Defining poor responders in assisted reproduction.

OBJECTIVE: The aim of this study was to establish an objective definition of "poor responders" for patients undergoing treatment with assisted reproduction. METHODS: A total of 782 infertile couples treated with assisted reproduction were studied by retrospective analysis of the data. Simple linear regression was performed between the number of oocytes retrieved and the clinical pregnancy rate. The sensitivity and specificity were then calculated and the receiver-operator characteristic (ROC) curves were drawn in order to determine a critical number of oocytes retrieved below which the clinical pregnancy rate was significantly diminished. RESULTS: An excellent correlation was found between the number of oocytes retrieved and the clinical pregnancy rate (r = 0.90). The clinical pregnancy rate started to become significantly lower when fewer than 5, 6, and 8 oocytes were retrieved from patients treated with ICSI, IVF, or TeSE/ICSI, respectively. CONCLUSIONS: The definition of poor responders in assisted reproduction depends on the treatment modality. Poor responders are patients undergoing treatment with ICSI, IVF, or TeSE/ICSI from whom fewer than 5, 6, or 8 oocytes are retrieved, respectively.

Sperm velocity and morphology, female characteristics, and the hypo-osmotic swelling test as predictors of fertilization potential: experience from the IVF model.

OBJECTIVE: To determine, among the following variables, the predictors of sperm fertilization potential of a given semen sample: sperm count, eight sperm velocity characteristics determined by computer-assisted semen analysis, the sperm morphology score determined by strict criteria, and the hypo-osmotic swelling (HOS) test, using the IVF model. DESIGN: Data from 58 couples attending the assisted conception unit for conventional IVF treatment were analyzed retrospectively by simple linear regression and multiple stepwise regression analysis, taking the fertilization rate as the dependent factor. RESULTS: The mean sperm velocity and the strict sperm morphology assessment were the only parameters showing significant correlation with the fertilization rate. A minimum sperm velocity of 13 microm/s and a minimum strict sperm morphology of 2% were necessary to achieve fertilization in 50% of the oocytes. The results of the HOS test did not correlate with the fertilization rate. An equation was devised to calculate the expected fertilization rate based on the mean sperm velocity and the strict morphology score, and can be used to counsel patients prior to assisted conception. CONCLUSIONS: The mean sperm velocity and strict sperm morphology evaluation are good predictors of fertilization potential, but the HOS test is not.

The use of the modified hypo-osmotic swelling test for the selection of immotile testicular spermatozoa in patients treated with ICSI: a randomized controlled study.

BACKGROUND: Various methods for the selection of viable sperm from among immotile testicular spermatozoa for use in ICSI have been described in non-randomized studies. We have conducted a randomized controlled study to compare the use of the modified hypo-osmotic swelling (HOS) test (50% culture medium + 50% Milli-Q grade water) with that of sperm selection on the basis of their morphology alone. METHODS: A total of 79 couples with immotile testicular spermatozoa treated with ICSI were randomly assigned into two groups. In the first group, spermatozoa used for injection were selected using the modified HOS test, while in the second group spermatozoa were selected on the basis of their morphology. RESULTS: The fertilization rate was significantly higher in the HOS test group (43.6%) compared with the no-HOS test group (28.2%) [odds ratio (OR) 2.494; 95% confidence interval (CI) 1.606-3.872]. The pregnancy and ongoing pregnancy rates were also higher in the HOS test group (27.3% versus 20.5%) compared with the no-HOS test group (5.7% versus 2.9%) (OR 6.188, 95% CI 1.282-29.860; and OR 8.743, 95% CI 1.050-72.783, respectively). CONCLUSIONS: The use of the modified HOS test for the selection of viable sperm from among immotile testicular spermatozoa for ICSI results in higher fertilization, pregnancy and ongoing pregnancy rates compared with morphological selection.

Impact of technical difficulties, choice of catheter, and the presence of blood on the success of embryo transfer--experience from a single provider.

PURPOSE: To investigate the impact of technical difficulties, choice of catheter, and the presence of blood during embryo transfer on the results of in vitro fertilization and ICSI. METHODS: A cohort of 784 consecutive cycles in 655 in vitro fertilization and ICSI patients were studied. RESULTS: Negotiating the cervix, using the volsellum, presence of blood on the catheter wall or on the cervix did not affect the results. Changing the catheter and blood on the catheter tip reduced the pregnancy (P < 0.05 and P < 0.05) and implantation rates (P < 0.001 and P < 0.01). The Ultrasoft catheter produced higher pregnancy (P < 0.0005) and implantation rates (P < 0.01) compared to the more rigid Frydman catheter. CONCLUSIONS: Negotiation of the cervix, the use of a volsellum, and the presence of blood on the catheter wall or on the cervix do not affect the results. Changing the catheter and blood on the catheter tip significantly diminish the pregnancy and implantation rates. Soft catheters perform better.