Assisted reproductive technology : experience with IVF/ICSI.

OBJECTIVE: To analyze success rates of assisted reproduction techniques ART (IVF/ICSI) in couples experiencing subfertility, and factors which may help in predicting treatment outcome. DESIGN: A prospective cohort follow-up study. PLACE AND DURATION OF STUDY: Study was conducted at Concept Fertility Centre, Karachi, between July 1, 2000 and December 31, 2002. SUBJECTS AND METHODS: A cohort of 310 couples undergoing 330 in-vitro fertilization (IVF) and intra cytoplasmic sperm injection (ICSI) cycles were followed for treatment outcomes. Predictor variables included age of women, cause of subfertility, drug regimen used for ovulation induction, day of embryo transfer, and ease of embryo transfer. While outcome variables included rates of fertilization, pregnancy, live birth, miscarriages, multiple pregnancies and ovarian hyperstimulation syndrome (OHSS). RESULTS: The overall pregnancy rate was 35.2 %, while takehome live-birth rate was 25.1%. Treatment cycles which were done for male factor only, had higher probability of success as compared to female factors or for unexplained infertility. Patients who underwent transvaginal ovum pick up and embryo transfer (TVOPU + ET) had an overall pregnancy rate of 29.4% as compared to those who underwent frozen embryo transfer (FET) cycles (22.6%). There was no statistically significant difference between pregnancy rates for ovulation induction with recumbent FSH (rFSH) and HMG (32.7% v 33.6%, p-value 0.87). Quality of embryo transfer was significantly better (33.7%, v 24.2%, p-value 0.042) in patients who conceived. CONCLUSION: Our results are comparable in terms of pregnancy rates, live birth rates and complication rates, to the results reported in international literature. We however, need more data from centres in Pakistan for future reference and research.

Intracytoplasmic sperm injection outcome using ejaculated sperm and retrieved sperm in azoospermic men.

INTRODUCTION: We aimed to determine pregnancy and miscarriage rates following intracytoplasmic sperm injection (ICSI) cycles using retrieved epididymal and testicular sperm in azoospermic men and ejaculated sperm in oligospermic and normospermic men. MATERIALS AND METHODS: This retrospective study was carried out on 517 couples who underwent ICSI. They included 96 couples with azoospermia and 421 with oligospermia or normal sperm count in the male partner. Of the men with azoospermia, 69 underwent percutaneous epididymal aspiration (PESA) and 47 underwent testicular sperm extraction (TESE). In the 421 men with oligospermia or normal sperm count, ejaculated sperm was used for ICSI. The differences in the outcomes of ICSI using PESA or TESE and ejaculated sperm were evaluated. The main outcome measures were pregnancy and miscarriage rates. RESULTS: No significant differences were seen in pregnancy and miscarriage rates with surgically retrieved and ejaculated sperm. The pregnancy rates (including frozen embryo transfer) were 43.5%, 36.2%, and 41.4% in couples with PESA, TESE, and ejaculated sperm, respectively (P = .93). The miscarriage rates were 16.7%, 23.5%, and 12.1%, respectively (P = .37). CONCLUSION: Intracytoplasmic sperm injection in combination with PESA and TESE is an effective method and can successfully be performed to treat men with azoospermia. The outcomes with these procedures are comparable to ICSI using ejaculated sperm.