In Vitro Fertilisation and Intracytoplasmic Sperm Injection predictive factors: A review of the effect of female age, ovarian reserve, male age, and male factor on IVF/ICSI treatment outcomes.

The development of assisted reproductive technology has allowed offspring in infertile couples, and specifically, allowed infertile men to conceive through Intracytoplasmic Sperm Injection (ICSI). Despite the proven efficacy of In Vitro Fertilisation (IVF) and ICSI, many factors can influence its success. In this review we present an analysis on the effect of Female age, Ovarian Reserve, Male age and Male factor on the outcomes of IVF/ICSI, to determine if and which can be applied to the practical context. A literature search on PubMed, EMBASE and MEDLINE for relevant articles was elaborated until July 2021, leading to the selection of 234 articles based on their titles. After reading through the abstracts, those that evaluated IVF/ICSI predicting factors were selected. Finally, only those approaching female age, ovarian reserve, male age and male factor were considered in this review. Higher female age and baseline ovarian markers alterations such as lower anti-Müllerian hormone and antral follicular count, and higher basal follicle-stimulating hormone, were associated with poorer outcomes. The predictive value of Male age and Male factor presented varied results across literature. The multifactorial nature of male fertility makes evaluation difficult. Although the first assessment of male infertility is based on sperm concentration, motility and morphology, semen parameters have shown low prognostic value, whilst sperm DNA alterations gain importance. Nevertheless, results remain controversial. While some factors have proven to predict IVF/ICSI success, other need to be further studied to be applied to practical context to allow the best prognosis possible.

Corifollitropin alpha was not detrimental to follicular ovarian responsiveness measured by follicular output rate (FORT).

Corifollitropin alpha has been demonstrated to be non-inferior to other gonadotropins in reproductive outcomes. However, its impact on follicular ovarian responsiveness has never been evaluated. Follicular Output Rate (FORT) is an option for objective assessment of the follicular responsiveness. A prospective study was conducted with 306 infertile patients undergoing in vitro fertilisation. Ovarian stimulation protocol was performed with a single dose of 100 µg (<60kg) or 150 µg (≥60kg) corifollitropin alpha in group 1 (n = 147), and 150-300 IU/day human menopausal gonadotropin in group 2 (n = 150). Comparing ovarian stimulation between corifollitropin alpha and human menopausal gonadotropin, no differences regarding FORT were found (40.0% for group 1 versus 40.83% for group 2; p = 0.930). Patients treated with corifollitropin alpha had a higher number of embryos when compared with human menopausal gonadotropin group (3.0 for group 1 versus 2.0 for group 2; p = 0.04). Other secondary outcomes preset were similar between groups. Therefore, corifollitropin alpha can be an excellent option to simplify in vitro fertilisation treatment due to the "patient-friendly" protocol.

Fresh transfer of an average quality slow growing day-3 embryo versus frozen transfer in a poor responder: a clinical management dilemma.

A common conundrum faced by clinicians is whether to go for fresh transfer or culture the embryos for future frozen transfer in a case of slow-growing embryo. This case report describes a successful pregnancy with the fresh transfer of a single day 3- 6-cell grade B embryo in a patient with poor ovarian reserve. Although more research is needed in this context, the fresh transfer can be considered as a treatment option in patients with optimal endometrium and well-controlled progesterone levels with slow-growing embryos.

Does acquired obstructive azoospermia have less impact than congenital azoospermia on ICSI results? Systematic review and meta-analysis.

An electronic-based search was performed with MEDLINE bases through PubMed, Cochrane through Central, and Embase until August 2020 for the purpose of evaluating the impact of the aetiology of obstructive azoospermia on ICSI cycles. In the final analysis, there were 15 cohort studies included, comparing a group of patients with acquired azoospermia and others due to congenital bilateral absence of the vas deferens submitted to ICSI. Those 15 articles within 4,480 couples were analysed, and similar fertilisation rate (65.1% vs. 65.3%; p = .38), pregnancy rate per cycle (40.0% vs. 43.1%; p = .06) and live birth rate (29.6% vs. 30.0%;p = .76) were found between groups. Comparing specifically post-vasectomy azoospermia and congenital groups, both presented a similar fertilisation rate (62.4% vs. 53.4%, respectively; OR 1.10; 95% CI, 0.79, 1.54; p = .56; I2  = 89%) and pregnancy rate per cycle (39.4% vs. 35.6%, respectively; OR 1.26; 95% CI, 0.96, 1.66; p = .09; I2  = 0%). However, a higher live birth rate was identified in the congenital group compared to vasectomy group (28.4% × 19.5%; OR 1.54; 95% CI, 1.11, 2.15; p = .01; I2  = 0%). The reasons for that are unclear and factors such as couple age and sperm DNA fragmentation should be considered.

Preimplantation genetic testing for monogenic diseases: a Brazilian IVF centre experience.

OBJECTIVE: To describe the cases of preimplantation genetic testing for monogenic diseases (PGT-M) in fertile couples who had undergone intracytoplasmic sperm injection (ICSI) cycles in a Brazilian in vitro fertilisation (IVF) centre and determine whether these cases were different from those reported from the European Society of Human Reproduction and Embryology (ESHRE). METHODS: This retrospective collection included data obtained from ICSI-PGT-M cycles between 2011 and 2016. The disease indication, number of biopsied embryos, biopsy stage, diagnosed and affected embryos, and cycles with embryo to transfer as well as implantation, pregnancy and miscarriage rates were analysed and compared to cycles without genetic diagnosis (PGT) and with ESHRE PGD Consortium collection XIV-XV. RESULTS: From 5,070 cycles performed, 72 had indications for PGT-M. The most common time for biopsy was cleavage-stage; 93% of the embryos had a diagnostic result, 59.4% of which were genetically transferable, resulting in 68% of the cycles with transferred embryos, a 22.1% implantation rate, and a 28.6% pregnancy rate. No differences in clinical outcomes of cycles with PGT-M or without PGT were observed. The day of biopsy and diagnostic success as well as implantation, pregnancy and miscarriage rates were similar to ESHRE collection. CONCLUSIONS: Although the proportion of cases with PGT-M was low, its efficacy was similar to what was reported in the European collection and represents a viable alternative for families at risk of transmitting a genetic disorder to their offspring. The main difference between our and ESHRE collection were the disease indications, which reflected the admixed, multi-ethnic Brazilian population.

Case report of Zika virus during controlled ovarian hyperstimulation: results from follicular fluid, cumulus cells and oocytes.

We describe a case of a 37-year-old female, indicated for in vitro fertilisation. She developed skin rash on her trunk and limbs, during the treatment. RT-PCR results were positive in her blood and negative in her husband's blood and semen. Oocyte aspiration was performed, retrieving 7 oocytes, follicular fluid, and cumulus cells. RT-PCR results for the follicular fluid and cumulus cells were negative for ZIKV, and positive for only 2 oocytes. This is the first report in the literature analysing ZIKV in the follicular fluid, cumulus cells, and oocytes, and will contribute to the understanding of ZIKV infection and transmission.

Analysis of the truth in advertising on the efficacy provided by assisted reproduction clinics / Análisis sobre la autenticidad de la publicidad sobre la eficacia de clínicas de reproducción asistida / Análise da verdade na publicidade sobre a eficácia fornecida pelas clínicas de reprodução assistida

Abstract: This paper analyses the efficacy data from assisted reproduction clinics, obtained from both scientific society reports and from studies published in specialised journals, in order to compare them with information published by Spanish assisted reproduction clinics on their websites. It aims to verify whether this information matches the reality of the findings in the media analysed or, in contrast, differs from the aforementioned scientific evidence. Our study shows marked discrepancies between the evidence of existing statistical data, and figures published by most of the clinics on their websites, which could constitute false advertising.

Resumen: Este estudio analiza los datos de eficacia de clínicas de reproducción asistida, obtenidos tanto de informes de sociedades científicas como de estudios publicados en revistas especializadas, para compararlos con la información publicada por las clínicas de reproducción asistida de España en sus sitios web. El objetivo es verificar si esta información es conforme a los hallados en informes y revistas o, por el contrario, difiere de la evidencia científica mencionada. Nuestro estudio demuestra marcadas discrepancias entre la evidencia de datos estadísticos existentes y las cifras publicadas por la mayoría de los sitios web de las clínicas, lo cual constituye falsa publicidad.

Resumo: Este artigo analisa os dados de eficácia de clínicas de reprodução assistida, obtidas de relatórios da sociedade científica e de estudos publicados em revistas especializadas, a fim de compará-los com informações publicadas por clínicas de reprodução assistida espanholas em seus websites. O artigo visa verificar se esta informação coincide com a realidade dos resultados encontrados nos meios de comunicação analisados ou, por outro lado, difere da evidência científica acima mencionada. Nosso estudo mostra discrepâncias entre a evidência dos dados estatísticos existentes e indicadores publicados pela maioria das clínicas em seus sites, que podem constituir falsa publicidade.

Supplementation of IVF medium with melatonin: effect on sperm functionality and in vitro produced bovine embryos.

Gamete co-incubation generates high free radical levels surrounding growing zygotes which may impair subsequent embryo viability. Melatonin eliminates a wide variety of free radicals; hence, we tried to improve in vitro embryo production by adding melatonin to in vitro fertilisation (IVF) media in high (Exp. 1) and low concentrations (Exp. 2), and we evaluated its effect on bull sperm function during IVF co-incubation time (Exp. 3). In Experiment 1, we supplemented IVF media culture with 0.01, 0.1 and 1 mmol of melatonin, along with a no melatonin control group. In Experiment 2, melatonin levels were reduced to 10, 100 and 1000 nmol, with a no melatonin control group. In Experiment 3, spermatozoa were incubated in IVF media with melatonin (as Exp. 2) and functional parameters were analysed at 0, 4 and 18 h. In Experiment 1, only 1 mmol melatonin showed lesser blastocyst rates than control (C: 23.2 ± 6.7% versus 1 mmol: 2.0 ± 1.7%). In Experiment 2, no statistical differences were found in cleavage percentage, blastocyst percentage and total cell count for any melatonin treatment. In Experiment 3, sperm samples with 1000 nmol melatonin had a significantly higher wobbler (WOB) coefficient, a lower percentage of intact acrosomes, a lower percentage of viable spermatozoa with ROS, greater DNA fragmentation and higher DNA oxidation than controls. Total fluorescence intensity for ROS at 10 nmol melatonin was significantly greater than controls (P < 0.05). IVF media with 1 mmol melatonin is deleterious for embryo development, and in lower concentrations, it modulated sperm functionality, but had no effects on embryo production.

Sperm characteristics and heterologous in vitro fertilisation capacity of Iberian ibex (Capra pyrenaica) epididymal sperm, frozen in the presence of the enzymatic antioxidant catalase.

The aim of this work was to evaluate the protective effect of catalase (CAT) on frozen/thawed ibex epididymal sperm recovered post mortem, and to detect any harmful effect this might have on sperm fertilisation capacity. Epididymal spermatozoa were diluted using a Tris-citric acid-glucose medium (TCG) composed of 3.8% Tris (w/v), 2.2% citric acid (w/v), 0.6% glucose (w/v), 5% glycerol (v/v), and 6% egg yolk (v/v). Sperm masses from the right epididymis were diluted with TCG medium, while those from the left were diluted with TCG medium supplemented with 200IU/mL CAT. Heterologous in vitro fertilisation (IVF) was used to assess the fertilisation capacity of this sperm. The addition of CAT to the extender did not improve frozen/thawed sperm variables. Moreover, a reduced fertilisation capacity was detected: sperm diluted with TCG provided 25.5% 2PN zygotes, while just 13.2% was recorded for that diluted with TCG-CAT (P<0.01). The percentage of cleaved embryos at 48hpi was higher (P<0.01) with the TCG sperm than with the TCG-CAT sperm (16.7% vs. 7.6%). The use of 200IU/mL CAT as an additive cannot, therefore, be recommended for the preservation of ibex epididymal sperm. Other antioxidants should, however, be tested in both this and related wild mountain ungulates.

Influence of manganese on apoptosis and glutathione content of cumulus cells during in vitro maturation in bovine oocytes.

We have investigated the effect of different Mn concentrations on (1) DNA integrity of cumulus cells by olive tail moment (OTM); (2) cumulus cells apoptosis by Annexin V staining assay; (3) intracellular total glutathione (GSH-GSSG) content; and (4) oocyte nuclear maturation and embryo cleavage after in vitro fertilisation (IVF). For this purpose, 0 (control), 2 (Mn1), 5 (Mn2) and 6 ng/mL (Mn3) Mn concentrations were added to IVM medium. Comet assay analysed by OTM was significantly higher in cumulus cells arising from COCs matured without Mn (control, P < 0.01) respect to cumulus cells obtained from COCs matured with Mn (control: 5.18 ± 2.3; Mn1: 2.93 ± 2.2; Mn2: 2.63 ± 2.4; Mn3: 2.92 ± 2.4). The frequency of apoptotic cells was higher in the control group (control: 6.63 ± 0.59; Mn1: 5.05 ± 0.5; Mn2: 4.61 ± 0.49; Mn3: 3.33 ± 0.42). Intracellular concentration of GSH-GSSG increased in oocytes and cumulus cells matured in the presence of Mn (P < 0.01). There were no differences in percentages of nuclear maturation when Mn was added to IVM medium at any concentration, but at 6 ng/mL Mn a higher cleavage rate was observed respect to the control group (P < 0.05). In conclusion, deficiency in Mn concentration during in vitro maturation increased the damage in the DNA molecule and the frequency of apoptotic cumulus cells. However, the addition of an adequate Mn concentration (6 ng/mL Mn) to IVM medium improved the health of cumulus-oocyte complexes and produced more cleaved embryos 48 h after IVF.

Safe multidisciplinary approach in deeply infiltrating endometriosis (DIE): is it feasible?

OBJECTIVE: Evaluate the type and incidence of postoperative complications after surgery for deep infiltrative endometriosis at Biocor Hospital. METHODS: Our observational study involved a multidisciplinary surgical team that performed laparoscopy on 154 patients suffering from pelvic pain. Surgical complications occurring up to the 30th postoperative day were recorded. RESULTS: Mean age patient age was 34.1 years. Infertility was present in 69 (45%) although 31% had not attempted to get pregnant. Dysmenorrhea was the most frequent symptom (79.3%) followed by chronic pelvic pain (59.7%) and deep dyspareunia (48,7%). Most cases required extensive surgery as the majority (n=117; 76.9%) were classified as severe endometriosis (ASRM grade IV). The most frequent surgical procedures were: 136 adhesiolysis, 100 intestinal surgeries (85 retosigmoidectomies), 92 peritonal lesion excision, 39 vaginal resections, 19 myomectomies, 21 hysterectomies and 5 partial bladder resections. Postoperative complications were recorded in 14 (9.59%) patients: 8 (5.48%) major complications and 6 (4.11%) minor. Major complications included blood transfusion (n=2) retosigmoid anastomosis dehiscence (1), rectovaginal fistula (n=1), urinary fistula (n=1), deep vein thrombosis (n=1), lower limb compartment syndrome with motor deficit (n=1) and one intestinal obstruction (n=1). Minor complications were abdominal wall infection (n=3), peripheral neuropathy (n=3), bladder atony (n=1) and bladder perforation (n=1). No deaths were observed. All major complication cases underwent retosigmoidectomy associated with vaginal resection (n=6), uterosacral ligament excision (n=5) or hysterectomy (n=3). CONCLUSION: The surgical treatment of DIE is complex and subject to complications. The surgical expertise of a multidisciplinary team plays a vital role in this setting.

Successful treatment of severe male factor infertility in Jamaica with intracytoplasmic sperm injection / Tratamiento exitoso de la infertilidad severa por factor masculino en Jamaica mediante inyección de esperma intracitoplasmático

OBJECTIVES: To examine the impact of intracytoplasmic sperm injection (ICSI) on the treatment of subfertile couples in Jamaica. METHOD: A review of the outcome of treatment cycles for infertile couples that underwent in-vitro fertilisation (IVF) and ICSI from 2003-05 at the Hugh Wynter Fertility Management Unit (HWFMU) of the University of the West Indies. Fertilisation and pregnancy rates for the cycles as well as the factors determining the success of the procedure were reviewed. SPSS 11.1 was used to do statistical calculations. RESULTS: Ninety-six ICSI cycles were done from January 1, 2003 to December 31, 2005. For couples with previous poor or no fertilisation in a standard IVF group (n = 12), the fertilisation rate was 72%; for those with substandard semen (n = 73), the fertilisation rate was 77.5%, for those with semen retrieved by surgical sperm method (n = 11), the fertilisation rate was 59%. The resulting live births were 0%, 12.5% and 27.3% respectively. There was a statistically significant impact ofage on pregnancy rates as the mean age ofthe females in the previously poor or no fertilisation in a standard IVF group (39.08 ± 5.14) was greater than those of the substandard semen group (35.93 ± 4.22) ]p = 0.023[ as well as the group with surgical sperm retrieval (32.82 ± 6.65) ]p = 0.019[. CONCLUSION: With ICSI, the fertilisation and pregnancy rates in Jamaica are comparable to international rates regardless of the cause of infertility. However, the age of the female partner does have a significant impact on the pregnancy rate following ICSI.

OBJETIVO: Examinar el impacto de la inyección de esperma intracitoplasmático (IEIC) en el tratamiento de las parejas subfértiles en Jamaica. MÉTODO: Se realizó un examen del resultado de los ciclos de tratamiento para las parejas infértiles que recurrieron a la fertilización in vitro (FIV) y a la IEIC de 2003 a 2005 en la Unidad de Tratamiento de la Fertilidad Hugh Wynter del Hospital Universitario de West Indies (HWFMU). Se examinaron las tasas de fertilización y embarazos en todos los ciclos así como los factores que determinan el éxito del procedimiento. Se usó el programa SPSS para realizar los cálculos estadísticos. RESULTADOS: Se realizaron noventa y seis ciclos de IEIC del 1ero de enero de 2003, al 31 de diciembre de 2005. Para parejas con ninguna o pobre fertilización en un grupo estándar de FIV (n - 12), la tasa de fertilización fue 72%; para aquellos con semen subestándar (n = 73), la tasa de fertilización fue 77.5%; para aquellos con semen recuperado mediante recuperación quirúrgica de esperma (n = 11), la tasa de fertilización fue 59%. Los nacimientos vivos resultantes fueron 0%, 12.5%, y 27.3% respectivamente. Hubo un impacto estadísticamente significativo de la edad sobre las tasas de comembarazo, ya que la edad promedio de las hembras en la fertilización previamente pobre o sin fertilización en un grupo FIV estándar (39.08 ± 5.14) fue mayor para las del grupo de semen subestándar (35.93 ± 4.22) ]p = 0.023[ así como las del grupo con recuperación quirúrgica del esperma (32.82 ± 6.65) ]p = 0.019[. CONCLUSIÓN: Con el uso de IEIC, las tasas de fertilización y embarazo en Jamaica, son comparables a las tasas internacionales, independientemente de cual sea la causa de la infertilidad. Sin embargo, la edad de la pareja hembra no tiene un impacto significativo sobre la tasa de embarazo una vez aplicada la IEIC.