Two successful pregnancies achieved by converting an in vitro fertilization cycle to an intrauterine insemination cycle in five cases with documented premature ovulation.

We here report two successful pregnancies obtained by converting an in vitro fertilization (IVF) cycle to an intrauterine insemination (IUI) cycle in five poor responder patients whose oocyte pick-up (OPU) procedures were canceled due to documented premature ovulation immediately before OPU. To our knowledge, this is the first article that demonstrates that switching an IVF cycle to an IUI cycle when premature ovulation occurs on the day of OPU can produce successful pregnancies, even in poor responder patients.

Outcome of intracytoplasmic sperm injection using fresh and cryopreserved-thawed testicular spermatozoa in 83 azoospermic men with Klinefelter syndrome.

AIM: To report the outcome of intracytoplasmic sperm injection (ICSI) cycles using fresh or cryopreserved-thawed testicular spermatozoa of men with Klinefelter syndrome (KS). METHODS: Medical records of 83 azoospermic men with KS who underwent testicular sperm extraction (TESE) were reviewed. The clinical parameters for predicting sperm retrieval and fertilization, implantation, pregnancy and live birth rates of ICSI cycles in these patients were evaluated. RESULTS: A total of 88 TESE procedures were performed with sperm retrieval rates of 39.8% per cycle (35/88) and 42.1% per patient (35/83). None of the studied clinical parameters were found to be informative in predicting successful sperm recovery. A total of 41 embryo transfer cycles were carried out using fresh testicular spermatozoa in 30, cryopreserved-thawed spermatozoa in 10 and cryopreserved-thawed embryo replacement in one. The fertilization and clinical pregnancy rates were comparable at 52.7% and 51.6% with fresh and 48.3% and 60% with cryopreserved-thawed testicular spermatozoa groups, respectively. Twenty-two clinical pregnancies were obtained, including 14 singletons, five twins, two triplets and one quadruplet and ended with the delivery of 13 singletons and six twins. In total, out of 25 delivered fetuses, four died (3 female, 1 male) following delivery and 21 newborns (14 female, 7 male) were healthy with a female to male ratio of 2:1. Conclusions We concluded that no clinical or laboratory parameter predicts the presence of spermatozoa in patients with KS, except the TESE procedure itself. The use of fresh or cryopreserved-thawed spermatozoa on ICSI cycle outcomes are equally successful in patients with KS.

Birth of a healthy boy using fresh testicular sperm in a patient with Klinefelter syndrome combined with Kartagener syndrome.

OBJECTIVE: To report a case of Klinefelter syndrome combined with Kartagener syndrome. DESIGN: Case report. SETTING: Private IVF center. PATIENT(S): A 35-year-old man with Klinefelter syndrome combined with Kartagener syndrome causing primary infertility. INTERVENTION(S): Testicular sperm extraction (TESE) and intracytoplasmic sperm injection (ICSI). MAIN OUTCOME MEASURE(S): Sperm recovery, fertilization, and live birth. RESULT(S): Ovulation induction of the female partner, recovery of spermatozoa by TESE from the male partner and ICSI of 9 metaphase II oocytes resulted in two fertilized oocytes. The delivery of a healthy boy with normal anatomy and 46,XY karyotype was achieved after the transfer of only one 4-cell grade 1 embryo. CONCLUSION(S): To our knowledge, this case with nonmosaic Klinefelter syndrome combined with Kartagener's syndrome is unique and demonstrates the revolutionary aspects of assisted reproductive technologies (ART) concerning male factor infertility.

Effect of heat-induced hypermotility on pregnancy rate in intrauterine insemination for male factor infertility associated with asthenospermia: a prospective, randomized, controlled study.

OBJECTIVE: To assess the effect of mild heat for the enhancement of sperm fertilizing capacity in intrauterine insemination for male factor infertility associated with asthenospermia. MATERIAL AND METHOD: Prospective, controlled, clinical study. Male factor infertility associated with asthenozoospermia was the criteria for inclusion. Ninety-seven couples were randomized to the study group while 100 couples were randomized to serve as the control group. Semen samples from the study group were processed with Percoll gradient and were left for incubation at 40 degrees C for 2 h. Semen samples from the control group were processed with Percoll gradient method and were incubated at 37 degrees C. Main outcome measure was the pregnancy rate. RESULTS: The mean concentration of total motile sperm (TMS) in the study group was 11.20 +/- 4.22 x 10(6) (range 7-18) after wash with Percoll while was increased to 62.41 +/- 12.49 x 10(6) (range 44-71) after heat treatment. The mean concentration of TMS in the control group was 13.90 +/- 5.66 x 10(6) (range 8-19) after wash with Percoll while was increased to 17.73 +/- 3.67 x 10(6) (range 14-22) after incubation at 37 degrees C. The difference in TMS concentrations between the study and the control group after incubation at different temperatures was statistically significant (p < 0.005). There were 24 pregnancies in the study group, providing a pregnancy rate of 24.7%. In the control group eight pregnancies were achieved (8%) (p = 0.001). CONCLUSION: Mild heat was found remarkably effective in asthenozoospermic males for increasing the concentration of inseminated total motile sperm and the pregnancy rate correspondingly.

Intrauterine insemination with double ejaculate compared with single ejaculate in male factor infertility: a pilot study.

The aim of this study was to compare the efficiency of using a double ejaculate with the efficiency of using a single ejaculate for intrauterine insemination in male subfertility. Eligibility for the study was a total motile sperm count between 1 x 10(6) and 5 x 10(6) on postwash sperm analysis. Thirty-nine couples were randomized to the study group, while another 50 couples were randomized to serve as the control group. Males in the study group were asked to produce a second semen sample within 2 hours of the first sample on the day of insemination. In the study group, the mean total motile sperm count in the first sample was 3.83 x 10(6) (SD +/- 0.85 x 10(6); range 1.1-4.9) and 3.99 x 10(6) (SD +/- 0.72 x 10(6); range 0.9-4.4) in the control group. The mean total motile sperm count in the second sample was 3.52 x 10(6) (SD +/- 1.46 x 10(6); range 0.9-3.7) in the study group. The mean total motile sperm count in the final inseminate was 7.35 x 10(6) (SD +/- 1.90 x 10(6); range 2.9-10.6) in the study group. The difference in total motile sperm counts between the study and the control group was statistically significant (P < .001). There were 6 pregnancies in the study group, providing a pregnancy rate of 15.3%, whereas there were 5 pregnancies in the control group, representing a pregnancy rate of 10% (P = .44). We concluded that although it does not increase the pregnancy rate significantly, obtaining a second semen sample when the motile sperm yield of the first semen sample is 1 million to 5 million significantly increases the total motile sperm count in the final inseminate.