Medicina Reproductiva y Embriología Clínica最新文献

Background

Fertilization failure or low fertilization rate after ICSI is around 1–3% in IVF treatments. Several strategies have been studied in order to bypass the lack of activation. The aim of this study is to evaluate embryo morphokinetics and reproductive outcomes after intracytoplasmic sperm injection (ICSI) with assisted oocyte activation (AOA) using a calcium ionophore (CaI) in patients with previous fertilization failure or low fertilization rate (under 30%) and severe male factor.

Methods

Multicentric retrospective cohort study including 70 patients with fertilization failure or low fertilization rate and severe male factor (sperm concentration under 1 million/mL) who underwent ICSI with CaI (756 oocytes), and 76 patients with severe male factor without previous fertilization failure who had standard ICSI (748 oocytes) between January 2011 and December 2016.

Results

CaI Exposed and non-exposed groups differed significantly for normal fertilization rates, pronuclear disappearance timing (tPNf), time to 4 cells stage, multinucleation at the 2- and 4-cell stages, and direct cleavage events. Implantation rate was higher in the non-exposed group (p = 0.023). Other morphokinetic variables were similar between groups. Pregnancy (higher in the non exposed group), abortion, and live birth rates, were also not statistically different among groups.

Conclusions

Although the fertilization and implantation rates were higher in the non-exposed group, ICSI-CaI was associated with an increased fertilization rate compared to patient previous attempts and thus with increased pregnancy chances. Because of the specific patient populations involved (patients with severe male factor with or without previous fertilization failure), the results might not generalize for patients with different etiologies.

Trial Registration: 1506-VLC-045-MM.

Introduction

Current evidence suggest that perinatal outcomes of children of patients subjected to in vitro fertilisation (IVF) with fresh embryo transfer (ET) are worse compared to frozen embryo transfer (FET). There are doubts if the cause might be related to the technique of vitrification or ovarian stimulation performed in IVF. The aim of this study is to assess the risk of preterm delivery in patients undergoing IVF with fresh ET versus FET.

Material and methods

Retrospective cohort study using data from the National Registry of Assisted Reproduction Techniques Activity - Registry of the Spanish Fertility Society (RNATRA) from 2010 to 2015, including women with a singleton pregnancy following autologous IVF (IVF-AO), or IVF with donation of oocytes (IVF-DO).

Results

A total of 371,308 cycles of IVF were performed, of which 263,306 followed IVF-AO (172,626 fresh ET, and 90,680 FET), and 108,002 underwent IVF-DO (57,944 fresh ET and 50,048 FET). The prevalence of preterm delivery was 12% in IVF-AO group and 18.6% in IVF-DO group. A decreased risk of early preterm delivery was observed after FET only in IVF-AO (OR: 0.87; 95% CI: 0.75-0.99), while an increased risk of late and moderate preterm delivery was found after FET, both in IVF-AO (OR: 1.12; 95% CI: 1.04-1.20) and IVF-DO (OR: 1.17; 95% CI: 1.08-1.26).

Conclusions

Both IVF-AO and IVF-DO have a high prevalence of preterm delivery. Cryopreservation is associated with a lower risk of early preterm delivery compared to fresh ET in patients undergoing IVF-AO; however, an increased risk of late and moderate preterm delivery was observed in both IVF-AO and IVF-DO. These findings should be analysed with caution due to methodological limitations.

Objective

The aim of the study is to assess whether delaying frozen embryo transfer (FET) after pre-implantation genetic testing for aneuploidy (PGT-A) cycle provides any benefit for reproductive outcomes.

Methods

Retrospective cohort study including a total of 913 frozen embryo transfers related to 5104 PGT-A cycles performed between May 2016 and March 2017 at IVI clinics. We compared the FET performed the month following the ovarian puncture (OPU) (n = 184) with the FET delayed one or more months (n = 700). The main outcome was clinical pregnancy rate (CPR) and the secondary outcomes were implantation (IR) and miscarriage rates.

Results

No significant statistical differences were detected between groups as regards patient age and cycle parameters. Similar results were also observed concerning metaphase II oocytes (11 ± 0.8 vs 10 ± 0.4, p = 0.03), number of blastocysts (4.3 ± 0.4 vs 3.8 ± 0.2, p = 0.122), euploid embryos (2.1 ± 0.3 vs 1.8 ± 0.1, p = 0.039), or transferred embryos (1.1 ± 0.1 vs 1.1 ± 0.2, p = 0.52). Finally, no significant differences were found in CPR (52.7% vs 54.9%, p = 0.33). The multivariate logistic regression showed that the number of euploid (OR = 1.170, 1.062–1.288; p = 0.001) and transferred embryos (OR = 2.530, 1.703–1.509; P< .001) significantly affected the probability of getting pregnant, while the timing of the frozen embryo transfer (OR = 1.090, 0.787–1.509; p = 0.604) did not have a significant effect on reproductive outcomes.

Conclusions

Delaying frozen embryo transfer after PGT-A cycles does not seem to improve outcomes in terms of pregnancy rates.

Kartagener syndrome is an autosomal recessive genetic disorder associated with male infertility. Mutations in genes that encode a protein called dynein affect sperm motility.

A good option for these patients is to enhance the sperm selection for ICSI that could lead to improve the reproductive outcomes. For this purpose, different strategies have been used successfully in isolated cases.

In the present case report, we successfully applied MACS technique to a semen sample. This immunomagnetic method of sperm selection was aimed at reducing apoptosis manifestations, including DNA fragmentation, to optimize the outcomes of the ICSI procedure. By doing so, we increased the chances of selecting spermatozoa with superior quality and higher fertilization potential in the presence of total asthenozoospermia, even after incubation with pentoxifylline. Six of ten oocytes (60%) were appropriately fertilized. Two good-quality embryos were transferred on day 3 resulting in a pregnancy and a healthy baby born and one cavitated blastocyst was frozen on day 5.

MACS technique used as a compliment of sperm preparation technique may be a promising approach in routine IVF practice for men with Kartagener syndrome to improve reproductive outcomes optimizing the outcomes of the ICSI procedure.

Introduction

Public centers with IVF/ICSI laboratory (In Vitro Fertilization/Intracytoplasmic Sperm Injection) must guarantee both the efficacy and safety of treatment in patients. Benchmarking offers us a vision of where we should direct our efforts in this regard. The objective of this work is to identify if the procedures carried out by national public centers are effective and safe.

Material and methods

Based on the National Activity Registry - Spanish Fertility Society Registry and an online survey, data on results, clinical practice and physical and human resources were obtained from 42 public centers that are included in its IVF/ICSI service portfolio. The results were compared with the specification at the desirable level of the quality indicators of UNE 179007:2013 (Quality Management Systems for Assisted Reproduction Laboratories) established by the Association for the Study of Reproduction Biology (ASEBIR). Those of greater efficiency and safety were defined and identified as ‘excellent’ centers, in order to carry out a benchmarking study.

Results

The average of the quality indicators analyzed in public centers, reached and/or exceeded the ASEBIR quality specifications at the desirable level. Two centers were considered ‘excellent’ for presenting a higher gestation rate with a low percentage of multiple gestations. These centers had a percentage of contraceptive cycle programming, embryonic transfer in blastocyst, deferred transfer, elective transfer of single embryo and percentage of cycles with conventional IVF versus ICSI higher than the average of public centers. Evaluating the human, physical resources and the weekly activity, no relation was obtained with better results.

Conclusions

Excellence in Public Centers is related more to a set of procedures than to a single one.

Background

It is estimated that around a 3% of the couples are affected by severe male factor infertility -oligozoospermia, cryptozoospermia and non-obstructive azoospermia-. It is suggested the existence of postesticular sperm damage due to the oxidative stress that sperm suffers through the male genital tract. Base on this, different authors have propose the generalised use of testicular sperm, surgically retrieved (TESE), instead of ejaculated sperm.

Objectives

Analysing the influence of the sperm source in couples affected by severe male factor infertility in the ICSI results, when DNA ejaculated sperm fragmentation has not been tested before.

Material and methods

A retrospective study was conducted based on a specific severe male factor ICSI cycle database, according to the selected sperm source -testicle or ejaculate-.

Results

We analysed a total amount of 152 ICSI cycles which were divided into two groups, 107 cycles conducted with fresh ejaculated spermatozoa and 45 cycles conducted with criopreserved testicular biopsy spermatozoa. The results showed no significant differences in social-demographical or ovarian stimulation variables. ICSI cycles results were not different either; we obtained similar fertilization rates (54.3% vs. 48.6%), implantation rates (23.1% vs. 22.8%) and pregnancy per embryo transfer rates (35.5% vs. 37.1%). We observed a trend towards greater miscarriage rate between the testicular sperm cycles (18.5% vs. 46.1%), as well as a reduced live birth rate (28.9% vs. 20.0%) in this group. However, no significance differences were found after the analyses.

Conclusion

No evidences were found in favour of mass testicular spermatozoa vs. ejaculated spermatozoa use in ICSI cycles, when DNA ejaculated sperm fragmentation has not been tested before.

Background and objective

With the advances in assisted reproduction techniques and above all thanks to the implementation of vitrification, there are more and more surplus pre-embryos in assisted reproduction cycles.

Material and methods

Retrospective observational study.

Results

The maternal age of patients who decided to donate their pre-embryos to other patients (41.38 ± 4.55) was higher than those who preferred to donate to research (39.56 ± 4.89), keep them for future use (37.38 ± 4.72), or discard them for no other purpose (40.87 ± 5.21) p-value: <0.05.

International patients decide to discard their pre-embryos for no other purpose (26.81% vs 21.30%; p-value: <0.05) or donate them to other couples (19.56% vs 14.04; p-value: <0.05) in greater proportion than national patients. In contrast, the percentage of national patients who decide to donate their embryos to research is greater than that of international patients (35.84% vs 28.50%; p-value: <0.05).

When we compared the responses obtained in terms of the origin of the oocytes (own or donated), we found that those who used donated oocytes decided to donate them to other couples in a higher percentage than those who used their own oocytes (21.67% vs 5.26%; p-value: >0.05). Patients who used donated oocytes decided to keep their pre-embryos in a lower percentage than patients who used their own oocytes (21.44% vs 41.75; p-value: <0.05).

Conclusions

According to this study, maternal age, nationality and origin of the oocytes are factors that can influence patients’ decisions about what to do with their surplus embryos from assisted reproduction cycles. In addition, it reiterates as in other studies that an improvement in the processes and circuits is necessary to obtain a greater number of responses from patients more.