Robert Wainer

Does hydrosalpinx reduce the pregnancy rate after in vitro fertilization

OBJECTIVEnTo determine the effect of hydrosalpinges on the pregnancy rate in an IVF program.nnnDESIGNnMulticentric retrospective analysis of clinical and laboratory data.nnnSETTINGnTwo assisted reproductive technology centers in university hospitals.nnnPATIENT(S)nFour hundred forty-three women, under 38 years of age, with pure tubal infertility. The patients were classified into the following five groups: bilateral hydrosalpinges (n = 37), unilateral hydrosalpinx (n = 54), bilateral tubal occlusion (n = 207), unilateral tubal occlusion (n = 55), and severe tubal disease without complete occlusion (n = 90).nnnMAIN OUTCOME MEASURE(S)nPregnancy and implantation rates.nnnRESULT(S)nThe pregnancy and the implantation rates per transfer (12.3% and 5.4%) obtained by women with bilateral hydrosalpinges are significantly lower than the rates (means = 23.1% and 12%) for all other tubal infertility groups.nnnCONCLUSION(S)nBilateral hydrosalpinges have a deleterious effect on the outcome of IVF program.

Effects of low concentrations of inhibin B on the outcomes of testicular sperm extraction and intracytoplasmic sperm injection

OBJECTIVEnTo study the effects of undetectable inhibin B concentrations on the outcomes of testicular sperm extraction (TESE) and of intracytoplasmic sperm injection (ICSI).nnnDESIGNnRetrospective study.nnnSETTINGnObstetrics, gynecology, and reproductive biology departments.nnnPATIENT(S)nWe carried out TESE on 75 men with nonobstructive azoospermia: 42 men had an inhibin B concentration of or = 15 pg/mL (group 2). Twenty-five ICSI cycles were carried out using sperm from men in group 1 (group A1), and 35 ISCI cycles were carried out using sperm from men in group 2 (group A2). The outcomes of ICSI in groups A1 and A2 were compared with those of 81 ICSI cycles performed for obstructive azoospermia (group B).nnnINTERVENTION(S)nTesticular sperm extraction, testicular spermatozoa cryopreservation, and ICSI.nnnMAIN OUTCOME MEASURE(S)nTesticular sperm extraction outcome, pregnancy, and delivery.nnnRESULT(S)nSperm were significantly less likely to be successfully recovered from men in group 1 than from those in group 2 (21% vs. 48%). The inhibin B concentration was significantly lower in men in whom TESE failed, but the FSH concentration did not differ. The implantation rate per embryo transferred was twofold lower in group A1 (7.4%) than in group B (16%), but this difference is not statistically significant.nnnCONCLUSION(S)nPatients with undetectable inhibin B concentration should be informed of the low chances of positive testicular biopsy, and more embryos should be transferred to improve the success rate.

Successful pregnancy and delivery after testicular sperm extraction despite an undetectable concentration of serum inhibin B in a patient with nonobstructive azoospermia

OBJECTIVEnTo describe a successful pregnancy and delivery after testicular sperm extraction (TESE) despite an undetectable concentration of serum inhibin B in a man with nonobstructive azoospermia.nnnDESIGNnCase report.nnnSETTINGnObstetrics and gynecology and reproductive biology departments.nnnPATIENT(S)nA 31-year-old woman and a 32-year-old man with nonobstructive azoospermia and an undetectable inhibin B serum level.nnnINTERVENTION(S)nTESE, testicular spermatozoa cryopreservation, intracytoplasmic sperm injection (ICSI).nnnMAIN OUTCOME MEASURE(S)nPregnancy and delivery.nnnRESULT(S)nSuccessful pregnancy and delivery of a normal healthy child following a third ICSI cycle with frozen-thawed spermatozoa extracted from the testis.nnnCONCLUSION(S)nThis case report shows that there is no minimal level of inhibin B below which TESE is always unsuccessful. The delivery of a normal healthy baby is strong evidence to perform TESE in these circumstances.

Peut-on optimiser la congélation des spermatozoïdes testiculaires? L’expérience du Centre Hospitalier de Poissy Saint-Germain@@@Optimizing testicular spermatozoa freezing: Poissy hospital experience

ResumeIl n’existe pas de facteur prédictif fiable permettant de pronostiquer avec certitude la présence ou l’absence de spermatozoïdes testiculaires chez les hommes atteints d’azoospermie sécrétoire. La proportion de biopsies testiculaires négatives chez ces patients est élevée, et il est donc préférable de pas pratiquer de manière synchrone la biopsie testiculaire et le cycle d’ICSI. Nous présentons ici notre expérience concernant 74 biopsies testiculaires effectuées pour azoospermie sécrétoire, ayant donné lieu à 60 cycles d’ICSI (25 couples). Les résultats sont comparés à ceux obtenus lors de 81 cycles d’ICSI effectués avec du sperme testiculaire ou épididymaire congelé lors d’indications excrétoires. Les spermatozoïdes sont congelés en petits volumes (micro-gouttes), ceci facilitant leur recherche après décongélation, et permettant d’augmenter le nombre de paillettes congelées. II est alors possible de procéder à plusieurs cycles d’ICSI pour une même biopsie testiculaire, y compris lorsque le tissu testiculaire est très pauvre en spermatozoïdes. Les résultats obtenus sont comparable dans les deux groupes, avec un taux de grossesse clinique par transfert embryonnaire de 18% dans les indications sécrétoires et de 26% dans les indications excrétoires. La réalisation systématique de la biopsie testiculaire et du cycle d’ICSI de façon asynchrone préserve les chances de grossesse du couple quel que soit l’étiologie de l’azoospermie, et permet une meilleur gestion de la prise en charge des couples concernés.Abstract50% or more of non-obstructive azoospermic men have no spermatozoa in their testicular tissue, and no non-invasive predictor of spermatogenesis is yet available. For this reason, we therefore performed all TESE (74 TESE for non-obstructive azoospermia and 37 TESE for obstructive azoospermia) prior to initiating ovarian stimulation. 34% (25/74) of TESE performed for non-obstructive azoospermia were successful. Spermatozoa were retrieved in 100% of cases of obstructive azoospermia. When TESE were positive, spermatozoa were frozen in 25–50 μl micro-droplets (several straws). 60 ICSI cycles (25 couples) were treated for non obstructive azoospermia. The clinical pregnancy rate per ICSI cycle was 18%, and the implantation rate per embryo transferred was 9.2%. 81 ICSI cycles (37 couples) were treated for obstructive azoospermia. The fertilization rate was 54%, and embryo transfer was performed in 89% (72/81) of cycles. The clinical pregnancy rate per embryo ICSI cycle was 26%, and the implantation rate per embryo transferred was 16%. This management of azoospermic patients, including TESE and multiple testicular tissue freezing in micro-droplets prior to ovarian stimulation, avoids ova pick-up cancellation and multiple TESE, as several ICSI can be performed after a single TESE. Our results show that this micro-technique for freezing testicular tissue is effective not only for obstructive azoospermia, but also for non-obstructive azoospermia when only very few spermatozoa can be extracted from the testis.