David Mortimer

LAPAROSCOPIC SPERM RECOVERY IN INFERTILE WOMEN

Sperm recovery from the peritoneal fluid was attempted in a group of infertile women in whom it was anticipated that all routine investigations would be normal (commonly referred to as ‘normal infertiles’). Forty‐four couples were recruited into the study but in retrospect only 24 met the study criteria of normal semen, normal pelvis and appropriate timing. In 15 of these 24 patients, spermatozoa were covered from the peritoneal fluid, and so far seven have become pregnant. In the nine patients where spermatozoa were not recovered, none have so far become pregnant. There was no correlation between sperm recovery and the quality of the post‐insemination cervical mucus examination. This test allows more accurate assessment of the ability of spermatozoa to reach the site of fertilization.

The development of a clinical test of sperm migration to the site of fertilization

In those patients whose infertility is unexplained after routine investigations, it is likely that there are defects of gamete transport, fertilization, or implantation. This paper describes the development of a test of sperm migration to the site of fertilization. A method of laparoscopic sperm recovery from the peritoneal cavity and fimbrial rinsings following insemination at midcycle is described. In all, 47 patients were studied, and spermatozoa were recovered in 55%. There was no difference in the success rate following artificial insemination or coital insemination. Successful sperm recovery could not be attributed to better semen quality or better timing of the procedure in the menstrual cycle. The spontaneous pregnancy rate in the positive sperm recovery group was significantly higher than in the negative group. A comparison was made between the results of the postcoital test and the results of laparoscopic sperm recovery. There was a poor correlation between the two tests. It is suggested that laparoscopic sperm recovery is useful in the investigation of and the further management of that group of patients whose infertility is unexplained.

Incidence and complications of multiple gestation in Canada: proceedings of an expert meeting

This paper reports the proceedings of a consensus meeting on the incidence and complications of multiple gestation in Canada. In addition to background presentations about current and possible future practice in Canada, the expert panel also developed a set of consensus points. The need for infertility to be understood, and funded, as a healthcare problem was emphasized, along with recognition of the emotional impact of infertility. It was agreed that the goal of assisted reproduction treatment is the delivery of a single healthy infant and that even though many positive outcomes have resulted from twin or even triplet pregnancies, the potential risks associated with multiple pregnancy require that every effort be made to achieve this goal. The evidence shows that treatments other than IVF (such as superovulation and clomiphene citrate) contribute significantly to the incidence of multiple pregnancy. There is an urgent need for studies to understand better the usage and application of these other fertility technologies within Canada, as well as the non-financial barriers to treatment. The final consensus of the expert panel was that with adequate funding and good access to treatment, it will be possible to achieve the goal of reducing IVF-related multiple pregnancy rates in Canada by 50%.

The mouse embryo culture system: improving the sensitivity for use as a quality control assay for human in vitro fertilization

OBJECTIVE To determine whether the mouse embryo culture system can be sensitized to provide improved differentiation of suboptimal culture media for in vitro fertilization. DESIGN Mouse embryo development in media prepared from one of three water sources were compared using embryos from two mouse strains, culturing embryos from either zygote or two-cell stage, and pretreating with either zona removal and/or cryopreservation. SETTING Academic research department, tertiary care referral center. RESULTS Embryos from CD1 mice were able to develop in suboptimal culture conditions, even when pretreated with zona removal or cryopreservation. Embryos from B6CBA/F1J mice were more sensitive to suboptimal culture conditions when harvested at the zygote stage than at the two-cell stage, and this sensitivity was improved after zona removal before culture. CONCLUSIONS The mouse embryo culture system has deficiencies as an assay of culture medium quality, but the sensitivity of the assay can be optimized by harvesting at the zygote stage from an appropriate strain and by zona pellucida removal before culture.

Successful circumvention of retrograde ejaculation in an infertile diabetic man

Pelvic autonomic neuropathy in diabetic men frequently results in erectile and ejaculatory problems. It is thought that from 30 to 50% of diabetic men can suffer from erectile problems (Clarke el al. 1979; McCulloch et al. 1980) although the aetiology is complex and cannot always be attributed entirely to autonomic neuropathy (Ewing et al. 1980; Fairburn 1981). Retrograde ejaculation is thought to occur less frequently, although in a study of 28 diabetic men between 20 and 57 years nine (32%) had aspermia (Klebanow & MacLeod 1960). Clearly the incidence of the complication will rise with length and severity of the disease but there have been several reports of the condition in men in the 20-40 years age group (Greene et al. 1963; Ellenberg & Weber 1966; Greene & Kelalis 1968). Unfortunately, retrograde ejaculation due to diabetic neuropathy does not usually respond to medical or surgical intervention (Clarke et al. 1979), although there can be exceptions (Andaloro Sr Dube 1975). Attempts at recovery of motile spermatozoa from urine (Hotchkiss et al. 1955; Walters & Kaufman 1959; Reiser 1961; Eliasson 1971) first resulted in a pregnancy with spermatozoa obtained from a diabetic man with retrograde ejaculation in 1971 (Bourne et al. 197 1). More recently the emphasis has been on ~ the development of non-invasive methods of circumventing the problem (Schram 1976; Mahadevan et al. 1981). Crich & Jequier (1978) reported successful pregnancies after artificial insemination with spermatozoa obtained from two patients with retrograde ejaculation, although in neither case due to diabetes. The patients were

Density gradient separation of sperm for artificial insemination.

Human spermatozoa for clinical procedures such as IUI or IVF, or for diagnostic or research studies of sperm fertilizing ability, must be separated from the seminal plasma environment not only as soon as possible after ejaculation but also as efficiently as possible, minimizing seminal plasma and bacterial carryover. Furthermore, in addition to technical simplicity and robustness, a sperm preparation method needs to select not just the more motile and morphologically normal spermatozoa but also those spermatozoa with reduced DNA damage. Currently the most effective and efficient technique for this is density gradient centrifugation, which has been extensively validated through research and clinical application. An optimized protocol based on silane-coated colloidal silica products is provided.

Quality and Risk Management in the IVF Laboratory: How are we doing?: benchmarking

1. Introduction 2. Regulation, licensing and accreditation 3. Quality and quality management 4. What is risk? 5. Process and systems 6. Making it work 7. Quality and risk management tools 8. Whats gone wrong? Troubleshooting 9. Risk management: being proactive 10. How are we doing? Benchmarking 11. Specifying systems 12. Human resources: finding (and keeping) the right staff 13. The well-run lab 14. References and recommended reading Index.

Infertility and Assisted Reproduction: Quality and Risk Management in the IVF Laboratory

This essential survival guide for successfully managing the modern-day IVF clinic condenses a wealth of expertise and experience from the authors in troubleshooting and implementing quality management in the IVF laboratory. With high-profile media coverage of mistakes at IVF clinics and escalating regulatory scrutiny, there is increasing pressure for professional accreditation. Modern accreditation schemes, which are largely based on the principles of ISO 9001 and related standards, require quality systems. Yet quality management beyond basic assay quality control is often poorly understood by biomedical scientists outside clinical chemistry laboratories. Quality and risk management are thus becoming hot topics for those working in IVF clinics and this book brings together, for the first time in one place, the basics of these essential aspects of laboratory management. The focus on taking a holistic approach to “prophylactic management” – prevention rather than cure – will be welcomed by all scientists working in IVF.

In Vitro Therapy for Sperm Motility: Specific and Nonspecific Treatments

Powerful assisted reproductive techniques (ART) have been developed to treat infertility. Intrauterine insemination (IUI) and in vitro fertilization (IVF) have been employed widely and allowed many couples the reward of children. With the improved ability to manipulate gametes precisely and routinely, intracytoplasmic sperm injection (ICSI) became possible and today represents one of the greatest technological advances in our capacity to treat various forms of infertility due to severe sperm defects. This highly technical treatment, however, is still not available in all ART centers and has been suggested to have a major drawback in that it bypasses the roocyte’s natural barriers that might discriminate spermatozoa before fertilization.