RESUMEN
OBJECTIVE: To evaluate the clinical outcomes of intracytoplasmic sperm injection (ICSI) and conventional in vitro fertilization (IVF) using sibling oocytes for treatment of primary and secondary infertility. METHODS: A total of 149 cycles of IVF and ICSI were conducted between January, 2003 and December, 2008 in our center, including 98 cycles in patients with primary infertility and 51 in those with secondary infertility. According to the embryos derived from ICSI, IVF and their combination, the clinical pregnancy rate, delivery rate and birth defect of the 3 groups were analyzed. RESULTS: The fertilization failure rate of IVF was significantly higher in primary infertility group than in secondary infertility group (10.2% vs 3.9%, P<0.05). No fertilization failure occurred in ICSI group. The fertilization rates and good quality embryo rates in ICSI group were significant higher than those in IVF group, and the abnormal fertilization rate was significantly lower in ICSI group (P<0.05). No significant difference were found in the implantation rates, clinical pregnancy rates, delivery rates or the rates of birth defects of the offsprings between IVF, ICSI and IVF+ICSI groups. CONCLUSION: IVF combined with ICSI may result in increased fertilization rate and avoid total fertilization failure with favorable clinical outcomes in patients with long-term infertility, and ICSI may not increase the birth defects of the offspring in these patients.
Asunto(s)
Fertilización In Vitro/métodos , Infertilidad Femenina/terapia , Inyecciones de Esperma Intracitoplasmáticas , Adulto , Transferencia de Embrión , Femenino , Humanos , Persona de Mediana Edad , Embarazo , Índice de Embarazo , Estudios Retrospectivos , Resultado del Tratamiento , Adulto JovenRESUMEN
OBJECTIVE: To explore the quality of the embryos, clinical outcomes and birth defects resulting from intracytoplasmic sperm injection (ICSI) treatment using sperms of different origins and parameters. METHODS: A total of 980 ICSI-ET (embryo-transfer) cycles were divided into 4 groups, namely normal sperm or mild oligozoospermia group (group A), severe oligozoospermia group (group B), epididymal aspirates group (group C) and testicular biopsies group (group D). The cleavage rate, embryo quality, fertilization rate, clinical pregnancy rate, and rates of birth defects were compared between the groups. RESULTS: The fertilization rate, cleavage rate and good-quality embryo rate were not significantly different among the 4 groups (P>0.05), and the embryo implantation rate and clinical pregnancy rate were significantly higher in group C than in groups A and B (P<0.05). Groups A, B and C showed no significant differences in the rates of birth defects (P>0.05), and no birth defects occurred in group D. CONCLUSIONS: Sperms of different parameters and origins used in ICSI treatment can achieve similar fertilization rate, good-quality embryo rate and delivery rate. The embryo implantation rate and clinical pregnancy rate of epididymal sperm group are higher than those of ejaculated groups, possibly due to the younger age of the patients and a greater number of oocytes retrieved in group C than in groups A and B.
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Anomalías Congénitas/etiología , Inyecciones de Esperma Intracitoplasmáticas/efectos adversos , Espermatozoides , Femenino , Fertilización , Humanos , Masculino , Resultado del TratamientoRESUMEN
OBJECTIVE: To evaluate the combined effect of endometrial thickness and pattern on clinical outcome in patients undergoing in vitro fertilization/intracytoplasmic sperm injection and embryo transfer (IVF/ICSI-ET). METHODS: Cycles of IVF/ICSI-ET conducted between January 2003 and December 2008 at a university-based reproductive center were reviewed retrospectively. Endometrial ultrasonographic characteristics were recorded on the day of hCG administration. In the combined analysis, endometrial thickness groups (group 1: equal or <7 mm; group 2: 7-14 mm; group 3: >14 mm) were subdivided into two endometrial patterns (pattern A: triple-line; pattern B: no-triple line). Clinical pregnancy rate (CPR) and early miscarriage rate in different groups were analyzed. RESULTS: A total of 2896 cycles were reviewed. Clinical pregnancy rate (CPR) was 24.4% in group 1-A. There were no second trimester pregnancies in group 1-B. Miscarriage rate in group 2-A was significantly lower compared to group 2-B (P < 0.01), although CPR did not show any significant differences between the groups. A no-triple line endometrial pattern with moderate endometrial thickness (7-14 mm) had a detrimental effect on pregnancy outcome, but not the occurrence of pregnancy. In group 3, there was no difference in CPR and miscarriage rates between the two patterns; adequate endometrial thickness (>14 mm) seemed to mitigate the detrimental impact (high miscarriage rate) of pattern B. CONCLUSION: Combined analysis of endometrial thickness and pattern on the day of hCG administration was a better predictor of the outcome of IVF/ICSI-ET and may be more helpful for patient counseling than the separate analyses.
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Transferencia de Embrión , Endometrio/patología , Endometrio/fisiopatología , Fertilización In Vitro , Infertilidad Femenina/diagnóstico , Adulto , Gonadotropina Coriónica/administración & dosificación , Estudios de Cohortes , Esquema de Medicación , Transferencia de Embrión/métodos , Endometrio/diagnóstico por imagen , Femenino , Fertilización In Vitro/métodos , Humanos , Infertilidad Femenina/patología , Ciclo Menstrual/fisiología , Tamaño de los Órganos , Embarazo , Índice de Embarazo , Pronóstico , Estudios Retrospectivos , Resultado del Tratamiento , Ultrasonografía , Adulto JovenRESUMEN
OBJECTIVE: To study the clinical features and outcomes of in vitro fertilization and embryo transfer (IVF-ET) in infertile patients due to polycystic ovary syndrome (PCOS) or polycystic ovaries (PCO). METHODS: This study involved 189 infertile patients with polycystic ovary syndrome (PCOS), with 129 polycystic ovaries (PCO), and 142 without PCOS or PCO (control) undergoing IVF-ET. The dosage of gonadotrophin (Gn), sex hormone level on the day of HCG administration, clinical pregnancy rate, spontaneous abortion rate and ovarian hyperstimulation syndrome (OHSS) rate were analyzed and compared between the 3 groups. RESULTS: No significant differences were found in the clinical pregnancy rate between the PCOS group (202 cycles), PCO group (134 cycles) and control group (150 cycles) (51.0%, 53.0% and 46.0%, respectively). The levels of LH and T and early spontaneous abortion rates were significantly higher in PCOS group than in PCO group and control group (P<0.05). The P level on HCG day was the highest in PCO group (P<0.05). The early spontaneous abortion rates and clinical pregnancy rate showed no significant differences between PCO group and control group (P>0.05). The dosage of Gn was significantly lower and OHSS rate higher in PCOS and PCO groups than in the control group (P<0.05). CONCLUSIONS: The clinical pregnancy rate of infertile patients with PCOS is similar with that of PCO patients and control patients undergoing IVF-ET treatment. PCOS, however, is associated with increased spontaneous abortion rate, possibly due to abnormality of LH and T release. The clinical outcomes in PCO patients are similar with those in the control patients, and elevated P level in the late follicular phase does not obviously influence the outcomes of IVF. Both PCOS and PCO are associated with increased risk of OHSS.
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Transferencia de Embrión , Fertilización In Vitro , Infertilidad Femenina/terapia , Quistes Ováricos/complicaciones , Síndrome del Ovario Poliquístico/complicaciones , Adulto , Estudios de Casos y Controles , Femenino , Humanos , Infertilidad Femenina/etiología , Embarazo , Resultado del Embarazo , Estudios RetrospectivosRESUMEN
OBJECTIVE: To investigate the association of the clinical characteristics and the outcome of in vitro fertilization and embryo transfer (IVF-ET) in infertile women with polycystic ovarian syndrome (PCOS) of different subtypes. METHODS: A total of 189 infertile women with PCOS undergoing IVF-ET were enrolled in this study. According to Rotterdam PCOS diagnosis criteria, the patients were classified into 3 PCOS subtypes, namely type I with PCO ultrasonography and oligo-ovulation/anovulation and hyperandrogenism (54 women, for whom 58 fresh IVF-ET cycles were performed); type II with PCO ultrasonography and oligo-ovulation/anovulation (117 women with 126 cycles); type III with PCO ultrasonography and hyperandrogenism (18 women with 18 cycles). The number of retrieved oocytes, fertilization rate, implantation rate, clinical pregnancy rate, spontaneous abortion rates and incidence of ovarian hyperstimulation syndrome (OHSS) were compared between the 3 groups. RESULTS: Except for the baseline serum T concentration in the early phase of menstrual cycle, which was significantly higher in groups I and III than in group II, no significant difference was found in the clinical characteristics between the 3 groups (P>0.05). Group I had the highest initial Gn dose, and the oocyte retrieval rates were significantly lower in groups I and III (P<0.05). The patients in group I had lower implantation rate and the clinical, on-going and cumulative pregnancy rates than groups II and III, but the differences were not statistically significant; the embryo early loss rate and spontaneous abortion rate appeared to be higher in groups I and III (P>0.05). Significantly elevated incidence of OHSS were noted in groups I and III (P<0.05). CONCLUSION: The women with different PCOS subtypes according to the Rotterdam criteria all have similar IVF-ET outcomes, and the increased embryo loss rate and spontaneous abortion rate in groups I and III might be associated with excessive androgen that disturbs oocyte and embryo development.