Objective: To determine the prognostic value of sperm DNA fragmentation levels, as measured by the sperm chromatin dispersion (SCD) test, in predicting IVF and ICSI outcome. Design: Double- blind prospective study. Se...Objective: To determine the prognostic value of sperm DNA fragmentation levels, as measured by the sperm chromatin dispersion (SCD) test, in predicting IVF and ICSI outcome. Design: Double- blind prospective study. Setting: University- affiliated private IVF setting. Patient(s): A total of 85 couples undergoing infertility treatment with IVF/ICSI. Intervention( s): Analysis of DNA fragmentation by the SCD test in 170 aliquots obtained from the ejaculate and from the processed semen used for assisted reproductive technologies (ART). Main Outcome Measure(s): Percentage of spermatozoa with fragmented DNA was statistically correlated with embryo quality and reproductive success. Result(s): Fertilization rate was inversely correlated with DNA fragmentation (r =- 0.245 P=.045). Higher DNA fragmentation rate gave an increased proportion of zygotes showing asynchrony between the nucleolar precursor bodies of zygote pronuclei (73.8% vs. 28.8% P < .001). In addition, the slower embryo development and worst morphology on day 6 was correlated with higher sperm DNA fragmentation (47.7% vs. 29.4% P=.044). We also observed a negative correlation between DNA fragmentation and the implantation rate (r =- 0.250 P=.042). However, SCD test values were not statistically different in cycles that resulted in a pregnancy compared with those that did not (33.2 vs. 28.2 and 32.4 vs. 34.7). Conclusion(s): This is the first report that describes a correlation between sperm DNA integrity, asmeasured by the SCD test, and fertilization rate, embryo quality, and implantation rate in IVF/ICSI. The degree of DNA fragmentation was inversely correlatedwith fertilization rate, synchrony of the nucleolar precursor bodies’ pattern in pronuclei, embryo ability to achieve blastocyst stage, and embryo morphological quality. Because SCD test values were correlated with embryo quality and blastocyst rate, the lack of correlation between sperm DNA fragmentation and pregnancy outcome in IVF might be due to embryo selection before transfer. The ability of the SCD test to predict the blastocyst rate after IVF/ICSI warrants further study.展开更多
Objective: To evaluate the results of a novel protocol that allows to rescue IVF unfertilized oocytes by intracytoplasmic sperm injection (ICSI).Design: Prospective clinical trial.Setting: Private reproductive medical...Objective: To evaluate the results of a novel protocol that allows to rescue IVF unfertilized oocytes by intracytoplasmic sperm injection (ICSI).Design: Prospective clinical trial.Setting: Private reproductive medical center.Patient(s): Thirty patients undergoing IVF.Intervention(s): Controlled ovarian stimulation (COS), conventional IVF, rescue ICSI, embryo culture, and embryo transfer.Main Outcome Measure(s): Identification of unfertilized IVF oocytes 6 hours after insemination and fertilization, and developmental rates of those oocytes after rescue microinjection, as well implantation and pregnancy rates (PR).Result(s): All oocytes (392) from 30 patients were inseminated with standard IVF 3 hours after ovum pick- up.Polar body (PB) status was checked at decumulation and rechecked 3 hours later.Eighty- two oocytes were fertilized after IVF alone and 184 nonactivated oocytes (failed fertilization) were rescue microinjected and 166 of them fertilized (20 patients).Cleavage stage on day 2 was significantly more advanced and embryo grade was higher after standard IVF fertilization than after rescue ICSI.Eight of the 30 embryos transferred were implanted in the IVF- only patients (27% )- and 8 of 68 embryos in the rescue ICSI patients (12% ).Conclusion(s): Rescue ICSI of unfertilized IVF oocytes 6 hours after insemination (9 hours after egg retrieval) can provide normal fertilization, embryo development, and pregnancy; however, corresponding outcome parameters tend to be impaired in comparison to the standard IVF fertilization results.展开更多
To determine whether the short or long protocol for controlled ovarian hyperstimulation works better in older patients undergoing IVF. Design: Controlled, randomized study. Setting: A single private IVF center. Patien...To determine whether the short or long protocol for controlled ovarian hyperstimulation works better in older patients undergoing IVF. Design: Controlled, randomized study. Setting: A single private IVF center. Patient(s): Two hundred twenty infertile women aged ≥ 40 years undergoing IVF.Intervention(s): At their first IVF cycle, the women were randomized into two stud groups according to a computer-generated number sequence: 110 patients were treated with a long protocol, and the other 110 were treated with a short protocol for controlled ovarian hyperstimulation. Main Outcome Measure(s): Days of stimulation, E2 level at the day of hCG administration, amount of FSH administered, number of oocytes collected, number of embryos obtained, pregnancy rate, implantation rate. Result(s): Patients treated with a long protocol showed a significantly higher number of oocytes retrieved, a higher number of embryos obtained, and a higher pregnancy rate, both for cycle and transfer, compared with the short-protocol patients. The other parameters evaluated did not show any statistically significant differences. Conclusion(s): Our study showed that the long protocol performed better than the short protocol in older women. Our findings demonstrated that flare-up in older women might be detrimental.展开更多
To describe a first case of parasitic twin achieved after intracytoplasmic sperm injection (ICSI). Case report. Perinatal center at a Japanese university hospital. A 30-year-old pregnant Japanese woman with a history ...To describe a first case of parasitic twin achieved after intracytoplasmic sperm injection (ICSI). Case report. Perinatal center at a Japanese university hospital. A 30-year-old pregnant Japanese woman with a history of secondary infertility achieved after ICSI was diagnosed with an omphalopagus parasitic twin pregnancy by prenatal ultrasound at 28 weeks of gestation. A female infant was delivered by scheduled cesarean section at 30 weeks of gestation. The cesarean section was performed for dystocia. Brief review of parasitic twin and malformations in fetuses achieved after ICSI. Resuscitation was not done because of the poor prognosis for both fetuses. Molecular analysis with informative genetic markers is consistent with monozygotic pregnancy. A careful ultrasound examination is indicated to detect additional anomalous findings in twin fetuses achieved after ICSI.展开更多
文摘Objective: To determine the prognostic value of sperm DNA fragmentation levels, as measured by the sperm chromatin dispersion (SCD) test, in predicting IVF and ICSI outcome. Design: Double- blind prospective study. Setting: University- affiliated private IVF setting. Patient(s): A total of 85 couples undergoing infertility treatment with IVF/ICSI. Intervention( s): Analysis of DNA fragmentation by the SCD test in 170 aliquots obtained from the ejaculate and from the processed semen used for assisted reproductive technologies (ART). Main Outcome Measure(s): Percentage of spermatozoa with fragmented DNA was statistically correlated with embryo quality and reproductive success. Result(s): Fertilization rate was inversely correlated with DNA fragmentation (r =- 0.245 P=.045). Higher DNA fragmentation rate gave an increased proportion of zygotes showing asynchrony between the nucleolar precursor bodies of zygote pronuclei (73.8% vs. 28.8% P < .001). In addition, the slower embryo development and worst morphology on day 6 was correlated with higher sperm DNA fragmentation (47.7% vs. 29.4% P=.044). We also observed a negative correlation between DNA fragmentation and the implantation rate (r =- 0.250 P=.042). However, SCD test values were not statistically different in cycles that resulted in a pregnancy compared with those that did not (33.2 vs. 28.2 and 32.4 vs. 34.7). Conclusion(s): This is the first report that describes a correlation between sperm DNA integrity, asmeasured by the SCD test, and fertilization rate, embryo quality, and implantation rate in IVF/ICSI. The degree of DNA fragmentation was inversely correlatedwith fertilization rate, synchrony of the nucleolar precursor bodies’ pattern in pronuclei, embryo ability to achieve blastocyst stage, and embryo morphological quality. Because SCD test values were correlated with embryo quality and blastocyst rate, the lack of correlation between sperm DNA fragmentation and pregnancy outcome in IVF might be due to embryo selection before transfer. The ability of the SCD test to predict the blastocyst rate after IVF/ICSI warrants further study.
文摘Objective: To evaluate the results of a novel protocol that allows to rescue IVF unfertilized oocytes by intracytoplasmic sperm injection (ICSI).Design: Prospective clinical trial.Setting: Private reproductive medical center.Patient(s): Thirty patients undergoing IVF.Intervention(s): Controlled ovarian stimulation (COS), conventional IVF, rescue ICSI, embryo culture, and embryo transfer.Main Outcome Measure(s): Identification of unfertilized IVF oocytes 6 hours after insemination and fertilization, and developmental rates of those oocytes after rescue microinjection, as well implantation and pregnancy rates (PR).Result(s): All oocytes (392) from 30 patients were inseminated with standard IVF 3 hours after ovum pick- up.Polar body (PB) status was checked at decumulation and rechecked 3 hours later.Eighty- two oocytes were fertilized after IVF alone and 184 nonactivated oocytes (failed fertilization) were rescue microinjected and 166 of them fertilized (20 patients).Cleavage stage on day 2 was significantly more advanced and embryo grade was higher after standard IVF fertilization than after rescue ICSI.Eight of the 30 embryos transferred were implanted in the IVF- only patients (27% )- and 8 of 68 embryos in the rescue ICSI patients (12% ).Conclusion(s): Rescue ICSI of unfertilized IVF oocytes 6 hours after insemination (9 hours after egg retrieval) can provide normal fertilization, embryo development, and pregnancy; however, corresponding outcome parameters tend to be impaired in comparison to the standard IVF fertilization results.
文摘To determine whether the short or long protocol for controlled ovarian hyperstimulation works better in older patients undergoing IVF. Design: Controlled, randomized study. Setting: A single private IVF center. Patient(s): Two hundred twenty infertile women aged ≥ 40 years undergoing IVF.Intervention(s): At their first IVF cycle, the women were randomized into two stud groups according to a computer-generated number sequence: 110 patients were treated with a long protocol, and the other 110 were treated with a short protocol for controlled ovarian hyperstimulation. Main Outcome Measure(s): Days of stimulation, E2 level at the day of hCG administration, amount of FSH administered, number of oocytes collected, number of embryos obtained, pregnancy rate, implantation rate. Result(s): Patients treated with a long protocol showed a significantly higher number of oocytes retrieved, a higher number of embryos obtained, and a higher pregnancy rate, both for cycle and transfer, compared with the short-protocol patients. The other parameters evaluated did not show any statistically significant differences. Conclusion(s): Our study showed that the long protocol performed better than the short protocol in older women. Our findings demonstrated that flare-up in older women might be detrimental.
文摘To describe a first case of parasitic twin achieved after intracytoplasmic sperm injection (ICSI). Case report. Perinatal center at a Japanese university hospital. A 30-year-old pregnant Japanese woman with a history of secondary infertility achieved after ICSI was diagnosed with an omphalopagus parasitic twin pregnancy by prenatal ultrasound at 28 weeks of gestation. A female infant was delivered by scheduled cesarean section at 30 weeks of gestation. The cesarean section was performed for dystocia. Brief review of parasitic twin and malformations in fetuses achieved after ICSI. Resuscitation was not done because of the poor prognosis for both fetuses. Molecular analysis with informative genetic markers is consistent with monozygotic pregnancy. A careful ultrasound examination is indicated to detect additional anomalous findings in twin fetuses achieved after ICSI.
