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Zhu X, Tian T, Jiesisibieke D, Fang S, Zhang N, Ma J, Xia Y, Liu P, Li R, Qiao J, Yang R. Clinical outcome of different embryo transfer strategies after late rescue ICSI procedure: a 10-year total fertilisation failure cohort study. BMC Pregnancy Childbirth 2023; 23:549. [PMID: 37525112 PMCID: PMC10388511 DOI: 10.1186/s12884-023-05859-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 07/19/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND Late rescue intracytoplasmic sperm injection (r-ICSI) has not been widely accepted as an alternative solution for unexpected total fertilisation failure (TFF) after in vitro fertilisation (IVF), due to the time-dependent in vitro deterioration of oocyte quality and endometrial growth not being synchronised with embryo development. This study aimed to evaluate the safety profile and effectiveness of freeze-all blastocyst transfer in combination with late r-ICSI. METHODS This was a retrospective cohort study carried out at the Reproductive Centre of Peking University Third Hospital, Beijing, China. All participants received treatment between 2009 and 2019. 2,270 patients in the aggregate encountered unexpected TFF during 149,054 cycles of IVF and adopted a late r-ICSI procedure. Among these patients, 263 women did not have cleavage-stage embryos available for evaluation. The remaining patients were grouped according to different embryo transfer (ET) strategies (926 women in Group 1 underwent fresh ET, 365 women in Group 2 underwent freeze-all ET, 716 women in Group 3 experienced blastulation failure). Patients received different ET strategies after r-ICSI, with the main outcome measures included live birth rate (LBR), cumulative live birth rate (cLBR), and conservative cLBR. RESULTS TFF occurred in 7.4% of all IVF cycles. Group 1 tended to be older at oocyte retrieval, with more infertile years, higher follicle-stimulating hormone (FSH) levels, higher gonadotropin consumption, and fewer oocytes retrieved. Group 2 exhibited considerably better LBRs following the first ET cycle (37.53% vs. 4.64%) and cLBRs (52.60% vs. 8.21%). After adjustment for covariates using binary logistic regression analyses, Group 2 still showed better obstetric performance in LBRs [OR:11.77, 95% CI (8.42-16.45)], cLBRs (OR:11.29, 95% CI (7.84-16.27)], and conservative cLBRs (OR:2.55, 95% CI (1.83-3.55)]. Additionally, the two groups showed similar miscarriage rates, whilst no new-borns with malformations or congenital diseases were reported. CONCLUSIONS Freeze-all blastocyst stage ET serves as an optimal strategy to support late r-ICSI. However, for women with limited oocytes available for r-ICSI use, weighing the benefits against the costs of the procedure might be prudent before implementing in vitro blastulation.
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Affiliation(s)
- Xiaxuan Zhu
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, No. 49 North Huayuan Road, Haidian District, Beijing, 100191, China
| | - Tian Tian
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, No. 49 North Huayuan Road, Haidian District, Beijing, 100191, China
- National Clinical Research Center for Obstetrics and Gynecology, Beijing, 100191, China
- Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing, 100191, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, 100191, China
| | - Dina Jiesisibieke
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, No. 49 North Huayuan Road, Haidian District, Beijing, 100191, China
| | - Shilin Fang
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, No. 49 North Huayuan Road, Haidian District, Beijing, 100191, China
| | - Nan Zhang
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, No. 49 North Huayuan Road, Haidian District, Beijing, 100191, China
| | - Jinxi Ma
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, No. 49 North Huayuan Road, Haidian District, Beijing, 100191, China
| | - Yuqi Xia
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, No. 49 North Huayuan Road, Haidian District, Beijing, 100191, China
| | - Ping Liu
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, No. 49 North Huayuan Road, Haidian District, Beijing, 100191, China
- National Clinical Research Center for Obstetrics and Gynecology, Beijing, 100191, China
- Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing, 100191, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, 100191, China
| | - Rong Li
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, No. 49 North Huayuan Road, Haidian District, Beijing, 100191, China
- National Clinical Research Center for Obstetrics and Gynecology, Beijing, 100191, China
- Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing, 100191, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, 100191, China
| | - Jie Qiao
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, No. 49 North Huayuan Road, Haidian District, Beijing, 100191, China
- National Clinical Research Center for Obstetrics and Gynecology, Beijing, 100191, China
- Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing, 100191, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, 100191, China
| | - Rui Yang
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, No. 49 North Huayuan Road, Haidian District, Beijing, 100191, China.
- National Clinical Research Center for Obstetrics and Gynecology, Beijing, 100191, China.
- Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing, 100191, China.
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, 100191, China.
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Bolton VN, Perez MJ, Hughes G, Moodley T, Dean M, Fernandez-Ponce A, Southall-Brown G, Kasraie J. The use of ICSI in ART: evidence for practice. HUM FERTIL 2023; 26:414-432. [PMID: 37609991 DOI: 10.1080/14647273.2023.2243071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
This article reviews the evidence regarding the safety and efficacy of intra-cytoplasmic sperm injection (ICSI). It provides evidence-based clinical and laboratory guidelines and recommendations for use of ICSI within an assisted reproductive technology (ART) service. The guidelines address the evidence for the use of ICSI rather than conventional IVF (cIVF); the use of ART techniques supplementary to ICSI; and risks associated with ICSI. This article is not intended to be the only approved standard of practice or to dictate an exclusive course of treatment. Other plans of management may be appropriate, taking into account the needs and medical history of the patient, available resources, and institutional or clinical practice limitations.
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Affiliation(s)
| | | | - George Hughes
- Assisted Conception Unit, Ninewells Hospital, Dundee, UK
| | - Therishnee Moodley
- The Centre for Reproductive Medicine, St. Bartholomew's Hospital, London, UK
| | - Morven Dean
- Assisted Conception Unit, Ninewells Hospital, Dundee, UK
| | | | | | - Jason Kasraie
- University of Chester and University Centre Shrewsbury, Chester, UK
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3
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Balli M, Cecchele A, Pisaturo V, Makieva S, Carullo G, Somigliana E, Paffoni A, Vigano’ P. Opportunities and Limits of Conventional IVF versus ICSI: It Is Time to Come off the Fence. J Clin Med 2022; 11:jcm11195722. [PMID: 36233589 PMCID: PMC9572455 DOI: 10.3390/jcm11195722] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 09/20/2022] [Accepted: 09/22/2022] [Indexed: 12/04/2022] Open
Abstract
Conventional IVF (c-IVF) is one of the most practiced assisted reproductive technology (ART) approaches used worldwide. However, in the last years, the number of c-IVF procedures has dropped dramatically in favor of intracytoplasmic sperm injection (ICSI) in cases of non-male-related infertility. In this review, we have outlined advantages and disadvantages associated with c-IVF, highlighting the essential steps governing its success, its limitations, the methodology differences among laboratories and the technical progress. In addition, we have debated recent insights into fundamental questions, including indications regarding maternal age, decreased ovarian reserve, endometriosis, autoimmunity, single oocyte retrieval-cases as well as preimplantation genetic testing cycles. The “overuse” of ICSI procedures in several clinical situations of ART has been critically discussed. These insights will provide a framework for a better understanding of opportunities associated with human c-IVF and for best practice guidelines applicability in the reproductive medicine field.
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Affiliation(s)
- Martina Balli
- Infertility Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milano, Italy
| | - Anna Cecchele
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122 Milano, Italy
| | - Valerio Pisaturo
- Infertility Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milano, Italy
| | - Sofia Makieva
- Kinderwunschzentrum, Klinik für Reproduktions-Endokrinologie, Universitätsspital Zürich, 8091 Zurich, Switzerland
| | - Giorgia Carullo
- Infertility Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milano, Italy
| | - Edgardo Somigliana
- Infertility Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milano, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122 Milano, Italy
| | | | - Paola Vigano’
- Infertility Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milano, Italy
- Correspondence:
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4
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Iwamoto A, Van Voorhis BJ, Summers KM, Sparks A, Mancuso AC. Intracytoplasmic sperm injection vs. conventional in vitro fertilization in patients with non-male factor infertility. Fertil Steril 2022; 118:465-472. [PMID: 35835597 DOI: 10.1016/j.fertnstert.2022.06.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 06/07/2022] [Accepted: 06/10/2022] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To compare the cumulative live birth rates (CLBRs) and cost effectiveness of intracytoplasmic sperm injection (ICSI) and conventional in vitro fertilization (cIVF) for non-male factor infertility. DESIGN A retrospective cohort study. SETTING Society for Assisted Reproductive Technology clinics. PATIENT(S) A total of 46,967 patients with non-male factor infertility with the first autologous oocyte retrieval cycle between January 2014 and December 2015. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) The primary outcomes were CLBR, defined as up to 1 live birth from an autologous retrieval cycle between 2014 and 2015, and linked fresh and frozen embryo transfers through 2016. The secondary outcomes included miscarriage rate, 2 pronuclei per oocyte retrieved, and the total number of transferred and frozen embryos. Analyses were performed on subsamples with and without preimplantation genetic testing for aneuploidy (PGT-A). A cost analysis was performed to determine the costs accrued by ICSI. RESULT(S) Among cycles without PGT-A in patients with non-male factor infertility, the CLBR was 60.9% for ICSI cycles vs. 64.3% for cIVF cycles, a difference that was not significantly different after adjustment for covariates (adjusted risk ratio, 0.99; 95% confidence interval, 0.99-1.00). With PGT-A, no difference in CLBR was found between ICSI and cIVF cases after adjustment (64.7% vs. 69.0%, respectively; adjusted risk ratio, 0.97; 95% confidence interval, 0.93-1.01). The patients were charged an estimated additional amount of $37,476,000 for ICSI without genetic testing and an additional amount of $7,213,500 for ICSI with PGT-A over 2 years by Society for Assisted Reproductive Technology clinics. CONCLUSION(S) In patients with non-male factor infertility, ICSI did not improve CLBR. Given the additional cost and the lack of CLBR benefit, our data show that the routine use of ICSI in patients with non-male factor infertility is not warranted.
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Affiliation(s)
- Aya Iwamoto
- Department of Obstetrics and Gynecology, University of Iowa Hospitals and Clinics, Iowa City, Iowa.
| | - Bradley J Van Voorhis
- Department of Obstetrics and Gynecology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Karen M Summers
- Department of Obstetrics and Gynecology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Amy Sparks
- Department of Obstetrics and Gynecology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Abigail C Mancuso
- Department of Obstetrics and Gynecology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
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5
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Weiner HS, Ulrich ND, Hipp L, Hammoud A, Xu M, Schon SB. Total fertilization failure with in vitro fertilization-intracytoplasmic sperm injection related to WEE2 mutation highlights emerging importance of genetic causes of in vitro fertilization failure. F S Rep 2022; 3:355-360. [PMID: 36568932 PMCID: PMC9783144 DOI: 10.1016/j.xfre.2022.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 06/28/2022] [Accepted: 08/16/2022] [Indexed: 12/27/2022] Open
Abstract
Objective To report a unique case of total fertilization failure (TFF) after in vitro fertilization with intracytoplasmic sperm injection related to homozygous WEE2 gene mutation and summarize the current literature and management of TFF. Design Case report. Setting Academic fertility center. Patients A 25-year-old woman and her 35-year-old partner with a history of near-complete fertilization failure after 2 cycles of in vitro fertilization/intracytoplasmic sperm injection. Interventions Consultation with medical and commercial genetic testing for WEE2, PLCZ1, and TLE6. Main Outcome Measures Oocyte fertilization. Results The patient was homozygous for WEE2 pathogenic variant impacting oocyte activation and resulting in infertility. Conclusions In the setting of TFF, early consideration should be given to genetic testing to assist couples in clinical decision-making and help limit the financial and emotional burden associated with unsuccessful fertility intervention.
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Affiliation(s)
| | - Nicole D. Ulrich
- University of Michigan Medical School, Ann Arbor, Michigan,Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Michigan Medicine
| | - Lauren Hipp
- Department of Genetic Medicine, Michigan Medicine, Ann Arbor, Michigan
| | - Ahmad Hammoud
- Department of Obstetrics and Gynecology, Oakland William Beaumont School of Medicine, Rochester, Michigan,IVF Michigan Fertility Centers, Bloomfield Hills, Michigan
| | - Min Xu
- University of Michigan Medical School, Ann Arbor, Michigan,Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Michigan Medicine
| | - Samantha B. Schon
- University of Michigan Medical School, Ann Arbor, Michigan,Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Michigan Medicine,Reprint requests: Samantha B. Schon, M.D., Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Michigan Medicine University of Michigan Medical School, Michigan Medicine, 1500 E Medical Center Drive, Ann Arbor, Michigan 4109.
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6
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Franasiak JM, Polyzos NP, Neves AR, Yovich JL, Ho TM, Vuong LN, Norman RJ. Intracytoplasmic sperm injection for all or for a few? Fertil Steril 2022; 117:270-284. [DOI: 10.1016/j.fertnstert.2021.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 12/02/2021] [Indexed: 11/04/2022]
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Intracytoplasmic sperm injection (ICSI) for non-male factor indications: a committee opinion. Fertil Steril 2020; 114:239-245. [PMID: 32654822 DOI: 10.1016/j.fertnstert.2020.05.032] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 05/27/2020] [Indexed: 12/21/2022]
Abstract
Intracytoplasmic sperm injection, while typically effective for overcoming low or absent fertilization in couples with a clear abnormality of semen parameters, is frequently used in combination with assisted reproductive technologies for other etiologies of infertility in the presence of semen parameters that meet the World Health Organization 2010 normative reference values. This committee opinion provides a critical review of the literature, where available, to identify situations where this may or may not be of benefit. This document replaces the previously published document of the same name, last published in 2012 (Fertil Steril 2012;98:1395-9).
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Affiliation(s)
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- American Society for Reproductive Medicine and Society for Assisted Reproductive Technology, Birmingham, Alabama
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8
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Semen parameters on the day of oocyte retrieval predict low fertilization during conventional insemination IVF cycles. J Assist Reprod Genet 2018; 36:291-298. [PMID: 30415469 DOI: 10.1007/s10815-018-1336-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 10/12/2018] [Indexed: 10/27/2022] Open
Abstract
PURPOSE Poor fertilization during conventional IVF is difficult to predict in the absence of abnormal semen parameters; large-scale studies are lacking. The purpose of this study is to evaluate factors associated with low fertilization rates in conventional insemination IVF cycles. METHODS A retrospective cohort study evaluating demographic, reproductive evaluation, and IVF cycle characteristics to identify predictors of low fertilization (defined as 2PN/MII ≤ 30% per cycle). Participants were included if they were undergoing their first IVF cycle utilizing fresh autologous oocytes and conventional insemination with male partner's sperm (with normal pretreatment semen analysis). They were randomly divided into a training set and a validation set; validation modeling with logistic regression and binary distribution was utilized to identify covariates associated with low fertilization. RESULTS Postprocessing sperm concentration of less than 40 million/ml and postprocessing sperm motility < 50% on the day of retrieval were the strongest predictors of low fertilization in the training dataset. Next, in the validation set, cycles with either low postprocessing concentration (≤ 40 million/ml) or low postprocessing progressive motility (≤ 50%) were 2.9-times (95% CI 1.4, 6.2) more likely to have low fertilization than cycles without either risk factor. Furthermore, cycles with low postprocessing concentration and progressive motility were 13.4 times (95% CI 4.01, 45.06) more likely to have low fertilization than cycles without either risk factor. CONCLUSIONS Postprocessing concentration and progressive motility on the day of oocyte retrieval are predictive of low fertilization in conventional IVF cycles with normal pretreatment diagnostic semen analysis parameters.
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Karabulut S, Aksünger Ö, Ata C, Sağıroglu Y, Keskin İ. Artificial oocyte activation with calcium ionophore for frozen sperm cycles. Syst Biol Reprod Med 2018; 64:381-388. [PMID: 29620419 DOI: 10.1080/19396368.2018.1452311] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Fertilization problems are the major problems that may be faced in 30-55% of the patients during an intracytoplasmic sperm injection (ICSI) cycle. A successful oocyte activation depends on factors related to both sperm and oocyte, and one of the important factors that mediates the process is Ca2+ concentration within the oocyte. Artificial oocyte activation (AOA) is a method used for fertilization problems that commonly involve the usage of Ca2+ ionophores and is usually used in problems such as total fertilization failure (TFF) and globozoospermia. The aim of the present study was to investigate possible effects of AOA for different groups of patients with fertilization failure. Four groups of patients (previous TFF, low oocyte number, severe sperm quality, and frozen sperm (FS) group) that underwent ICSI with AOA were included in the study. All groups had similar control groups with same indications except TFF, where AOA was not performed. Fertilization rates were significantly higher in the TFF group than those observed in other AOA groups. Fertilization rates and quality of embryos observed in the remaining AOA groups were higher than those of the controls, which were statistically insignificant. Prgenancy rates were higher in all AOA groups compared to the controls, although the differences were significant in FS group only. Quality of embryos and pregnancy rates were lower in the TFF group compared to the remaining AOA groups indicating possible concomitant problems. Fertilization rates, quality of embryos and pregnancy rates seemed to be increased in all indication groups suggesting that not only TFF patients but also a wide variety of patients with different indications may benefit from AOA. ABBREVIATIONS ICSI: Intracytoplasmic sperm injection; ARTs: Assisted reproductive techniques; Ca: Calcium; AOA: Artificial oocyte activation; TFF: Total fertilization failures; OAT: Oligoasthenoteratozoospemia; IVF: In vitro fertilization; SOAT: Severe OAT; LON: Low ooctye number; FS: Frozen sperm; hCG: human chorionic gonadotrophin; PVP: polyvinylpyrrolidone; HSA: human serum albumin.
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Affiliation(s)
- Seda Karabulut
- a School of Medicine , İstanbul Medipol University , İstanbul.,b REMER (Regenerative and Restorative Medicine Research Center) , İstanbul Medipol University , İstanbul , Turkey
| | - Özlem Aksünger
- c Memorial Antalya Hastanesi/Tüp Bebek Merkezi , Antalya , Turkey
| | - Can Ata
- c Memorial Antalya Hastanesi/Tüp Bebek Merkezi , Antalya , Turkey
| | - Yusuf Sağıroglu
- d IVF Unit , Florence Nightingale Hospital Kadıkoy , İstanbul , Turkey
| | - İlknur Keskin
- a School of Medicine , İstanbul Medipol University , İstanbul.,b REMER (Regenerative and Restorative Medicine Research Center) , İstanbul Medipol University , İstanbul , Turkey
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10
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Lee SH, Lee JH, Park YS, Yang KM, Lim CK. Comparison of clinical outcomes between in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) in IVF-ICSI split insemination cycles. Clin Exp Reprod Med 2017; 44:96-104. [PMID: 28795049 PMCID: PMC5545226 DOI: 10.5653/cerm.2017.44.2.96] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 01/19/2017] [Accepted: 04/25/2017] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE This study aimed to compare the clinical outcomes between in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) in sibling oocytes. Additionally, we evaluated whether the implementation of split insemination contributed to an increase in the number of ICSI procedures. METHODS A total of 571 cycles in 555 couples undergoing split insemination cycles were included in this study. Among them, 512 cycles (89.7%) were a couple's first IVF cycle. The patients were under 40 years of age and at least 10 oocytes were retrieved in all cycles. Sibling oocytes were randomly allocated to IVF or ICSI. RESULTS Total fertilization failure was significantly more common in IVF cycles than in ICSI cycles (4.0% vs. 1.4%, p<0.05), but the low fertilization rate among retrieved oocytes (as defined by fertilization rates greater than 0% but <30%) was significantly higher in ICSI cycles than in IVF cycles (17.2% vs. 11.4%, p<0.05). The fertilization rate of ICSI among injected oocytes was significantly higher than for IVF (72.3%±24.3% vs. 59.2%±25.9%, p<0.001), but the fertilization rate among retrieved oocytes was significantly higher in IVF than in ICSI (59.2%±25.9% vs. 52.1%±22.5%, p<0.001). Embryo quality before embryo transfer was not different between IVF and ICSI. Although the sperm parameters were not different between the first cycle and the second cycle, split insemination or ICSI was performed in 18 of the 95 cycles in which a second IVF cycle was performed. CONCLUSION The clinical outcomes did not differ between IVF and ICSI in split insemination cycles. Split insemination can decrease the risk of total fertilization failure. However, unnecessary ICSI is carried out in most split insemination cycles and the use of split insemination might make ICSI more common.
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Affiliation(s)
- Sun Hee Lee
- Laboratory of Reproductive Medicine, Cheil General Hospital and Women's Healthcare Center, Dankook University College of Medicine, Seoul, Korea.,Department of Biosciences, Institute of Basic Sciences, College of Natural Sciences, Sungshin Women's University, Seoul, Korea
| | - Jae Hyun Lee
- Laboratory of Reproductive Medicine, Cheil General Hospital and Women's Healthcare Center, Dankook University College of Medicine, Seoul, Korea
| | - Yong-Seog Park
- Laboratory of Reproductive Medicine, Cheil General Hospital and Women's Healthcare Center, Dankook University College of Medicine, Seoul, Korea
| | - Kwang Moon Yang
- Department of Obstetrics and Gynecology, Cheil General Hospital and Women's Healthcare Center, Dankook University College of Medicine, Seoul, Korea
| | - Chun Kyu Lim
- Laboratory of Reproductive Medicine, Cheil General Hospital and Women's Healthcare Center, Dankook University College of Medicine, Seoul, Korea
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11
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Sarais V, Pagliardini L, Rebonato G, Papaleo E, Candiani M, Viganò P. A Comprehensive Analysis of Body Mass Index Effect on in Vitro Fertilization Outcomes. Nutrients 2016; 8:109. [PMID: 26907340 PMCID: PMC4808839 DOI: 10.3390/nu8030109] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 02/05/2016] [Accepted: 02/18/2016] [Indexed: 02/05/2023] Open
Abstract
The effect of a raised body mass index (BMI) on the outcome of assisted reproduction technology (ART) still represents a controversial issue. Even less clear is whether BMI acts with a potential detrimental effect on IVF outcomes via a deleterious effect on innate quality of oocytes or on the environmental milieu within the uterus. With the aim to better understand the mechanisms underlying the potential deleterious effect of an increased BMI on IVF outcomes, we have evaluated the effects of female BMI on number and quality of retrieved oocytes, fertilization rate, embryo score and incidences of ongoing pregnancy and live births among couples undergoing IVF in an Italian population. Data from 1602 women who underwent their first IVF cycle were retrospectively analyzed. A significantly reduced percentage of mature oocytes when comparing obese (BMI ≥ 30 kg/m2) and normal-weight patients (BMI = 18.50–24.99 kg/m2) was found. After adjusting for maternal age and other confounders, odds for ongoing pregnancy rate showed no differences across different BMI categories. However, a significant increased odds ratio (OR) could be observed for miscarriage rate in patients with BMI ≥ 25 (OR = 2.5; p = 0.04). These results should be taken into account in order to define optimal strategies for overweight and obese patients referring to ART procedures.
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Affiliation(s)
- Veronica Sarais
- Obstetrics and Gynecology Unit, San Raffaele Scientific Institute, 20132 Milano, Italy.
| | - Luca Pagliardini
- Division of Genetics and Cell Biology, San Raffaele Scientific Institute, 20132 Milano, Italy.
| | - Giorgia Rebonato
- Obstetrics and Gynecology Unit, San Raffaele Scientific Institute, 20132 Milano, Italy.
| | - Enrico Papaleo
- Obstetrics and Gynecology Unit, San Raffaele Scientific Institute, 20132 Milano, Italy.
| | - Massimo Candiani
- Obstetrics and Gynecology Unit, San Raffaele Scientific Institute, 20132 Milano, Italy.
| | - Paola Viganò
- Division of Genetics and Cell Biology, San Raffaele Scientific Institute, 20132 Milano, Italy.
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12
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Zhu J, Jiang H, He RB, Yin HQ, Wang CL, Li Y, Du X. Association between etiologic factors in infertile couples and fertilization failure in conventional in vitro fertilization cycles. Andrology 2015; 3:717-22. [PMID: 26097073 DOI: 10.1111/andr.12048] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2015] [Revised: 03/22/2015] [Accepted: 04/08/2015] [Indexed: 10/23/2022]
Abstract
The aim of this study was to investigate the relationship between the etiology of the couples and risk of fertilization failure (FF) in conventional in vitro fertilization (IVF) cycles and the effect of rescue intracytoplasmic sperm injection (ICSI) technique to offspring. A total of 2542 IVF cycles were divided into four groups according to infertile etiology: Group A - primary infertility with normal semen parameters; Group B - secondary infertility with oligoasthenozoospermia; Group C - primary infertility with oligoasthenozoospermia; and Group D - secondary infertility with normal semen parameters. The results showed that there were significant differences in incidence of FF among Group A (16.8%), Group B (20.9%), Group C (48.7%), and Group D (0.9%) (p < 0.001). Logistic regression models demonstrated that primary infertility (OR: 10.898, 95% CI: 4.651-25.583, p < 0.001) and oligoasthenozoospermia (OR: 12.215, 95% CI: 5.903-25.276, p < 0.001) were independent risk factors for FF. There were no significant differences in main outcomes between conventional ICSI and rescue ICSI. In conclusion, the patients with primary infertility and oligoasthenozoospermia might be at higher risk of FF. The rescue ICSI technique is safe and helpful for IVF cycles of FF.
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Affiliation(s)
- J Zhu
- Reproductive Medicine Center, the 105th Hospital of PLA, Hefei, China
| | - H Jiang
- Reproductive Medicine Center, the 105th Hospital of PLA, Hefei, China
| | - R-B He
- Reproductive Medicine Center, the 105th Hospital of PLA, Hefei, China
| | - H-Q Yin
- Reproductive Medicine Center, the 105th Hospital of PLA, Hefei, China
| | - C-L Wang
- Reproductive Medicine Center, the 105th Hospital of PLA, Hefei, China
| | - Y Li
- Reproductive Medicine Center, the 105th Hospital of PLA, Hefei, China
| | - X Du
- Reproductive Medicine Center, the 105th Hospital of PLA, Hefei, China
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Uncommon but devastating event: total fertilisation failure following intracytoplasmic sperm injection. Andrologia 2015; 48:164-70. [DOI: 10.1111/and.12427] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2015] [Indexed: 12/13/2022] Open
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Krog M, Prior M, Carlsen E, Loft A, Forman J, Pinborg A, Andersen AN. Fertilization failure after IVF in 304 couples—A case-control study on predictors and long-term prognosis. Eur J Obstet Gynecol Reprod Biol 2015; 184:32-7. [DOI: 10.1016/j.ejogrb.2014.10.037] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 10/22/2014] [Indexed: 11/28/2022]
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Peultier AS, Fréour T, Cazenave N, Barrière P. [Fertilization failure in IVF and ICSI]. ACTA ACUST UNITED AC 2014; 44:380-6. [PMID: 25200349 DOI: 10.1016/j.jgyn.2014.07.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Revised: 07/14/2014] [Accepted: 07/22/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To assess male and female clinical and biological parameters that may explain fertilization failure in vitro fertilization (IVF) and IVF with intra-cytoplasmic sperm injection (ICSI). MATERIAL AND METHODS Retrospective case-control study including 1282 IVF or ICSI cycles at the centre hospitalier universitaire of Nantes from September 2010 to February 2012. The "Fertilization Failure" group, showing no sign of fertilization, has been compared with the "Control patients" group, getting at least one embryo. RESULTS Several significant differences were noted as, in the "Fertilization Failure" group, lower values of antral follicles (P<0.05), of inseminated oocytes (P<0.001) and active sperm (P<0.001) in IVF, and a lower quantity and quality of oocytes (P<0.001) in ICSI. The correlation tests have confirmed a significant association with these parameters. However, the logistic regression tests did not identify explanatory or predictive factor in IVF or ICSI. CONCLUSION In our study, in accordance with literature data, impaired sperm parameters were mainly involved in complete fertilization failure in IVF, and a lower oocyte quality in ICSI.
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Affiliation(s)
- A-S Peultier
- Service de médecine et biologie de la reproduction, hôpital Mère-Enfant, CHU de Nantes, quai Moncousu, 44093 Nantes cedex 1, France.
| | - T Fréour
- Service de médecine et biologie de la reproduction, hôpital Mère-Enfant, CHU de Nantes, quai Moncousu, 44093 Nantes cedex 1, France
| | - N Cazenave
- Octogone CERPP, université de Toulouse 2 Le Mirail, 5, allée Antonio-Machado, 31000 Toulouse, France
| | - P Barrière
- Service de médecine et biologie de la reproduction, hôpital Mère-Enfant, CHU de Nantes, quai Moncousu, 44093 Nantes cedex 1, France
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Shinar S, Almog B, Levin I, Shwartz T, Amit A, Hasson J. Total fertilization failure in intra-cytoplasmic sperm injection cycles--classification and management. Gynecol Endocrinol 2014; 30:593-6. [PMID: 24811096 DOI: 10.3109/09513590.2014.911275] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
In this retrospective cohort study we intended to propose a classification and preliminary management strategy for couples exhibiting total fertilization failure (TFF) in intra-cytoplasmic sperm injection (ICSI) cycles. Sixteen couples with a total of 27 cycles exhibiting TFF, age <40 and/or more than four M2 oocytes aspirated were enrolled. While TFF occurred in 4.3% of all 3723 ICSI cycles, in women younger than 40 with at least 5 M2 oocytes the TFF rate was 0.7%. Indications for ICSI were severe male factor and unexplained infertility. Of the 16 couples with TFF, 4 demonstrated a single episode of TFF, with either subsequent or former normal fertilizations, thus implying possible sporadic faulty laboratory conditions. Ten couples demonstrated repeated total or very low fertilization rates, hinting at a gamete defect not overcome by ICSI. Two couples experienced TFF in the first and only cycle performed at our unit. We conclude that initial and repeated TFF hints at severe gamete defects for which only donor gametes may prove successful while sporadic TFF events could simply imply a technical modifiable condition.
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Affiliation(s)
- Shiri Shinar
- The Sarah Racine IVF Unit, Department of Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center (Affiliated to the Sackler School of Medicine), Tel Aviv University , Tel Aviv , Israel
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Chen L, Xu Z, Zhang N, Wang B, Chen H, Wang S, Sun H. Neonatal outcome of early rescue ICSI and ICSI with ejaculated sperm. J Assist Reprod Genet 2014; 31:823-8. [PMID: 24824350 DOI: 10.1007/s10815-014-0245-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Accepted: 05/05/2014] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To evaluate the impact of early rescue ICSI on neonatal outcome. METHODS This retrospective study compared the neonatal outcome of early rescue ICSI and ICSI with ejaculated sperm, including 233 children who were conceived after early rescue ICSI and a control group of 906 children who were conceived after ICSI with ejaculated sperm, and all of the children had a gestational age of 20 weeks or more. The numbers of live and stillbirths, perinatal deaths, prematurity, birthweights and birth defects of the children were compared. RESULTS Children in the early rescue ICSI group showed no increased risk of stillbirths, perinatal death or birth defects. Those children also did not differ from those of the ICSI with ejaculated sperm group in gender rate, birthweight, gestational age or prematurity. CONCLUSIONS Early rescue ICSI did not increase the adverse effect on the neonatal outcome when compared to that of ICSI with ejaculated sperm.
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Affiliation(s)
- Linjun Chen
- Reproductive Medicine Center, Drum Tower Hospital Affiliated to Nanjing University Medical College, Nanjing, Jiangsu, 210008, China,
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Durand M, Sifer C. [Complete fertilization failure following conventional IVF or ICSI: is it predictable? How to manage?]. GYNECOLOGIE, OBSTETRIQUE & FERTILITE 2013; 41:727-734. [PMID: 24239479 DOI: 10.1016/j.gyobfe.2013.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Indexed: 06/02/2023]
Abstract
The occurrence of complete fertilization failure following conventional in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) is a rare event. Each of six physiological stages of the fertilisation can be failing. The cause of a fertilisation failure is either the spermatozoa, or the oocyte. The aim of this study was to determine if this event is predictable, and to define the later strategy. On all sperm tests available, it seems that only, tests of zona pellucida binding and acrosomique reaction are relatively predictive of a complete fertilization failure after IVF. No test allows at the moment to predict an oocyte contribution to unsuccessful fertilization. The strategy retained after a complete fertilization failure following the first attempt of IVF is to propose an ICSI; either to do an IVF if this event arises in the rank n+1, or when the number of inseminated oocytes was low. Concerning the ICSI, the low number of micro-injected oocyte is often in question; so the strategy retained following a first fertilization failure after ICSI is to perform a new ICSI attempt after optimization of the ovarian stimulation. When the cause is spermatic, it is indicated trying a modified ICSI with the use of pentoxifiline, or an intracytoplasmic morphologically selected sperm injection (IMSI), sometimes with assisted oocyte activation. In last solution, we can propose the ovum donation.
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Affiliation(s)
- M Durand
- Service d'histologie-embryologie-cytogénétique-CECOS, CHU Jean-Verdier, AP-HP, avenue du 14-Juillet, 93140 Bondy, France
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Vitek WS, Galárraga O, Klatsky PC, Robins JC, Carson SA, Blazar AS. Management of the first in vitro fertilization cycle for unexplained infertility: a cost-effectiveness analysis of split in vitro fertilization-intracytoplasmic sperm injection. Fertil Steril 2013; 100:1381-8. [PMID: 23876534 PMCID: PMC4503359 DOI: 10.1016/j.fertnstert.2013.06.035] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2012] [Revised: 06/18/2013] [Accepted: 06/19/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To determine the cost-effectiveness of split IVF-intracytoplasmic sperm injection (ICSI) for the treatment of couples with unexplained infertility. DESIGN Adaptive decision model. SETTING Academic infertility clinic. PATIENT(S) A total of 154 couples undergoing a split IVF-ICSI cycle and a computer-simulated cohort of women <35 years old with unexplained infertility undergoing IVF. INTERVENTION(S) Modeling insemination method in the first IVF cycle as all IVF, split IVF-ICSI, or all ICSI, and adapting treatment based on fertilization outcomes. MAIN OUTCOME MEASURE(S) Live birth rate, incremental cost-effectiveness ratio (ICER). RESULT(S) In a single cycle, all IVF is preferred as the ICER of split IVF-ICSI or all ICSI ($58,766) does not justify the increased live birth rate (3%). If two cycles are needed, split IVF/ICSI is preferred as the increased cumulative live birth rate (3.3%) is gained at an ICER of $29,666. CONCLUSION(S) In a single cycle, all IVF was preferred as the increased live birth rate with split IVF-ICSI and all ICSI was not justified by the increased cost per live birth. If two IVF cycles are needed, however, split IVF/ICSI becomes the preferred approach, as a result of the higher cumulative live birth rate compared with all IVF and the lesser cost per live birth compared with all ICSI.
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Affiliation(s)
- Wendy S Vitek
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, University of Rochester School of Medicine & Dentistry, Rochester, New York.
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Karipcin FS, Moragianni VA, Milette B, Kinzer DR, Thornton KL, Barrett B, Penzias AS. Effect of steroid and antibiotic treatment during assisted hatching on IVF outcomes. HUM FERTIL 2012. [PMID: 23190298 DOI: 10.3109/14647273.2012.739721] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
There are limited data on the use of steroids and antibiotics in assisted reproductive technology (ART). Our aim was to evaluate the impact of these treatments on the outcome of IVF cycles in which Assisted Hatching (AH) was performed. We studied a retrospective cohort in a large university-affiliated infertility centre. Data from 1126 AH cycles performed between 2007 and 2009 were reviewed. Cycles were categorized as "treatment" (n = 640) and "no treatment" (n = 486), depending on whether they received steroids and antibiotics. The primary outcome was live birth. Secondary outcomes included implantation, spontaneous abortion, biochemical, clinical and ectopic pregnancy. Logistic regression was used to calculate odds ratios (OR) and 95% confidence intervals (CI). OR were adjusted (AOR) for age, BMI, baseline FSH, peak estradiol, cycle number, number of oocytes retrieved, number of embryos that underwent AH, number of high-implantation potential embryos, number of embryos transferred and physician in charge. The AOR (95% CI) of live birth was 1.91 (1.08-3.38), of clinical pregnancy, 1.75 (1.08-2.83) and of biochemical pregnancy, 0.24 (0.07-0.85). Our study suggests that treatment with steroids and antibiotics during AH cycles significantly increases the odds of live birth.
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Affiliation(s)
- Fethiye Sinem Karipcin
- Department of Obstetrics and Gynecology, University of Texas Medical Branch at Galveston, Galveston, TX, USA
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Intracytoplasmic sperm injection (ICSI) for non-male factor infertility: a committee opinion. Fertil Steril 2012; 98:1395-9. [PMID: 22981171 DOI: 10.1016/j.fertnstert.2012.08.026] [Citation(s) in RCA: 101] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Accepted: 08/14/2012] [Indexed: 11/19/2022]
Abstract
Intracytoplasmic sperm injection, while typically effective for overcoming low or absent fertilization in couples with a clear abnormality of semen parameters, is frequently utilized in combination with assisted reproductive technologies for other etiologies of infertility in the presence of normal semen parameters. This committee opinion provides a critical review of the literature, where available, to identify situations where this may or may not be of benefit.
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The effect of body mass index on the outcomes of first assisted reproductive technology cycles. Fertil Steril 2012; 98:102-8. [DOI: 10.1016/j.fertnstert.2012.04.004] [Citation(s) in RCA: 117] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Revised: 03/31/2012] [Accepted: 04/03/2012] [Indexed: 11/21/2022]
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Effects of the Statutory Health Insurance Modernization Act on the supply and expenditure situation in cases of assisted reproductive technologies in Germany. Fertil Steril 2010; 93:1011-3. [DOI: 10.1016/j.fertnstert.2009.07.1665] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2008] [Revised: 07/10/2009] [Accepted: 07/24/2009] [Indexed: 11/22/2022]
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