as was the number of oocytes obtained. Thus, the more oocytes obtained in the lower morphological groups, the better the chance of fertilization. The fertilization rate in the morphology group of 0% to 4% normal forms was 45.6% (37/81) and in the group >14% normal forms was 85.2% (69/81).

CONCLUSIONS

It was shown that in patients where </= 10 x 10(6) motile spermatozoa were obtained, the role of morphology (evaluated by IVOS) as well as the number of oocytes were important predictors of fertilization. The computer can assist to identify these patients with a poor prognosis for fertilization.

The influence of a mineral oil overlay on the zona pellucida binding potential of human spermatozoa

The objective of the study was to evaluate the effect of mineral oil on zona pellucida binding potential of human spermatozoa. The study compared zona binding using micro volume droplets under mineral oil as apposed to micro droplets in cryopreservation straws. Spermatozoa from eight proven fertile sperm donors were used. One hundred and fifty five matched hemizonae in 50 microliters, 100 microliters and 200 microliters insemination sperm droplets were co-incubated; (i) under mineral oil and (ii) 0.5 ml plastic cryopreservation straws. The results were analysed to determine the number of the zona bound spermatozoa during each experiment. Microvolumes with an oil overlay had a decrease in sperm bound per hemizona of 38% (mean +/- SD; 563 +/- 415 vs. 921 +/- 597), 51% (mean +/- SD; 392 +/- 359 vs. 800 +/- 566 sperm) and 18% (mean +/- SD; 502 +/- 369 vs. 618 +/- 445) in 200 microliters, 100 microliters and 50 microliters respectively, compared to microvolumes in cryopreservation straws. It was concluded that mineral oil may have some detrimental factors which interfere with zona binding of spermatozoa.

Development of a predictive model for optimal zona pellucida binding using insemination volume and sperm concentration

OBJECTIVE

To develop a predictive model under hemizona assay (HZA) conditions for human spermatozoa concentrations and insemination volume for optimum zona pellucida (ZP) binding.

DESIGN

Analysis of 20 different insemination volumes for zona binding and sperm morphology under HZA conditions.

SETTING

Reproductive biology unit, tertiary medical center.

PATIENTS

Four proven fertile sperm donors.

MAIN OUTCOME MEASURES

5-, 20-, 50-, 80-, and 100-microL droplets were analyzed with four different concentrations of 0.5 x 10(6), 1.0 x 10(6), 2.0 x 10(6), and 4.0 x 10(6) cells/mL to determine the number of sperm bound to each hemizona. Fifteen hemizonae were used for each insemination volume or microdroplet. Response surface regression model with volume and concentration as the regressor variables has been used.

RESULTS

The response surface of binding for the factors concentration and volume showed nonlinear association. A formula, indicating the optimal sperm insemination volume for maximum sperm binding to the ZP, Vmax = -(b1 + b5c)/2b6c, is described. The transformed data indicated 60 microL containing 4 x 10(6) sperm/mL to be optimal. Although morphology of zona spermatozoa is superior compared with seminal and postswim-up samples, no difference among the percentage of the normal morphology in different microdroplets could be demonstrated.

CONCLUSION

Optimal volume for the obtained concentration of spermatozoa from a patient can be calculated and therapeutically used for cases of severe oligozoospermic patients by microvolume inseminations in IVF practice.