The outcome of intracytoplasmic sperm injection in patients with retrograde ejaculation

The objective of this retrospective clinical study was to assess the benefit of assisted fertilization in cases of anejaculatory infertility due to retrograde ejaculation. We report the outcome of intracytoplasmic sperm injection (ICSI) treatment. In 16 couples in which the men suffered from retrograde ejaculation. We performed 35 cycles of ICSI with spermatozoa retrieved from post-ejaculatory urine. The patients had been instructed to alkalinize the urine by ingesting sodium bicarbonate before the procedure. The fertilization rate averaged 51.2%. Seven clinical pregnancies were achieved. Three spontaneous first trimester abortions occurred, but three live offspring were delivered and one pregnancy is ongoing. In conclusion, the use of ICSI may be feasible for patients with retrograde ejaculation who are resistant to medical treatment and whose sperm quality is so low or unpredictable that intrauterine insemination or conventional methods of in-vitro fertilization are not possible.

Pregnancies achieved after frozen-thawed pronuclear oocytes obtained by intracytoplasmic sperm injection with spermatozoa extracted from frozen-thawed testicular tissues from non-obstructive azoospermic men

The use of frozen-thawed testicular tissue as a source of spermatozoa for intracytoplasmic sperm injection (ICSI) in non-obstructive azoospermia yields favourable fertilization and pregnancy rates while avoiding both repetitive biopsies and unexpected cycle cancellations. Spermatozoa were obtained from frozen-thawed testicular biopsy specimens from 67 non-obstructive azoospermic men. Following fertilization, supernumerary two pronuclear (2PN) oocytes were frozen. After thawing, 17 cycles of embryo transfer were carried out with a mean number of 2.7 embryos and a mean cumulative embryo score (CES) of 18.3 per transfer. The clinical pregnancy and implantation rates per transfer in these cycles (23.5 and 8.3% respectively) were comparable to those of fresh embryo transfers (35.7 and 12.7% respectively) with a mean number of 2.7 embryos and a mean CES of 28.7 per transfer. Abortion rates, although higher with cryopreserved 2PN oocytes were not significantly different. With this approach, cryopreservation of supernumerary 2PN oocytes can be used to improve the cumulative pregnancy rates in a severely defective spermatogenetic population. To our knowledge, these are the first pregnancies reported which have been obtained by the transfer of cryopreserved pronuclear oocytes obtained from ICSI using cryopreserved testicular spermatozoa.

Limited ovarian stimulation results in the recovery of mature oocytes in polycystic ovarian disease patients: a preliminary report

This pilot study including five patients, examined the feasibility of obtaining oocytes from partially stimulated ovarian follicles in patients with polycystic ovarian disease (PCOD). We evaluated oocyte maturity, and fertilization potentials. The diagnosis of PCOD was based on ultrasound findings and endocrine criteria. The long protocol of pituitary ovarian axis down-regulation was used and follicles were stimulated with daily injections of human menopausal gonadotropin (HMG), until the mean diameter of the leading follicle reached 12 mm. A full dose of HCG (10000 I.U.) was administered and oocytes were collected 36 h later. The mean number of oocytes collected per patient was 12.6+/-4.9, the mean number of MII oocytes was 8.8+/-4.4, with fertilization rate of 70.5% following intracytoplasmic sperm injection (ICSI). To our knowledge this is the first report in the literature documenting the recovery of mature oocytes following limited stimulation of the ovaries. The potentials of this novel approach open a new dimension in the management of patients with PCOD.

Transfer technique and catheter choice influence the incidence of transcervical embryo expulsion and the outcome of IVF

We examined the influence of the procedures used in embryo transfer on pregnancy rates. Over a period of 15 months (Nov. 1996-Jan. 1998), 320 patients were recruited. They were randomized on an alternate basis either to a Wallace catheter or an Erlangen metal catheter. Randomization was also applied within the same groups for embryo transfer at 48 h and 72 h post-insemination. Fifty patients randomly selected from each group were subjected to speculum examination 15 min following embryo transfer, during which any fluid leaking from the cervix was examined for the presence of embryos. In five patients a transvaginal-transmyometrial transfer was performed. The pregnancy rate appeared to be slightly higher in patients who had their embryos transferred at 72 h than in those patients who had their transfers at 48 h, but this difference was not significant in either group. (The ease with which the Erlangen catheter was used compared with that of the Wallace catheter was reflected in a significantly lower incidence of uterine sounding of cervical dilatation and bleeding.) Also there was a significant increase (P = 0.0001) in the mucus attached to the tip of the Wallace catheter and the embryos trapped compared with those of the Erlangen group (P = 0.0007). The pregnancy rate per embryo transfer was apparently higher in the Erlangen group than in the Wallace group but this difference was not significant. In eight (16%) patients of the Wallace group, 1-3 embryos were found in the fluid sucked from the external os, compared with three (6%) patients in the Erlangen group, but again this difference was not significant. In 92% of patients who became pregnant, the transfer procedure was smooth and easy. Successful embryo transfer was not influenced by the time of transfer post-insemination. The choice of catheter did not affect pregnancy rate. In cases in which transcervical transfer is very difficult or impossible, transvaginal-transmyometrial transfer is a viable option. The significance of early or late expulsion of transferred embryos into the vagina needs to be addressed in larger controlled studies.

The effect of multiple cryopreservation procedures and blastomere biopsy on the in-vitro development of mouse embryos

Preimplantation genetic diagnosis is currently used in clinical practice. In experienced hands the biopsy procedure alone does not affect the further in-vitro and in-vivo developmental potential of animal and human embryos. No data exist on the combination of cryopreservation of embryos at the pronuclear and/or 8-cell stage and/or biopsy at the 8-cell stage. Pronuclear stages of mouse F1 hybrids (C57Bl/jxCBA) were harvested and divided into several experimental groups. The developmental rates of zygotes, which were neither biopsied nor cryopreserved were used as data control. Others were only cryopreserved at the pronuclear stage (C-PN), or at the cleavage stage (C-CS), or both. Each of these groups was also combined with or without a biopsy. Only the hatched blastocyst rate (HBR), but not the 'simple' blastocyst rate, showed significant differences between groups. Neither C-PN (HBR = 60.42%), nor C-CS (63.16%), nor a combination of both (59.46%) had an impact on the hatched blastocyst rate when compared with that of the control group (67.46%). The biopsy procedure (55.93%) also proved not to be harmful for the embryos. The embryos, which were C-PN and C-CS, and subsequently biopsied, showed a significantly lower hatched blastocyst rate (39.62%) than that of the control, C-PN, C-CS, and C-PN/C-CS groups (P < 0.05). The combination of C-PN and cleavage-stage biopsy also lead to a lower hatched blastocyst rate (42.22%), compared with that of the control group (P < 0.05). It was concluded that couples must be advised that an effect on embryos which have undergone a combined cryopreservation and micromanipulation procedure cannot be ruled out. However, cryopreservation at the pronuclear or at the 8-cell stage alone, or in combination with a biopsy procedure, does not influence the further development of the embryo.