Chromosome analysis in embryos from young patients with previous parity.

This study included 173 young couples of proven fertility who had previously undergone preimplantation genetic screening for chromosomes X and Y for family balancing. Several months later, when the outcome of the pregnancies was already known, the blastomeres from the corresponding embryos transferred were reanalysed by fluorescence in-situ hybridization (FISH) for chromosomes 13, 16, 18, 21, 22 with the aim of investigating correlation with embryo viability and the level of FISH sensitivity (embryos confirmed to be euploid). According to the results, informative in 152 couples, the proportion of euploid embryos was significantly lower in 53 nonpregnant women when compared with 99 women with term pregnancy (49% versus 75% respectively, P < 0.001). In addition, in 21 nonpregnant patients, all embryos transferred were found to be chromosomally abnormal. The level of FISH sensitivity was calculated in the group of term pregnancies where the number of euploid embryos was expected to exceed or match with the number of babies born. The resulting false-negative rate was 4.0% per patient and 1.9% per embryo. These findings confirmed the limited prediction power of embryo morphology on implantation but also the relevance of chromosomal abnormalities in causing embryo demise.

Assisted oocyte activation overcomes fertilization failure in globozoospermic patients regardless of the DPY19L2 status.

STUDY QUESTION: Does DPY19L2 status influence intracytoplasmic sperm injection (ICSI) outcomes with or without assisted oocyte activation (AOA)? SUMMARY ANSWER: DPY19L2 mutations have no major impact on ICSI outcomes in globozoospermic patients. WHAT IS KNOWN ALREADY: Globozoospermia is a rare and severe teratozoospermia characterized by round-headed spermatozoa lacking an acrosome. Recently, it has been shown that DPY19L2 mutations can be found in a vast majority of, but not all, globozoospermic patients (66.7%). These patients suffer from primary infertility due to a sperm-related oocyte activation deficiency secondary to the absence of an acrosome that can be overcome by the application of AOA. STUDY DESIGN, SIZE, DURATION: Cohort study, retrospective, 34 patients, 83 cycles. MATERIALS, SETTING, METHODS: Clinical and biologic data were collected from 29 patients mutated for DPY19L2 and 5 non-mutated patients. In total, 35 ICSI cycles using AOA and 48 conventional ICSI cycles were included in the analysis. Patients were divided into groups according to whether or not they were mutated for DPY19L2 and whether or not they received AOA. MAIN RESULTS AND THE ROLE OF CHANCE: Regardless of the presence of a DPY19L2 mutation, the fertilization rates with AOA are restored to normal when compared with conventional ICSI in our cohort of globozoospermic patients. Also, when performing ICSI plus AOA, both mutated and non-mutated cases have similar positive hCG rates, ongoing pregnancy rates and live birth rates per transfer. On the contrary, the fertilization rate in globozoospermic patients using conventional ICSI is correlated with the presence of a DPY19L2 mutation, with slightly better, although still very low, fertilization rates in patients carrying a DPY19L2 mutation. Nevertheless, when performing conventional ICSI, both mutated and non-mutated cases have similar very low positive hCG rates, ongoing pregnancy rates and live birth rates per transfer. LIMITATIONS: A limitation of this study is the low number of included non-mutated cases. WIDER IMPLICATIONS OF THE FINDINGS: We propose a pathway for the clinical management of globozoospermic patients depending on the phenotype that includes several diagnostic and therapeutic steps. STUDY FUNDING/COMPETING INTEREST(S): None.

A step towards decentralized wastewater management in the Lower Jordan Rift Valley.

In order to address serious concerns over public health, water scarcity and groundwater pollution in Jordan, the expansion of decentralized wastewater treatment and reuse (DWWT&R) systems to small communities is one of the goals defined by the Jordan government in the "Water Strategy 2009-2022". This paper evaluates the general potential of decentralized wastewater system solutions to be applied in a selected area of the Lower Jordan Rift Valley in Jordan. For the study area, the connection degree to sewer systems was calculated as 67% (5% in the rural sector and 75% in the urban sector). The annual wastewater production available for DWWT&R in the rural sector of the investigation area was calculated to be nearly 3.8 million m(3) at the end of 2007. The future need of wastewater treatment and reuse facilities of the rural sector was estimated to be increasing by 0.11 million m(3) year(-1), with an overall potential of new treatment capacity of nearly 15,500 population equivalents (pe) year(-1). The overall potential for implementing DWWT&R systems in the urban sector was estimated as nearly 25 million m(3) of wastewater in 2007. The future need of wastewater treatment and reuse facilities required for the urban sector was estimated to be increasing at a rate of 0.12 million pe year(-1). Together with the decision makers and the stakeholders, a potential map with three regions has been defined: Region 1 with existing central wastewater infrastructure, Region 2 with already planned central infrastructure and Region 3 with the highest potential for implementing DWWT&R systems.

A prospective, randomized, controlled trial comparing highly purified hMG with recombinant FSH in women undergoing ICSI: ovarian response and clinical outcomes.

BACKGROUND: To assess the clinical profile and efficacy in assisted reproductive treatment of a new human-derived highly purified (HP) menotropin, we compared HP hMG and recombinant (r) FSHalpha use in ICSI within a prospective, randomized, controlled study. METHODS: 100 infertile women were treated with HP hMG (50 patients) or rFSHalpha (50 patients). All patients received the same daily gonadotrophin dose (150 IU) following GnRH agonist suppression (long regimen) until more than three follicles >17 mm and estradiol (E(2)) levels >600 pg/ml were reached. Patients were monitored with daily LH, FSH, hCG, estradiol (E(2)), progesterone, and testosterone measurements; and alternate day pelvic ultrasound. RESULTS: Treatment duration (11.1 +/- 0.4 versus 12.9 +/- 0.5 days, P < 0.05) and gonadotrophin dose (22.4 +/- 1.0 versus 27.0 +/- 1.5 ampoules, P < 0.05) were lower in the HP hMG group. Conversely, peak pre-ovulatory E(2) (1342 +/- 127 versus 933 +/- 109 pg/ml, P < 0.005); and area under the curve of E(2) (3491 +/- 350 versus 2602 +/- 349 pg/ml.day, P < 0.05), immunoreactive serum FSH (65.9 +/- 2.1 versus 48.8 +/- 1.8 IU/l.day, P < 0.001). and hCG (1.7 +/- 0.3 versus 0.0 +/- 0.0 IU/l/day, P < 0.001) during treatment were higher in the HP hMG group. Cycle cancellation rates, transferred embryo number, pregnancy rates per started cycle (30 versus 28%) and per embryo transfer (35 versus 35%) and miscarriage rates (6 versus 6%) were not significantly different. CONCLUSIONS: HP hMG treatment was associated with: (i) a more efficient patient response, as reflected by reduced treatment duration and gonadotrophin requirements; (ii) increased serum levels of hCG, E(2), and immunoreactive FSH during treatment; (iii) an ICSI outcome indistinguishable from rFSHalpha.

Efficiency of percutaneous testicular sperm aspiration as a mode of sperm collection for intracytoplasmic sperm injection in nonobstructive azoospermia.

PURPOSE: We determined the feasibility of obtaining mature spermatozoa for intracytoplasmic sperm injection (ICSI) by percutaneous testicular sperm aspiration in men with nonobstructive azoospermia. We also compared the results of ICSI using spermatozoa recovered by open excisional biopsy versus percutaneous testicular sperm aspiration. MATERIALS AND METHODS: A total of 84 men with nonobstructive azoospermia underwent percutaneous testicular sperm aspiration to recover testicular spermatozoa for ICSI on the day of ova retrieval from the wife. Percutaneous testicular sperm aspiration was performed with the patient under general anesthesia in the upper and lower poles of each testis. It was followed by immediate microscopic search of the aspirate to confirm the presence of spermatozoa. In the absence of spermatozoa open excisional biopsy was performed in the same setting. RESULTS: Percutaneous testicular sperm aspiration resulted in the recovery of mature spermatozoa in 45 men (53.6%). Of the remaining 39 men (46.4%) requiring open biopsy adequate spermatozoa were recovered in 28 (71.8%). Although the fertilization rate was significantly higher in the sperm aspiration group, the cleavage and pregnancy rates were similar in the 2 groups. CONCLUSIONS: Percutaneous testicular sperm aspiration was a successful initial approach to collect mature spermatozoa in a high proportion of men with nonobstructive azoospermia. It is safe, minimally invasive and well tolerated by all patients.

Sex selection and preimplantation genetic diagnosis at The Farah Hospital.

The issue of sex selection by using preimplantation genetic diagnosis (PGD) for non-medical reasons has been the subject of heated debate. Although the ethical arguments regarding this subject are complex, we would like to extend and express some views based on practical experience, with a special focus on individual needs in developing countries, taking into consideration: social, cultural, religious, financial and scientific aspects.

Role of testicular fine needle aspiration in the diagnosis of azoospermia.

Fine needle aspiration (FNA) of the testis is gaining recognition as an important step in the diagnosis of azoospermia. In 1000 azoospermic men receiving a short-acting anaesthetic, each testis was subject to FNA from three standard sites--lower, middle and upper zones--using 26-gauge needles. Azoospermia was graded in the following way: adequate spermatozoa (A1), low, scanty or rare spermatozoa (A2), spermatid arrest (B1), spermatocyte arrest (B2), Sertoli cell-only pattern (C) and sclerosis (D). The FNA grade showed a strong correlation with cell yield, testicular volume and serum follicle stimulating hormone (FSH) levels (all p < 0.0001). Excretory and secretory azoospermia corresponded strongly with FNA grades A1 and A2, respectively. FNA grading was predictive of clinical outcome in terms of sperm yield at testicular sperm extraction, fertilization and pregnancy. In our series, FNA of the testis was relatively free of complications; we recommend its use in the routine diagnosis of azoospermia.

Triplet pregnancy and delivery after intracytoplasmic injection of round-headed spermatozoa.

Intracytoplasmic sperm injection (ICSI) of round-headed spermatozoa into mature oocyte resulted in normal fertilization, embryo development and pregnancy in a 28 year old female. The husband had a long history of primary infertility. Three ICSI attempts were carried out and fertilization and embryo development occurred in all trials. However, only the third trial led to a pregnancy, which proved to be quadruplet after the transfer of four embryos. One embryo vanished and the remaining triplets were delivered at 35 weeks of gestation by Caesarean section. Two of the babies, a boy weighing 2000 g and a girl weighing 2250 g at birth were discharged in a good condition 1 week after delivery and the third baby, a boy weighing 1550 g, was discharged 3 weeks after delivery.