Ahmed Kamal

Selective single blastocyst transfer reduces the multiple pregnancy rate and increases pregnancy rates: a pre‐ and postintervention study

Objective  To examine the clinical pregnancy rate (CPR) and multiple pregnancy rate (MPR) in a large in vitro fertilisation (IVF) programme before and after the introduction of single blastocyst transfer (SBT) strategy in a selected group of women.

Electrical activation of oocytes after intracytoplasmic sperm injection: a controlled randomized study

OBJECTIVE To evaluate the electrical activation of oocytes in patients with previously failed or limited fertilization after intracytoplasmic sperm injection (ICSI) and in patients with possible failure of fertilization. DESIGN Prospective randomized study. SETTING A private IVF center in Egypt. PATIENT(S) Two hundred forty-six patients with severe oligoasthenospermia or nonobstructive azoospermia with total teratospermia or totally immotile spermatozoa were selected for the study. Patients who previously had total failure or limited fertilization after ICSI also were included. INTERVENTION(S) Sibling oocytes were randomly divided after ICSI into two groups: the study group (n = 1,640) was subjected to electroactivation, and the control group (n = 1,435), to no electroactivation. Electroactivation was performed by using a double-square direct-current pulse. Embryo transfer was performed with the best available embryos. MAIN OUTCOME MEASURE(S) Fertilization rate, degeneration rate, and pregnancy outcome. RESULT(S) Two hundred forty-one ICSI cycles were included in the study. The fertilization rate was statistically significantly higher in the electroactivated group as compared with in the control group (68% vs 60%, odds ratio = 1.397, 95% confidence interval = 1.197 to 1.629). The oocyte degeneration rate was not statistically significantly different between the two groups (5.9% vs 4.9%, odds ratio = 0.96, 95% confidence interval = 0.73 to 1.26). In total, 112 clinical pregnancies resulted (pregnancy rate = 46.5%). Total fertilization failure occurred in 5 cycles in the control group, and none failed in the study group. CONCLUSION(S) Oocyte electroactivation after ICSI significantly improved the fertilization rate in severe oligoasthenoteratospermia and nonobstructive azoospermia.

Does the outcome of ICSI in cases of obstructive azoospermia depend on the origin of the retrieved spermatozoa or the cause of obstruction? A comparative analysis

OBJECTIVE To compare the outcomes of intracytoplasmic sperm injection (ICSI) for men with obstructive azoospermia and normal spermatogenesis, according to the use of epididymal or testicular spermatozoa and the cause of obstruction. DESIGN Retrospective study. SETTING Private infertility center. PATIENT(S) A detailed chart review of a cohort of 1,121 men with obstructive azoospermia who underwent intracytoplamic sperm injection (ICSI) was performed. INTERVENTION(S) Patients were grouped according to the origin of spermatozoa: epididymal (n=331) or testicular (n=790). They were further classified into two subgroups according to the cause of obstruction: congenital bilateral absence of vas deferens (CBAVD; n=434), and other causes of obstruction (n=687). MAIN OUTCOME MEASURE(S) Fertilization, clinical pregnancy, and miscarriage rates. RESULT(S) Fertilization (64.2% vs. 68.0%), clinical pregnancy (42.3% vs. 43.2%), and miscarriage (17.6% vs. 18.4%) rates did not differ between epididymal spermatozoa and testicular spermatozoa, respectively. Fertilization, clinical pregnancy, and miscarriage rates were also similar in the patients with CBAVD or due to other causes of obstruction. CONCLUSION(S) The source of sperm used for ICSI in cases of obstructive azoospermia and the etiology of the obstruction do not affect the outcome in terms of fertilization, pregnancy, or miscarriage rates.

Reduction of the multiple pregnancy rate in a preimplantation genetic diagnosis programme after introduction of single blastocyst transfer and cryopreservation of blastocysts biopsied on Day 3

BACKGROUND An elective single-embryo transfer (SET) policy has not been applied to preimplantation genetic diagnosis (PGD) for inherited genetic disorders because of concerns regarding post-thaw survival of biopsied embryos. Our objective was to evaluate the survival and pregnancy potential of embryos biopsied for PGD at the cleavage stage and cryopreserved at the blastocyst stage and its contribution to the overall success of an elective SET policy in a PGD programme. METHODS From January 2006, all couples who had two or more transferable PGD blastocysts biopsied on Day 3 of culture were offered single-blastocyst transfer (SBT) and cryopreservation of surplus blastocyst(s) using a slow-freezing technique. We compared the outcome of 32 cryo-thawed PGD cycles with that of 191 cryo-thawed conventional in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) cycles performed between January 2006 and July 2008. We also compared the outcome of all fresh PGD cycles performed before and after January 2006. RESULTS The cryo-thawed blastocyst survival rate was similar between the PGD and IVF/ICSI groups (87% versus 88%, P = 0.94). There was no significant difference in the implantation and clinical pregnancy rates between the two groups (35% versus 29%, P = 0.45 and 34% versus 36%, P = 0.77, respectively). During the same period, the multiple pregnancy rate in the fresh PGD programme dropped from 36% to 10% (OR = 0.20, 95% CI 0.08-0.48, P < 0.001) with no reduction in pregnancy rates. CONCLUSIONS The survival and implantation potential of biopsied PGD embryos cryopreserved at the blastocyst stage is comparable to that of non-biopsied IVF/ICSI cryopreserved blastocysts. Elective SBT and cryopreservation of surplus blastocysts for later use should extend to include PGD for inherited genetic disorders.

The impact of spermatozoa preincubation time and spontaneous acrosome reaction in intracytoplasmic sperm injection : a controlled randomized study

OBJECTIVE To determine the optimum time interval between semen processing and incubation before intracytoplasmic sperm injection (ICSI) and correlate it with the acrosomal reaction rate. DESIGN Controlled randomized study. SETTING The Egyptian IVF-ET Center. PATIENT(S) Couples with male factor infertility undergoing ICSI using ejaculated semen. INTERVENTION(S) The patients were prospectively randomized according to differences in sperm preincubation time before ICSI into 1-hour, 3-hour, and 5-hour groups. The status of the acrosome was studied using electron microscopy. MAIN OUTCOME MEASURE(S) The primary outcome measures were fertilization rate and acrosome reaction rate. Secondary outcome measures were the implantation and pregnancy rates. RESULT(S) The rate of acrosomally reacted spermatozoa was the highest (68.2%) after 5 hours of incubation and lowest (25.6%) after 1 hour of incubation. The difference was statistically significant. The fertilization rate was the highest (74%) using spermatozoa incubated for 3 hours as compared with 1 hour (70%) and 5 hours (67%), but the difference was not statistically significant. CONCLUSION(S) Acrosome reaction is time dependent; the optimum incubation time of spermatozoa before ICSI was 3 hours, which resulted in the highest fertilization rate.

Intracytoplasmic Sperm Injection in Difficult Cases: The Egyptian Experience

The first successful pregnancies after intracytoplasmic sperm injection (ICSI) in human were reported by Palermo et al. (1). Since then, major developments occurred in this field and ICSI became a standard treatment for male factor infertility irrespective of the severity of the condition. The scope of ICSI widened to include a broad range of indications.