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J Mandelbaum

Publications and source records attributed to J Mandelbaum.

115 records · Page 7Linked to original sources
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[Oocyte maturity and quality: value of intracytoplasmic sperm injection. Fertility of microinjected oocytes after in vitro maturation].

Many studies in IVF practice, have tried to assess the maturity and quality of oocytes prior to insemination and relate it to IVF efficiency and to the pattern of ovarian stimulation. They were based on the indirect evaluation of the aspect of the cumulus-corona-cell complex (CCC) which was rapidly shown to be poorly correlated to the oocyte nuclear and cytoplasmic maturity in stimulated cycles. For sperm microinjection procedures, oocytes need to be peeled off from any follicular cell through hyaluronidase action in order to gain an easy access to the zona pellucida and the ooplasm. If therefore becomes possible to precisely known at recovery the nuclear status of the oocyte cohort as well as the rate of degenerative gametes. Immature oocytes can be further matured in vitro. Moreover, the ICSI procedure (intracytoplasmic sperm injection) allows a direct assessment of the cytoplasmic maturation, whatever the maturity of the ZP and its receptors and of the plasma membrane. On a preliminary evaluation of 70 ICSI cycles performed in our collaborative group from september to november 1994 and leading to a 24 % pregnancy rate per oocyte pick-up we focused on the true maturation of the oocyte cohort, its outcome and correlation with ICSI efficiency and stimulation protocol. On the 760 oocytes, 13.9% were atretic, 9% at the germinal vesicle stage (GV), 3.4% in metaphase 1 and 73.7% in metaphase 2 at recovery.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
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[Indications for intracytoplasmic sperm injection: possible influence of oocyte quality on the results].

Intracytoplasmic sperm injection is theoretically the first line treatment of many forms of severe male infertility, but the prognostic factors are to be determined according to the indications. Thus the results of two clinical teams working with the same biological Unit show statistically different pregnancy rates per oocyte pick-up (15.9% versus 35.7% - p < 0.02) and per transfer (16.9% versus 34.9% - p < 0.03). They could by explained by female factors such as age and ovarian response to stimulation, which probably have influence on embryonic quality.

Cytoplasm↗
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[Male hypogonadotrophic hypogonadism: successful treatment of infertility with HMG + HCG (author's transl)].

Ten typical cases of male eunuchoidism (two with anosmia) are reported. After administration of clomifene citrate to five patients there was no change in blood levels of gonadotrophins in four cases; in the fifth, a small and transitory increase of LH was noted. The intravenous injection of LHRH (100 mcg) to five patients induced an increase of serum LH in all cases and serum FSH in three cases. The initial site of the dysfunction is possibly hypothalamic with secondary gonadotrophic pituitary insufficiency. Among six patients desiring paternity, prolonged treatment (for 36 to 98 weeks), with HCG(1700-7000 I.U. weekly) + HMG (450-825 I.U. FSG weekly) resulted in the appearance of spermatozoa in the seminal fluid in five cases and a pregnancy was obtained in four cases. Methods of treatment are discussed.

Adult↗
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[Fertility tests (hamster, electronic microscopy): are they useful?].

Tests of sperm function are often considered to be able to predict the in vivo or in vitro fertility of a given patient although they only assess part of the process of sperm fertilizing ability. It appears from the literature, that the sperm penetration assay (SPA) which investigates the sperm fusiogenic and nuclear functions cannot accurately predict the in vivo fertility and there is still much debate on the reliability of its correlation with in vitro fertilization (IVF) principally in cases of severe sperm deficiency. With the development of new techniques of assisted fertilization, by-passing the zona pellucida, a test of sperm fusion, hetero or homospecific as well, could be interesting. Considering sperm ultrastructure and beyond some specific morphological alterations of the whole sperm population that can be responsible for the infertility, such studies were not able, as yet, to reveal significative differences between semen fertile in vitro or not.

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[Oocyte maturation and intracytoplasmic sperm injection].

Intracytoplasmic sperm injection (ICSI), treatment of severe male infertility allows an accurate evaluation of oocyte maturity at recovery after corona-cell removal. In cycles comprising a GnRH analog desensitization and a stimulation by hMG or FSH, 12% of oocytes aspirated from follicles (> 14 mm), 34 hours post-hCG are still immature, in prophase or metaphase 1. They are able to achieve meiosis in vitro in 66% of the cases and will be fertilized (2 PN) by ICSI in 51% of the cases as the in vivo mature oocytes of the same cohort. Nevertheless, the quality of cytoplasmic maturation and consequently of embryonic viability remains to be assessed as there still are few pregnancies arising from in vitro matured oocytes. ICSI also represents the only way to obtain normal fertilization in some exceptional but observed anomalies of oocyte maturation, particularly when there is a lack of zona reaction leading to repetitive polyspermy in conventional IVF.

Adult↗
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[Are there indications for intra-cytoplasmic sperm injection in female infertility?].

ICSI for oocyte pathology may represent the solution in case of zona pellucida anomalies, deficiency of the oolemma fusion ability or absence of cortical reaction. These indications remain scarce and difficult to be displayed. A link could be shown by some authors between some oocyte morphologic anomalies and IVF fertilization failures which are overcome by ICSI. Other dysmorphic oocytes are associated with an impairment in cytoplasm function which results in a poor embryonic viability on which ICSI has no effect. When few oocytes are recovered (< or = 5) and the semen characteristics are not optimal, ICSI may rectified the decrease in fertilization rates obtained after classical insemination. Lastly, ICSI will become increasingly used in case of oocyte in-vitro maturation or freezing instead of classical IVF which is less efficient.

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