Objective: The hemizona assay(HZA) is an established functional test that examines in vitro sperm-zona pellucida binding capacity with high predictive power for fertilization outcome in IVF. The objective of this stud...Objective: The hemizona assay(HZA) is an established functional test that examines in vitro sperm-zona pellucida binding capacity with high predictive power for fertilization outcome in IVF. The objective of this study was to evaluate the value of the HZA as a predictor of pregnancy in patients undergoing controlled ovarian hyperstimulation(COH) and intrauterine insemination(IUI). Design: Prospective clinical study. Setting: Academic center. Patient(s): Eighty-two couples with unexplained or male factor infertility that underwent 313 IUI cycles. Intervention(s): Basic semen analysis and HZA were performed within three months of starting COH/IUI therapy. Main Outcome Measure(s): Hemizona index(HZI) and clinical pregnancy. Result(s): Overall, patients with an HZI of < 30 had a significantly lower pregnancy rate compared to patients with an HZI of ≥30(11.1%vs. 40.6%, respectively; P < .05; relative risk for failure to conceive: 1.5[confidence interval 1.2-1.9]). In all patients combined, and in the range of HZI 0-60, the duration of infertility(P=.000) and the HZI(P=.004) were significant determinants of conception(receiver operating characteristics(ROC) analysis). In couples with male infertility, the average path velocity and HZI were significant predictors of conception(P=.001 and P=.005, respectively, ROC analysis). The negative and positive predictive values of the HZA for pregnancy were 93%and 69%, respectively. Logistic regression analysis provided models of HZI(P=.021) and duration of infertility(P=.037) with highest predictability of conception in male factor and unexplained infertility groups, respectively. Conclusion(s): TheHZA predicted pregnancy in the IUI setting with high sensitivity and negative predictive value in couples withmale infertility. Results of this spermfunction test are useful in counseling couples before allocating them into COH/IUI therapy.展开更多
Objective: To examine the effect of withholding gonadotropins on the outcome of embryos after cryopreservation and thawing. Design: Retrospective clinical evaluation of patients having cryopreserved-thawed ET trials w...Objective: To examine the effect of withholding gonadotropins on the outcome of embryos after cryopreservation and thawing. Design: Retrospective clinical evaluation of patients having cryopreserved-thawed ET trials with coasting during the corresponding ovarian stimulation cycle. Setting: Academic tertiary clinical care unit. Patient(s): Patients with cryopreserved embryos having coasting in their fresh IVF cycle and age-matched controls without coasting, both groups receiving the same stimulation protocol (long GnRH agonist plus recombinant FSH). Intervention(s): All patients had a cycle in which embryos were transferred fresh and a cycle of thawing of cryopreserved embryos with the aim of transferring in a steroid-supplemented cycle. Main Outcome Measure(s): Embryo survival, implantation, and clinical pregnancy rates. Result(s): Post-thawing embryo survival (66.4%vs 73%), implantation (12.3%vs 13.0%), and clinical pregnancy rates (31.5%vs 38.0%) were similar in study and control groups, respectively. Patients with coasting for ≥3 days had significantly lower post-thawing embryo survival rates compared with patients having shorter duration of coasting (< 3 days) and controls. Implantation and pregnancy rates, however, were similar in the three groups. Conclusion(s): Coasting did not seem to have a detrimental effect on oocyte and embryo quality because the implantation competence of transferred concepti after cryopreservation and thawing was similar to that of controls. However, prolonged coasting (≥3 days) had a subtle negative impact on the post-thaw survival rate.展开更多
文摘Objective: The hemizona assay(HZA) is an established functional test that examines in vitro sperm-zona pellucida binding capacity with high predictive power for fertilization outcome in IVF. The objective of this study was to evaluate the value of the HZA as a predictor of pregnancy in patients undergoing controlled ovarian hyperstimulation(COH) and intrauterine insemination(IUI). Design: Prospective clinical study. Setting: Academic center. Patient(s): Eighty-two couples with unexplained or male factor infertility that underwent 313 IUI cycles. Intervention(s): Basic semen analysis and HZA were performed within three months of starting COH/IUI therapy. Main Outcome Measure(s): Hemizona index(HZI) and clinical pregnancy. Result(s): Overall, patients with an HZI of < 30 had a significantly lower pregnancy rate compared to patients with an HZI of ≥30(11.1%vs. 40.6%, respectively; P < .05; relative risk for failure to conceive: 1.5[confidence interval 1.2-1.9]). In all patients combined, and in the range of HZI 0-60, the duration of infertility(P=.000) and the HZI(P=.004) were significant determinants of conception(receiver operating characteristics(ROC) analysis). In couples with male infertility, the average path velocity and HZI were significant predictors of conception(P=.001 and P=.005, respectively, ROC analysis). The negative and positive predictive values of the HZA for pregnancy were 93%and 69%, respectively. Logistic regression analysis provided models of HZI(P=.021) and duration of infertility(P=.037) with highest predictability of conception in male factor and unexplained infertility groups, respectively. Conclusion(s): TheHZA predicted pregnancy in the IUI setting with high sensitivity and negative predictive value in couples withmale infertility. Results of this spermfunction test are useful in counseling couples before allocating them into COH/IUI therapy.
文摘Objective: To examine the effect of withholding gonadotropins on the outcome of embryos after cryopreservation and thawing. Design: Retrospective clinical evaluation of patients having cryopreserved-thawed ET trials with coasting during the corresponding ovarian stimulation cycle. Setting: Academic tertiary clinical care unit. Patient(s): Patients with cryopreserved embryos having coasting in their fresh IVF cycle and age-matched controls without coasting, both groups receiving the same stimulation protocol (long GnRH agonist plus recombinant FSH). Intervention(s): All patients had a cycle in which embryos were transferred fresh and a cycle of thawing of cryopreserved embryos with the aim of transferring in a steroid-supplemented cycle. Main Outcome Measure(s): Embryo survival, implantation, and clinical pregnancy rates. Result(s): Post-thawing embryo survival (66.4%vs 73%), implantation (12.3%vs 13.0%), and clinical pregnancy rates (31.5%vs 38.0%) were similar in study and control groups, respectively. Patients with coasting for ≥3 days had significantly lower post-thawing embryo survival rates compared with patients having shorter duration of coasting (< 3 days) and controls. Implantation and pregnancy rates, however, were similar in the three groups. Conclusion(s): Coasting did not seem to have a detrimental effect on oocyte and embryo quality because the implantation competence of transferred concepti after cryopreservation and thawing was similar to that of controls. However, prolonged coasting (≥3 days) had a subtle negative impact on the post-thaw survival rate.
