Yolanda Mínguez

In vitro fertilization plus preimplantation genetic diagnosis in patients with recurrent miscarriage: an analysis of chromosome abnormalities in human preimplantation embryos

OBJECTIVE To analyze the incidence of numeric chromosomal abnormalities in preimplantation embryos from women with unexplained recurrent miscarriage (RM) so as to seek an etiology and to determine whether the use of IVF may be indicated to treat these cases. DESIGN Prospective controlled study. SETTING University laboratory of reproductive genetics and a tertiary referral center for infertility. PATIENT(S) Nine women with a mean (+/-SD) of 3.9 +/- 0.6 RMs who were undergoing IVF and preimplantation genetic diagnosis, and a control group of young (n = 10) and older (n = 6) patients who were undergoing preimplantation genetic diagnosis because of sex-linked diseases. INTERVENTION(S) In vitro fertilization, embryo culture for 72 hours, blastomere biopsy, and analysis of chromosomes 13, 16, 18, 21, 22, X, and Y with the use of fluorescent in situ hybridization. Transfer of chromosomally normal embryos into the uterus. MAIN OUTCOME MEASURE(S) Numeric chromosomal abnormalities in human embryos. RESULT(S) Sixty-six embryos from patients with RM were compared with 62 embryos from young patients and 41 embryos from older patients. There was a significant increase in the rate of abnormal embryos in the patients with RM and the older patients compared with the controls. Abnormalities in most of the chromosomes studied were higher in the RM group than in the control group, especially those affecting chromosome 13. CONCLUSION(S) There was an increase in numeric chromosomal abnormalities in preimplantation embryos from women with RM that could be the cause of infertility in many couples with unexplained RM. The use of IVF in such circumstances may be indicated if successful preimplantation genetic diagnosis is added to the procedure.

Implications of sperm chromosome abnormalities in recurrent miscarriage

Purpose:Our purpose was to assess the existence of sperm chromosome abnormalities in recurrent pregnancy loss in an assisted reproduction program.Methods:In this prospective study, 12 sperm samples from couples undergoing in vitro fertilization with two or more first-trimester spontaneous abortions were analyzed. Diploidy and disomy in decondensed sperm nuclei were assessed for chromosomes 13, 18, 21, X, and Y using two- and three-color fluorescence in situ hybridization.Results:Sex chromosome disomy in sperm samples from recurrent abortion couples was significantly increased compared to that from internal controls (0.84% vs 0.37%). In a subpopulation of seven couples who underwent oocyte donation, mean frequencies for sex chromosome disomy (1%) were even higher and diploidy (0.43%) was also significantly increased.Conclusions:These results suggest an implication of sperm chromosome abnormalities in some cases of recurrent pregnancy loss.

The role of in vitro fertilization and intracytoplasmic sperm injection in couples with unexplained infertility after failed intrauterine insemination

OBJECTIVE To determine an optimal insemination technique in patients undergoing IVF after failed IUI and the role of intracytoplasmic sperm injection (ICSI) in such cases. DESIGN Prospective, randomized study in couples with unexplained infertility (n = 63) and mild endometriosis (n = 7) undergoing IVF after four IUI cycles. Sibling oocytes were randomized into standard IVF or ICSI insemination according to the order of retrieval. SETTING In vitro fertilization program at the Instituto Valenciano de Infertilidad, Valencia, Italy. PATIENT(S) Seventy couples with unexplained infertility undergoing IVF after failing to conceive with controlled ovarian stimulation and IUI. INTERVENTION(S) In vitro fertilization and ICSI. MAIN OUTCOME MEASURE(S) Fertilization, cleavage, and embryo quality were compared in IVF- and ICSI-inseminated oocytes. RESULT(S) There was no significant difference in fertilization rates between ICSI (60.4%) and conventional IVF (54.0%). Similarly, there was no difference in embryo quality between both groups. There was no total fertilization failure in ICSI-inseminated oocytes, whereas 8 (11.4%) of 70 cases showed absence of fertilization when conventional IVF was used. CONCLUSION(S) Couples with unexplained infertility and mild endometriosis failing to conceive with IUI and undergoing IVF have an 11.4% chance of fertilization failure that can be overcome easily by using ICSI in at least some oocytes. ICSI, however, is not superior to IVF as an insemination technique in most cases. These data should be used in counseling patients.

TESTICULAR SPERM EXTRACTION AND INTRACYTOPLASMIC SPERM INJECTION: A CHANCE OF FERTILITY IN NONOBSTRUCTIVE AZOOSPERMIA

PURPOSE We evaluate the efficacy of testicular sperm extraction and results of intracytoplasmic sperm injection in cases of nonobstructive azoospermia. In addition, we define predictive parameters for successful testicular sperm extraction in these patients. MATERIALS AND METHODS A total of 154 patients with nonobstructive azoospermia underwent multiple testicular biopsies to obtain testicular spermatozoa and for histopathological diagnosis. Results of testicular sperm extraction were related to suspected etiology of azoospermia, patient age, maximal testicular volume, serum follicle-stimulating hormone and histopathology. When testicular sperm extraction was successful, intracytoplasmic sperm injection was performed. RESULTS Spermatozoa were obtained from 63 patients (41%). No potential predictive parameters precluded successful testicular sperm retrieval. Fertilization was achieved in 74 of 76 intracytoplasmic sperm injection cycles. Normal 2 pronuclear fertilization was observed in 55% of the intact oocytes after microinjection. Clinical pregnancies were achieved in 21 cases for a pregnancy rate of 28% per started cycle. There were 4 miscarriages and 11 live births from 9 deliveries. In addition, a set of twins died after birth because of prematurity. Seven pregnancies were ongoing. CONCLUSIONS Men with nonobstructive azoospermia may have areas of preserved spermatogenesis in the testicles, and these spermatozoa can be retrieved for intracytoplasmic sperm injection. Although some clinical and histopathological parameters are associated with significantly different sperm recovery rates, it is not possible to predict with certainty the outcome of testicular sperm extraction in an individual patient. If testicular sperm extraction is successful, intracytoplasmic sperm injection offers the chance of pregnancy to these otherwise intractably infertile couples.

Pregnancy in an azoospermic patient with markedly elevated serum follicle-stimulating hormone levels

OBJECTIVE To assess the possibility of achieving a pregnancy in an azoospermic patient with markedly elevated serum FSH level. DESIGN A case report. SETTING In vitro fertilization program at the Instituto Valenciano de Infertilidad. PATIENT An azoospermic patient with small testes and serum FSH level (38.7 mIU/mL) higher than three times normal. Testicular biopsy revealed Sertoli cell-only syndrome with focal spermatogenesis. INTERVENTIONS Intracytoplasmic microinjection of testicular tissue-extracted spermatozoa. MAIN OUTCOME MEASUREMENTS Fertilization rate, cleavage rate, clinical pregnancy. RESULTS Eight of 11 (73%) intact oocytes showed two pronuclei. All of them cleaved normally. Four embryos were replaced into the uterine cavity and the other four were cryopreserved. A twin clinical pregnancy was achieved. CONCLUSION Spermatozoa may be present in testicular biopsy specimens of azoospermic patients with severe spermatogenic failure despite markedly elevated serum FSH level. These patients can be fertile after intracytoplasmic testicular sperm microinjection.

Intracytoplasmic Testicular Sperm Injection: An Effective Treatment for Otherwise Intractable Obstructive Azoospermia

PURPOSE We evaluated the efficacy of intracytoplasmic sperm injection with testicular spermatozoa. MATERIALS AND METHODS Intracytoplasmic sperm injection was performed with spermatozoa obtained from testicular biopsy specimens in 15 patients with obstructive azoospermia, in whom standard microsurgical procedures were not feasible or had previously failed. RESULTS Fertilization was achieved in 14 of 15 cycles. Mean fertilization rate per cycle was 63.6%. Four clinical pregnancies occurred, for a pregnancy rate of 26.7% per started cycle and 28.6% per transfer. CONCLUSIONS Intracytoplasmic testicular sperm injection is followed by high fertilization rates, and offers the chance of a pregnancy to otherwise intractably infertile couples with obstructive azoospermia.

Intracytoplasmic Sperm Injection: A Treatment for Extreme Oligospermia

PURPOSE We evaluated the efficacy of intracytoplasmic sperm injection in patients with extreme oligospermia. MATERIALS AND METHODS A total of 67 intracytoplasmic sperm injection cycles was attempted in 58 infertile couples in which the husbands had extreme oligospermia (less than 100,000 spermatozoa per ml. ejaculate). RESULTS Fertilization was achieved in 65 of 67 cycles. Mean fertilization rate per cycle was 66.4%. A total of 18 clinical pregnancies was obtained, for a pregnancy rate of 26.8% per started cycle. There were 4 miscarriages and 8 live births from 5 deliveries. Nine pregnancies are ongoing. CONCLUSIONS Intracytoplasmic sperm injection in patients with extreme oligospermia is associated with high fertilization rates and offers the chance of pregnancy to these otherwise intractably infertile couples.