[IMSI versus ICSI for male factor infertility: A meta-analysis].

OBJECTIVE: To evaluate the efficacy and safety of intracytoplasmic morphologically selected sperm injection (IMSI) versus intracytoplasmic sperm injection (ICSI) in in vitro fertilization (IVF) for couples with male factor infertility. METHODS: Using the Cochrane system evaluation method, we searched MEDLINE, EMBASE, CENTRAL, ClinicalTrials.gov, and SinoMed and manually searched the reference lists of the included studies and relevant reviews for randomized controlled trials (RCT) comparing ICSI and IMSI published from 1992 to July 2017. We performed a meta-analysis on the included literature with the RevMan 5.3 software and subgroup analyses due to the prominent clinical heterogeneity of the patients. RESULTS: Of the 280 articles retrieved, 8 RCTs were included, involving 1 741 IVF cycles (842 cycles of IMSI versus 899 cycles of ICSI). There was no evidence for any significant difference between IMSI and ICSI in the live birth rate in the subgroup of infertility induced by pure male factors (RR = 1.31, 95% CI: 0.68－2.51; very low quality evidence from 1 RCT with 77 cycles) but an association of IMSI with an increased clinical pregnancy rate (RR = 1.46, 95% CI: 1.02－2.07; low quality evidence from 4 RCTs with 813 cycles), nor was there any evidence for that in the live birth rate (RR = 0.88, 95% CI: 0.60－1.31; low quality evidence from 1 RCT with 255 cycles) or clinical pregnancy rate (RR = 1.03, 95% CI: 0.86－1.23; moderate quality evidence from 3 RCTs with 851 cycles) in the subgroup of infertility caused by accompanying male factors. CONCLUSIONS: The evidence is of low quality for the association of IMSI with an increased rate of clinical pregnancy and is not sufficient to support the routine use of IMSI in IVF for male factor infertility.

Assisted Hatching in Couples with Advanced Maternal Age: A Systematic Review and Meta-analysis.

This systematic review aimed to evaluate the efficacy and safety of assisted hatching (AH) performed in couples with advanced maternal age. We searched for randomized controlled trials (RCTs) in electronic databases, including MEDLINE, EMBASE and CENTRAL (from inception to January 2018); in addition, we hand-searched the reference lists of included studies and similar reviews. We included RCTs comparing AH versus no treatment (control). The meta-analysis was performed by RevMan 5.3 software. The search retrieved 943 records and 8 RCTs were included, comprising 870 cycles (n=440 for AH, and n=430 for control). There was no significant difference in the rates of live birth (RR 0.88, 95% CI 0.65 to 1.18, 3 RCTs, n=427, I2=0%), clinical pregnancy (RR 1.00, 95% CI 0.83 to 1.19, 8 RCTs, n=870, I2=22%), implantation (RR 1.07, 95% CI 0.83 to 1.39, 4 RCTs, n=1359, I2=0%), miscarriage (RR 1.13, 95% CI 0.66 to 1.94, 2 RCTs, n=116, I2=0%) and multiple pregnancy (RR 0.89, 95% CI 0.31 to 2.52, 1 RCT, n=97, I2=not applicable) between the treatment group and control group. No reasonable conclusions could be drawn regarding reproductive outcomes after AH in patients with advanced maternal age due to the small sample pooled in meta-analyses. Studies of high methodological quality and with adequate power are necessary to further investigate the value of AH in assisted conception of those patients.

Fallopian tube occlusion with a shape memory polymer device: evaluation in a rabbit model.

BACKGROUND: The present study evaluates the feasibility of a shape memory polymer (SMP) device for fallopian tube occlusion in rabbits. STUDY DESIGN: The SMP contraceptive device is made of poly(dl-lactic acid)-based poly(urethane urea) SMP in the shape of a spiral cylinder that was 10 mm long and had a diameter of 2.6 mm. Using this device, bilateral transuterine fallopian tube occlusions were performed in 78 New Zealand white female rabbits. Forty-eight female rabbits (group 1) were chosen as the experimental group and were implanted with the SMP devices. The remaining 30 female rabbits (group 2) served as the control group, which only received an incision in the abdomen but no SMP device. Follow-up consisted of hysterosalpingography, histologic evaluation and contraceptive effect. In addition, the shape memory behavior and in vivo degradation characterization of the SMP device were observed in this study. RESULTS: Under heat (37 °C) stimulation, the temporary shape SMP device returned to its permanent shape within 60 s. The average weight loss percentage of SMP devices was 7.0% at 2 weeks and 72.5% at 12 weeks. The inflammatory reactions caused by SMP devices were aseptic and nonspecific at 2 and 12 weeks, respectively. The SMP device boundaries and the surrounding tissues were obscured by fiber hyperplasia in 11/12 tubes at 24 weeks. Hysterosalpingography showed an occluded fallopian tube of Group 1 in 6/6 rabbits at 12 weeks and 6/6 rabbits at 24 weeks. No pregnancy was found in all 18 rabbits of group 1 (contraceptive rate of 100%); all 20 rabbits in the control group were pregnant. CONCLUSION: Biodegradable and biocompatible SMP devices could provide reliable, instant and permanent tubal occlusion.

[Regulation of epidermal growth factor, thyrotropin releasing hormone and dexamethasone on the expression of fetal lung SP mRNAs in rabbits].

OBJECTIVE: To compare the effect of epidermal growth factor (EGF), thyrotropin releasing hormone (TRH) and dexamethasone (Dex) on the expression of surfactant protein (SP)-A, SP-B and SP-C mRNA in fetal rabbit lungs. METHODS: Sixty-four Japanese white pregnant rabbits, put into four different groups (16 rabbits each), were given EGF (EGF group), TRH (TRH group), Dex (Dex group) or normal saline (control group) intravenously from gestational day 22(nd) (5 rabbits in each group) or 24(th) (11 rabbits in each group) for three days before killing. The levels of SP-A, SP-B and SP-C mRNAs in the fetal rabbit lungs were detected by reverse transcription polymerase chain reaction (RT-PCR) and Southern blotting. RESULTS: In the 27(th) gestational day, SP-B mRNA levels in the fetal rabbit lungs in all treated groups were found significantly higher than those in the control group (P < 0.05). In the 25(th) day, there had a higher expression of SP-A and SP-C mRNAs in the fetal lungs in all groups, but SP-B mRNA could be tested only in the Dex group. SP-B mRNA level was lower than that of SP-A mRNA and SP-C mRNA in the same fetal lungs in the 27(th) gestationed day. CONCLUSION: The time of detectable SP-B mRNA in rabbit fetal lungs appeared later than that of the SP-A and SP-C mRNAs. The expression of SP-B mRNA is lower in comparison with those of SP-A mRNA and SP-C mRNA in the same samples. Prenatal maternal treatment with intravenously Dex, EGF and TRH could increase the expression of SP-B mRNA in fetal rabbit lungs, and the effect of Dex may be more significant at earlier stage of gestation.