How general semen quality influences the blastocyst formation rate: Analysis of 4205 IVF cycles.

OBJECTIVE: To select embryos with higher implantation potential, the extended culture has been the most frequently applied strategy worldwide, and consequently leads to higher live birth rates per transfer. Sperm quality is a determining feature, and it may influence the outcomes of IVF from fertilization to embryo development. Therefore, we hypothesize that blastocyst formation may also be impaired by general semen quality. METHODS: We analyzed 4205 IVF cycles. Four study groups were designed according to semen quality: normal, mild alteration, severe alteration and epididymis. All cycles were intended to extend embryo culture until the blastocyst stage, and embryo development was evaluated. RESULTS: Regarding cleavage rate, the normal and mild alteration semen groups were equivalent, and the severe alteration and epididymis semen groups were equivalent to each other. The blastocyst formation rate decreased with semen quality. At least one blastocyst formed in 79.9% of cycles for the normal semen group, whereas the percentage of cycles with the formation of at least one blastocyst was slightly lower for the mild alteration (75.6%), severe alteration (76.4%) and epididymis (76.8%) semen groups. A multivariate logistic regression showed that for each additional cleaved embryo on day 3, the chance of having at least one blastocyst doubles. Additionally, the chance of having at least one blastocyst decreased when semen presented mild or severe alterations. CONCLUSION: The general quality of sperm is a good predictor of blastocyst formation, significantly affecting the likelihood of having at least one blastocyst at the end of the cycle. Based on our findings, it is necessary to consider general semen quality and the number of cleaved embryos when forecasting the possibility of blastocyst formation and transfer in an extended culture system.

Ovarian stimulation with daily late follicular phase administration of low-dose human chorionic gonadotropin for in vitro fertilization: a prospective, randomized trial.

OBJECTIVE: Evaluate the effectiveness of a new ovarian stimulation (OS) protocol before IVF. DESIGN: Prospective clinical randomized trial. SETTING: Private centers. PATIENT(S): Three hundred and twenty-three intended-to-treat women candidates for IVF. INTERVENTION(S): Patients were divided into three groups and administered the following treatments: group A, recombinant hFSH from day 3 until follicles reached 13-14 mm, when recombinant hFSH was lowered to 75 IU daily and daily injections of 200 IU of hCG and a GnRH antagonist were administered until final maturation; group B, recombinant hFSH and a GnRH antagonist; group C, recombinant hFSH and a GnRH agonist. MAIN OUTCOME MEASURE(S): Primary outcome was the number of mature oocytes. Secondary outcomes included average initial and total recombinant hFSH dosage, serum E2 level on day of ovulation, number of oocytes retrieved, fertilization, number of top-quality embryos, endometrial thickness, implantation rate, pregnancy rate (PR), and incidence of ovarian hyperstimulation syndrome (OHSS). RESULT(S): The numbers of oocytes retrieved, mature oocytes, fertilization, top-quality embryos, and embryos transferred were comparable in all groups. Implantation rate, PR, and incidence of OHSS were also comparable. The total dose of recombinant hFSH was significantly lower in group A (1,674.7 +/- 59.4 IU, vs. 2,197.9 +/- 77.8 IU in group B and 2,156.7 +/- 80.9 IU in group C). CONCLUSION(S): This new OS protocol permits follicles and oocytes to fully develop, helps generate top-quality embryos, avoids premature ovulation, establishes clinical pregnancies, reduces administration of recombinant hFSH, minimizes costs, and does not increase the chances of OHSS.

Produçäo de embriöes a partir do desenvolvimento de oócitos imaturos in vitro: valor de estimulaçäo curta com FSH / In vitro development of immature oocytes to viable embryos: brief ovarian stimulation with FSH

OBJETIVO: Avaliar os recentes avanços nas técnicas de maturaçäo oocitária que têm possibilitado o desenvolvimento de embriöes a partir de oócitos imaturos. Desta forma objetivamos avaliar a maturaçäo ovular, taxas de fertilizaçäo e desenvolvimento embrionário em oócitos imaturos aspirados sob pequenas doses de estímulo gonadal. MATERIAL E MÉTODOS: 8 mulheres entre 28 e 39 anos foram submetidas a estimulaçäo com urofolitrofina purificada (Metrodin) e seus oócitos coletados quando pelos menos 2 deles atingiram diâmetro médio de 10mm. Os oócitos coletados foram cultivados em meio TCM-199 suplementado com soro sintético. Metrodin, Profasi (hCG) e Piruvato, ambiente controlado a 37 graus Celsius e concentraçäo de CO2 a 5 por cento por 24 até 72h. Após avaliaçäo da maturidade ovular, procedeu-se a ICSI e transferência de embriöes morfologicamente normais por via transcervical para cavidade uterina. RESULTADOS: 43 oócitos coletados de 7 pacientes foram submetidos a maturaçäo in vitro. Em uma das pacientes näo evidenciou presença de oócitos. Observou-se desenvolvimento até primeiro corpúsculo polar em 27 (63 por cento) ocócitos, sendo que destes, 17 (63 por cento) fertilizaram e 15 (88 por cento) apresentaram clivagem em seu seguimento. Como resultado, obtivemos 1 gravidez após 6 transferências (1/6 - 17 por cento por transferência) que resultaram em gestaçäo viável, com evoluçäo normal, atualmente no segundo trimestre. CONCLUSÖES: Estes resultados demonstram a viabilidade de cultura e conseqüente maturaçäo in vitro de oócitos imaturos, observando-se resultados em termos de taxas de fertilizaçäo, clivagem e gravidez, próximas as encontradas em ciclos induzidos até o completo desenvolvimento ovular.