Keith Harrison

Stress and semen quality in an in vitro fertilization program.

While a greater understanding is emerging of the psychological stresses of infertility treatment, little is known about the specific effects of these stresses upon the quality of the semen sample used at the fertilization stage in an in vitro fertilization and embryo transfer (IVF-ET) program. This study evaluated two semen profiles for each of 500 couples on IVF treatment. The first semen sample was collected in the couples pre-IVF workup, and the second sample was given by husbands after ovum aspiration, and used to inseminate the eggs in vitro. Comparisons of samples revealed that sperm density, total sperm count, and both quantitative and qualitative sperm motility were significantly lower in the second sample presented for IVF. For 91% of cases, there was no change across samples in assigned fertility index categories. However, 14 cases revealed a deterioration, falling from normal to pathologic, while 21 cases changed in semen character from normal in IVF workup to severely pathologic in IVF treatment. For these cases, the incidence of total fertilization failure in the procedure also dramatically increased. Several steps are discussed in the better management of patients with such declines in semen quality.

Multiple-sited (heterotopic) pregnancy after in vitro fertilization and gamete intrafallopian transfer *

Pregnancies occurring simultaneously in different body sites (heterotopic pregnancies) are a rare condition thought to occur in 1 of 30,000 spontaneous pregnancies. Individual cases may occur after in vitro fertilization (IVF) or gamete intrafallopian transfer (GIFT). In the past 4½ years, our unit has performed 6,204 IVF/GIFT or pronuclear stage transfer cycles of treatment. Ten such pregnancies proven by surgical, ultrasound, and histological diagnosis have occurred. In the same period 640 IVF, 355 GIFT, and 6 pronuclear stage transfer clinical pregnancies were achieved. This suggests that the incidence of heterotopic pregnancy after assisted reproduction is closer to 1 of 100 pregnancies. Clinicians managing early complications of IVF, GIFT, and/or pronuclear stage transfer pregnancies should be aware of this relatively high incidence of concomitant intrauterine and extrauterine pregnancy.

The Effect of Patient Smoking Habit on the Outcome of IVF and GIFT Treatment

EDITORIAL COMMENT: This paper provides strong evidence that infertile women who are smokers achieve significantly fewer successful pregnancies with treatment. This is yet another reason to advise smokers to conquer the habit, although worry about reproductive failure (perhaps the most potent of all anxieties) may result in increased difficulty in giving up this variety of drug addiction ‐ unfortunately this is likely to particularly apply to heavy smokers.

Miscarriage karyotype and its relationship with maternal body mass index, age, and mode of conception.

This study investigated the association between miscarriage karyotype and body mass index, maternal age, and mode of conception. Miscarriages after IVF and/or intracytoplasmic sperm injection were less frequently aneuploid; advanced maternal age was associated with an increase in aneuploid products of conception; overweight and obese women aged <35 years were less likely to have aneuploid miscarriages than women in a healthy weight range, suggesting alternate mechanisms for miscarriage in this population.

The predictive value of idiopathic failure to fertilize on the first in vitro fertilization attempt

OBJECTIVE To investigate the subsequent performance of patients with idiopathic fertilization failure on the first in vitro fertilization (IVF) cycle. DESIGN A retrospective study of 2,322 consecutive patients undergoing their initial IVF cycle. SETTING Advanced infertility treatment in an IVF/general infertility clinic. PATIENTS In 5 years, 94 couples with unexplained failed oocyte fertilization had 270 cycles of treatment. Each couples performance was tracked through subsequent cycles of treatment. INTERVENTIONS In vitro fertilization with husband and donor sperm. MAIN OUTCOME MEASURE(S) Investigated retrospectively after 5 years of data collection. RESULTS Sixty-five couples of the original 94 had a second IVF attempt. Fifty of these successfully fertilized oocytes with husbands sperm and 4 with donor sperm. Nineteen of the 65 couples who continued treatment achieved a pregnancy, and only one couple had continuing fertilization failure. CONCLUSIONS The prognosis in the study group was surprisingly favorable despite the initial failed IVF treatment cycle.

Fertilization of human oocytes in relation to varying delay before insemination

Fertilization and pregnancy rates in an in vitro fertilization and embryo transfer program were studied after a range of insemination times of between 1 and 26 hours after oocyte recovery. There was no significant variation in fertilization rate across this range. The pregnancy rate showed no significant variation for insemination between 3 and 16 hours after aspiration. However, it was disappointing at 2 hours (3%), and no pregnancies were achieved from the nine patients whose ova were inseminated 20 or more hours after aspiration. It is concluded that mature oocytes can be inseminated in vitro at any time between 3 and 16 hours after aspiration and still retain the same potential to produce a pregnancy.

Contribution of the assisted reproductive technologies to fertility in males suffering spinal cord injury.

Summary: This study reviews 19 couples referred between 1990 and 1997 for fertility treatment for anejaculatory infertility in the male partner following spinal injury. Using sperm obtained by assisted ejaculation procedures, 14 of the 19 patients (74%) achieved at least 1 pregnancy. Pregnancy rates per treatment cycle were 12.0% for timed intrauterine insemination, 38.9% for gamete intra‐Fallopian transfer and 19.2% for intracytoplasmic sperm injection followed by uterine embryo transfer. Choice of the appropriate assisted reproduction treatment to match the available semen quality results in a high level of success in such patients.

Sperm DNA fragmentation in men with malignancy

OBJECTIVE To determine if men with malignancy have increased sperm DNA fragmentation compared with men presenting for sperm donation. DESIGN Retrospective observational study. SETTING Tertiary-level fertility center. PATIENT(S) Eighty-nine men with cancer presenting for prophylactic semen cryopreservation and 35 men presenting for sperm donation. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Sperm DNA fragmentation index (DFI) measured by sperm chromatin assay. RESULT(S) The mean sperm DFI in men with a diagnosis of cancer, 9.88% (95% confidence interval [CI] 7.84%-12.44%), did not differ from that found in men presenting for sperm donation 10.46% (95% CI 8.68%-11.80%). There were no significant differences in mean sperm DFI within cancer subgroups or when comparing testicular and nontesticular cancers. Subgroup analysis lacked statistical power. Men with testicular cancer have significantly reduced sperm concentration compared with both control subjects and men with nontesticular cancer. CONCLUSION(S) In our study population there was no difference in sperm DFI between men undergoing prophylactic semen cryopreservation and men presenting for sperm donation. Sperm DFI assessment has limited utility in the routine evaluation of men presenting for semen cryopreservation.

Postoperative Vomiting Factors in IVF Patients

Summary: Postoperative vomiting patterns were documented in 504 patients having general anaesthesia for oocyte retrieval for in vitro fertilization or related procedures and compared with patient preoperative history and expectations, response to ovarian hyperstimulation, and details of the anaesthesia. The results showed that the likelihood of vomiting was related to peak plasma oestradiol level and the patients expectation based on previous experience of anaesthesia.

Incidence of transmissible diseases in a network of assisted reproduction clinics throughout Queensland

In assisted reproduction, knowledge of the presence of transmissible disease assists diagnosis and permits appropriate risk minimisation. The overall incidence was lowest in the Brisbane full‐cost clinic and highest in the Springwood low‐cost clinic. Male partners predominated over females, particularly in the low‐cost clinic. Hepatitis C was the most commonly detected infection with the highest incidence in the low‐cost clinic. HIV was the least commonly detected infection amongst those tested.