Fertilization and embryo development with spermatozoa obtained from testicular sperm extraction into oocytes generated from human chorionic gonadotropin-primed in vitro maturation cycles

ICSI outcomes using testicular spermatozoa in non-azoospermic couples with recurrent ICSI failure and no previous live births

BACKGROUND

The use of testicular over ejaculated spermatozoa for ICSI has been presented as an alternative to overcome infertility in men with poor semen parameters or high levels of sperm DNA fragmentation.

OBJECTIVE

To evaluate the efficacy of testicular ICSI outcomes in couples with no previous live birth and recurrent ICSI failure using ejaculated spermatozoa by comparison to the outcomes of couples with similar history of recurrent ICSI using ejaculated spermatozoa only.

MATERIALS AND METHODS

A total of 145 couples undergoing ejaculated or testicular ICSI cycles with no previous live births and with at least two previous failed ICSI cycles with ejaculated spermatozoa were evaluated retrospectively. ICSI was performed either with ejaculated (E-ICSI) or with testicular (T-ICSI) spermatozoa. Semen parameters and sperm DNA quality were assessed prior to the oocyte collection day. Primary outcomes included cumulative live birth and pregnancy rates. Secondary analysis included percentage of DNA fragmentation in ejaculated spermatozoa (SCSA^® and TUNEL).

RESULTS

Patients undergoing T-ICSI (n = 77) had a significantly higher clinical pregnancy rate/fresh embryo transfer (ET) (27.9%; 17/61) and cumulative live birth rate (23.4%; 15/64) compared to patients using E-ICSI (n = 68) (clinical pregnancy rate/fresh ET: 10%; 6/60 and cumulative live birth rate: 11.4%; 7/61). Further, T-ICSI yield significantly better cumulative live birth rates than E-ICSI for men with high TUNEL (≥36%) (T-ICSI: 20%; 3/15 vs. E-ICSI: 0%; 0/7, p < 0.025), high SCSA^® (≥25%) scores (T-ICSI: 21.7%; 5/23 vs. E-ICSI: 9.1%; 1/11, p < 0.01), or abnormal semen parameters (T-ICSI: 28%; 7/25 vs. E-ICSI: 6.7%; 1/15, p < 0.01).

CONCLUSIONS

The use of testicular spermatozoa for ICSI in non-azoospermic couples with no previous live births, recurrent ICSI failure, and high sperm DNA fragmentation yields significantly better live birth outcomes than a separate cohort of couples with similar history of ICSI failure entering a new ICSI cycle with ejaculated spermatozoa.

Birth after human chorionic gonadotropin-primed oocyte in vitro maturation and fertilization with testicular sperm in a normo-ovulatory patient

In this report, we present a case of in vitro maturation (IVM) with surgical retrieved testicular sperm in a normo-ovulatory female. Human chorionic gonadotropin-primed IVM, testicular biopsy for sperm retrieval and intracytoplasmic sperm injection with fresh sperm were performed. Fourteen cumulus-oocyte complexes were obtained in germinal vesicle or metaphase I stage, eight oocytes reached metaphase II, seven presumptive zygotes were obtained, and three cleavage stages embryos in day 2 were transferred producing a singleton pregnancy. A single healthy newborn was obtained. Our results suggest that IVM may be an alternative for in vitro fertilization in normo-ovulatory women even if surgical retrieval of sperm is needed. Further research is required to depict contributing factors to the success of IVM in indications different from polycystic ovaries syndrome and the role of male gamete.

Quebec public funding facilitates fertility preservation for male cancer patients

BACKGROUND

Sperm cryopreservation remains the only clinically feasible option to preserve male fertility. The quality of counselling provided by the treating physicians and the cost of sperm cryopreservation can both influence a patient's decision about whether to preserve sperm. On 5 August 2010, the Quebec government introduced provincial coverage of assisted reproductive technologies, with sperm cryopreservation included as a covered service. The aim of the present study was to evaluate whether and how such a program affects the behaviour of cancer patients with respect to sperm cryopreservation.

METHODS

We analyzed the database derived from male patients undergoing sperm cryopreservation from August 2008 to August 2012 at our centre. The retrieved data included patient age, male infertility or oncologic diagnosis, sperm quality parameters, and details about the number of visits for sperm cryopreservation.

RESULTS

The number of cancer patients who cryopreserved sperm before and after the policy change did not differ significantly, but a marked increase in the number of non-cancer patients was observed. Further analysis revealed that, after implementation of the public funding program, the total number of sperm cryopreservation sessions per patient increased significantly in cancer patients but not in non-cancer patients.

CONCLUSIONS

It appears that cancer patients who are willing to freeze sperm are keen to return for more sessions of sperm banking when no fees are associated with the service. Those findings suggest that cost reduction is an important factor for improving delivery of fertility preservation services to male cancer patients.

Recombinant LH supplementation during IVF cycles with a GnRH-antagonist in estimated poor responders: A cross-matched pilot investigation of the optimal daily dose and timing

Although it is widely accepted that patients, who are considered poor responders to in vitro fertilization (IVF) benefit from recombinant luteinizing hormone (rLH) supplementation during an in vitro fertilization cycle, particularly when gonadotropin‑releasing hormone (GnRH)‑antagonist (ant) treatment is used the optimal administration timing and daily dose of rLH remains to be elucidated. The aim of the present study was to investigate the optimal timing of rLH‑supplementation to improve ovarian response, embryo quality, endometrial thickness and pregnancy rate in infertile, estimated poor responders to IVF, undergoing GnRH‑ant treatment. In addition, the present study aimed to evaluate the optimal daily dose to achieve the same outcomes. A prospective‑randomized‑cross‑matched investigation was performed on 40 patients undergoing a GnRH‑ant‑treatment‑cycle The patients were randomly assigned to either group A (rLH‑75 IU/day) or group B (rLH‑150 IU/day) and further randomized into subgroup A1/B1, in which rLH was administered at recombinant follicle stimulating hormone (rFSH) administration, and subgroup A2/B2, in which rLH was administered at GnRH‑ant administration. Patients who did not become pregnant during the first cycle (35 patients), were treated a second time, cross‑matched for groups and subgroups. Improved ovarian response, embryo quality and pregnancy rate were achieved by administering rLH at 150 IU/day, starting from GnRH‑ant administration, independently from the total rLH dose administered. Improved endometrial thickness at oocyte retrieval day was achieved by administering rLH at 150 IU from the start of rFSH administration. These data led to the hypothesis that ovarian responses are affected by the timing of administration more than the total‑dose of rLH. The optimal window to administer rLH appears to be the mid‑to‑late follicular phase, despite the fact that rLH‑supplementation in the early‑follicular phase appeared to increase endometrial thickness and to enhance its morphology. Standardization of the optimal daily dose and supplementation timing of rLH may resolve the debate regarding its efficacy in increasing the number of pregnancies and neonatal survival rates.

Assisted reproductive outcomes of male cancer survivors

PURPOSE

The objective of our study was to evaluate the reproductive outcome of male cancer survivors treated with intracytoplasmic sperm injection (ICSI) using cryopreserved sperm and compare it with the same treatment in non-cancer males.

METHODS

We retrospectively analyzed database derived from cancer and non-cancer patients undergoing sperm cryopreservation from August 2008 to August 2012 at a university-based center. We evaluated the reproductive outcome of those cancer and non-cancer patients that had frozen sperm and returned subsequently to the clinic for assisted reproduction.

RESULTS

We studied 272 males with cancer and 296 infertile males. The most prevalent types of cancer in our cohort were lymphoma (25.3 %), testicular cancer (19.2 %), leukemia (7.3 %), and other malignancies including sarcoma, gastrointestinal, and central nervous system malignancies (48.2 %). The use rate of cryopreserved sperm was 10.7 % for cancer patients and 30.7 % for non-cancer patients. The mean age of males with cancer who returned to the clinic for fertility treatment was 36.7 ± 6 years, and the diagnoses were testis cancer (43.4 %), lymphoma (36.9 %), leukemia (13 %), and other malignancies (6.7 %). Live birth rate of the cancer cohort was 62.1 %, which was higher than that of the normospermic non-cancer population (p < 0.0047).

CONCLUSIONS

The use rate of cryopreserved sperm from oncofertility preservation cases is at around 10 %. The live birth rate using assisted reproductive technologies among these patients is at least comparable to that of the non-cancer population.

IMPLICATIONS FOR CANCER SURVIVORS

To our knowledge, this was the first comparative study of male cancer survivors treated with ICSI using cryopreserved sperm, which were compared to non-cancer males undergoing the same treatment. Male fertility preservation is a highly valued service that should be strongly encouraged prior to beginning cytotoxic cancer treatment. These results can help healthcare professionals in oncology to improve the quality of counseling on fertility preservation when managing young men with newly diagnosed cancer that require gonadotoxic treatment.

Could empirical low-dose-aspirin administration during IVF cycle affect both the oocytes and embryos quality via COX 1-2 activity inhibition?

PURPOSE

To compare qualitative and quantitative ovarian response in idiopathic infertile women treated with low-dose-aspirin (LDA) during in-vitro-fertilization (IVF) cycles (pl) versus untreated ones.

METHODS

We conducted an observational-cohort-study on normo-responders patients aged between 25 and 45,years referred to Assisted-Reproductive Unit --University of Padua--in order to evaluate the ovarian response effects (both qualitative and quantitative) after LDA administration. In detail we aim to assess if LDA administration could improve ovarian response, reducing the gonadotropin administration, and if its administration could increase the amount of follicles greater than 16 mm at pick-up, the amount and quality of oocytes retrieved, the amount and quality of embryos, the chance to achieve a pregnancy and to carry it on.

RESULTS

One hundred six LDA-treated patients (Group-A) and 100 not-treated ones (Group-B) were homogeneous for age and BMI. The Group-A, compared to Group-B, showed higher gonadotropin request, higher number of ovarian follicles at pick-up, more follicles bigger than 16 mm in diameter and more retrieved oocytes (despite higher number of immature and at germinal vesicle stage oocytes) but lower quality of obtained embryos. The comparison between two Groups in term of retrieved oocytes /number of follicles, mature oocytes/retrieved oocytes, fertilized oocytes/mature oocytes and good embryos quality/mature oocytes showed a strongly advantageous ratio for Group-B. For each considered outcome, we found a dose-related effect.

CONCLUSIONS

It is mandatory to define which patients could benefit from LDA administration and the adequate timing to administer it since the empirical administration could negatively affect both oocyte and embryo quality during IVF cycles.