Appendix A: Cryotech® Vitrification Thawing.

In the last 15-20 years, many centers are using vitrification as a method of choice for cryopreservation of human oocytes and embryos. As vitrification technologies have improved their success profiles, new applications seem to have emerged, making IVF treatments more successful and more flexible.This appendix describes the Cryotech® method, which is the latest "minimal volume approach" method, suitable for cryopreservation of oocytes and embryos of any developmental stage, including blastocysts. Dr. Masashige Kuwayama, who has introduced major advances in oocyte and embryo cryopreservation, has developed this method. A detailed protocol has been described with finer tips for the accurate use of the method for perfect survival and safety.

In vitro fertilization/intracytoplasmic sperm injection for male infertility.

Progress in the field of assisted reproduction, and particularly micromanipulation, now heralds a new era in the management of severe male factor infertility, not amenable to medical or surgical correction. By overcoming natural barriers to conception, in vitro fertilization and embryo transfer (IVF-ET), subzonal sperm insemination, partial zona dissection, and intracytoplasmatic injection of sperm (ICSI) now offer couples considered irreversibly infertile, the option of parenting a genetically related child. However, unlike IVF, which necessitates an optimal sperm number and function to successfully complete the sequence of events leading to fertilization, micromanipulation techniques, such as ICSI, involving the direct injection of a spermatozoon into the oocyte, obviate all these requirements and may be used to alleviate severe male factor infertility due to the lack of sperm in the ejaculate due to severely impaired spermatogenesis (non-obstructive azoospermia) or non-reconstructable reproductive tract obstruction (obstructive azoospermia). ICSI may be performed with fresh or cryopreserved ejaculate sperm where available, microsurgically extracted epididymal or testicular sperm with satisfactory fertilization, clinical pregnancy, and ongoing pregnancy rates. However, despite a lack of consensus regarding the genetic implications of ICSI or the application and efficacy of preimplantation genetic diagnosis prior to assisted reproductive technology (ART), the widespread use of ICSI, increasing evidence of the involvement of genetic factors in male infertility and the potential risk of transmission of genetic disorders to the offspring, generate major concerns with regard to the safety of the technique, necessitating a thorough genetic evaluation of the couple, classification of infertility and adequate counseling of the implications and associated risks prior to embarking on the procedure. The objective of this review is to highlight the indications, advantages, limitations, outcomes, implications and safety of using IVF/ICSI for male factor infertility to enable a more judicious use of these techniques and maximize their potential benefits while minimizing foreseen complications.

Embryo transfer using the SureView catheter-beacon in the womb.

OBJECTIVE: To compare the performance of the SureView catheter, a new ultrasonic embryo transfer (ET), with the classic Wallace catheter during ultrasound-guided ET. DESIGN: Prospective, randomized study. SETTING: Private, academically affiliated clinic. PATIENT(S): 175 patients undergoing donor egg in vitro fertilization with ET (IVF-ET). INTERVENTION(S): Ultrasound-guided ET by a single physician with a standardized technique randomly using one of the two catheters. MAIN OUTCOME MEASURE(S): Implantation rate, pregnancy rate, ease of transfer, and visualization of catheter. RESULT(S): The echo-dense tip and the entire length of the SureView catheter were consistently seen with ultrasound guidance. Visualization was statistically significantly better, but there was no statistically significant difference with regard to the ease of transfer. Comparing the SureView with the classic Wallace catheters, the implantation rate (27.76% vs. 23.56%, respectively) and clinical pregnancy rate (41.02% vs. 43.29%, respectively) were similar in both groups. However, the physician using the SureView catheter noted a remarkably superior ease of transfer. CONCLUSION(S): The SureView catheter with its ultrasonic contrast properties simplifies ultrasound-guided ET, but pregnancy rates are similar to those obtained when a classic Wallace catheter is used.

Antibubble trajectory during embryo transfers in donor egg IVF does not predict success.

Transient motion of embryo transfer-associated antibubbles was observed. This prospective study was performed to determine if this antibubble movement can predict a successful outcome. Transabdominal ultrasound-guided embryo transfers were performed in 187 recipients receiving identical hormone replacement therapy. All embryo transfers were performed by the first author, using the Sureview embryo transfer catheter, in 30 mul of culture media. Observation was made of the catheter placement in relation to the endometrial surface and uterine fundus during embryo transfer. Ultrasound-guided tracking of antibubble within the uterine cavity was done immediately after the piston was depressed at the time of embryo deposition. The antibubble movement was upwards (group A) in 104 embryo transfers and downwards (group B) in 83 transfers. No movement of embryo-associated air out of the uterine cavity, either into the cervix or the intramural portion of the Fallopian tube, was observed. The clinical pregnancy rate was similar in both groups: 47.12% in group A versus 45.78% in group B. The total implantation rate/embryo transferred was 19.34% in group A compared with 20.07% in group B. The movement of the embryo transfer-associated antibubble is unlikely to be a factor in predicting success in donor egg IVF cycles.