S. Kumagai

Seven pregnancies and deliveries from non-mosaic Klinefelter syndrome patients using fresh and frozen testicular sperm.

AbstractPurpose: The aim of this study was to investigate the feasibility of using frozen-thawed testicular sperm as well as the timing of testicular sperm extraction (TESE) in patients with non-mosaic Klinefelter syndrome. Methods: Intracytoplasmic sperm injection (ICSI) was performed in six of 17 (35%) patients whose sperm was recovered by TESE. Multiple biopsies of both testes were performed on the day of oocyte retrieval in all but one of the six patients. Results: Seven pregnancies and deliveries were achieved in five couples, and one couple was unsuccessful. Five pregnancies were achieved using fresh motile sperm, and two were achieved using frozen-thawed sperm. Sperm cryopreservation was not possible in one of the five couples because of the small number of recovered sperm, and possible in four other couples for subsequent ICSI. One woman whose husband had TESE performed prior to ovarian stimulation did not become pregnant. This may be due to the attainment of only a few immotile sperm following the frozen-thawed procedure. Conclusion: The outcome of ICSI using fresh or frozen-thawed testicular sperm in patients with non-mosaic Klinefelter syndrome was identical; however, TESE should be performed on the day of oocyte retrieval until such time as a procedure with a higher sperm yield from TESE is available. Moreover, an improved recovery procedure after cryopreservation-thawing of a single spermatozoon must be developed.

Oocyte Retrieval and Embryo Transfer

ABSTRACT When the first successful delivery following in vitro fertilization and embryo transfer was reported in 1978, oocyte aspiration was performed laparoscopically under general anesthesia. Since 1985, almost all IVF centers have collected oocytes using transvaginal ultrasound-directed methods for the good reason that these methods are the easiest, most accurate and most acceptable to patients. Color Doppler ultrasonography is recommended to decrease blood loss during oocyte aspiration. Embryos were gently, slowly and transcervically, expelled into the uterine cavity, with the patient in a lithotomy position. This basic method remained unchanged since the first description. Relatively important factors for successful embryo transfer include removal of hydrosalpinges, absence of blood or mucus on catheter, using soft catheter type, avoidance of fundus contact, avoiding tenaculum, removal of all mucus, ultrasonography of cavity before transfer, inject one embryo within 10 μL volume slowly 1.5 cm from fundus, trial transfer, ultrasonographic monitoring, and antiprostaglandins administration to prevent uterine contractions.