T.C. Bonetti

Artificial oocyte activation with calcium ionophore A23187 in intracytoplasmic sperm injection cycles using surgically retrieved spermatozoa

OBJECTIVE To evaluate the effect of artificial oocyte activation (AOA) on intracytoplasmic sperm injection (ICSI) cycles using surgically retrieved sperm. DESIGN Laboratory study. SETTING Fertility/assisted fertilization center. PATIENT(S) Couples undergoing surgical sperm retrieval for ICSI (n = 204). INTERVENTION(S) Application of calcium ionophore A23187 for AOA. MAIN OUTCOME MEASURE(S) Cycles were divided into experimental groups according to the origin of the sperm used for injection and the type of azoospermia: [1] testicular sperm aspiration in nonobstructive-azoospermic patients (TESA-NOA group, n = 58), [2] TESA in obstructive-azoospermic patients (TESA-OA group, n = 48), [3] and percutaneous epididymal sperm aspiration in obstructive-azoospermic patients (PESA-OA, n = 98). For each experimental group, cycles where AOA was applied (subgroup: activation) were compared with cycles in which AOA was not applied (subgroup: control). The fertilization, high-quality embryo, implantation, and pregnancy rates were compared among the subgroups. RESULT(S) For patients undergoing TESA, AOA did not improve ICSI outcomes for either type of azoospermia. However, for cases in which the injected sperm were retrieved from the epididymis, a statistically significantly increased rate of high-quality embryos was observed with AOA. CONCLUSION(S) Artificial oocyte activation may improve ICSI outcomes in azoospermic patients when epididymal, but not testicular spermatozoa, are injected.

Artificial oocyte activation using calcium ionophore in ICSI cycles with spermatozoa from different sources

The present study evaluated the effect of artificial oocyte activation (AOA) with calcium ionophore A23187 on intracytoplasmic sperm injection (ICSI) cycles using spermatozoa from different sources. The 314 cycles evaluated were divided into three groups according to sperm origin; the ejaculated group (n = 92), the epididymal group (n = 82), and the testicular group (n = 140). Each group was further split into experimental subgroups, depending on whether or not AOA was performed. In addition, the cycles of women younger than 36 years were evaluated separately. For each experimental group, ICSI outcomes were compared between subgroups. No significant difference was observed between subgroups for all sperm origin groups. When evaluating only the cycles of women younger than 36 years of age, AOA increased the percentage of high-quality embryos (74.5 versus 53.0%, P = 0.011) and the implantation rate (19.3 versus 10.5%, P = 0.0025) when it was used with ejaculated spermatozoa, and the percentage of high-quality embryos (64.4 versus 50.3%, P = 0.006) when epididymal spermatozoa were used. These results may suggest that both sperm maturity and oocyte quality play a role in oocyte activation. However, this study is to be continued to confirm these findings.

Deciding the fate of supernumerary frozen embryos: parents' choices

Embryo cryopreservation is a routine procedure in assisted reproductive technologies. Although couples have been informed about all potential procedures, some of them face the dilemma of what to do with surplus frozen embryos. The purpose of this qualitative study was to evaluate the attitude of patients toward their surplus cryopreserved embryos. Fifty patients who had undergone successful IVF cycles, and had surplus embryos cryopreserved were selected from a clinical database. We could contact twenty two patients agreed to participate in the study and responded the interview. Seventeen participants (77.3%) believed that cryostoraged embryos were ‘life’. Patients who would discard embryos rather than donate to research expressed their concern about the misuse of embryos. Those who would discard rather than donate to other couples considered that donating an embryo would be like giving away a child. Seven patients were unsure whether life had begun at this stage of development. Although some couples thought of their embryos as little more than biological material, others envisioned them as living entities or ‘virtual’ children. The decisions on whether to donate embryos to another couple, or discard them were coloured by strong values about human life and equated with child abandonment.

Predictive Factors of Repeat Sperm Aspiration Success

OBJECTIVES To evaluate the outcomes of repeated testicular sperm aspirations (TESAs) and to investigate whether the interval between TESA procedures, success in the first attempt, and patient age might influence the results. METHODS The patient population in the present study consisted of couples undergoing TESA for intracytoplasmic sperm injection. Of these, 189, 46, 42, and 19 male patients underwent 1, 2, 3, and 4 sperm retrievals, respectively. The effects of the interval between TESA procedures, success of the previous attempts, and patient age on sperm recuperation in a repeated procedure were evaluated. RESULTS Of the patients with nonobstructive azoospermia from whom sperm was not retrieved in the first procedure, 16.6% had successful sperm retrieval at the second procedure. In 57.1% of the patients who did not achieve sperm recuperation for the second attempt, sperm could be retrieved in the third procedure. Finally, of the patients without success in the third attempt, 40.0% had successful sperm retrieval at the fourth attempt. Success in the preceding TESA procedure positively influenced the success of sperm retrieval in a repeated attempt, and a trend for a negative effect of paternal age in the success of a repeated TESA attempt was noted. However, the interval between procedures had no influence on TESA success. CONCLUSIONS The results of our study have shown that patient age and the success of the first TESA may predict the results of additional attempts. However, TESA may result in sperm recovery even when the first recovery procedure was not successful. Moreover, sperm recovery did not seem to be affected by the interval between procedures.