Pauline Cisneros

Fertilization after standard in vitro fertilization versus intracytoplasmic sperm injection in subfertile males using sibling oocytes

OBJECTIVE To compare conventional IVF with ICSI in the subfertile male population using sibling oocytes. Results from males with isolated severe teratozoospermia also are analyzed. DESIGN Prospective experimental study. SETTING University based IVF clinic. PATIENT(S) Group A: 18 patients with one or more abnormalities in count, motility, or morphology. Group B: 20 patients with isolated severe teratozoospermia (< or = 4% Kruger Strict Criteria). INTERVENTION(S) Ovulation induction, random allocation of sibling oocytes, and IVF or ICSI. MAIN OUTCOME MEASURE(S) Fertilization rates (fertilization per cycle, fertilization per oocytes, and fertilization per couple) and embryo quality. RESULT(S) In group A, fertilization occurred in 13 of 18 (72%) of IVF cycles and 17 of 18 (94%) of ICSI cycles. Overall, 69 of 120 (58%) oocytes fertilized after IVF, whereas 80 of 131 (61%) fertilized after ICSI. The mean (+/-SEM) percent of oocytes fertilized per couple was 44.6%+/-9.0% with IVF and 62.7%+/-5.6% with ICSI (not statistically significant). In group B, fertilization occurred in 18 of 20 (90%) cycles after IVF and 20 of 20 (100%) cycles with ICSI. Overall, 54 of 113 (48%) of the oocytes fertilized after IVF, whereas 82 of 124 (66%) fertilized with ICSI. The mean (+/-SEM) percent of oocytes fertilized per couple was 50.9%+/-7.1 % with IVF and 66.6%+/-4.7% with ICSI. No statistically significant difference in embryo quality after IVF versus ICSI was demonstrated. CONCLUSION(S) With severe teratozoospermia, ICSI results in higher fertilization rates than conventional IVF, without altering embryo quality. In our subfertile male population, there is a trend toward improved fertilization with ICSI, with less failed fertilization.

Paternal gonadal mosaicism detected in a couple with recurrent abortions undergoing PGD: FISH analysis of sperm nuclei proves valuable

Many couples are now seeking preimplantation genetic diagnosis (PGD) and fluorescence in-situ hybridization (FISH) as an alternative approach to avoid spontaneous abortion by ensuring transfer of presumed chromosomally normal embryos. This case report describes unexpected findings in a couple having three spontaneous abortions and two failed IVF cycles. In two IVF PGD cycles, four of 13 (30.8%) embryos (blastomeres) demonstrated duplication involving the Down syndrome critical region, detectable by a locus specific chromosome 21 probe. The same duplication was subsequently detected by FISH in 66 of 1002 (6.6%) sperm nuclei, demonstrating paternal gonadal mosaicism. Cytogenetic studies of peripheral blood revealed normal karyotypes in both the male and female partners. This identification of paternal germ cell or gonadal mosaicism suggests that analysis of sperm nuclei prior to undergoing IVF with PGD may be of value in patients with recurrent spontaneous abortions or multiple failed IVF.

Preimplantation genetic diagnosis for a known cryptic translocation: Follow-up clinical report and implication of segregation products

This report describes preimplantation genetic diagnosis (PGD) of a couple with a known paternally‐derived balanced cryptic translocation 46,XY.ish t(2q;17q)(210E14−,B37c1+;B37c1−,210E14+) in embryos from a couple who previously had a child with severe mental retardation and was previously described in this journal [Bacino et al., 2000 ]. This child inherited the unbalanced product of translocation from her father: 46,XX.ish der(2)t(2q;17q)pat(210E14−,B37c1+). The couple desired a normal offspring and sought PGD to avoid clinical pregnancy termination. They were treated three times with in vitro fertilization followed by PGD. Two sequential FISH hybridizations were performed. In the first hybridization, telomeric probes to 2q and 17q and a chromosome 17 centromere probe were employed. The second hybridization screened for maternal age‐related aneuploidy (X,Y,13,18,21). Of the 18 informative embryos, only 4 (22%) were normal. The remaining 12 (67%) were abnormal; most with unbalanced products (10/12) from the paternally‐derived rearrangement. The most frequent mode of segregation observed for this cryptic translocation was adjacent‐1 (7/18, 39%). This suggests cryptic translocations are amenable to PGD and, as are traditional translocations, demonstrate higher frequencies of unbalanced segregants than the empiric risk of 10–15% observed at amniocentesis or chorionic villus sampling. Thus, cryptic translocations presumably behave like overt translocations, in that PGD must be performed on a relatively large number of embryos to assure even 2–3 transferable embryos.

Vitamin supplements improve the fertility potential of a subfertile male with macrocytic anemia--a case study.

cies and described both the method and the outcome of transcervically and transabdominally performed procedures (11). The t ransabdominal approach appears to be associated with a lower abor t ion rate compared to the t ranscervica l method, however, the procedurally related risk for embryoscopy has not yet been determined. It can be anticipated that complications will occur with this technique. These complications are likely to include infection, ruptured membranes, abortion, fetal trauma, and possibly premature labor. One will also need to be watchful for any unanticipated effects. All of these complications will need to be balanced against less invasive diagnostic methods such as transabdominal and transvaginal ultrasonography and their limitations. In addition to being a new diagnostic modality, embryoscopy has the potential of being an instrument for early in utero treatment of certain genetic disorders. Fetal stem cell transfusion has the potential of correcting thalassemia or sickle cell disease in utero. Embryoscopy is the most logical instrument to use for intravascular transfusion at this early stage of development, when the fetal immune system would be accepting of an allograph without rejection. It is important to determine the risk of embryoscopy as a diagnostic modality before the risk is further confused by the addition of other variables such as blood drawing or transfusion. Risk assessment is further complicated by the infrequent need for the procedure such that any one investigator is not likely to be able collect a large series of patients. It is for this reason that diagnostic cases need to be published in detail. 6. Daffos F, Capella-Pavlofsky M, Forestier F: Fetal blood sampling during pregnancy with the use of a needle guided by ultrasound: A study of 606 consecutive cases. Am J Obstet Gynecol 1985;153:655-660 7. Nicolaides KH, Soothhill PW, Rodeck CH, Cambell S: Ultrasound guided sampling of umbilical cord and placental blood to assess fetal well-being. Lancet 1986;1:1065-1967 8. Elejalde BR, de Elejalde MM: Early genetic amniocentesis, safety, complications, time to obtain results and contraindications. Am J Hum Genet 1988;43:A232 9. Hanson FW, Zorn EM, Tennant FR, Marianos S, Samuels S: Amniocentesis before 15 weeks gestation: Outcome, risks and technical problems. Am J Obstet Gynecol 1987;156: 1524-1531 10. Ginsberg N, Brandt T, Cadkin A, Verlinsky Y, Pergarnent E: Technical aspects of chorionic villi sampling in the first trimester of pregnancy. In First Trimester Fetal Diagnosis Fraccaro M, Simoni G, Brambati B (eds). Berlin/Heidelberg/ New York/Tokyo Springer-Verlag, 1984, pp 25-31 11. Dumez Y, Mandelbrot L, Dommergues M: Diagnostic embryoscopy: 50 cases of early first trimester prenatal diagnosis. Prenatal Diagn 1992;Suppl 12:S10