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Sun N, Fang X, Jiao Y, Wang Y, Wan Y, Wu Z, Jin H, Shi H, Song W. Adverse maternal and neonatal outcomes of preimplantation genetic testing with trophectoderm biopsy: a retrospective cohort study of 3373 intracytoplasmic sperm injection single frozen-thawed blastocyst transfer cycles. Arch Gynecol Obstet 2024; 309:2427-2437. [PMID: 37389643 DOI: 10.1007/s00404-023-07120-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 06/20/2023] [Indexed: 07/01/2023]
Abstract
PURPOSE To investigate whether trophectoderm biopsy increases the risk of adverse maternal and neonatal outcomes in intracytoplasmic sperm injection (ICSI) single frozen-thawed blastocyst transfer cycles. METHODS This respective cohort study enrolled 3373 ICSI single frozen-thawed blastocyst transfer cycles with and without trophectoderm biopsy. Statistical methods including univariate logistic regression analysis, multivariate logistic regression analysis, and stratified analyses were performed to explore the impact of trophectoderm biopsy on adverse maternal and neonatal outcomes. RESULTS The rates of adverse maternal and neonatal outcomes were comparable between the two groups. Univariate analysis showed that the live birth rate (45.15% vs. 40.75%; P = 0.010) in the biopsied group was statistically higher than that in the unbiopsied group, and the rates of miscarriage (15.40% vs. 20.00%; P = 0.011) and birth defects (0.58% vs. 2.16%; P = 0.007) were statistically lower in the biopsied group. After adjusting for confounding factors, the rates of miscarriage (aOR = 0.74; 95% CI = 0.57-0.96; P = 0.022) and birth defects (aOR = 0.24, 95% CI = 0.08-0.70, P = 0.009) in the biopsied group were significantly lower than those in the unbiopsied group. Stratified analyses showed that the birth defects rate after biopsy was significantly reduced in the subgroups of age < 35 years old, BMI ≥ 24 kg/m2, artificial cycle with downregulation, poor-quality blastocysts, and Day 5 poor-quality blastocysts. CONCLUSION Preimplantation genetic testing (PGT) with trophectoderm biopsy does not increase the risk of adverse maternal and neonatal outcomes in ICSI single frozen-thawed blastocyst transfer cycles, and PGT can effectively reduce the rates of miscarriage and birth defects.
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Affiliation(s)
- Ning Sun
- Reproductive Medical Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, People's Republic of China
| | - Xingyu Fang
- Reproductive Medical Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, People's Republic of China
| | - Yunyun Jiao
- Reproductive Medical Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, People's Republic of China
| | - Yuan Wang
- Reproductive Medical Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, People's Republic of China
| | - Ying Wan
- Reproductive Medical Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, People's Republic of China
| | - Zhaoting Wu
- Reproductive Medical Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, People's Republic of China
| | - Haixia Jin
- Reproductive Medical Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, People's Republic of China
| | - Hao Shi
- Reproductive Medical Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, People's Republic of China
| | - Wenyan Song
- Reproductive Medical Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, People's Republic of China.
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Bovine ICSI: limiting factors, strategies to improve its efficiency and alternative approaches. ZYGOTE 2022; 30:749-767. [PMID: 36082429 DOI: 10.1017/s0967199422000296] [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: 11/07/2022]
Abstract
Intracytoplasmic sperm injection (ICSI) is an assisted reproductive technique mainly used to overcome severe infertility problems associated with the male factor, but in cattle its efficiency is far from optimal. Artificial activation treatments combining ionomycin (Io) with 6-dimethylaminopurine after piezo-ICSI or anisomycin after conventional ICSI have recently increased the blastocyst rate obtained. Compounds to capacitate bovine spermatozoa, such as heparin and methyl-β-cyclodextrin and compounds to destabilize sperm membranes such as NaOH, lysolecithin and Triton X-100, have been assessed, although they have failed to substantially improve post-ICSI embryonic development. Disulfide bond reducing agents, such as dithiothreitol (DTT), dithiobutylamine and reduced glutathione, have been assessed to decondense the hypercondensed head of bovine spermatozoa, the two latter being more efficient than DTT and less harmful. Although piezo-directed ICSI without external activation has generated high fertilization rates and modest rates of early embryo development, other studies have required exogenous activation to improve the results. This manuscript thoroughly reviews the different strategies used in bovine ICSI to improve its efficiency and proposes some alternative approaches, such as the use of extracellular vesicles (EVs) as 'biological methods of oocyte activation' or the incorporation of EVs in the in vitro maturation and/or culture medium as antioxidant defence agents to improve the competence of the ooplasm, as well as a preincubation of the spermatozoa in estrous oviductal fluid to induce physiological capacitation and acrosome reaction before ICSI, and the use of hyaluronate in the sperm immobilization medium.
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Molecular Profiling of Spermatozoa Reveals Correlations between Morphology and Gene Expression: A Novel Biomarker Panel for Male Infertility. BIOMED RESEARCH INTERNATIONAL 2021; 2021:1434546. [PMID: 34604380 PMCID: PMC8485144 DOI: 10.1155/2021/1434546] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 08/23/2021] [Accepted: 08/27/2021] [Indexed: 11/18/2022]
Abstract
Choosing spermatozoa with an optimum fertilizing potential is one of the major challenges in assisted reproductive technologies (ART). This selection is mainly based on semen parameters, but the addition of molecular approaches could allow a more functional evaluation. To this aim, we used sixteen fresh sperm samples from patients undergoing ART for male infertility and classified them in the high- and poor-quality groups, on the basis of their morphology at high magnification. Then, using a DNA sequencing method, we analyzed the spermatozoa methylome to identify genes that were differentially methylated. By Gene Ontology and protein-protein interaction network analyses, we defined candidate genes mainly implicated in cell motility, calcium reabsorption, and signaling pathways as well as transmembrane transport. RT-qPCR of high- and poor-quality sperm samples allowed showing that the expression of some genes, such as AURKA, HDAC4, CFAP46, SPATA18, CACNA1C, CACNA1H, CARHSP1, CCDC60, DNAH2, and CDC88B, have different expression levels according to sperm morphology. In conclusion, the present study shows a strong correlation between morphology and gene expression in the spermatozoa and provides a biomarker panel for sperm analysis during ART and a new tool to explore male infertility.
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Dieamant F, Petersen CG, Vagnini LD, Renzi A, Petersen B, Massaro F, Zamara C, Nicoletti A, Ricci J, Oliani AH, Oliveira JBA, Franco JG. Impact of Intracytoplasmic Morphologically Selected Sperm Injection (IMSI) on Birth Defects: A Systematic Review and Meta-Analysis. JBRA Assist Reprod 2021; 25:466-472. [PMID: 34224237 PMCID: PMC8312289 DOI: 10.5935/1518-0557.20210030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE It is generally accepted that the incidence of birth defects in spontaneously conceived children ranges between 2.0-4.0%. However, several studies have shown that babies born after assisted reproductive technology (ART) procedures tend to present more congenital malformations than naturally conceived children, with 6.5% of the children born after intracytoplasmic sperm injection (ICSI) presenting birth defects. The use of high magnification sperm selection before ICSI was introduced in the early 2000s to allow the identification of spermatozoa with low risk of sperm DNA damage. Intracytoplasmic morphologically selected sperm injection (IMSI) is expected to change the incidence of congenital malformations, although data on the incidence of birth defects in children conceived after IMSI are still scarce. METHODS A systematic review based on searches performed in electronic databases (PubMed, EMBASE, Web of Science, SCOPUS, and Cochrane Central Register of Controlled Trials) including articles published by February 2021 was conducted to identify trials comparing the neonatal outcomes of ICSI and IMSI. The outcome measured was the rate of birth defects in children born after ICSI or IMSI. Three trials were included as targets for data extraction and meta-analysis. RESULTS Our meta-analysis included 3907 children conceived after IMSI (1280) or ICSI (2627). The incidence of birth defects was statistically different, with 2.5% (32/1280) in IMSI and 4.5% (119/2627) in ICSI (RR=0.59; 95% CI=0.40-0.87; p=0.007). The results demonstrated that IMSI decreased the incidence of structural defects compared to ICSI - 2.2% (18/830) vs. 3.8% (78/2049) - in a statistically significant manner (RR=0.58; 95%CI=0.35-0.96; p=0.04). No significant difference was observed in chromosomal abnormalities (Trisomy 13; 18; 21 and Triple X) between children conceived after IMSI (8/830) or ICSI (19/2049) (RR=1.07; 95%CI=0.47-2.43; p=0.87). CONCLUSIONS IMSI seems to be an effective tool at reducing the incidence of structural defects compared to ICSI. However, IMSI does not change the incidence of chromosomal abnormalities.
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Affiliation(s)
- Felipe Dieamant
- Center for Human Reproduction Prof Franco Jr, Ribeirão Preto, Brazil.,Paulista Center for Diagnosis Research and Training, Ribeirão Preto, Brazil
| | - Claudia G Petersen
- Center for Human Reproduction Prof Franco Jr, Ribeirão Preto, Brazil.,Paulista Center for Diagnosis Research and Training, Ribeirão Preto, Brazil
| | - Laura D Vagnini
- Paulista Center for Diagnosis Research and Training, Ribeirão Preto, Brazil
| | - Adriana Renzi
- Paulista Center for Diagnosis Research and Training, Ribeirão Preto, Brazil
| | - Bruna Petersen
- Center for Human Reproduction Prof Franco Jr, Ribeirão Preto, Brazil.,Paulista Center for Diagnosis Research and Training, Ribeirão Preto, Brazil
| | - Fabiana Massaro
- Center for Human Reproduction Prof Franco Jr, Ribeirão Preto, Brazil
| | - Camila Zamara
- Center for Human Reproduction Prof Franco Jr, Ribeirão Preto, Brazil
| | - Andreia Nicoletti
- Center for Human Reproduction Prof Franco Jr, Ribeirão Preto, Brazil
| | - Juliana Ricci
- Center for Human Reproduction Prof Franco Jr, Ribeirão Preto, Brazil
| | - Antonio H Oliani
- Faculdade de Medicina de Rio Preto (FAMERP), São José do Rio Preto, Brazil
| | - João Batista A Oliveira
- Center for Human Reproduction Prof Franco Jr, Ribeirão Preto, Brazil.,Paulista Center for Diagnosis Research and Training, Ribeirão Preto, Brazil
| | - José G Franco
- Center for Human Reproduction Prof Franco Jr, Ribeirão Preto, Brazil.,Paulista Center for Diagnosis Research and Training, Ribeirão Preto, Brazil
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Chen L, Fang J, Jiang W, Wang J, Li D. Effects of the sperm DNA fragmentation index on the clinical and neonatal outcomes of intracytoplasmic sperm injection cycles. J Ovarian Res 2020; 13:52. [PMID: 32359369 PMCID: PMC7196230 DOI: 10.1186/s13048-020-00658-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 04/27/2020] [Indexed: 11/16/2022] Open
Abstract
Background Most studies have mainly focused on the effects of the sperm DNA fragmentation index (DFI) on fertilization, embryonic developmental potential and aneuploidy, pregnancy and abortion rates after in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) and have remained controversial. However, few studies have reported the effects of sperm DFI on neonatal outcomes, including stillbirths, neonatal deaths, sex, gestational age, prematurity, birthweight, low birth weight (LBW) and birth defects in newborns. Our objective was to evaluate the effects of sperm DFI on the clinical and neonatal outcomes of ICSI cycles. Methods This retrospective study analysed a total of 2067 oocyte retrieval, 1139 transfer and 713 delivery cycles from conventional ICSI cycles, including 301, 469, and 214 live-born infants in groups segregated according to sperm DFI as the < 15%, 15–30% and > 30% groups, respectively. The clinical and neonatal outcomes were compared among the three groups. Results Sperm DFI did not significantly affect the rates of fertilization, clinical pregnancy, miscarriage or ongoing pregnancy. Sperm DFI did not increase the risk of stillbirths or neonatal deaths. The rates of stillbirths and neonatal deaths were not significantly different among the three groups. The sex, gestational age, prematurity, birthweight and LBW of newborns in the three groups were not significantly affected by sperm DFI. Moreover, sperm DFI did not increase the number of birth defects in children. Conclusions Sperm DFI did not affect the clinical or neonatal outcomes of ICSI cycles.
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Affiliation(s)
- Linjun Chen
- Reproductive Medical Center, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Zhongshan, Road 321#, Nanjing, 210008, People's Republic of China.
| | - Junshun Fang
- Reproductive Medical Center, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Zhongshan, Road 321#, Nanjing, 210008, People's Republic of China
| | - Weihua Jiang
- Reproductive Medical Center, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Zhongshan, Road 321#, Nanjing, 210008, People's Republic of China
| | - Jie Wang
- Reproductive Medical Center, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Zhongshan, Road 321#, Nanjing, 210008, People's Republic of China
| | - Dong Li
- Reproductive Medical Center, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Zhongshan, Road 321#, Nanjing, 210008, People's Republic of China
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6
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Marzano G, Chiriacò MS, Primiceri E, Dell’Aquila ME, Ramalho-Santos J, Zara V, Ferramosca A, Maruccio G. Sperm selection in assisted reproduction: A review of established methods and cutting-edge possibilities. Biotechnol Adv 2020; 40:107498. [DOI: 10.1016/j.biotechadv.2019.107498] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 11/26/2019] [Accepted: 12/06/2019] [Indexed: 12/31/2022]
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7
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Chen L, Li D, Ni X, Zhu L, Zhang N, Fang J, Jiang W, Wang J. Effects of the normal sperm morphology rate on the clinical and neonatal outcomes of conventional IVF cycles. Andrologia 2020; 52:e13568. [PMID: 32196721 DOI: 10.1111/and.13568] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 02/12/2020] [Accepted: 02/17/2020] [Indexed: 12/11/2022] Open
Affiliation(s)
- Linjun Chen
- Reproductive Medical Center Nanjing Drum Tower Hospital The Affiliated Hospital of Nanjing University Medical School Nanjing China
| | - Dong Li
- Reproductive Medical Center Nanjing Drum Tower Hospital The Affiliated Hospital of Nanjing University Medical School Nanjing China
| | - Xiaobei Ni
- Reproductive Medical Center Nanjing Drum Tower Hospital The Affiliated Hospital of Nanjing University Medical School Nanjing China
| | - Lihua Zhu
- Reproductive Medical Center Nanjing Drum Tower Hospital The Affiliated Hospital of Nanjing University Medical School Nanjing China
| | - Ningyuan Zhang
- Reproductive Medical Center Nanjing Drum Tower Hospital The Affiliated Hospital of Nanjing University Medical School Nanjing China
| | - Junshun Fang
- Reproductive Medical Center Nanjing Drum Tower Hospital The Affiliated Hospital of Nanjing University Medical School Nanjing China
| | - Weihua Jiang
- Reproductive Medical Center Nanjing Drum Tower Hospital The Affiliated Hospital of Nanjing University Medical School Nanjing China
| | - Jie Wang
- Reproductive Medical Center Nanjing Drum Tower Hospital The Affiliated Hospital of Nanjing University Medical School Nanjing China
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8
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Alteri A, Pisaturo V, Tilleman K, D’Angelo A. The IVF Shopping List: To Tick or Not to Tick. EUROPEAN MEDICAL JOURNAL 2019. [DOI: 10.33590/emj/10311849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Alessandra Alteri
- Obstetrics and Gynecology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Valerio Pisaturo
- Reproductive Medicine Department, International Evangelical Hospital, Genoa, Italy
| | - Kelly Tilleman
- Department of Reproductive Medicine, Ghent Fertility and Stem Cell Team (G-Fast), Ghent University Hospital, Ghent, Belgium
| | - Arianna D’Angelo
- Wales Fertility Institute, University Hospital of Wales, Cardiff University, Cardiff, UK
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9
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Tarozzi N, Nadalini M, Borini A. Effect on Sperm DNA Quality Following Sperm Selection for ART: New Insights. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1166:169-187. [DOI: 10.1007/978-3-030-21664-1_10] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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10
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Cirkel C, König IR, Schultze-Mosgau A, Beck E, Neumann K, Griesinger G. The use of intracytoplasmic sperm injection is associated with a shift in the secondary sex ratio. Reprod Biomed Online 2018; 37:703-708. [PMID: 30385144 DOI: 10.1016/j.rbmo.2018.09.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Revised: 09/10/2018] [Accepted: 09/12/2018] [Indexed: 11/30/2022]
Abstract
RESEARCH QUESTION What is the association between assisted reproductive technologies and human sex ratio as a proportion of male offspring at birth. DESIGN A total of 59,628 singleton deliveries resulting from IVF, intracytoplasmic sperm injection (ICSI) and intrauterine insemination (IUI) or ovulation induction from 101 IVF clinics in Germany, that had been documented in a national German IVF registry, were analysed. Sex ratio after assisted reproductive technology was also compared with the sex ratio reported in the birth records of the German Federal Statistical Office. RESULTS The sex ratio was 50.0% (95% CI 49.5% to 50.5%) for ICSI, 52.2% (95% CI 51.5% to 52.9%) for IVF, 52.2% (95% CI 50.9% to 53.5%) for IUI or ovulation induction and 51.3% in the national birth records, respectively. Significant differences existed across the three treatment groups (P = 6.86 × 10-7) as well as in pairwise comparisons between ICSI versus IVF (P = 6.88 × 10-7) and ICSI versus IUI or ovulation induction (P = 0.003). No difference existed between the groups IUI or ovulation induction versus IVF. Same results were also present after stratification by maternal age: IVF versus ICSI (P = 6.433 × 10-7), ICSI versus IUI or ovulation induction (P = 0.003), and IVF versus IUI or ovulation induction (non-significant). Compared with the national birth records, ICSI is associated with a lower sex ratio compared with the reference group (P < 0.001), whereas IVF is associated with a higher sex ratio (P = 0.015). CONCLUSIONS The use of ICSI is associated with an equal proportion of sexes at birth, which is not the case for IVF, IUI or ovulation induction, or natural conception. This phenomenon is not influenced by maternal age.
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Affiliation(s)
- Christoph Cirkel
- Department of Obstetrics and Gynecology, University Hospital Schleswig-Holstein/Campus Luebeck, Ratzeburger Allee 160, Luebeck 23538, Germany.
| | - Inke R König
- Institute of Medical Biometry and Statistics, University of Luebeck, Luebeck, Germany
| | - Askan Schultze-Mosgau
- Department of Reproductive Medicine and Gynecological Endocrinology, as well as Medical Biometry and Statistics, Ratzeburger Allee 160, Luebeck 23538, Germany
| | - Elmar Beck
- Anfomed GmbH, Röttenbacher Str. 17, 91096, Möhrendorf, Germany
| | - Kay Neumann
- Department of Reproductive Medicine and Gynecological Endocrinology, as well as Medical Biometry and Statistics, Ratzeburger Allee 160, Luebeck 23538, Germany
| | - Georg Griesinger
- Department of Reproductive Medicine and Gynecological Endocrinology, as well as Medical Biometry and Statistics, Ratzeburger Allee 160, Luebeck 23538, Germany
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11
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Gaspard O, Vanderzwalmen P, Wirleitner B, Ravet S, Wenders F, Eichel V, Mocková A, Spitzer D, Jouan C, Gridelet V, Martens H, Henry L, Zech H, d'Hauterive SP, Nisolle M. Impact of high magnification sperm selection on neonatal outcomes: a retrospective study. J Assist Reprod Genet 2018; 35:1113-1121. [PMID: 29607458 DOI: 10.1007/s10815-018-1167-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 03/16/2018] [Indexed: 12/15/2022] Open
Abstract
PURPOSE The aim of this study was to compare the effect of the deselection of spermatozoa presenting vacuole-like structures using IMSI (intracytoplasmic morphologically selected sperm injection) with ICSI (intracytoplasmic sperm injection) by means of neonatal outcomes. METHODS In a retrospective two-center analysis, a total of 848 successful IMSI or ICSI cycles ending with a live birth, induced abortion, or intrauterine fetal death (IUFD) were included. RESULTS The IMSI and ICSI groups included 332 and 655 babies or fetuses, respectively. The parents were older in the IMSI group than in the ICSI group (mothers were 35.1 vs 32.9 years, and fathers were 39.1 vs 36.2 years). The multiple pregnancy rate was higher in the IMSI group. The mean pregnancy duration and mean birth weight were almost identical in both groups. There was no significant difference in major congenital malformations between the two groups. However, this rate was decreased in the IMSI group compared to that in the ICSI group (1.8 vs 3.2%), the difference being mainly found in singletons (1.4 vs 3.3%). Boys were more often affected than girls in both groups. The percentages of chromosomal abnormalities did not differ between the IMSI and ICSI groups (0.6 and 0.8%). The reported congenital malformations mainly affected the heart, urogenital, and musculoskeletal systems. CONCLUSIONS In the present study, the malformation rates observed in the IMSI and ICSI groups were not significantly different, even if slightly lower after IMSI. However, the observed difference followed the same trends observed in previous reports, indicating the possible impact of IMSI on decreasing congenital malformation occurrences. This highlights the necessity to prospectively evaluate the impact of IMSI on neonatal outcome after IVF treatment.
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Affiliation(s)
- Olivier Gaspard
- Centre de Procréation Médicalement Assistée - ULiège, Centre Hospitalier Universitaire de Liège, Liège, Belgium.
| | | | | | - Stéphanie Ravet
- Centre de Procréation Médicalement Assistée - ULiège, Centre Hospitalier Universitaire de Liège, Liège, Belgium
| | - Frédéric Wenders
- Centre de Procréation Médicalement Assistée - ULiège, Centre Hospitalier Universitaire de Liège, Liège, Belgium
| | | | - Alice Mocková
- Department of Neonatology, Faculty of Medicine in Pilsen and University Hospital, Charles University in Prague, Prague, Czech Republic
| | | | - Caroline Jouan
- Centre de Procréation Médicalement Assistée - ULiège, Centre Hospitalier Universitaire de Liège, Liège, Belgium
| | - Virginie Gridelet
- Centre de Procréation Médicalement Assistée - ULiège, Centre Hospitalier Universitaire de Liège, Liège, Belgium.,GIGA I3, Center of Immunoendocrinology, University of Liège, Liège, Belgium
| | - Henri Martens
- GIGA I3, Center of Immunoendocrinology, University of Liège, Liège, Belgium
| | - Laurie Henry
- Centre de Procréation Médicalement Assistée - ULiège, Centre Hospitalier Universitaire de Liège, Liège, Belgium
| | - Herbert Zech
- IVF-Centers Prof. Zech, Bregenz, Austria.,IVF-Centers Prof. Zech, Salzburg, Austria
| | - Sophie Perrier d'Hauterive
- Centre de Procréation Médicalement Assistée - ULiège, Centre Hospitalier Universitaire de Liège, Liège, Belgium
| | - Michelle Nisolle
- Centre de Procréation Médicalement Assistée - ULiège, Centre Hospitalier Universitaire de Liège, Liège, Belgium
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12
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Affiliation(s)
- Jose G Franco
- Center for Human Reproduction Prof. Franco Jr, Ribeirao Preto, SP, Brazil.,Paulista Center for Diagnosis Research and Training, Ribeirao Preto, SP, Brazil
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13
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Beltran Anzola A, Pauly V, Montjean D, Meddeb L, Geoffroy-Siraudin C, Sambuc R, Boyer P, Gervoise-Boyer MJ. No difference in congenital anomalies prevalence irrespective of insemination methods and freezing procedure: cohort study over fourteen years of an ART population in the south of France. J Assist Reprod Genet 2017; 34:867-876. [PMID: 28444613 DOI: 10.1007/s10815-017-0903-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 03/05/2017] [Indexed: 10/19/2022] Open
Abstract
PURPOSE A retrospective cohort study was conducted to evaluate and compare the prevalence of congenital anomalies in babies and fetuses conceived after four procedures of assisted reproduction technologies (ART). METHODS The prevalence of congenital anomalies was compared retrospectively between 2750 babies and fetuses conceived between 2001 and 2014 in vitro fertilization with standard insemination (IVF), IVF with intracytoplasmic sperm injection (ICSI), IVF with frozen embryo transfer (FET-IVF), and ICSI with frozen embryo transfer (FET-ICSI). Congenital anomalies were described according to European Surveillance of Congenital Anomalies (EUROCAT) classification. The parental backgrounds, biologic parameters, obstetric parameters, and perinatal outcomes were compared between babies and fetuses with and without congenital anomalies. Data were analyzed by the generalized estimating equation. RESULTS Between 2001 and 2014, a total of 2477 evolutionary pregnancies were notified. Among these pregnancies, 2379 were included in the analysis. One hundred thirty-four babies and fetuses had a congenital anomaly (4.9%). The major prevalences found among the recorded anomalies were congenital heart defects, chromosomal anomalies, and urinary defects. However, the risk of congenital anomalies in babies and fetuses conceived after FET was not increased compared with babies and fetuses conceived after fresh embryo transfer, even when adjusted for confounding factors (p = 0.40). CONCLUSIONS There is no increased risk of congenital anomalies in babies and fetuses conceived by fresh versus frozen embryo transfer after in vitro fertilization with and without micromanipulation. Indeed, distribution of congenital anomalies found in our population is consistent with the high prevalence of congenital heart defects, chromosomal anomalies, and urinary defects that have been found by other authors in children conceived by infertile couples when compared to children conceived spontaneously.
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Affiliation(s)
- Any Beltran Anzola
- Département de Santé Publique et Maladies Chroniques, Unité de recherche EA 3279, Faculté de médecine, Aix-Marseille Université, 27 Boulevard Jean Moulin, 13005, Marseille, France. .,Service de Médecine et Biologie de la Reproduction, Hôpital Saint Joseph, 26 Boulevard du Louvain, 13008, Marseille, France.
| | - Vanessa Pauly
- Département de Santé Publique et Maladies Chroniques, Unité de recherche EA 3279, Faculté de médecine, Aix-Marseille Université, 27 Boulevard Jean Moulin, 13005, Marseille, France.,Assistance Publique Hôpitaux de Marseille - Service d'information médicale, Hôpital de la Conception, 147 Boulevard Baille, 13005, Marseille, France
| | - Debbie Montjean
- Service de Médecine et Biologie de la Reproduction, Hôpital Saint Joseph, 26 Boulevard du Louvain, 13008, Marseille, France
| | - Line Meddeb
- Assistance Publique Hôpitaux de Marseille - Service des Maladies Infectieuses, Hôpital de la Conception, 147 Boulevard Baille, 13005, Marseille, France
| | - Cendrine Geoffroy-Siraudin
- Service de Médecine et Biologie de la Reproduction, Hôpital Saint Joseph, 26 Boulevard du Louvain, 13008, Marseille, France
| | - Roland Sambuc
- Département de Santé Publique et Maladies Chroniques, Unité de recherche EA 3279, Faculté de médecine, Aix-Marseille Université, 27 Boulevard Jean Moulin, 13005, Marseille, France.,Assistance Publique Hôpitaux de Marseille - Service d'information médicale, Hôpital de la Conception, 147 Boulevard Baille, 13005, Marseille, France
| | - Pierre Boyer
- Service de Médecine et Biologie de la Reproduction, Hôpital Saint Joseph, 26 Boulevard du Louvain, 13008, Marseille, France
| | - Marie-José Gervoise-Boyer
- Service de Médecine et Biologie de la Reproduction, Hôpital Saint Joseph, 26 Boulevard du Louvain, 13008, Marseille, France
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14
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Affiliation(s)
- Luke Simon
- Andrology and IVF Laboratory, Department of Surgery (Urology); University of UT; Salt Lake City UT USA
| | - Monis B. Shamsi
- Andrology and IVF Laboratory, Department of Surgery (Urology); University of UT; Salt Lake City UT USA
| | - Douglas T. Carrell
- Andrology and IVF Laboratory, Department of Surgery (Urology); University of UT; Salt Lake City UT USA
- Department of Obstetrics and Gynecology; University of UT; Salt Lake City UT USA
- Department of Human Genetics; University of UT; Salt Lake City UT USA
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15
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Hershko-Klement A, Sukenik-Halevy R, Biron Shental T, Miller N, Berkovitz A. Intracytoplasmic morphologically selected sperm injection and congenital birth defects: a retrospective cohort study. Andrology 2016; 4:887-93. [PMID: 27317040 DOI: 10.1111/andr.12221] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Revised: 04/14/2016] [Accepted: 04/18/2016] [Indexed: 11/27/2022]
Abstract
Our objective was to study the birth defect rates in intracytoplasmic morphologically selected sperm injection (IMSI) pregnancies. A cohort of couples presenting male factor infertility between January 2006 and January 2014 was retrospectively analyzed. Discharge letters and a telephone interview were performed for assessing pregnancy outcome. All clinical data were reviewed by a board certified medical geneticist. Main outcomes were fetal/birth defect and chromosomal abnormality rates. Two thousand two hundred and fifty-eight pregnancies were available for analysis, of them, 1669 (73.9%) resulting from ICSI and 2258 (26.1%) achieved by IMSI. Pregnancy outcome distribution did not show a significant difference. For the fresh embryo transfer cohort, fetal/birth defect rate was 4.5%, chromosomal aberration rate was 1.0%, and structural malformation rate was 3.5%. IMSI vs. ICSI pregnancies were less likely to involve a fetal/birth defect: 3.5% vs. 4.8%, respectively, but did not reach a statistical significance OR 0.71 (95% CI 0.39-1.22). Split by multiplicity, this trend existed only for singleton pregnancies; 1.4% structural malformations rate vs. 3.8%, respectively, OR 0.35 (95% CI 0.11-0.9). The frozen cohort demonstrated a significantly lower birth defect rate (OR 0.25, 95% CI 0.09-0.58). We conclude that IMSI procedure does not involve an increased malformation rate and may offer a reduced anomaly incidence. Further studies are required.
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Affiliation(s)
- A Hershko-Klement
- The Department of Obstetrics and Gynecology, Meir Medical Center, Kfar-Saba, Israel.,Sakler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - R Sukenik-Halevy
- The Department of Obstetrics and Gynecology, Meir Medical Center, Kfar-Saba, Israel.,Sakler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Genetic Institute, Meir Medical Center, Kfar-Saba, Israel
| | - T Biron Shental
- The Department of Obstetrics and Gynecology, Meir Medical Center, Kfar-Saba, Israel.,Sakler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - N Miller
- The Department of Obstetrics and Gynecology, Meir Medical Center, Kfar-Saba, Israel.,Sakler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - A Berkovitz
- The Department of Obstetrics and Gynecology, Meir Medical Center, Kfar-Saba, Israel.,Sakler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Assuta Medical Center, Tel Aviv, Israel
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16
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Different Levels of DNA Methylation Detected in Human Sperms after Morphological Selection Using High Magnification Microscopy. BIOMED RESEARCH INTERNATIONAL 2016; 2016:6372171. [PMID: 27148551 PMCID: PMC4842358 DOI: 10.1155/2016/6372171] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Revised: 03/15/2016] [Accepted: 03/21/2016] [Indexed: 11/18/2022]
Abstract
Objective. To analyze DNA methylation levels between two groups of spermatozoa taken from the same sample, following morphological selection by high magnification (HM) at 6100x microscopy. A prospective study was conducted and studied 876 spermatozoa from 10 randomly selected men. Sperm morphology was characterized at HM according to criteria previously established. High-scoring Score 6 and low-scoring Score 0 sperm were selected. Sperm DNA methylation level was assessed using an immunoassay method targeting 5-methylcytosine residues by fluorescence microscopy with imaging analysis system to detect DNA methylation in single spermatozoon. Results. In total, 448 S6 spermatozoa and 428 S0 spermatozoa were analyzed. A strong relationship was found between sperm DNA methylation levels and sperm morphology observed at HM. Sperm DNA methylation level in the S6 group was significantly lower compared with that in the S0 group (p < 10(-6)), OR = 2.4; and p < 0.001, as determined using the Wilcoxon test. Conclusion. Differences in DNA methylation levels are associated with sperm morphology variations as observed at HM, which allows spermatozoa with abnormal levels to be discarded and ultimately decrease birth defects, malformations, and epigenetic diseases that may be transmitted from sperm to offspring in ICSI.
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17
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Esteves SC, Sánchez-Martín F, Sánchez-Martín P, Schneider DT, Gosálvez J. Comparison of reproductive outcome in oligozoospermic men with high sperm DNA fragmentation undergoing intracytoplasmic sperm injection with ejaculated and testicular sperm. Fertil Steril 2015; 104:1398-405. [PMID: 26428305 DOI: 10.1016/j.fertnstert.2015.08.028] [Citation(s) in RCA: 147] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2015] [Revised: 08/08/2015] [Accepted: 08/24/2015] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To investigate the effectiveness of intracytoplasmic sperm injection (ICSI) using testicular sperm as a strategy to overcome infertility in men with high sperm DNA fragmentation (SDF). DESIGN Prospective, observational, cohort study. SETTING Private IVF centers. PATIENT(S) A total of 147 couples undergoing IVF-ICSI and day 3 fresh ETs whose male partner has oligozoospermia and high SDF. INTERVENTION(S) Sperm injections were carried out with ejaculated sperm (EJA-ICSI) or testicular sperm (TESTI-ICSI) retrieved by either testicular sperm extraction (TESE) or testicular sperm aspiration (TESA). SDF levels were reassessed on the day of oocyte retrieval in both ejaculated and testicular specimens. MAIN OUTCOME MEASURE(S) Percentage of testicular and ejaculated spermatozoa containing fragmented DNA (%DFI) and clinical pregnancy, miscarriage, and live-birth rates. RESULT(S) The %DFI in testicular sperm was 8.3%, compared with 40.7% in ejaculated sperm. For the TESTI-ICSI group versus the EJA-ICSI group, respectively, the clinical pregnancy rate was 51.9% and 40.2%, the miscarriage rate was 10.0% and 34.3%, and the live-birth rate was 46.7% and 26.4%. CONCLUSION(S) ICSI outcomes were significantly better in the group of men who had testicular sperm used for ICSI compared with those with ejaculated sperm. SDF was significantly lower in testicular specimens compared with ejaculated counterparts. Our results suggest that TESTI-ICSI is an effective option to overcome infertility when applied to selected men with oligozoospermia and high ejaculated SDF levels.
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Affiliation(s)
- Sandro C Esteves
- Androfert, Andrology and Human Reproduction Clinic, Campinas, Brazil.
| | | | | | | | - Jaime Gosálvez
- Unit of Genetics, Department of Biology, Universidad Autónoma de Madrid, Madrid, Spain
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18
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Sakkas D, Ramalingam M, Garrido N, Barratt CLR. Sperm selection in natural conception: what can we learn from Mother Nature to improve assisted reproduction outcomes? Hum Reprod Update 2015; 21:711-26. [PMID: 26386468 PMCID: PMC4594619 DOI: 10.1093/humupd/dmv042] [Citation(s) in RCA: 142] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 08/12/2015] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND In natural conception only a few sperm cells reach the ampulla or the site of fertilization. This population is a selected group of cells since only motile cells can pass through cervical mucus and gain initial entry into the female reproductive tract. In animals, some studies indicate that the sperm selected by the reproductive tract and recovered from the uterus and the oviducts have higher fertilization rates but this is not a universal finding. Some species show less discrimination in sperm selection and abnormal sperm do arrive at the oviduct. In contrast, assisted reproductive technologies (ART) utilize a more random sperm population. In this review we contrast the journey of the spermatozoon in vivo and in vitro and discuss this in the context of developing new sperm preparation and selection techniques for ART. METHODS A review of the literature examining characteristics of the spermatozoa selected in vivo is compared with recent developments in in vitro selection and preparation methods. Contrasts and similarities are presented. RESULTS AND CONCLUSIONS New technologies are being developed to aid in the diagnosis, preparation and selection of spermatozoa in ART. To date progress has been frustrating and these methods have provided variable benefits in improving outcomes after ART. It is more likely that examining the mechanisms enforced by nature will provide valuable information in regard to sperm selection and preparation techniques in vitro. Identifying the properties of those spermatozoa which do reach the oviduct will also be important for the development of more effective tests of semen quality. In this review we examine the value of sperm selection to see how much guidance for ART can be gleaned from the natural selection processes in vivo.
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Affiliation(s)
- Denny Sakkas
- Boston IVF, 130 Second Ave, Waltham, MA 02451, USA
| | - Mythili Ramalingam
- Reproductive and Developmental Biology, Medical School, Ninewells Hospital, University of Dundee, Dundee DD19SY, UK
| | | | - Christopher L R Barratt
- Reproductive and Developmental Biology, Medical School, Ninewells Hospital, University of Dundee, Dundee DD19SY, UK
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19
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La Sala GB, Nicoli A, Fornaciari E, Falbo A, Rondini I, Morini D, Valli B, Villani MT, Palomba S. Intracytoplasmic morphologically selected sperm injection versus conventional intracytoplasmic sperm injection: a randomized controlled trial. Reprod Biol Endocrinol 2015; 13:97. [PMID: 26307050 PMCID: PMC4549869 DOI: 10.1186/s12958-015-0096-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 08/20/2015] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Intracytoplasmic morphologically selected sperm injection (IMSI) is still proposed and employed in the clinical practice to improve the reproductive outcome in infertile couples scheduled for conventional intracytoplasmic sperm injection (cICSI). The aim of the current randomized controlled trial (RCT) was to test the hypothesis that IMSI gives a better live birth delivery rate than cICSI. METHODS Infertile couples scheduled for their first cICSI cycle for male factor were allocated using a simple randomization procedure. All available biological and clinical data were recorded and analyzed in a triple-blind fashion. RESULTS Our final analysis involved the first 121 patients (48 and 73 subjects for IMSI and cICSI arm, respectively) because the trial was stopped prematurely on the advice of the data safety and monitoring Committee because of concerns about IMSI efficacy at the first interim analysis. No significant difference between arms was detected in rates of clinical pregnancy per embryo transferred [11/34 (32.3%) vs. 15/64 (23.4%); odds ratio (OR) 1.56, 95% (confidence interval) CI 0.62-3.93, P = 0.343] and of live birth delivery [9/48 (18.8%) vs. 11/73 (15.1%); OR 1.30, 95%CI 0.49-3.42, P = 0.594). CONCLUSION Current data did not support the routine use of IMSI in the clinical practice for improving cICSI results in unselected infertile couples with male factor.
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Affiliation(s)
- Giovanni Battista La Sala
- Obstetrics and Gynecology Unit, Arcispedale S. Maria Nuova of Reggio Emilia, IRCCS, Reggio Emilia, Viale Risorgimento 80, 42123, Reggio Emilia, Italy
- University of Modena and Reggio Emilia, Via del Pozzo, 71, 41124, Modena, Italy
| | - Alessia Nicoli
- Obstetrics and Gynecology Unit, Arcispedale S. Maria Nuova of Reggio Emilia, IRCCS, Reggio Emilia, Viale Risorgimento 80, 42123, Reggio Emilia, Italy
| | - Eleonora Fornaciari
- Obstetrics and Gynecology Unit, Arcispedale S. Maria Nuova of Reggio Emilia, IRCCS, Reggio Emilia, Viale Risorgimento 80, 42123, Reggio Emilia, Italy
| | - Angela Falbo
- Obstetrics and Gynecology Unit, Arcispedale S. Maria Nuova of Reggio Emilia, IRCCS, Reggio Emilia, Viale Risorgimento 80, 42123, Reggio Emilia, Italy
| | - Ilaria Rondini
- Obstetrics and Gynecology Unit, Arcispedale S. Maria Nuova of Reggio Emilia, IRCCS, Reggio Emilia, Viale Risorgimento 80, 42123, Reggio Emilia, Italy
| | - Daria Morini
- Obstetrics and Gynecology Unit, Arcispedale S. Maria Nuova of Reggio Emilia, IRCCS, Reggio Emilia, Viale Risorgimento 80, 42123, Reggio Emilia, Italy
| | - Barbara Valli
- Obstetrics and Gynecology Unit, Arcispedale S. Maria Nuova of Reggio Emilia, IRCCS, Reggio Emilia, Viale Risorgimento 80, 42123, Reggio Emilia, Italy
| | - Maria Teresa Villani
- Obstetrics and Gynecology Unit, Arcispedale S. Maria Nuova of Reggio Emilia, IRCCS, Reggio Emilia, Viale Risorgimento 80, 42123, Reggio Emilia, Italy
| | - Stefano Palomba
- Obstetrics and Gynecology Unit, Arcispedale S. Maria Nuova of Reggio Emilia, IRCCS, Reggio Emilia, Viale Risorgimento 80, 42123, Reggio Emilia, Italy.
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20
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Neyer A, Zintz M, Stecher A, Bach M, Wirleitner B, Zech NH, Vanderzwalmen P. The impact of paternal factors on cleavage stage and blastocyst development analyzed by time-lapse imaging-a retrospective observational study. J Assist Reprod Genet 2015; 32:1607-14. [PMID: 26286759 DOI: 10.1007/s10815-015-0558-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 08/06/2015] [Indexed: 01/25/2023] Open
Abstract
PURPOSE Various time-lapse studies have postulated embryo selection criteria based on early morphokinetic markers. However, late paternal effects are mostly not visible before embryonic genome activation. The primary objective of this retrospective study was to investigate whether those early morphokinetic algorithms investigated by time-lapse imaging are reliable enough to allow for the accurate selection of those embryos that develop into blastocysts, while of course taking into account the correlation with the type of injected spermatozoa. METHODS During a period of 18 months, a total of 461 MII oocytes from 43 couples with severe male factor infertility and previous "external" IVF failures after cleavage-stage embryo transfer (ET) were fertilized by intracytoplasmic morphologically selected sperm injection (IMSI). Thereof, 373 embryos were monitored in a time-lapse incubator until ET on day 5. Blastocyst outcome in combination with three previously postulated MKc (cc2: t3-t2, 5-12 h; t3, 35-40 h; t5, 48-56 h) and the morphology of the selected sperm were analyzed. RESULTS A significant increase in the rate of blastocysts (54.0 vs. 36.3 %; P < 0.01) and top blastocysts (25.3 vs. 10.8 %; P < 0.001) was observed in the group of those meeting all three morphokinetic criteria (MKc3). However, MKc3 were only met in 23.3 % of all embryos. Moreover, TBR was influenced by the type of injected spermatozoa. In both groups, TBR decreased dramatically (MKc3, 35.0 vs. 17.0 %; MKc < 3, 14.2 vs. 8.4 %) when class II/III sperm instead of class I were injected. CONCLUSION Early morphokinetic parameters might give some predictive information but fail to serve as a feasible selective tool for the prediction of blastocyst development given the influence of the type of spermatozoa injected.
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Affiliation(s)
- Anton Neyer
- IVF Centers Prof. Zech-Bregenz, Römerstrasse 2, 6900, Bregenz, Austria.
| | - Martin Zintz
- IVF Centers Prof. Zech-Bregenz, Römerstrasse 2, 6900, Bregenz, Austria
| | - Astrid Stecher
- IVF Centers Prof. Zech-Bregenz, Römerstrasse 2, 6900, Bregenz, Austria
| | - Magnus Bach
- IVF Centers Prof. Zech-Bregenz, Römerstrasse 2, 6900, Bregenz, Austria
| | | | - Nicolas H Zech
- IVF Centers Prof. Zech-Bregenz, Römerstrasse 2, 6900, Bregenz, Austria
| | - Pierre Vanderzwalmen
- IVF Centers Prof. Zech-Bregenz, Römerstrasse 2, 6900, Bregenz, Austria
- Centre Hospitalier Interrégional Edith Cavell (CHIREC), Braine-l'Alleud, Brussels, Belgium
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21
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Setti AS, Braga DP, Figueira RC, Iaconelli A, Borges E. Intracytoplasmic morphologically selected sperm injection results in improved clinical outcomes in couples with previous ICSI failures or male factor infertility: a meta-analysis. Eur J Obstet Gynecol Reprod Biol 2014; 183:96-103. [DOI: 10.1016/j.ejogrb.2014.10.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Revised: 08/06/2014] [Accepted: 10/04/2014] [Indexed: 10/24/2022]
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22
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Belloc S, Hazout A, Zini A, Merviel P, Cabry R, Chahine H, Copin H, Benkhalifa M. How to overcome male infertility after 40: Influence of paternal age on fertility. Maturitas 2014; 78:22-9. [DOI: 10.1016/j.maturitas.2014.02.011] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Revised: 02/19/2014] [Accepted: 02/21/2014] [Indexed: 12/13/2022]
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