Dietmar Spitzer

The combination matters - distinct impact of lifestyle factors on sperm quality: a study on semen analysis of 1683 patients according to MSOME criteria

BackgroundPoor sperm quality can negatively affect embryonic development and IVF outcome. This study is aimed at investigating the influence of various lifestyle factors on semen quality according to MSOME (motile sperm organelle morphology examination) criteria.Methods1683 male patients undergoing assisted reproductive technologies (ART) in our clinic were surveyed about their age, BMI (body mass index), ejaculation frequency, nutrition, sports, sleeping habits and social behavior. Semen samples were collected and evaluation of semen parameters according to MSOME and WHO criteria was performed. Results were grouped and statistically analyzed.ResultsAlthough single parameters had minor effects on sperm parameter, the combination of age, BMI, coffee intake, ejaculatory frequency and duration of sexual abstinence were identified as factors having a negative effect on sperm motility. Additionally, we could demonstrate that MSOME quality was reduced. The negative impact of age, BMI and coffee intake on sperm quality could be compensated if patients had a high ejaculation frequency and shorter periods of sexual abstinence.ConclusionsCombinations of adverse lifestyle factors could have a detrimental impact on sperm, not only in terms of motility and sperm count but also in terms of sperm head vacuolization. This negative impact was shown to be compensated by higher ejaculation frequency and a shorter period of sexual abstinence. The compensation is most likely due to a shorter storage time in the male gonads, thus reducing the duration of sperms’ exposure to reactive oxygen species (ROS).

Transfer of blastocysts with deviant morphological and morphokinetic parameters at early stages of in-vitro development: a case series

Time-lapse imaging is increasingly applied as an adjunct to reproductive medicine. The gained information of the morphological and morphokinetic variables before the onset of transcription are supposed to be good predictors for the selection of the best embryo for transfer and are often seen in line with clinical outcomes. This retrospective case series investigated the outcome of transferred blastocysts that did not fulfil the proposed embryo scores at early cleavage or at later stages of development. The observations were made by time-lapse imaging. This study reports the birth of 16 healthy children after day-5 blastocyst transfer, of which at least one of the transferred embryos originated from deviant morphology and/or kinetic cleavage patterns. This case series suggests that some blastocysts derived from embryos with poor conventional morphological score and/or suboptimal morphokinetics can be successfully transferred and might result in live births. Such results might raise awareness that discarding embryos based only on early events is not a suitable approach to give patients the chance to conceive. In conclusion, to date only the transfer of viable embryos after culturing them until day 5 guarantees optimal embryo selection and helps to prevent embryo wastage.

Effects of embryo transfer quality on pregnancy and live birth delivery rates.

BackgroundTo analyze the effects of embryo transfer (ET) quality on clinical pregnancy (CPR) and live birth delivery rates (LBDR).MethodsIn a retrospective study at a single, private infertility center between November 2005 and December 2009 one thousand fifty-five day-3 and day-5 ETs following IVF/ICSI/IMSI were evaluated. We analyzed the impact of an atraumatic ET with a soft catheter (ET 1), after external guidance (ET 2), after probing of the cervix with a stylet (ET 3), or after grasping the portio vaginalis with a tenaculum (ET 4) on CPR and LBDR.ResultsThe use of external guidance showed a significantly reduced LBDR as compared to an atraumatic ET (26.0% vs. 32.5%). The lowest CPR and LBDR were found in ET 4. The application of stylets in cases of difficult ETs was superior to the use of external guidance. No differences in miscarriages between ET 1–4 were noted.ConclusionsBesides embryo culture and patient history, the quality of an ET might also have an important impact on pregnancy outcome. Techniques to ensure an atraumatic ET, such as mechanic uterine cavity length measurements, before starting treatment might help identify patients at risk for a difficult ET and lead to modified treatments, such as the primary use of a stylet. Limitation of study: retrospective analysis

Intrauterine administration of human chorionic gonadotropin does not improve pregnancy and life birth rates independently of blastocyst quality: a randomised prospective study

BackgroundSuccessful embryo implantation depends on axa0well-timed maternal-embryonic crosstalk. Human chorionic gonadotropin (hCG) secreted by the embryo is known to play a key role in this process and to trigger a complex signal transduction cascade allowing the apposition, attachment, and invasion of the embryo into the decidualized uterus. Production of hCG was reported to be dependent on blastocyst quality and several articles suggested that intrauterine hCG injection increases pregnancy and implantation rates in IVF patients. However, no study has as yet analysed birth rates as final outcome. Our objective was to determine whether clinical outcome after blastocyst transfer can be improved by intrauterine injection of hCG and whether this is dependent on blastocyst quality.MethodsA prospective randomised study was conducted in two settings. In cohort A, hCG application was performed two days before blastocyst transfer. In cohort B, the administration of hCG occurred just prior to embryo transfer on day 5. For both cohorts, patients were randomised to either intrauterine hCG application or to the control group that received culture medium. Clinical outcome was analysed according to blastocyst quality of transferred embryos.ResultsThe outcome of 182 IVF-cycles (cohort A) and 1004 IVF-cycles (cohort B) was analysed. All patients received a fresh autologous blastocyst transfer on day five. Primary outcomes were pregnancy rates (PR), clinical pregnancy rates (cPR), miscarriage rates (MR), and live birth rates (LBR). No improvement of clinical outcome after intrauterine hCG administration on day 3 (cohort A) or day 5 (cohort B) was found, independently of blastocyst quality transferred. The final outcome in cohort A: LBR after transfer of top blastocysts was 50.0xa0% with hCG and 53.3xa0% in the control group. With non-top blastocysts, LBR of 17.1xa0% (hCG) and 18.2xa0% (control) were observed (n.s.). In cohort B, LBR with top blastocysts was 53.3xa0% (hCG) and 48.4xa0% (control), with non-top blastocysts it came to 28.7xa0% (hCG) and 35.0xa0% (control). The differences between the groups were statistically not significant. Furthermore, we investigated axa0possible benefit of hCG administration in correlation with female age. In both age groups (<38xa0years andu2009≥u200938xa0years) we found similar LBR after treatment with hCG vs. medium. A LBR of 47.1xa0% vs. 48.7xa0% was obtained in the younger group and 26.6xa0% vs. 30.8xa0% in the older group.ConclusionsIn contrast to previous studies indicating a substantial benefit from intrauterine hCG application in cleavage stage embryo transfers, in our study we could not find any evidence for improvement of clinical outcome in blastocyst transfer cycles, neither with top nor with non-top quality morphology.

Sperm head vacuoles are not affected by in-vitro conditions, as analysed by a system of sperm-microcapture channels.

Since the introduction of the motile sperm organelle morphology examination, there has been increasing recognition of the fact that the presence of large nuclear vacuoles might have deleterious effects on embryo development. Nevertheless, one fundamental question still being debated is whether specific in-vitro conditions during the handling of semen have an impact on vacuole formation. This studys objective was to analyse whether incubation temperature (20, 37°C) or oxidative stress stimulates the formation of nuclear vacuoles. Furthermore, it examined whether vacuoles disappear in the presence of an acrosome reaction inducer. Therefore, a system of sperm-microcapture channels was developed to permit the observation of the same living spermatozoa over a period of 24h. Neither incubation at 37°C nor induction of oxidative stress led to de-novo formation of nuclear vacuoles. Induction of the acrosome reaction using calcium ionophore A23587 did not lead to any modifications in the proportion of spermatozoa with vacuoles or to the disappearance of pre-existing vacuoles. According to these observations, it is concluded that nuclear vacuoles on the sperm head are already produced at earlier stages of sperm maturation and are not induced or modulated by routine laboratory environments. The examination of spermatozoa at very high magnification has led to the increasingly widespread recognition that the presence of large vacuoles in the human sperm head has deleterious effects on embryo development. One fundamental question, however, still remains: do specific conditions in the laboratory during the preparation and the handling of semen have an impact on vacuole formation? Our initial objective was to analyse whether different incubation temperatures (20, 37°C) and the induction of oxidative stress lead to the formation of sperm head vacuoles. Furthermore, we examined whether vacuoles disappear in the presence of an acrosome reaction inducer. In order to do this we developed a system of sperm-microcapture channels, which permits the observation of the same living spermatozoa over a period of 24h. Incubation at 37°C or induction of oxidative stress did not lead to the formation of any new vacuoles. After inducing the acrosome reaction, we did not detect any modification in the proportion of vacuolated spermatozoa. According to our observations, different temperatures or environmental conditions in the laboratory have no impact on the formation or disappearance of vacuoles. We conclude that sperm head vacuoles are already produced at earlier stages of sperm maturation.

Antioxidant Supplementation of Subfertile Men Improves Top-Blastocyst Rate in Couples Undergoing IVF/IMSI

Antioxidant Supplementation of Subfertile Men Improves Top-Blastocyst Rate in Couples Undergoing IVF/IMSI n nIn recent years, oxidative stress (OS) has been identified as important factor in male infertility. Thus, the intake of antioxidants to improve semen quality (in subfertile men) has been widely discussed. Improvements of semen quality after supplementation have been reported. However, this issue is still underevaluated. Critics complain a lack of data regarding firstly the use of antioxidants due to the heterogeneity between patient groups, nutritional supplements and treatment effect and secondly rare data in regard to the impact of supplementation on assisted reproduction technique (ART) outcome. In this study the effect of an antioxidant supplementation (AOS) on semen quality and therapy outcome of 92 couples undergoing fertility treatment was assessed..

Impact of high magnification sperm selection on neonatal outcomes: a retrospective study

PurposeThe aim of this study was to compare the effect of the deselection of spermatozoa presenting vacuole-like structures using IMSI (intracytoplasmic morphologically selected sperm injection) with ICSI (intracytoplasmic sperm injection) by means of neonatal outcomes.MethodsIn a retrospective two-center analysis, a total of 848 successful IMSI or ICSI cycles ending with a live birth, induced abortion, or intrauterine fetal death (IUFD) were included.ResultsThe IMSI and ICSI groups included 332 and 655 babies or fetuses, respectively. The parents were older in the IMSI group than in the ICSI group (mothers were 35.1 vs 32.9xa0years, and fathers were 39.1 vs 36.2xa0years). The multiple pregnancy rate was higher in the IMSI group. The mean pregnancy duration and mean birth weight were almost identical in both groups. There was no significant difference in major congenital malformations between the two groups. However, this rate was decreased in the IMSI group compared to that in the ICSI group (1.8 vs 3.2%), the difference being mainly found in singletons (1.4 vs 3.3%). Boys were more often affected than girls in both groups. The percentages of chromosomal abnormalities did not differ between the IMSI and ICSI groups (0.6 and 0.8%). The reported congenital malformations mainly affected the heart, urogenital, and musculoskeletal systems.ConclusionsIn the present study, the malformation rates observed in the IMSI and ICSI groups were not significantly different, even if slightly lower after IMSI. However, the observed difference followed the same trends observed in previous reports, indicating the possible impact of IMSI on decreasing congenital malformation occurrences. This highlights the necessity to prospectively evaluate the impact of IMSI on neonatal outcome after IVF treatment.

Principles of 3D Ultrasound

Within the last few years, 3D ultrasound (US) has become an approved tool for use in the field of in vitro fertilization (IVF). An increasing number of publications within the last decade have demonstrated that the application of 3D sonography in medicine is superior to the conventional 2D technique. Therefore, it is very likely that it will play an increasingly important role in assisted reproductive techniques (ART) such as follicle monitoring or in the detection of pelvic pathologies. However, as 3D ultrasound is still a new tool, there is a lack of standardization. Moreover, many aspects of this innovative technique and its novel instruments are often not well understood by many operators. Therefore, 3D US application often lags behind its scope. This chapter will address the basic principles and techniques for producing 3D US images and how to optimize image quality. We will discuss its technical capabilities as well as its limitations, such as artifacts due to improper calibration. In addition, a short list of clinical applications for this technique will be presented.

Dietary Supplementation Improves Blastocyst Number and Ongoing Pregnancy Rate of IVF Patients with Hashimoto Thyroiditis

In Assisted Reproduction Techniques (ART), autoimmune disorders of the thyroid gland present as common concomitant diseases. Hypothyroidism caused by autoimmune thyroiditis can impair fertility and pregnancy. Hashimoto thyroiditis (HT) is the most common autoimmune thyroid disease (AITD). Patients with HT undergoing IVF/ICSI using the long protocol are thought to benefit from a broad therapeutic concept. We compared the outcome of two different therapeutic schemes for HT patients presenting at our fertility clinic and compared the outcome to ART patients without thyroiditis. TSH level was adjusted to under 2 µIU/mL using L-thyroxine, as required. Concurrent medication from the time of oocyte puncture included daily administration of fragmin (dalteparin) and acetylsalicylic acid (ASA), as well as prednisolone in increasing dosage. One group of these HT patients (group1, n=56) had additionally highly-dosed folic acid, another group (group 2, n=50, referred to as the supplemented group) was alternatively supplemented with a micronutrient preparation containing selenium, high-dose folic acid, B-vitamins, antioxidants and iron. We compared the number of oocytes, fertilization rate, blastocyst formation rate, pregnancy- and ongoing pregnancy rate between the two groups. Also, the ART outcomes of both groups were compared to ART results of non-HT patients within the same age group. We observed a significant increase in the blastocyst rate and demonstrated a substantial rise in ongoing pregnancy rate of the supplemented patients. These also needed less L-thyroxine to achieve optimal TSH level. The outcome of the micronutrient supplemented patients corresponded to the average of healthy IVF patients without HT at our clinic.

EGP: expected gametes performance evaluated by blastocyst culture, a new standard to define "response" from a holistic viewpoint.

Capsule Introduction of EGP, combining ovarian response, gametes quality, fertilization, and embryo development to day 5, will redefine evaluation of IVF-success and quality control.