Marguerite Camus

CRYOPRESERVATION OF SUPERNUMERARY MULTICELLULAR HUMAN EMBRYOS OBTAINED AFTER INTRACYTOPLASMIC SPERM INJECTION

OBJECTIVEnTo investigate the pregnancy rate of frozen-thawed human supernumerary multicellular embryos that were cryopreserved after intracytoplasmic sperm injection or IVF.nnnDESIGNnA clinical study.nnnSETTINGnConsenting patients in an academic research environment.nnnPATIENTSnCouples with severe male infertility, indicated by failed or sporadic fertilization after IVF or subzonal insemination or by < 500,000 progressively motile spermatozoa in the entire ejaculate, and couples for IVF during the same period.nnnINTERVENTIONSnAfter microinjection or IVF, the three best-quality embryos were transferred, and 1,171 embryos from intracytoplasmic sperm injection compared with 2,495 embryos from IVF were frozen with dimethyl sulphoxide. Of these, 413 and 969 embryos were thawed, respectively.nnnMAIN OUTCOME MEASUREnThe survival rate, the total and clinical pregnancy rates, the delivery rate, and the preclinical abortion rate were calculated.nnnRESULTSnFifty-three percent of the thawed intracytoplasmic sperm injection embryos survived. Twenty-two pregnancies have been established in 101 transfers, corresponding to a total pregnancy rate of 21.8% per transfer. The clinical pregnancy rate was 12.9% per transfer and the delivery rate was 5.9% per transfer. Of the IVF embryos, 51% survived and 37 pregnancies have been established in 253 transfers. The total and clinical pregnancy rates and the delivery rate were 14.6%, 10.7%, and 7.1%, respectively. The preclinical abortion rate was 40.9% for cryopreserved intracytoplasmic sperm injection embryos and 27.0% for IVF embryos.nnnCONCLUSIONSnThe high incidence of preclinical abortions after transfer of human embryos cryopreserved after intracytoplasmic sperm injection requires extension of the series.

Intracytoplasmic sperm injection versus in vitro fertilization: A randomized controlled trial and a meta-analysis of the literature

OBJECTIVEnTo compare ICSI with IVF using two insemination concentrations in moderate male infertility and to compare these data with other randomized controlled trials (RCTs).nnnDESIGNnProspective, randomized, controlled trial and meta-analysis.nnnSETTINGnUniversity-based tertiary referral center.nnnPATIENT(S)nSeventy-three couples undergoing ART.nnnINTERVENTION(S)nIn one IVF group a standard insemination concentration of 0.2 x 10(6)/mL was used, whereas in the other group a high insemination concentration (HIC) of 0.8 x 10(6)/mL was used. Each protocol was compared with ICSI on sibling oocytes.nnnMAIN OUTCOME MEASURE(S)nFertilization, fertilization failure, and embryonic development.nnnRESULT(S)nThe overall fertilization rate was significantly lower after standard IVF than after ICSI: 37.4% vs. 64.3%. Where HIC IVF was used, the overall fertilization rate was not significantly different from that after ICSI: 59.6% vs. 67.6%. Eight randomized controlled trials were selected and reviewed together with the present randomized controlled trial by meta-analysis. The risk ratio for an oocyte to become fertilized was 1.9 (95% confidence interval of 1.4 to 2.5) in favor of ICSI, and 3.1 ICSI cycles may be needed to avoid one complete fertilization failure after conventional IVF (95% CI of 1.7 to 12.4).nnnCONCLUSION(S)nThe data from this study and the meta-analysis show that ICSI is a more efficient technique in terms of fertilization, but not in comparison with HIC IVF.

Adverse effect of amniofetography on fetal thyroid function

Amniofetography is a valuable tool for the diagnosis of fetal malformations. This technique is being used routinely in pregnancies carrying a high risk of external fetal malformations. There are very few published data concerning the effect of radiopaque dyes, containing large amounts of iodide, on fetal thyroid function. We have performed serial determinations of serum thyrotropin and thyroxine in seven newborn infants to assess the effect of amniofetogrpahy on fetal thyroid function. This work demonstrates that amniofetography induces a transient impairment of fetal thyroid function.

Adnexal torsion after gonadotrophin ovulation induction for IVF or ICSI and its conservative treatment

Abstractu2002This study was designed to find out the incidence of ovarian torsion in the patients who were in ovulation induction treatment for either In vitro fertilization (IVF) or Intracytoplasmic sperm injection (ICSI). Also operative laparoscopic conservative treatment (detorsion or unwinding the twisted adnex) was tried to perform to all the patients. Among 10,583 cycles 9 ovarian torsion cases had been diagnosed laparoscopically between January 1994 and October 1998. 104 ovarian hyperstimulation syndrome (OHSS) patients were evaluated during that time. From 104 hyperstimulated cases three had torsion of the adnex and two of them were pregnant. Five of the patients were clinically and one was chemically pregnant. First, laparoscopy was done to all the patients and 8 of them could be detorsioned, in one case unwinding performed by laparotomy because of the large size of the ovary. No complications were observed after conservative surgery. These results demonstrate that, in the IVF or ICSI clinics ovarian torsion has to be regarded as one of the major complications especially if the patients are hyperstimulated or pregnant or both. Immediate manipulation is needed conservatively, preserving the ovaries which were very important for those infertile patients.

Outcome of pregnancies after intracytoplasmic sperm injection and the effect of sperm origin and quality on this outcome

Abstract Objective: To describe the outcome of pregnancies obtained after intracytoplasmic sperm injection (ICSI) and the impact of the origin and quality of sperm used on this outcome. Design: Retrospective analysis. Setting: A tertiary referral center for assisted reproduction. Patient(s): Pregnant patients conceived after microinjection of ejaculated sperm (n = 1,427), epididymal sperm (n = 79), and testicular sperm (n = 93). Intervention(s): ICSI, epididymal sperm aspiration, and testicular biopsy. Main Outcome Measure(s): Stillbirth, prematurity, and early perinatal mortality. Result(s): The delivery rate of multiple births was 31.4%, and the preterm delivery rate was 25.6%. The prematurity rates in singletons, twins, and triplets were 9.9%, 56.7%, and 96.6%, respectively. The early perinatal mortality rate of the entire population was 26.1‰. In the ejaculated-sperm group, when the sperm was severely defective (group 1), 14 intrauterine deaths occurred (3.1%). In the second and third groups, in which sperm was moderately defective, there were 2 deaths and 1 death (0.6% and 0.4%), respectively. The difference between the number of deaths in group 1 vs. groups 2/3 was statistically significant. Conclusion(s): The rates of multiple pregnancies, preterm deliveries, low birth weight, and early perinatal mortality were higher after ICSI than after natural conception. In the ejaculated-sperm group, the rate of intrauterine death was higher in the severely defective sperm group than in the better-quality sperm groups.

Absolute asthenozoospermia and ICSI: what are the options?

BACKGROUNDnComplete asthenozoospermia, i.e. 100% immotile spermatozoa in the ejaculate, is reported at a frequency of 1 of 5000 men. Its diagnosis implies a poor fertility prognosis even with ICSI. It is extremely important to distinguish between two different groups of patients with complete asthenozoospermia, i.e. virtual or absolute asthenozoospermia. With the former group having some motile spermatozoa after extensive processing of the semen, absolute asthenozoospermia can be associated with metabolic deficiencies, ultrastructural abnormalities of the sperm flagellum, necrozoospermia otherwise it can be idiopathic. In the management of persistent absolute asthenozoospermia, it is very important to elucidate its nature and whenever possible to correct the potential causes.nnnMETHODSnWe reported data published in the literature on the aetiology of absolute asthenozoospermia and the different techniques to improve ICSI outcome. We propose an algorithm for diagnosis and treatment of this condition. RESULTS Different results regarding fertilization, cleavage and pregnancy rate have been published in patients with absolute asthenozoospermia undergoing ICSI. However, the results vary widely depending on the sperm origin and the technique applied for immotile sperm selection. The percentage of viable spermatozoa varies between 0 and 100%.nnnCONCLUSIONSnAbsolute immotile spermatozoa is one of the most important causes of reduced fertilization and pregnancy rates after ICSI and different techniques are used to improve ICSI outcomes. However, it still remains unclear which is the best technique to improve the pregnancy outcomes in these couples.

Serum thyrotrophin determination on day 5 of life as screening procedure for congenital hypothyroidism.

In 327 newborns cord blood thyroxine (T4) was 11.8 +/- 0.4 mug/100 ml (SEM) (151.9 +/- 5.1 nmol/l), and serum thyrotrophin (TSH) 6.7+/-1.0 muU/ml. Variability was marked for both T4 and TSH. Remeasured in the same patients on the fifth day of life, the TSH level was 3.7 +/- 1.0 muU/ml, lower than at birth (P less than 0.001), while scattering of TSH values was much smaller, with 99.4 % of values less than 12 muU/ml...

Prospective randomized study on the cryopreservation of human embryos with dimethylsulfoxide or 1,2-propanediol protocols*†

OBJECTIVEnTo investigate the optimal protocol for cryopreservation of human embryos obtained from IVF.nnnDESIGNnProspective randomized study.nnnSETTINGnConsenting patients in an academic research environment.nnnPATIENTSnCouples undergoing IVF.nnnINTERVENTIONSnA cohort of 2,220 supernumerary multicellular embryos were obtained from 488 patients who were randomized over slow freezing protocols with dimethylsulfoxide (DMSO, 819 embryos), 1,2-propanediol (699 embryos) or a mixture of DMSO and 1,2-propanediol (702 embryos). A total of 725 embryos have been thawed (DMSO, 232 embryos; 1,2-propanediol, 250 embryos and DMSO and 1,2-propanediol, 243 embryos) for transfer in natural ovarian cycles.nnnMAIN OUTCOME MEASURESnEmbryo survival rate, embryo implantation rate, clinical pregnancy rate (PR), delivery rate, live-birth rate.nnnRESULTSnThe embryo survival rate was significantly higher with the DMSO protocol (52.6%) than with the 1,2-propanediol (32.0%) or the DMSO and 1,2-propanediol protocols (34.9%). The clinical PR per thawing cycle was significantly higher in the DMSO protocol (17.2%) than in the 1,2-propanediol protocol (3.9%). The clinical implantation rate per embryo thawed was significantly different between a DMSO-frozen embryo (4.7%) and a 1,2-propanediol-frozen embryo (1.2%). A DMSO and 1,2-propanediol-frozen embryo had a 3.7% chance of of implantation. The delivery rate per thawing cycle was significantly higher in the DMSO protocol (12.5%) than in the 1,2-propanediol protocol (2.6%). The live-birth rates per embryo thawed were 3.5%, 0.8%, and 2.9% in the DMSO, 1,2-propanediol, and DMSO and 1,2-propanediol groups, respectively.nnnCONCLUSIONnSupernumerary multicellular embryos as presented in daily clinical IVF practice have the highest chance of survival and of implantation after cryopreservation when DMSO has been used.

Effect of repeated assisted reproductive technology cycles on ovarian response

OBJECTIVEnTo assess the effect of repeated assisted reproductive technology (ART) cycles on the ovarian response in patients treated with human menopausal gonadotropins and GnRH agonists.nnnDESIGNnRetrospective analysis.nnnSETTINGnTertiary referral center.nnnPATIENT(S)nThree thousand two hundred forty-nine patients who had completed at least two in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) cycles (minimum two, maximum six cycles per patient).nnnINTERVENTION(S)nNine thousand three hundred seventy-nine repeated IVF/ICSI cycles.nnnMAIN OUTCOME MEASURE(S)nMean number of cumulus oocyte complexes (COC) retrieved per cycle, mean number of ampules used per attempt.nnnRESULT(S)nRepeated ART cycles did not exert a significant effect on the mean number of COC retrieved per attempt in contrast to maternal age, which was inversely related to the mean number of COC retrieved in all cycles performed. Across repeated ART attempts, an increase in the mean number of ampules used per cycle was observed. This was due to an effect of maternal age, which increased in line with the mean number of ampules used per cycle, as well as to an age-independent effect of repeated cycles.nnnCONCLUSION(S)nAn age-independent deterioration of the ovarian response appears to occur across repeated ART cycles.

Spontaneous pregnancies in couples who discontinued intracytoplasmic sperm injection treatment: a 5-year follow-up study

OBJECTIVEnTo analyze the occurrence of deliveries after spontaneous conception in patients who have discontinued unsuccessful intracytoplasmic sperm injection (ICSI) treatment.nnnDESIGNnCohort follow-up study.nnnSETTINGnTertiary referral center.nnnPATIENT(S)nBetween July 1992 and December 1993, 200 Belgian women younger than 37 years underwent 433 consecutive unsuccessful ICSI cycles with freshly ejaculated sperm and eventually discontinued their treatment.nnnINTERVENTION(S)nUltrasound-guided oocyte retrieval and ICSI.nnnMAIN OUTCOME MEASURE(S)nDelivery after 25 weeks following a spontaneous pregnancy.nnnRESULT(S)nThe mean age at the time of the last oocyte pick-up was 31.0 +/- 3.9 years. The mean time interval between the last ICSI and the end of the follow-up period was 47.7 +/- 12.1 months. Twenty-three spontaneous pregnancies ending in delivery after 25 weeks were observed (11.5%). The cumulative delivery rate reached a plateau of 10% after 36 months of follow-up. The mean time interval (from last oocyte retrieval) for spontaneous pregnancy to occur after discontinuing ICSI treatment was 20.2 +/- 13.7 months. Proportional hazards analysis showed that delivery rate was reduced by 2.0% per year of infertility.nnnCONCLUSION(S)nThis study suggests that duration of infertility appears to be predictive of the likelihood of live delivery after spontaneous conception following an unsuccessful ICSI treatment.