Effect of acupuncture on assisted reproduction treatment outcomes.

BACKGROUND: Acupuncture has recently been used as a complementary technique in the management of infertility. It has physiological and psychological effects and may be considered an alternative for stress reduction in women undergoing infertility treatments. OBJECTIVE: To examine the hypothesis that acupuncture treatment may increase the pregnancy rate in patients undergoing intracytoplasmic sperm injection cycles. METHODS: Patients enrolled in the study were stratified according to age and randomised to either a control group (n=208) or acupuncture group, (n=208). The pregnancy, implantation and abortion rates of the two groups were compared. RESULTS: No influence of acupuncture treatment on clinical outcomes was seen; however, when cycles in which the causes of infertility were exclusively tubal-uterine or idiopathic were evaluated separately, a positive influence of acupuncture on pregnancy (OR=5.15, 95% CI 1.03 to 34.5; p=0.048) was noted. Moreover, trends toward an increase in implantation were seen when acupuncture was performed (regression coefficient: 0.645; p=0.092). CONCLUSION: The results suggest that acupuncture treatment had no influence when performed immediately before and immediately after embryo transfer, on clinical outcomes overall. In a subgroup analysis, when the embryo was not affected by an ovarian or seminal influence, a benefit was noted.

Assisted reproductive technology outcomes in azoospermic men: 10 years of experience with surgical sperm retrieval.

An azoospermic man suffers from an absence of sperm in the ejaculate and this condition is present in about 10% of infertile men. Obstructive azoospermia (OA) is characterized by an occlusion or partial absence of the reproductive tract with the presence of normal spermatogenesis. On the other hand, non-obstructive azoospermia (NOA) is characterized by impaired spermatogenesis. In these cases, spermatozoa can be obtained by percutaneous epididymal or testicular sperm aspiration (PESA and TESA, respectively) and used for intracytoplasmic injection (ICSI). To compare ICSI outcomes using spermatozoa that were surgically retrieved by PESA and TESA, azoospermic patients were divided into the following categories: (i) TESA-NOA (n = 102), (ii) TESA-OA (n = 103), and (iii) PESA-OA (n = 171). Fertilization, pregnancy, and implantation rates were compared between the groups. We noted a lower normal fertilization rate (p = 0.0017) and a higher abortion rate (p = 0.0387) among men in the TESA group who had OA when compared with men in the PESA group who had OA. On the other hand, a lower normal fertilization rate (p = 0.05) and a lower rate of non-cleaved embryos (p = 0.034) was found in the TESA group of NOA patients as compared to the TESA group of OA patients. No statistically significant differences were detected between the TESA and PESA groups and the OA and NOA groups, respectively. The clinical outcomes of embryos arising from ICSI cycles using spermatozoa harvested via PESA and TESA were similar, regardless of whether the patient had obstructive or non-obstructive azoospermia.

Metaphase II human oocyte morphology: contributing factors and effects on fertilization potential and embryo developmental ability in ICSI cycles.

Morphologic abnormalities in the oocyte are relevant for determining its developmental fate and could be related to controlled ovarian stimulation protocols and ovarian response. The contributing factors of oocyte dysmorphism incidence and its effects on fertilization potential and embryo development are the object of discussion in this study.

Zona pellucida birefringence in in vivo and in vitro matured oocytes.

OBJECTIVE: To evaluate zona pellucida birefringence (ZPB) in immature and mature oocytes collected after controlled ovarian stimulation and to assess the influence of ZPB on oocyte development. DESIGN: Prospective study. SETTING(S): Private assisted reproduction centre. PATIENT(S): Thirty patients undergoing intracytoplasmic sperm injection. INTERVENTION(S): The ZPB of mature and immature oocytes was evaluated using a polarization imaging software module, and the oocytes were classified as high birefringence (HB) or low birefringence. MAIN OUTCOME MEASURE(S): The ZPB of in vivo and in vitro matured oocytes and its influence on spontaneous nuclear maturation in vitro, fertilization, and embryo quality. RESULT(S): The percentage of HB oocytes was higher in immature than in mature oocytes (40.1 vs. 23.6%). Among immature oocytes, an increased percentage of HB in prophase-I stage oocytes compared to metaphase I stage oocytes was also observed (50.7 vs. 25.0%). However, the percentage of HB oocytes did not change when comparing oocytes before and after in vitro maturation for both prophase I and metaphase I oocytes. No influence of ZPB was observed on the spontaneous in vitro maturation potential. Exclusively for metaphase II retrieved oocytes, a positive influence of ZPB on fertilization (odds ratio [OR], 1.78; 95% confidence interval [CI], 1.27-2.49) and embryo quality (OR, 2.28; 95% CI, 1.04-4.99) was noted. CONCLUSION(S): ZPB may be a useful tool to predict embryo quality for metaphase-II oocytes. Moreover, the completion of nuclear changes in the production of metaphase-II oocytes in vitro may not reflect their molecular maturity.

Outcome of ICSI using zona pellucida-bound spermatozoa and conventionally selected spermatozoa.

This study aimed to investigate whether the spermatozoa-zona pellucida binding test is able to select spermatozoa with higher fertilization potential and higher rate of successful embryo development. This prospective study was performed with metaphase II (MII) oocytes retrieved from couples undergoing intracytoplasmic sperm injection (ICSI) cycles. For each patient, half of the MII oocytes were injected using a routine ICSI method (control group, n = 194) while the other half were injected with previously zona pellucida-bound spermatozoa (ZP-binding group, n = 194). Fertilization rate, high-quality embryo rate, and embryo transfer rate were compared between the groups. No significant difference was observed among the groups in the fertilization rate (76.8% versus 77.3% for control and ZP-binding groups, respectively). However, an increased percentage of high-quality embryos was observed when zona pellucida-bound spermatozoa were injected (70.0% versus 83.3% for control and ZP-binding groups, respectively, P = 0.003). Moreover, when embryo selection was performed while ignoring experimental group origin, embryos from the ZP-binding group were more commonly selected for transfer (43.6% versus 54.6% for control and ZP-binding groups, respectively, P = 0.004). These findings suggest that the spermatozoa-zona pellucida binding test may be an efficient method to identify the most competent spermatozoa for ICSI.

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.

Poor ovarian response in patients younger than 35 years: is it also a qualitative decline in ovarian function?

OBJECTIVE: To investigate whether poor response to controlled ovarian stimulation (COS) is due to a qualitative decline in ovarian function. METHODS: This retrospective cohort study included 436 patients younger than 35-years old, undergoing COS for intracytoplasmic sperm injection (ICSI). Patients with four or fewer MII oocytes after COS (poor-responder group, PR, n = 52) were age-matched with normoresponder patients (NR, n = 364). RESULTS: Although similar duration of stimulation (10.5 +/- 0.4 and 9.3 +/- 0.8 days; p = 0.1358), increased doses of gonadotrophins (2510 +/- 865 and 2253 +/- 572 IU; p = 0.0061) were used in the PR. The results show a increased chance of cycle ending of PR (PR: 26.9% and NR: 3.1%; p < 0.0001). Although the lower total number of oocytes retrieved (2.4 +/- 1.4 and 16.2 +/- 9.3; p < 0.0001), equal rate of fertilization (70.2% and 72.0%, p = 0.1190) and high quality embryos were obtained (50.0% and 45.2%; p = 0.4895), resulting in similar implantation (14.5% and 19.7%; p = 0.2246) and abortion (10.0% and 15.4%; p = 1.00) rates, respectively. A trend towards increased pregnancy rate per embryo transfer in NR group was noted (PR: 26.3% and NR: 42.2%; p = 0.0818). CONCLUSIONS: Low ovarian response could be associated mainly with a quantitative rather than a qualitative decline in ovarian function. Therefore, even if the ovarian response to stimulation is low, patients aged < or =35 years should process to oocyte retrieval.

Zona pellucida birefringence score and meiotic spindle visualization in relation to embryo development and ICSI outcomes.

The meiotic spindle and the zona pellucida exhibit molecular order when imaged with polarized optics. This study aimed to investigate possible factors contributing to the zona pellucida birefringence score and meiotic spindle visualization, and to evaluate whether these structures may predict intracytoplasmic sperm injection outcomes. Oocytes were divided into groups according to zona pellucida birefringence and meiotic spindle visualization. In addition, the cycles were split into three groups based on the zona birefringence of transferred embryos. A positive correlation was observed between zona birefringence and meiotic spindle visualization. In addition, when the meiotic spindle was observed, the fertilization rate among oocytes with high or low zona pellucida birefringence was similar. Implantation and pregnancy rates were significantly higher when embryos derived from high birefringence oocytes were exclusively transferred (P = 0.041 and P = 0.004 respectively). Furthermore, the miscarriage rate was higher when embryos derived from low birefringence oocytes were exclusively transferred. On the other hand, the total dose of FSH negatively affected meiotic spindle visualization. Results show that selection of embryos based on zona pellucida and meiotic spindle imaging can significantly improve implantation and pregnancy rates. Moreover, the dose of FSH used for ovarian stimulation may affect the organization of the oocyte meiotic spindle.

A comparison of post-thaw results between embryos arising from intracytoplasmic sperm injection using surgically retrieved or ejaculated spermatozoa.

OBJECTIVE: To study the effect of freeze-thaw on embryos derived from intracytoplasmic sperm injection (ICSI) using surgically retrieved and ejaculated spermatozoa. DESIGN: Retrospective study. SETTING: Private IVF center. PATIENT(S): Three hundred eighty-three patients undergoing frozen-thawed ET cycles. INTERVENTION(S): Testicular sperm aspiration (TESA) or percutaneous epididymal sperm aspiration (PESA) were the sperm surgical retrieval methods used for ICSI. Embryos resulting from ICSI using surgically retrieved and ejaculated spermatozoa were frozen, thawed, and transferred. MAIN OUTCOME MEASURE(S): Post-thaw survival, implantation, and pregnancy rates. RESULT(S): No differences were found between the ejaculated sperm and TESA/PESA groups in terms of post-thaw survival rate (68.4% vs. 66.1%, respectively), pregnancy rate (20.1% vs. 16.1%), and implantation rate (10.6% vs. 12.7%). Similar results were found for those variables when comparing TESA and PESA groups. CONCLUSION(S): Cleavage embryos arising from ICSI cycles using testicular and epididymal spermatozoa can be frozen with survival, pregnancy, and implantation rates comparable to those obtained with ejaculated spermatozoa.

Obtenção de gametas seguros por meio de associação de técnicas de processamento seminal para casais sorodiscordantes para HIV / Safe gametes acquisition through association of seminal processing techniques with HIV serodiscordant couples

OBJETIVO: o objetivo deste estudo foi avaliar os parâmetros laboratoriais e clínicos de pacientes submetidos à reprodução humana assistida, associando técnicas de processamento seminal para eliminação de partículas virais da amostra de sêmen em casais nos quais o homem é infectado pelo vírus da imunodeficiência humana adquirida (HIV). MÉTODOS: foram avaliados 11 ciclos de injeção intracitoplasmática de espermatozóide (ICSI) realizados em casais nos quais os homens eram infectados pelo HIV (Grupo HIV), e 35 ciclos de ICSI nos quais se utilizaram espermatozóides doados (Grupo Controle). As amostras de sêmen dos doadores foram submetidas à análise seminal completa, processamento seminal (lavagem) e criopreservação. Os homens do Grupo HIV receberam antibioticoterapia prévia e realizou-se análise seminal, lavagem e gradiente descontínuo de densidade antes da criopreservação. As amostras foram avaliadas para carga viral e a ICSI foi realizada quando não houve detecção do HIV. RESULTADOS: quanto aos resultados da análise seminal, os grupos se mostraram comparáveis em relação à concentração e motilidade progressiva dos espermatozóides. Entretanto, a porcentagem de espermatozóides morfologicamente normais foi maior no Grupo Controle (14,3 por cento) comparado ao HIV (5,8 por cento; p=0,002). Na avaliação dos parâmetros embrionários, as taxas de fertilização normal (Controle: 74,7 por cento e HIV: 71,7; p=0,838) e de bons embriões (Controle: 42,4 por cento e HIV: 65,1 por cento; p=0,312) foram semelhantes. Por outro lado, o Grupo Controle apresentou melhores resultados clínicos que o HIV (gestação continuada: 52,9 e 12,5 por cento; p=0,054; implantação: 42,6 e 10,4 por cento; p=0,059, respectivamente), apesar de as diferenças não serem estatisticamente significantes. Após o nascimento, não houve soroconversão das mães e das crianças nascidas. CONCLUSÕES: a associação de técnicas de processamento seminal para eliminação do HIV de amostras...

PURPOSE: the propose of this study was to analyze the clinical and laboratorial parameters of patients submitted to human assisted reproduction techniques with association of sperm processing techniques, in order to remove virus particles from semen samples of couples in which men was infected by human immunodeficiency virus (HIV). METHODS: it was assessed 11 intracytoplasmatic sperm injection (ICSI) cycles from couples whose men were HIV seropositive (HIV Group), and 35 cycles in which semen donors' samples were used in ICSI procedures (Control Group). Semen samples from Control Group were submitted to routine semen analysis, sperm wash and cryopreservation. The man from HIV Group received previous antibiotic therapy; the semen samples were analyzed routinely and prepared by sperm wash and density gradient method before cryopreservation. Those samples were evaluated to viral load and ICSI was performed when no HIV was detected. RESULTS: regards to semen analysis the groups were similar to sperm concentration and progressive motility. Nevertheless, the percentage of sperm with normal morphology were higher on Control Group (14.3 percent) than HIV (5.8 percent; p=0.002). On embryo parameters assessment, the normal fertilization (CT: 74.7 percent and HIV: 71.7; p=0.838, respectively) and good embryos rate (CT: 42.4 percent and HIV: 65.1 percent; p=0.312, respectively) were comparable. On the other hand, the Control Group presented better clinic results than HIV Group (ongoing pregnancy rate: 52.9 percent versus 12.5 percent; p=0.054, and implantation rate: 42.6 versus 10.4 percent; p=0.059, respectively), however the differences were not statistically significant. After delivery, no seroconversion was observed on mother and child. CONCLUSIONS: the association of sperm processing techniques in order to remove HIV from semen samples does not influence in laboratorial parameters of assisted reproduction techniques cycles. On the other hand, ...

Spindle imaging: a marker for embryo development and implantation.

OBJECTIVE: To examine whether the presence of birefringent spindles in living human oocytes can be used as a predictive factor associated with embryo morphology to allow embryo selection before transfer and its association with IVF outcomes. DESIGN: Prospective study. SETTING: Assisted reproduction center in Brazil. PATIENT(S): One hundred fifty-seven patients undergoing intracytoplasmic sperm injection cycles, resulting in 1,097 metaphase II oocytes. INTERVENTION(S): Meiotic spindles were evaluated before intracytoplasmic sperm injection in all metaphase II oocytes. MAIN OUTCOME MEASURE(S): Meiotic spindles' imaging and fertilization rate, embryo development, and implantation rate. RESULT(S): Birefringent spindles were detected in 65.9% (SD group). The normal fertilization rate and rate of early-cleavaged embryos were higher in the SD group compared with in the spindle-non-detected (SND) group. When only embryos from the SD group were selected for transfer, the pregnancy and implantation rates were 44.4% and 23.0%, and when only embryos from the SND group were transferred, those rates were 18.2% and 8.7%, respectively (statistically significant differences). CONCLUSION(S): Spindle visualization can be an important tool for predicting better fertilization potential, embryo development, and clinical outcomes, suggesting that embryo selection for transfer may be based not only on embryo morphology but also on oocyte nuclear maturity.

Prognostic value of meiotic spindle imaging on fertilization rate and embryo development in in vitro-matured human oocytes.

OBJECTIVE: To evaluate the relationship between spindle visualization and intracytoplasmic sperm injection (ICSI) outcomes in controlled ovarian stimulation (COS) cycles. DESIGN: Prospective study. SETTING: Assisted reproduction center. PATIENT(S): Thirty patients undergoing ICSI cycles. INTERVENTION(S): Meiotic spindle was evaluated before ICSI in 234 in vivo- and 101 in vitro-matured oocytes MAIN OUTCOME MEASURE(S): Meiotic spindle imaging, fertilization rate, and embryo development. RESULT(S): Spindle was present in 74.3% and 73.8% of the in vivo- and in vitro-matured oocytes, respectively. Spindle detection rate in oocytes derived from germinal vesicle and metaphase-I stage was, respectively, 50% and 86%. The fertilization rate achieved by the in vivo-matured oocytes was 71.8%, and spindle was detected in 75.6% of the fertilized oocytes and only 34.8.% of the nonfertilized oocytes. In the in vitro-matured oocytes, the fertilization rate was 66.1%, and spindle was detected in 81.4% of the fertilized oocytes and in 59.1% of the nonfertilized oocytes. Ten out of 43 (23.2%) in vitro-matured derived embryos were considered to be high quality, all derived from spindle-detected oocytes, which represents an increase of 13.0% on the overall number of high-quality embryos. CONCLUSION(S): Meiotic spindle imaging may be useful to predict in vitro-matured oocyte development. However, other factors may contribute to the decreased developmental competence of in vitro-matured oocytes.

[Safe gametes acquisition through association of seminal processing techniques with HIV serodiscordant couples]. / Obtenção de gametas seguros por meio de associação de técnicas de processamento seminal para casais sorodiscordantes para HIV.

PURPOSE: the propose of this study was to analyze the clinical and laboratorial parameters of patients submitted to human assisted reproduction techniques with association of sperm processing techniques, in order to remove virus particles from semen samples of couples in which men was infected by human immunodeficiency virus (HIV). METHODS: assessed were 11 intracytoplasmatic sperm injection (ICSI) cycles from couples whose men were HIV seropositive (HIV Group), and 35 cycles in which semen donors' samples were used in ICSI procedures (Control Group). Semen samples from Control Group were submitted to routine semen analysis, sperm wash and cryopreservation. The man from HIV Group received previous antibiotic therapy; the semen samples were analyzed routinely and prepared by sperm wash and density gradient method before cryopreservation. Those samples were evaluated to viral load and ICSI was performed when no HIV was detected. RESULTS: with regards to semen analysis, the groups were similar to sperm concentration and progressive motility. Nevertheless, the percentage of sperm with normal morphology were higher on Control Group (14.3%) than HIV (5.8%; p=0.002). On embryo parameters assessment, the normal fertilization (CT: 74.7% and HIV: 71.7; p=0.838, respectively) and good embryos rate (CT: 42.4% and HIV: 65.1%; p=0.312, respectively) were comparable. On the other hand, the Control Group presented better clinic results than HIV Group (ongoing pregnancy rate: 52.9% versus 12.5%; p=0.054, and implantation rate: 42.6 versus 10.4%; p=0.059, respectively), however the differences were not statistically significant. After delivery, no seroconversion was observed on mother and child. CONCLUSIONS: the association of sperm processing techniques in order to remove HIV from semen samples does not influence in laboratorial parameters of assisted reproduction techniques cycles. On the other hand, it has been demonstrated excellent results getting safety gametes to serodiscordant couples.

Use of pig oocytes for training new professionals in human assisted reproduction laboratories.

OBJECTIVE: To evaluate whether swine oocytes are useful for training new technicians in a human reproduction laboratory. DESIGN: Prospective study. SETTING: Graduate school in assisted reproductive techniques (ART) in Brazil. PATIENT(S): Students in a human reproduction laboratory. INTERVENTION(S): Medium-sized follicles were aspirated from prepubertal gilts' ovaries and collected at a slaughterhouse. Oocytes were retrieved from the follicular fluid. Twenty-one students trained during four periods of 20 hours each were evaluated as to their ability to perform micromanipulation and were compared with a group of well-trained professionals (control group). MAIN OUTCOME MEASURE(S): Students' ability in oocyte retrieval, oocyte manipulation, and intracytoplasmic sperm injection during and after the 80 hours of training. RESULT(S): Students were able to retrieve, on average, 23.8 oocytes per ovary. Their micromanipulation skills substantially increased, reaching an oocyte retrieval rate of 77.2%, compared with 84.9% in the control group after the training period. Although the oocyte damage rate gradually decreased, from 52.0% after 20 hours of training to 5.4% after 80 hours, these figures were still above the control group oocyte damage rate by 0.3%, which was a statistically significant level. Regarding intracytoplasmic sperm injection, within 40 hours, no students were able to perform a single injection; and by the end of 80 hours, they achieved an average of 4.0 oocytes per hour, whereas the control group injected 20.6 oocytes per hour, a statistically significant difference. CONCLUSION(S): Swine ovaries may be a useful tool in the spectrum of training techniques for unskilled assisted reproductive techniques laboratory professionals.