Ashraf Farrag Rahman

Impact of Technical Difficulties, Choice of Catheter, and the Presence of Blood on the Success of Embryo Transfer—Experience from a Single Provider

AbstractPurpose: To investigate the impact of technical difficulties, choice of catheter, and the presence of blood during embryo transfer on the results of in vitro fertilization and ICSI. Methods: A cohort of 784 consecutive cycles in 655 in vitro fertilization and ICSI patients were studied. Results: Negotiating the cervix, using the volsellum, presence of blood on the catheter wall or on the cervix did not affect the results. Changing the catheter and blood on the catheter tip reduced the pregnancy (P < 0.05 and P < 0.05) and implantation rates (P < 0.001 and P < 0.01). The Ultrasoft catheter produced higher pregnancy (P < 0.0005) and implantation rates (P < 0.01) compared to the more rigid Frydman catheter. Conclusions: Negotiation of the cervix, the use of a volsellum, and the presence of blood on the catheter wall or on the cervix do not affect the results. Changing the catheter and blood on the catheter tip significantly diminish the pregnancy and implantation rates. Soft catheters perform better.

The value of sperm velocity, strict morphology and the hypo-osmotic swelling test as predictors of the sperm fertilization potential.

BACKGROUND: Although prevalence of infertility is high and are predominantly or partly due to a male factor, the diagnostic tools in male fertility are insufficient being mainly based on the evaluation of sperm concentration, motility and morphology . These parameters are, however, poorly standardized, subjective) and not powerful predictors of fertility. OBJECTIVE: The aim of this work was to evaluate the sperm velocity characteristics, the sperm morphology assessment determined by strict criteria and the hypo-osmotic swelling (HOS) test as predictors of sperm fertilization potential. MATERIALS ANDMETHODS: A comparison of 3 parameters to determine which of them is a better predictor of the fertilization potential of a given semen sample in the IVF model, namely the sperm velocity characteristics determined by computerised semen analysis, strict sperm morphology and the HOS test. Data from 58 couples attending the assisted conception unit for conventional in-vitro fertilization (IVF) treatment were analyzed. Simple linear regression and multiple stepwise regression analysis were performed taking the fertilization rate as the dependent variable and the following as independent variables: (1) female partner’s age, (2) number of human menopausal gonadotropin (hMG) ampoules, (3) sperm count, (4) grade A motility, (5) grade B motility, (6) grade C motility, (7) grade A+B motility, (8) mean sperm velocity, (9) linear velocity, (10) linearity index, (11) strict morphology and (12) the HOS test. The results were used to calculate the cut-off levels for the statistically significant predictors of fertilization. RESULTS: Only themean sperm velocity and the strict spermmorphology assessment showed significant correlation with the fertilization rate. The cutoff values were a mean sperm velocity of 16 mm/sec and a strict sperm morphology of 10 %. A minimum sperm velocity of 13 mm/sec and a minimum strict sperm morphology of 2 % were necessary to achieve fertilization in 50% of the oocytes. The results of the HOS test did not correlate with the fertilization rate. CONCLUSIONS: Sperm velocity and strict spermmorphology evaluation are good predictors of fertilization potential. The HOS test is not a good predictor of fertilization potential.