S. Papier

Birth of twin males with normal karyotype after intracytoplasmic sperm injection with use of testicular spermatozoa from a nonmosaic patient with Klinefelter’s syndrome

OBJECTIVE To report the birth of healthy twin males after the use of testicular spermatozoa from a nonmosaic patient with Klinefelters syndrome. DESIGN Case report. SETTING Private reproduction center with university affiliation. PATIENT(S) A couple undergoing intracytoplasmic sperm injection (ICSI) combined with testicular sperm extraction because of the husbands secretory azoospermia and a nonmosaic 47,XXY peripheral blood karyotype. The wife, a healthy female, presented with a history of oligomenorrhea. INTERVENTION(S) ICSI was performed using testicular spermatozoa; 3 mM pentoxifylline solution was used to induce sperm motility because the spermatozoa recovered were all immotile. MAIN OUTCOME MEASURE(S) Normal fertilization, embryo cleavage, pregnancy outcome, and peripheral blood karyotype of the newborns. RESULT(S) Thirteen metaphase II oocytes were injected. Seven of them fertilized normally and six did not fertilize. Three good-quality embryos (4-cell stage class II) were transferred, and four were cryopreserved at the two-cell and four-cell stages using a slow freezing protocol. Twelve days after ET, a beta-hCG determination was positive. Ultrasonographic examination revealed three intrauterine fetal sacs, but one of them showed a fetal pole without cardiac activity and vanished in subsequent ultrasonographic examinations. The patient delivered twins with normal male peripheral blood karyotypes. CONCLUSION(S) Normal outcome after the use of testicular sperm extraction and ICSI in a nonmosaic patient with Klinefelters syndrome reaffirms the notion of low transmission risk of this gonosomal aneuploidy.

Healthy baby born after reduction of sperm DNA fragmentation using cell sorting before ICSI.

Magnetic activated cell sorting (MACS) with annexin V microbeads recognizes externalized phosphatidylserine (PS) residues on the surface of apoptotic spermatozoa. The successful use of this novel technique applied to a highly apoptotic semen sample before performing intracytoplasmic sperm injection (ICSI) is reported here. The use of annexin V microbeads for selecting non-apoptotic spermatozoa seems to reduce the percentage of altered cells, improving the chance of pregnancy after ICSI.

Virtual hysteroscopy by multidetector computed tomography

Currently accepted techniques that evaluate the uterus and female reproductive system in the infertility workup algorithm include hysterosonography, hysteroscopy and hysterosalpingography. Based on high speed multidetector computed tomography (MDCT) which can acquire high-quality volumetric data of the pelvic region in a single brief scan, MDCT virtual hysteroscopy is proposed as a developing, non-invasive alternative diagnostic procedure for the evaluation of uterine pathology and other gynecologic disorders. Findings of the technique are illustrated.

Changes in DNA fragmentation during sperm preparation for intracytoplasmic sperm injection over time

OBJECTIVE To compare the DNA fragmentation of semen samples established by terminal deoxynucleotide transferase-mediated dUTP nick-end labeling (TUNEL) after incubation in polyvinylpyrrolidone (PVP) and hyaluronic acid (HA) for different time periods. DESIGN Comparative prospective study. SETTING Center for reproductive medicine. PATIENT(S) Twenty-seven semen samples from infertile patients. INTERVENTION(S) None. METHODS Semen analysis and DNA fragmentation assays (TUNEL) were performed. Two groups were established: A) normal TUNEL (<20%); and B) Abnormal TUNEL (≥ 20%). TUNEL was performed in neat (T0), postgradient (TG), 1-hour postgradient (TG1), and 2-hour postgradient (TG2) samples and in TG2 samples after 0.5, 1.0, and 1.5 hours of incubation in PVP or HA. RESULT(S) TUNEL levels were significantly reduced after gradient separation compared with neat values. In group A, TUNEL levels were significantly higher in the TG2 + 1.5 hours in PVP and HA samples but did not reach abnormal levels. In group B, TUNEL levels were significantly higher in the TG2 + 1 hour in PVP and HA samples. CONCLUSION(S) Sperm DNA fragmentation significantly decreased after centrifugation gradient, regardless of the initial levels of the sample. Samples with TUNEL ≥ 20% were more susceptible to a significant increase in DNA fragmentation over time, with similar increases being observed over time for samples that were incubated in HA or PVP. These data may be relevant for sperm preparation for intracytoplasmic sperm injection.

Clinical use of 64-row multislice computed tomography hysterosalpingography in the evaluation of female factor infertility

OBJECTIVE To evaluate the potential clinical value of 64-row multislice computed tomography hysterosalpingography (MSCT-H) in the evaluation of female patients with a diagnosis of infertility and compare it with the use of standard X-ray hysterosalpingography (HSG). DESIGN Comparative prospective study. SETTING Outpatient Imaging Diagnostic Centre, Diagnóstico Maipú, Buenos Aires, Argentina, and a university-affiliated fertility institute (Centro de Estudios en Ginecología y Reproducción, Buenos Aires, Argentina). PATIENT(S) Twenty-two female patients with a diagnosis of infertility. INTERVENTION(S) Sixty-four-row MSCT-H and conventional X-ray HSG. MAIN OUTCOME MEASURE(S) Diagnostic accuracy of MSCT-H for the evaluation of cervical, uterine, and tubal pathology. RESULT(S) We found that 64-row MSCT-H was useful in identifying female reproductive tract abnormalities, showing in the per patient analysis a sensitivity of 100% and a specificity of 85.71%. This new procedure can be performed without a tenaculum, making it well tolerated. Clinical complications did not occur in any of the patients participating in the study. CONCLUSION(S) Sixty-four-row MSCT-H is a valuable alternative diagnostic technique in the infertility workup algorithm for the evaluation of the female reproductive tract.

Conservative management versus aspiration of functional ovarian cysts before ovarian stimulation for assisted reproduction.

AbstractPurpose: To compare the efficiency of transvaginal ultrasound-guided functional ovarian cyst aspiration, withconservative management, in the outcome of patientsundergoing assisted reproductive technique (ART) (in vitrofertilization or intracytoplasmic sperm injection). Thesecysts were identified before ovarian stimulation begun andafter administration of a midluteal GnRH agonist. Methods: Fifty nine patients undergoing ART from January1, 1997 to February 28, 1999, who developed functionalovarian cysts were included. Aspirations of these cysts(n = 14) versus conservative management(n = 45) were compared. Total number of ovarian folliclesdeveloped, number of oocytes retrieved, estradiol levels onthe day of human chorionic gonadotropin, fertilization rate,number of good quality embryos transferred, implantation,and clinical pregnancy rate per cycle were evaluated. Results: No statistical differences were observed betweenthe two groups in any of the selected parameters. Conclusions: Cyst aspiration and conservative managementshowed similar implantation and pregnancy rates, in patientswho develop functional ovarian cysts after pituitarydown-regulation following luteal phase gonadotropin-releasinghormone agonist administration. Prospective studies areneeded to confirm this trend.

Two-dimensional and three-dimensional imaging of uterus and fallopian tubes in female infertility

Noninvasive imaging techniques play an important role in the female infertility diagnostic algorithm. In this review article, a description of the diagnostic performance and potential clinical value of both computerized tomographic virtual hysterosalpingography (CT-VHGS) and magnetic-resonance virtual hysterosalpingography (MR-VHSG) is made, describing for both techniques, to guarantee the best possible diagnostic outcome, patient preparation and normal and principal pathologic findings. Both noninvasive diagnostic imaging modalities improve the diagnostic confidence in identification of the specific cause of female infertility. These procedures are well tolerated and can be performed without tenaculum and sedation. The combined analysis of all the imaging data offers the gynecologist a wide information spectrum, enabling a better therapeutic decision. CT-VHSG and MR-VHSG are consistent diagnostic imaging modalities for the evaluation of the female reproductive system, with an excellent diagnostic performance compared with traditional diagnostic exams and allowing a comprehensive assessment of the female reproductive system.

Correlation between Cytoplamic Oocyte Maturation and Chromosomal Aneuploidies - Impact on fertilization, embryo quality and pregnancy.

OBJECTIVE To establish the relationship between oocyte cytoplasmic maturation and its chromosomal status and determine the effect of this feature over the reproductive outcome in patients with sub-optimal fertilization in ART. METHODS Fifty couples who underwent ART were selected. From nineteen patients, 22 metaphase II-MII and 18 failed-fertilized oocytes after ICSI were studied. The first polar body was collected for chromosomal analysis by aCGH. Oocytes were processed by immunocytochemistry (ICC) to determine oocyte maturation: assessment of inactive MPF status and the conformation-alignment of the metaphase plate.Other 31 couples presented sub-optimal fertilization (<50%) after ICSI, and failed-fertilized oocytes were studied by ICC. Two groups were conformed according to the main feature observed: A) cytoplasmic immaturity and sperm premature chromosome condensation and B) sperm nuclear decondensation failure with mature cytoplasm. RESULTS Regarding MII mature oocytes, 87% had a normal metaphase plate and 84% were chromosomally normal. Contrary, immature oocytes presented abnormal metaphase plate (86%) and just 33% were euploid. In failed-fertilized oocytes: 100% of mature oocytes had a normal metaphase plate and 71% were euploid. When oocytes were cytoplasmic immature, 37% of them were normal (metaphase plate) and 50% were chromosomally normal.The global rate of aneuploidies and metaphase plate disarrangements in immature oocytes (MII+failed-fertilized) were significantly higher than mature oocytes (P<0.05).In patients with sub-optimal fertilization, the percentage of top quality embryos and pregnancy rate was significantly higher in group B (P<0.05). CONCLUSION Oocyte cytoplasmic immaturity is related to metaphase plate anomalies and aneuploidies. Fertilized oocytes, from a cohort with sub optimal fertilization with cytoplasmic immaturity, had poorer reproductive outcomes.

A shared egg donor program: which is the minimum number of oocytes to be allocated?

PurposeTo evaluate which is the minimum number of oocytes to be allocated to each recipient in a shared egg donor program.MethodsWe analyzed 953 recipients that received at least 4 metaphase II (MII) oocytes in the period 2006–2008. We retrospectively divided the recipients according to the number of MII oocytes actually received.ResultsNo statistically significant differences were found among the analyzed strata in clinical pregnancy rate (A:43.7%; B:45.6%; C:48.6%; D:45.5%; E:53%, P = NS) and miscarriage rate. However, the rate of top quality transferred embryos, and the embryo freezing rate were significantly higher among those recipients that received 7 or more mature eggs.ConclusionsAfter a large sample was analyzed, no significant differences in fresh embryo transfer outcome were encountered when a different number of oocytes was allocated. A minimum of 4 MII oocytes seems to achieve satisfactory pregnancy rates in our shared egg donor program.

Histerosalpingografía virtual por TC multidetector de 64 filas: Hallazgos en 2.500 pacientes

Objective. To depict typical features of virtual hysterosalpingography (VHSG) in infertile patients. Material and methods: 2500 VHSG performed using a 64-row MDCT were evaluated. Results: Cervical abnor- malities visualized corresponded to parietal irregularities (21%); thickened folds (9%); polyps (11%); diverticula (5%); cervical strictures (8%), and synechiae (1.5%). At the level of uterine cavity, polyps (44%); submucous myomas (8%); intramural and subserosal fibroids (11%); synechiae (10%); malformations (10%); adenomyosis (4%), and cesarean section scar (3%). Unilateral hydrosalpinx (7%) and bilateral hydrosalpinx (2%). Tubal obs- truction was reported in 6% of cases. The average radiation dose was 0.94 mSv. Eighty-four percent of the patients reported mild pain or no postoperative discomfort. Conclusions: The virtual hysterosalpingography allowed a proper assessment of the internal genital organs, providing useful diagnostic information on infertility and other gynecological disorders. It constitutes a virtually painless, low-dose radiation technique, besides being well tolerated by patients. Keywords: Fallopian tubes, Multidetector computed tomography, Uterus, Virtual hysterosalpingography, Virtual studies.