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PubMed2004

Chromosome aneuploidy in the spermatozoa of two men with globozoospermia.

The objective of this study was to determine the aneuploidy level in spermatozoa in two men with globozoospermia. Sperm nuclei were analysed by fluorescence in-situ hybridization (FISH) in two infertile males with globozoospermia. Dual FISH for chromosomes 7 and 9, 13 and 21, and triple FISH for chromosomes X, Y, and 18 was performed. The main outcome measured was meiotic segregation differences between both globozoospermic men and controls. A statistically significant difference in disomies 13 and 21 was found between patients 1 and 2. The diploidy rate of spermatozoa of patient 1 (0.876%) was significantly increased compared with that of patient 2 (0.304%) and control men (0.293%). In conclusion there seems to be a slightly increased frequency of aneuploidy in round-headed spermatozoa. However, it is unlikely that these aneuploid spermatozoa would be used in assisted reproduction techniques.

Adult↗

PubMed2001

Follicular flushing at oocyte retrieval: a reappraisal.

A survey of Australian assisted reproduction technique (ART) units revealed many (> 50%) use flushing of the follicle in addition to direct aspiration of the fluid during oocyte retrieval. The rationale is that flushing offers an advantage to the patient, with a larger number of oocytes being collected and thus a higher potential for pregnancy Following a complication in a patient, the medical staff determined that flushing might have been implicated. While this was later shown to be unfounded, the unit changed the method of oocyte collection, thus providing an opportunity historically to evaluate the differences between aspiration of follicular fluid alone or with additional flushing of each follicle. Thus the aim of this analysis was to test the hypothesis that aspiration alone does not effect the outcomes of ART with respect to oocyte numbers collected, their quality and subsequent fertilisation, or ultimate pregnancy rate in a large patient group (n = 2378). During the review period (1991-1993) the manufacturer of the aspiration needles; the pump and pressure used for aspiration; the staff involved in all procedures; and the premises, equipment and media used for oocyte collection and culture remained constant. Similarly the two patient groups did not differ in their demographics and physical characteristics. There was no difference (p > 0.5) in the number of oocytes collected, the number of embryos created or the pregnancy rate for that treatment cycle. There was also no significant difference between the two groups in fertilisation rates, irrespective of the type of treatment being used in vitro fertilisation (IVF), gamete intrafallopian transfer (GIFT) or intracytoplasmic sperm injection (ICSI)). The data presented in this paper are not prospective. They use historical comparison and are confounded by minor changes in ovarian stimulation protocols, but the conclusions are still valid. These data suggest there is no difference in the outcome of ART (from oocyte collection through to pregnancy rate) whether or not aspiration of follicles is accompanied by flushing. First principles of surgery advocate the shortest possible operating time, the simplest procedure and minimum amount of tissue handling as maxims for reducing complication. Therefore, as a routine, flushing would seem superfluous in ART.

Female↗

PubMed2006

A review of upper extremity deep vein thrombosis in pregnancy: unmasking the 'ART' behind the clot.

BACKGROUND: Upper extremity deep vein thrombosis (UEDVT) is uncommon and is associated with well-defined risk factors in the general population. Increasingly, UEDVTs are being reported during pregnancy, particularly those achieved with the use of assisted reproductive techniques (ART), and in conjunction with ovarian hyperstimulation syndrome (OHSS). AIM: We performed this review was to estimate the incidence of UEDVT associated with ART, to examine the risk factors and presentation of UEDVT in pregnancy, and to determine if differences exist between this cohort and the general population. RESULTS: There were 35 published case reports of UEDVT in pregnant women. The incidence of this condition is estimated to be 0.08-0.11% of treatment cycles in women undergoing ART. The development of UEDVT is not always be preceded by OHSS. In addition, commonly associated risk factors for UEDVT were not often reported for UEDVT that developed during pregnancy. Instead the association of UEDVT and ART was common. UEDVT in pregnancy also appears to involve the internal jugular vein more often than the subclavian vein. The reported risk of thrombus extension in this cohort, despite anticoagulation therapy, is also disconcerting. CONCLUSION: Because UEDVT may not be a rare entity during pregnancy in association with the use of ART, clinicians should be better informed of its presentation and clinical course in these women. Once UEDVT develops, appropriate therapeutic anticoagulation should be instituted and patient carefully monitored. The long-term implications and recurrence rate of this condition in pregnancy warrants further prospective studies.

Female↗

PubMed2004

Use of Mammalian eggs for assessment of human sperm function: molecular and cellular analyses of fertilization by intracytoplasmic sperm injection.

PROBLEMS: Intracytoplasmic sperm injection (ICSI ) has been described as the 'cure' for male sterility because a single sperm can now be directly introduced into an egg with some chance of pregnancy. While ICSI has revolutionized the practice of assisted reproductive techniques (ART), there are few molecular and cellular studies about its safety and efficacy. Even by using ICSI, fertilization in humans succeeds only if the sperm effectively accomplishes a number of tasks including 'post-ICSI events' in fertilization. To assess the function of human sperm after ICSI, we used heterologous ICSI with human sperm into animal eggs. Egg activation, sperm decondensation and sperm centorosomal function were examined in sperm from fertile men and infertile patients. METHODS: Sperm from fertile men and infertile patients were injected into hamster, rabbit and bovine eggs by Piezo micromanipulator, and studied in decondensation of sperm nuclei, egg activation and microtubule organization. RESULTS: Decondensation human sperm head following ICSI into hamster eggs occurred initially form basal lesion, and apical portion of sperm nuclei which is surrounded by acrosome and perinuclear theca, still condensed in early pronuclear stage. Radial array of microtubules from sperm centrosome 'sperm aster' which is essential for pronuclear movement was observed in 30% rabbit eggs following ICSI with human sperm. By heterologous ICSI system with fertile human sperm and bovine eggs, 83.3% of eggs was activated and 60% eggs had sperm aster, indicating that bovine Piezo ICSI system is appropriate for assessing human sperm oocyte activation ability and human sperm centrosomal function. Oocyte activation and sperm centrosomal function were significantly low in sperm from men with globozoospermia and men with dysplasia of fibrous sheath. CONCLUSION: These assays indicate differences of the process of fertilization between in vitro fertilization and ICSI, and reflect the human sperm function especially for the 'post-ICSI events' in fertilization. More molecular and cellular analyses in fertilization by ICSI are needed for improvement of ART.

Acrosome↗

PubMed2006

Implantation of the human embryo: research lines and models. From the implantation research network 'Fruitful'.

Infertility is an increasing problem all over the world, and it has been estimated that 10-15% of couples in fertile age have fertility problems. Likewise induced unsafe abortion is a serious threat to women's health. Despite advances made in assisted reproduction techniques, little progress has been made in increasing the success rate during fertility treatment. This document describes a wide range of projects carried out to increase the understanding in the field of embryo implantation research. The 'Fruitful' research network was created to encourage collaborations within the consortium and to describe our different research potentials to granting agencies or private sponsors.

Animals↗

PubMed2005

Genomic imprinting and reproduction.

Genomic imprinting is the parent-of-origin specific gene expression which is a vital mechanism through both development and adult life. One of the key elements of the imprinting mechanism is DNA methylation, controlled by DNA methyltransferase enzymes. Germ cells undergo reprogramming to ensure that sex-specific genomic imprinting is initiated, thus allowing normal embryo development to progress after fertilisation. In some cases, errors in genomic imprinting are embryo lethal while in others they lead to developmental disorders and disease. Recent studies have suggested a link between the use of assisted reproductive techniques and an increase in normally rare imprinting disorders. A greater understanding of the mechanisms of genomic imprinting and the factors that influence them are important in assessing the safety of these techniques.

Adult↗

PubMedDate not supplied

Detection of HIV and HCV RNA in semen from Brazilian coinfected men using multiplex PCR before and after semen washing.

INTRODUCTION: Prolonged survival of patients under HAART has resulted in new demands for assisted reproductive technologies. HIV serodiscordant couples wish to make use of assisted reproduction techniques in order to avoid viral transmission to the partner or to the newborn. It is therefore essential to test the effectiveness of techniques aimed at reducing HIV and HCV loads in infected semen using molecular biology tests. METHODS: After seminal analysis, semen samples from 20 coinfected patients were submitted to cell fractioning and isolation of motile spermatozoa by density gradient centrifugation and swim-up. HIV and HCV RNA detection tests were performed with RNA obtained from sperm, seminal plasma and total semen. RESULTS: In pre-washing semen, HIV RNA was detected in 100% of total semen samples, whereas HCV RNA was concomitantly amplified in only one specimen. Neither HIV nor HCV were detected either in the swim-up or in the post-washing semen fractions. CONCLUSIONS: Reduction of HIV and/or HCV shedding in semen by density gradient centrifugation followed by swim-up is an efficient method. These findings lead us to believe that, although semen is rarely found to contain HCV, semen processing is highly beneficial for HIV/HCV coinfected individuals.

Adult↗

PubMed2002

[Performance of in vitro fertilization in Germany].

In Germany the application of assisted reproductive techniques (ART) is regulated by federal legislation. Compared with the international situation the "German Embryo Protection Law" is very "restrictive" and various methods of ART are prohibited, e.g. oocyte/embryo donation, embryo cryopreservation and Preimplantation Genetic Diagnosis (PGD). Furthermore, in Germany only 1 to 3 fertilized oocytes may be cultured to embryo. All these embryos then have to be transferred into the uterus of a particular patient. Additional fertilized oocytes can only be cryopreserved in a pronuclear state. The success rate of ART has increased significantly over the past few years owing to the introduction of blastocyst cultures and the selection of 1 to 2 good quality blastocysts for embryo transfer. Furthermore, the transfer of only 1 to 2 blastocysts effectively reduces the risk of high rank multiple pregnancies. In Germany, however, the selection of only a few good quality blastocysts for transfer is prohibited by law. New laboratory techniques, e.g. pronuclear scoring and polar body biopsy screening for aneuploidy are in accordance with German law. The application of these methods provides a selection of "good quality oocytes" and seems to increase the overall success rate. Further studies are required, however. The success rate, quality and cost effectiveness of ART in Germany appears compromised when compared with many other countries. What is more, in contrast to the international situation research and development in ART in Germany has been decreasing constantly over the past few years, due to the inappropriate regulations of the German health care system and the insufficient support given to university-based centers.

Blastocyst↗

PubMed2002

[Use of GnRH antagonists (cetrorelix) in assisted reproduction: first report in Mexican literature].

The use of GnRH antagonists in assisted reproduction techniques (ARTs) has been shown to be effective in blocking the luteinizing hormone (LH), without a repercussion on ovaric response. The present study reports the use of a GnRH antagonist (cetrorelix) 0.25 mg/d s.c. in patients stimulated with recombinant FSH (rFSH) for IVF/ICSI. 44 patients with mean age of 33.3 years were included in this study, four patients were receptors for oocyte donation program and another patients was receptor for frozen embryos. Controlled ovarian stimulation was carried out with rFSH, starting on day 3 of menstrual cycle. The total mean dose used was 3.570 +/- 1.102 UI for each patient. The LH serum concentrations were monitored during ovaric stimulation, in two patients a premature LH surge (> 10 UI/L) was detected. The oocytes were collected 36 hours after hCG administration, the mean preovulatory oestradiol was 4.006 +/- 2.418 pg/mL. The mean total oocytes retrieved was 10.8 +/- 7.4 per patient, the fertilization rate was 58.3%, in only three patients fertilization was failed. No difference was observed in oocyte retrieval, fertilization rate, implantation rate between both groups (GnRH antagonists versus GnRH agonists). The embryo transfer was realized on day 3, and only two patients was on blastocyst stage. In 17 of 41 patients with successful transfer, pregnancy was achieved in the group with antagonists, and 8 of 20 patients in the group with agonists. In conclusion Cetrorelix prevents adequately premature LH surges and allows an effective ovaric response in controlled stimulation in IVF cycles, except in patients in oocyte donation programs who require higher cetrorelix doses.

Adult↗

PubMed2003

Fertility treatments and craniosynostosis: California, Georgia, and Iowa, 1993-1997.

OBJECTIVE: Craniosynostosis, a malformation caused by premature closure of 1 or more cranial sutures, is a rare birth defect usually of unknown cause; however, it is often associated with advanced maternal age. Because fertility treatments are also associated with increased maternal age, this study investigated the possible association between fertility treatments and craniosynostosis. METHODS: Data from the Birth Defect Risk Factor Surveillance study were used, which included infants who were delivered from 1993 through 1997 in California, Georgia, and Iowa. Cases were defined as infants who had nonfamilial, nonsyndromic craniosynostosis and were ascertained through existing birth defect surveillance systems. Controls, infants without birth defects, were selected from the same regions and time period. RESULTS: Mothers of 99 case infants and 777 control infants from the 3 study locations participated in this study by completing a telephone interview. Unadjusted analyses showed associations with craniosynostosis for mothers who had used clomiphene citrate (odds ratio[OR]: 3.8; 95% confidence interval [CI]: 1.1-12.3), artificial insemination (OR: 4.2; 95% CI: 0.8-9.4), or assisted reproductive techniques (OR: 4.2; 95% CI: 0.5-27.3). CONCLUSIONS: This is the first study that has found associations between fertility treatments and craniosynostosis. However, the numbers are small; therefore, the results should be viewed with caution.

California↗

PubMed2003

Obstetric and neonatal risk of pregnancies after assisted reproductive technology: a matched control study.

BACKGROUND: The aim of the study was to evaluate the obstetric and neonatal outcome of pregnancies after assisted reproduction technology (ART) in comparison with matched controls from spontaneous pregnancies. METHODS: A total of 12 920 deliveries at the Department of Obstetrics and Gynecology, University of Szeged, from 1 January 1995 to 31 December 2001 were subjected to retrospective analysis. Two hundred and eighty-four singleton, 75 twin and 17 triplet pregnancies after ovulation induction (n = 114; 30.3%), intrauterine insemination (n = 33; 8.8%) and in vitro fertilization (n = 229; 60.9%) were evaluated. The pregnancy outcome of the singleton and twin pregnancies was compared with that for controls matched with regard to age, gravidity and parity and previous obstetric outcome after spontaneous pregnancies. RESULTS: Twenty-four percent of the assisted reproductive pregnancies were multiple pregnancies. The incidences of singleton intrauterine growth retardation (IUGR) and preterm birth were reasonably similar to those among the controls (IUGR: 6.3% vs. 4.2%; preterm births: 13.0% vs. 9.9%, for the cases and the controls, respectively). As compared with the controls, there was an increased incidence of cesarean section among the singleton (41.2% vs. 34.5%, p = 0.12; OR 1.33; 95% CI 0.95-1.87) and twin assisted reproduction pregnancies (66.7% vs. 60.0%), but without significant differences. CONCLUSIONS: Increased obstetric risk could be observed concerning threatened preterm delivery and cesarean section rate in the study group. The perinatal outcome of singleton and twin pregnancies following assisted reproductive techniques is comparable with that of spontaneously conceived, matched pregnancies.

Adult↗

PubMedDate not supplied

[Human oocyte freezing in Spain: comment on the Real Decree 120/2003].

This work analyzes some scientific, ethic and legal aspects about the freezing of human ovocites in Spain. Inside the context of the Law 35/1998 of Assisted Reproduction Techniques, it is analyzed the Royal Decree 120/2003 which regulates the authorization of controlled experiences with reproductive aims. These experiences investigate the fecundation of ovocites or ovaric tissue previously frozen. It is also studied the inform made through parliament by the General Court of Judicial Power and it is also valued the importance of the terms "experience", "investigation" and "project" used in the legal text.

Cryopreservation↗

PubMed2003

[Comparison of the results of an assisted-reproduction program related with the day of follicular aspiration].

UNLABELLED: The proper time for the oocyte retrieval allow us to obtain good quality oocytes In assisted reproduction techniques, improving fertilization and pregnancy rates. The follicular aspiration has been done by vaginal ultrasounds when we can see at least 3 follicles > or = 16 mm diameter. OBJECTIVE: To compare oocyte quality, fertilization and pregnancy rate-according to the day of the follicular aspiration. MATERIAL AND METHODS: 438 cycles were studied in the Instituto para el Estudio de la Concepción Humana in Monterrey Mexico, comparing oocyte quality, fertilization and pregnancy rate. RESULTS: If egg retrieval was done on day 12 of the cycle, we obtained a mean of 7.61 good quality oocytes, 51% of them fertilized and the pregnancy rate was 36.8%, when the aspiration was performed on day 13 of the cycle, we obtained a mean of 7 good quality oocytes, 59% of them fertilized and the pregnancy rate was 34%, and if the oocyte retrieval was on day 14 of the cycle, we obtained a mean of 6.42 good quality oocytes, 57% of the fertilized and the pregnancy rate was 31.7%. DISCUSSION: The oocyte quality, fertilization and pregnancy rate were slightly better if the oocyte retrieval was performed on day 12 or 13 of the cycle, rather than day 14. However this was no statistical significative.

Adult↗

PubMedDate not supplied

Reproduction decision making for couples affected by HIV: a review of the literature.

Medical issues faced by HIV-affected couples include transmission risks between partners and between mother and child, as well as the technologies and procedures available to reduce those risks. Assisted reproductive techniques discussed are artificial insemination, in vitro fertilization, intracytoplasmic sperm injection, self-insemination, and timed intercourse. It is important that physicians be aware of reproductive options available to couples affected by HIV and be prepared to engage in nonjudgmental dialogue with patients. This review is the result of a literature search performed to identify useful information to counsel HIV-serodiscordant and HIV-seroconcordant couples facing decisions on reproduction.

Adult↗

PubMedDate not supplied

In vivo and in vitro decondensation of human sperm and assisted reproduction technologies.

For a successful fertilization and pronucleus formation to occur, not only a properly condensed sperm nucleus, but also decondensation ability in the oocyte is important. The sperm abnormalities causing failure of sperm decondensation in the oocyte are unrecognizable by conventional semen analysis and different methods are used. The chromatin decondensation ability of the human spermatozoa in vivo and in vitro and its association with infertility and assisted reproduction techniques (ART) are clearly discussed in this paper. The factors affecting the decondensation ability of the human sperm are also mentioned. It is suggested that the methods currently used to assess sperm chromatin decondensation are of limited value in assessing fertilization and pregnancy rates after ART.

Female↗

PubMed2005

[Your ART ticket is no longer valid after how many attempts?].

The economic implications of the use of assisted reproductive techniques require consideration. Since March 2005, in France, only 6 intrauterine inseminations and 4 IVF attempts are free of charge for the patient. However, definition of "acceptable" pregnancy rate for a new attempt remains discussed (10%, 15%, 20%?). Furthermore, several criteria should be considered when discussing a new IVF attempt, including woman age, FSH levels, antral follicle count and infertility aetiology. For example, in patients with secondary infertility, reasonable pregnancy rates (15-20%) can be archived even after 6 or 7 failures.

Female↗

PubMed2005

[Economic aspects of the selection of patients and temporary suspensions].

Economic implications of the use of ART (assisted reproductive techniques) require consideration. Initial patient selection is performed in few infertility centers, according to several criteria: age, FSH levels, follicle antral count, previous IVF attempt. Once should recognize that patient selection is efficient in reducing cost of IVF. Nevertheless, drop-out occurring in the middle of a IVF cycle increase Baby cost.

Female↗

PubMedDate not supplied

[How current data can guide mother-infant health planning. An insight into data sources and methodologies].

OBJECTIVES: To evaluate how Hospital Discharge Records (SDO) and Certificates of Delivery Care (CEDAP) can be utilized to determine the number of deliveries and births; to calculate indicators for monitoring mother-infant health status, the exposure to risk factors during pregnancy and the health care provided. DESIGN AND SETTING: CEDAP and SDO of all patients admitted to any hospital in the Veneto Region (4.7 million inhabitants, about 44,000 births) during the year 2003 were considered. An area-based study on deliveries and births, a retrospective cohort study on pregnancies, and a prospective cohort study on newborns up to the first year of age were performed to calculate health indicators. These indicators were compared to two official data sources: National Institute of Statistics (ISTAT) and Italian National Institute of Health (ISS). MAIN OUTCOME MEASURES: Descriptive indicators concerning mother-infant health status (conception, pregnancy, delivery, newborns and events during the first year of age). RESULTS: SDO provide highly accurate data on pregnancies, births and stillborns, which overlap with values reported by ISTAT Combining data from SDO and CEDAP with findings fom the process of tracking mothers and infants'cohorts, allows the calculation of many indicators on conception (n. 9), pregnancy (n. 8), delivery (n. 8), newborn (n. 15), and events during the first year of age (n. 6). In the Veneto Region the general fertility rate is 40.95% per hundred, with a relatively late mean age at delivery (32 years). Pregnant women undergoing prenatal invasive procedures are 23.5% and the caesarean section rate is 29%. Infants born to foreign mothers are 16%, whereas 2.5% are conceived through assisted reproduction techniques, 0.9% are very low birth weight, and 0.3% are extremely low birth weight; neonatal and infant mortality rates are 2.2% per hundred and 2.9% per hundred respectively. CONCLUSION: The proposed system is immediately feasible also at a local level, making reliable and informative data available to guide health policies.

Adolescent↗