ABSTRACT
Nonobstructive azoospermia is caused in up to 10% by microdeletions of the Y chromosome in the azoospermia factor (AZF) region, which is divided into three nonoverlapping areas (AZFa, AZFb and AZFc). In 25 male patients with AZF microdeletions, the results of two different techniques for surgical sperm retrieval (SR), conventional multilocular TESE and microdissection TESE, were studied retrospectively over a period of 19 years. Conventional multilocular TESE was carried out in 11 patients and microdissection TESE in 14 patients. Successful SR was possible only in patients with isolated AZFc microdeletions, so only the 20 patients with AZFc microdeletions alone were taken into account for the comparison of the both operative techniques. The sperm detection rate for conventional multilocular TESE was 25%, the sperm detection for microdissection TESE was significantly higher with 67%. In all patients, a histological examination of the testicular tissue was carried out, which showed a mixed picture, but Sertoli-cell-only syndrome in most cases. FSH was no prognostic marker for successful SR. In two of six couples performing an intracytoplasmic sperm injection until now, a pregnancy occurred.
Subject(s)
Azoospermia/surgery , Infertility, Male/surgery , Microdissection , Sex Chromosome Disorders of Sex Development/surgery , Sperm Retrieval , Azoospermia/genetics , Biopsy , Chromosome Deletion , Chromosomes, Human, Y , Female , Humans , Male , Pregnancy , Retrospective Studies , Sertoli Cell-Only Syndrome/pathology , Sex Chromosome Aberrations , Sperm Injections, Intracytoplasmic/methods , Testis/pathologyABSTRACT
OBJECTIVE: The aim of these studies was to investigate whether the leucocytic ultrafiltrate LeukoNorm Cytochemia, which is approved for the treatment of immunologically-based recurrent spontaneous abortions (RSA), improves treatment results in patients with repetitive IVF or ICSI failures. MATERIAL AND METHODS: Included in this study were patients with 3 embryo transfers, with at least 8 morphologically good-looking embryos of the categories a and b, and no conception. Excluded were patients with accompanying endocrine disorders, uterine malformations, and those exhibiting the presence of an antiphospholipid syndrome and of further autoantibody syndromes (e.g. antinuclear antibodies [ANA]). The patients were treated in three prospective, randomized studies. The studies differed with respect to the frequency and timing of the administration of LeukoNorm Cytochemia. RESULTS: Pregnancy rates in each of the study protocols were generally higher than in the normal treatment group. Because of the small number of patients (study I: 10 patients), the differences were not always significant. The results of study III, which is still ongoing and in which LeukoNorm Cytochemia has been given on 5 consecutive days starting with the day of oocyte retrieval, are more significant. In the treatment group of study III the pregnancy rate was 55% as opposed to a rate of 21.2% in the non-treatment group. CONCLUSIONS: The administration of LeukoNorm Cytochemia can significantly improve treatment results in patients with repetitive IVF or ICSI failures. Currently the most favourable results are observed with a dosage of 1 unit/10 kg on 5 consecutive days, starting with the day of oocyte retrieval. These results imply that, in the IVF or ICSI programmes, there exists a group of patients with disturbances in the embryo-maternal dialogue, and therefore no conceptions. Furthermore, the results demonstrate that the administration of LeukoNorm Cytochemia can improve the implantation rate of transferred embryos in these patients. We conclude that growth factors and cytokines synthesized and secreted by leucocytes have an important influence on embryonic implantation and growth.
Subject(s)
Abortion, Habitual/prevention & control , Embryo Transfer , Fertilization in Vitro , Sperm Injections, Intracytoplasmic , Transfer Factor/administration & dosage , Abortion, Habitual/immunology , Adult , Cytokines/blood , Dose-Response Relationship, Drug , Drug Administration Schedule , Female , Humans , Infant, Newborn , Pregnancy , Randomized Controlled Trials as Topic , Treatment FailureABSTRACT
It is reported on the results of 250 treatment cycles in which we carried out intracytoplasmic injections (ICSI) with frozen and thawed testicular spermatozoa (cryo-TESE). Up to July 1997 we treated 127 patients, 225 embryo transfers were performed (90%), and an average of 2.3 preimplantation embryos were transferred. This resulted in 53 clinical pregnancies, six patients aborted (11.3%). The pregnancy rate was 21.2% per treatment cycle, 23.5% per embryo transfer, and 41.7% per patient. This so called cumulative pregnancy rate is still about to rise, because 49 out of the 72 non-pregnant patients are still in our ICSI-program. Twenty-two children are born, 2 twins and 1 triplet. All children are healthy and without any major malformations. We conclude from these results that using cryopreserved testicular sperm for ICSI is an effective and successful approach for the treatment of severe testicular insufficiency. In comparison to the use of native testicular sperm with the necessity of repetitive testicular biopsies, cryopreservation is advantageous in many concerns (e.g. logistic, organisatoric and financial) and is therefore recommended for clinical routine.
Subject(s)
Fertilization in Vitro/methods , Spermatozoa/transplantation , Female , Humans , Infant, Newborn , Infertility, Male/etiology , Infertility, Male/therapy , Male , Microinjections , Pregnancy , Pregnancy, Multiple , Retrospective Studies , Semen Preservation , Treatment OutcomeABSTRACT
We report on our experiences with 25 married couples that approached us for intracytoplasmatic sperm injection (ICSI) after previous failure of artificial insemination by donor (AID). AID has been carried out in several specialized fertility centers. We traditionally refrain from donor semen procedures. All patients have undergone at least 4 treatment cycles of AID, the maximum was 20. With exception of one all patients have been inseminated after ovarian hyperstimulation according to different protocols (e.g. GnRH-A/FSH, hMG; CC/hMG). Prior to ICSI we have confirmed male subfertility being in all patients of severe grade. All patients have been proven to have ejaculated spermatozoa. We have performed 71 treatment cycles for ICSI so far, 19 patients have become pregnant, 3 have aborted. The pregnancy rate per cycle is 26%, per embryo transfer 30%, and per patient 76%. We think that these results are primarily caused by so far unknown defects in oocytes and their function during fertilization. Besides, we assume psychosomatic causes maybe involved.
Subject(s)
Fertilization in Vitro/methods , Insemination, Artificial, Heterologous , Oligospermia/therapy , Spermatozoa/transplantation , Adult , Embryo Transfer , Female , Follow-Up Studies , Humans , Infant, Newborn , Male , Microinjections , Pregnancy , Treatment FailureABSTRACT
This is a report on a pregnancy achieved by in-vitro fertilisation (IVF) with intracytoplasmatic sperm injection (ICSI) after testicular sperm extraction (TESE). Because of a bilateral absence of the ductus deferens, microsurgical epididymal sperm aspiration (MESA) was not possible. This anatomic situation was probably caused by a bilateral herniotom during childhood. The wife became pregnant in the first treatment cycle and meanwhile gave birth to a healthy boy. This case report demonstrates that the ICSI procedure is successful even with testicular spermia and extremely low sperm counts.
Subject(s)
Fertilization in Vitro/methods , Injections , Sperm-Ovum Interactions , Adult , Female , Humans , Infant, Newborn , Male , Pregnancy , Sperm Count , Testis/cytology , Treatment OutcomeABSTRACT
For the first time we report on an intact and ongoing triplet pregnancy after intracytoplasmatic sperm injection of cryopreserved testicular sperm. Indication was azoospermia due to hypergonadotropic hypogonadism. The patient conceived in the third treatment cycle after 25 treatment cycles with donor sperm that had been carried out without success in two other treatment centers.
Subject(s)
Fertilization in Vitro , Oligospermia/therapy , Pregnancy, Multiple , Semen Preservation , Adult , Female , Humans , Male , Pregnancy , TripletsABSTRACT
An in vitro model based on luteinised granulosa cells gained during an in vitro fertilisation programme examines the question of whether prednisolone, and thus glucocorticoids in general, are capable of exerting an influence on the secretion of oestradiol and progesterone. It can be demonstrated that prednisolone leads to dosage-dependent increases in the concentration of both steroids, even independently of concurrent stimulation by human chorionic gonadotropin. A similar mechanism for aromatase activity of human adipose cells is suggested.