1
|
Zhang X, Chao S, Ye N, Ouyang D. Emerging trends in sperm selection: enhancing success rates in assisted reproduction. Reprod Biol Endocrinol 2024; 22:67. [PMID: 38877490 PMCID: PMC11177495 DOI: 10.1186/s12958-024-01239-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 06/01/2024] [Indexed: 06/16/2024] Open
Abstract
This comprehensive review explores the evolving landscape of sperm selection techniques within the realm of Assisted Reproductive Technology (ART). Our analysis delves into a range of methods from traditional approaches like density gradient centrifugation to advanced techniques such as Magnetic-Activated Cell Sorting (MACS) and Intracytoplasmic Morphologically Selected Sperm Injection (IMSI). We critically assess the efficacy of these methods in terms of sperm motility, morphology, DNA integrity, and other functional attributes, providing a detailed comparison of their clinical outcomes. We highlight the transition from conventional sperm selection methods, which primarily focus on physical characteristics, to more sophisticated techniques that offer a comprehensive evaluation of sperm molecular properties. This shift not only promises enhanced prediction of fertilization success but also has significant implications for improving embryo quality and increasing the chances of live birth. By synthesizing various studies and research papers, we present an in-depth analysis of the predictability of different sperm selection procedures in ART. The review also discusses the clinical applicability of these methods, emphasizing their potential in shaping the future of assisted reproduction. Our findings suggest that the integration of advanced sperm selection strategies in ART could lead to more cost-effective treatments with reduced duration and higher success rates. This review aims to provide clinicians and researchers in reproductive medicine with comprehensive insights into the current state and future prospects of sperm selection technologies in ART.
Collapse
Affiliation(s)
- Xiang Zhang
- College of Animal Science and Technology, China Agricultural University, Beijing, 100193, China
| | - Shuen Chao
- Center for Engineering in Medicine and Surgery, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, 02129, USA
| | - Ningxin Ye
- Center for Engineering in Medicine and Surgery, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, 02129, USA
- Department of Biology, University of Ottawa, Ottawa, ON, K1N 6N5, Canada
| | - Dongfang Ouyang
- Center for Engineering in Medicine and Surgery, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, 02129, USA.
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, M5S 3G8, Canada.
| |
Collapse
|
2
|
Thompson JG, McLennan HJ, Heinrich SL, Inge MP, Gardner DK, Harvey AJ. A brief history of technical developments in intracytoplasmic sperm injection (ICSI). Dedicated to the memory of J.M. Cummins. Reprod Fertil Dev 2024; 36:RD24047. [PMID: 38902908 DOI: 10.1071/rd24047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 05/29/2024] [Indexed: 06/22/2024] Open
Abstract
Intracytoplasmic sperm injection (ICSI) is an assisted reproductive technology for treatment of severe male infertility introduced into clinical practice in 1992. This review provides a brief history of the development of ICSI by acknowledging major developments in the field. The review addresses key developments in pre-clinical and early studies, how ICSI compares with in vitro fertilisation, long-term consequences, how the mechanistic approach to ICSI has changed in both manual and semi-automated approaches, and how sperm selection procedures are integrated into ICSI. From the beginnings using animal models in the 1960-1970s, the development of ICSI is a remarkable and transformative success story. Indeed, its broad use (70% of cycles globally) exceeds the need required for treating infertile males, and this remains a controversial issue. There remain questions around the long-term health impacts of ICSI. Furthermore, advances in automation of the ICSI procedure are occurring. An estimated 6million children have been born from the ICSI procedure. With further automation of sperm selection technologies, coupled with automation of the injection procedure, it is likely that the proportion of children born from ICSI will further increase.
Collapse
Affiliation(s)
- J G Thompson
- Fertilis Pty Ltd, Frome Road, Helen Mayo South, The University of Adelaide, Adelaide, SA 5005, Australia; and Robinson Research Institute, Adelaide Medical School, The University of Adelaide, Adelaide, SA 5005, Australia; and ART Lab Solutions Pty Ltd, 10 Pulteney Street, Adelaide, SA 5005, Australia
| | - H J McLennan
- Fertilis Pty Ltd, Frome Road, Helen Mayo South, The University of Adelaide, Adelaide, SA 5005, Australia
| | - S L Heinrich
- Fertilis Pty Ltd, Frome Road, Helen Mayo South, The University of Adelaide, Adelaide, SA 5005, Australia
| | - M P Inge
- Fertilis Pty Ltd, Frome Road, Helen Mayo South, The University of Adelaide, Adelaide, SA 5005, Australia
| | - D K Gardner
- Melbourne IVF, East Melbourne, Vic 3002, Australia; and School of BioSciences, University of Melbourne, Parkville, Vic 3010, Australia
| | - A J Harvey
- Melbourne IVF, East Melbourne, Vic 3002, Australia; and School of BioSciences, University of Melbourne, Parkville, Vic 3010, Australia
| |
Collapse
|
3
|
Cutting ER, Abdallah KS, Mol BW. Is there a treatable cause of repeated implantation failure, or is it simply treatment failure by chance? Reprod Biomed Online 2024; 48:103845. [PMID: 38636349 DOI: 10.1016/j.rbmo.2024.103845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 12/03/2023] [Accepted: 01/17/2024] [Indexed: 04/20/2024]
Abstract
RESEARCH QUESTION Does repeated implantation failure (RIF) sometimes have a cause, or is it simply treatment failure by chance? DESIGN A hypothetical model of a cohort of 1000 women undergoing four repeated IVF attempts was constructed. A proportion of women with RIF carried an underlying risk factor negatively affecting implantation, compared with women without the factor. In strategy A, women had standard IVF without additional treatment; in strategy B, the women received standard IVF plus an additional treatment. The sensitivity analysis varied the prevalence of the underlying risk factor from 5% to 50%. The model was compared with literature studies where a treatment strategy had been applied. RESULTS With strategy A, the clinical pregnancy rate decreased with subsequent IVF attempts (31% in the first transfer with a risk factor prevalence of 5%, to 8% in the fourth transfer with a risk factor prevalence of 50%). As the prevalence increased, the clinical pregnancy rate was higher with strategy A. For strategy B, the clinical pregnancy rates for the modelled cohort decreased with each subsequent IVF attempt. Regardless of the prevalence of the risk factor, the decline in clinical pregnancy rate was less strong (from 32% in the first transfer with a prevalence of 5%, to 25% in the fourth transfer with a prevalence of 50%). When applying the model to the literature studies, the trends expected for strategy B (decreasing clinical pregnancy rates) were not expressed. CONCLUSIONS RIF might therefore be of iatrogenic origin due to the low success rate of IVF and might be triggered by the increasing female age associated with higher numbers of RIF.
Collapse
Affiliation(s)
- E R Cutting
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia.
| | - K S Abdallah
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia; Department of Obstetrics and Gynaecology, Assiut University, Assiut, Egypt
| | - B W Mol
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia; Womens and Children's Program Monash Health, Clayton, Melbourne, Victoria, Australia; Aberdeen Centre for Women's Health Research, School of Medicine, University of Aberdeen, Aberdeen, UK
| |
Collapse
|
4
|
Maghraby H, Elsuity MA, Adel N, Magdi Y, Abdelbadie AS, Rashwan MM, Ahmed OY, Elmahdy M, Khan KS, Fawzy M. Quantifying the association of sperm DNA fragmentation with assisted reproductive technology outcomes: An umbrella review. BJOG 2024. [PMID: 38450853 DOI: 10.1111/1471-0528.17796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 02/08/2024] [Accepted: 02/09/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND Systematic reviews and meta-analyses are instrumental in shaping clinical practice. However, their findings can sometimes be marred by discrepancies and potential biases, thereby diluting the strength of the evidence presented. Umbrella reviews serve to comprehensively assess and synthesise these reviews, offering a clearer insight into the quality of the evidence presented. In the context of the relationship between sperm DNA fragmentation (SDF) and assisted conception outcomes, there is a divergence in the literature. Some reviews suggest a clear cause-and-effect linkage, whereas others present conflicting or inconclusive results. OBJECTIVES In this umbrella review we aimed to synthesise the evidence collated in systematic reviews and meta-analyses summarising the association of SDF with assisted reproductive technology (ART) outcomes. SEARCH STRATEGY After preregistration (https://doi.org/10.17605/OSF.IO/6JHDP), we performed a comprehensive search of the PubMed, Scopus, Cochrane Library, Web of Science and Embase databases. We conducted a search for systematic reviews on the association between SDF and ART without any restrictions on language or publication date. SELECTION CRITERIA Systematic reviews and meta-analyses assessing the association between SDF and ART outcomes were eligible. DATA COLLECTION AND ANALYSIS We assessed the quality of the included reviews using AMSTAR 2 and ROBIS, and determined the degree of overlap of primary studies between reviews estimating the corrected covered area (CCA), adjusted for structural missingness. We evaluated the most recent reviews assessing the association of SDF with live birth, pregnancy, miscarriage, implantation, blastulation and fertilisation. The synthesis of evidence was harmonised across all included quantitative syntheses, re-estimating the odds ratio (eOR) in random-effects meta-analyses with 95% confidence intervals (95% CIs) and 95% prediction intervals (95% PIs). We categorised the evidence strength into convincing, highly suggestive, suggestive, weak or nonsignificant, according to the meta-analysis re-estimated P-value, total sample size, I2 statistic for heterogeneity, small study effect, excess significance bias and the largest study significance. MAIN RESULTS We initially captured and screened 49 332 records. After excluding duplicate and ineligible articles, 22 systematic reviews, 15 of which were meta-analyses, were selected. The 22 reviews showed a moderate degree of overlap (adjusted CCA 9.2%) in their included studies (overall n = 428, with 180 unique studies). The 15 meta-analyses exhibited a high degree of overlap (adjusted CCA = 13.6%) in their included studies (overall n = 274, with 118 unique studies). AMSTAR 2 categorised the quality of evidence in 18 reviews as critically low and the quality of evidence in four reviews as low. ROBIS categorised all the reviews as having a high risk of bias. The re-estimated results showed that the association of SDF with live birth was weak in one and nonsignificant in four meta-analyses. Similarly, the association of SDF with pregnancy, miscarriage, implantation, blastulation and fertilisation was also weak or nonsignificant. The association of high SDF with different ART outcomes was also weak or nonsignificant for different interventions (IVF, ICSI and IUI) and tests. CONCLUSIONS This umbrella review did not find convincing or suggestive evidence linking SDF with ART outcomes. Caution should be exercised in making any claims, policies or recommendations concerning SDF.
Collapse
Affiliation(s)
- Hassan Maghraby
- Obstetrics and Gynaecology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
- Egyptian Foundation for Reproductive Medicine and Embryology (EFRE), Alexandria, Egypt
| | - Mohamad AlaaEldein Elsuity
- Egyptian Foundation for Reproductive Medicine and Embryology (EFRE), Alexandria, Egypt
- Dermatology, Venereology and Andrology Department, Sohag University, Sohag, Egypt
- Ibnsina, Ajyal, Qena, Amshag IVF Facilities, Sohag and Assiut, Egypt
| | - Nehal Adel
- Egyptian Foundation for Reproductive Medicine and Embryology (EFRE), Alexandria, Egypt
- Madina Fertility Centre, Madina Women's Hospital, Alexandria, Egypt
| | - Yasmin Magdi
- Egyptian Foundation for Reproductive Medicine and Embryology (EFRE), Alexandria, Egypt
- Al-Yasmeen Fertility and Gynaecology Centre, Benha, Qalubyia, Egypt
| | - Amr S Abdelbadie
- Egyptian Foundation for Reproductive Medicine and Embryology (EFRE), Alexandria, Egypt
- Department of Obstetrics and Gynaecology, Aswan University, Aswan, Egypt
| | - Mosab M Rashwan
- Ibnsina, Ajyal, Qena, Amshag IVF Facilities, Sohag and Assiut, Egypt
- Forensic Medicine & Clinical Toxicology Department, Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Ola Youssef Ahmed
- Obstetrics and Gynaecology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
- Egyptian Foundation for Reproductive Medicine and Embryology (EFRE), Alexandria, Egypt
| | - Mohamed Elmahdy
- Obstetrics and Gynaecology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
- Egyptian Foundation for Reproductive Medicine and Embryology (EFRE), Alexandria, Egypt
| | - Khalid S Khan
- Centre for Biomedical Research in Epidemiology and Public Health Network (CIBERESP), University of Granada, Granada, Spain
| | - Mohamed Fawzy
- Egyptian Foundation for Reproductive Medicine and Embryology (EFRE), Alexandria, Egypt
- Ibnsina, Ajyal, Qena, Amshag IVF Facilities, Sohag and Assiut, Egypt
| |
Collapse
|
5
|
Feng Q, Li W, Callander EJ, Wang R, Mol BW. Applying a simplified economic evaluation approach to evaluate infertility treatments in clinical practice. Hum Reprod 2024; 39:448-453. [PMID: 38148026 PMCID: PMC10905501 DOI: 10.1093/humrep/dead265] [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: 05/15/2023] [Revised: 11/20/2023] [Indexed: 12/28/2023] Open
Abstract
IVF is the backbone of infertility treatment, but due to its costs, it is not affordable for everyone. The cost of IVF is further escalated by interventions added to the routine treatment, which are claimed to boost pregnancy rates, so-called add-ons. Consequently, it is critical to offset the increased costs of an intervention against a potentially higher benefit. Here, we propose using a simplified framework considering the cost of a standard IVF procedure to create one live-born baby as a benchmark for the cost-effectiveness of other fertility treatments, add-ons inclusive. This framework is a simplified approach to a formal economic evaluation, enabling a rapid assessment of cost effectiveness in clinical settings. For a 30-year-old woman, assuming a 44.6% cumulative live birth rate and a cost of $12 000 per complete cycle, the cost to create one live-born baby would be ∼$27 000 (i.e. willingness to pay). Under this concept, the decision whether to accept or reject a new treatment depends from an economic perspective on the incremental cost per additional live birth from the new treatment/add-on, with the $27 000 per live-born baby as a reference threshold. This threshold can vary with women's age, and other factors such as the economic perspective and risk of side effects can play a role. If a new add-on or treatment costs >$27 000 per live birth, it might be more rational to invest in a new IVF cycle rather than spending on the add-on. With the increasing number of novel technologies in IVF and the lack of a rapid approach to evaluate their cost-effectiveness, this simplified framework will help with a more objective assessment of the cost-effectiveness of infertility treatments, including add-ons.
Collapse
Affiliation(s)
- Qian Feng
- Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia
| | - Wentao Li
- Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia
| | - Emily J Callander
- Discipline for Health Services Management, School of Public Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Rui Wang
- Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia
| | - Ben W Mol
- Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia
- Aberdeen Centre for Women's Health Research, School of Medicine, University of Aberdeen, Aberdeen, UK
| |
Collapse
|
6
|
Kadu KS, More A, Choudhary N, Dutta S, Shrivastava J, Gajabe G. Application of Physiological Sperm Selection in Assisted Reproductive Technology (ART) for Patients With Diabetes Mellitus: A Case Report. Cureus 2024; 16:e53018. [PMID: 38410342 PMCID: PMC10895562 DOI: 10.7759/cureus.53018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 01/26/2024] [Indexed: 02/28/2024] Open
Abstract
This case report revolves around a 35-year-old woman and her 39-year-old husband, who have been married for 10 years and were seeking treatment for their secondary infertility. The husband had been diagnosed with diabetes mellitus (DM) for the past seven years and had been on continued medication. Both partners underwent medical evaluations, and the husband was found to have normozoospermia. The wife had a normal ovarian reserve but was still facing difficulties in conception. Previous medical history showed that the husband's DM had been treated with metformin, and the woman had a history of unsuccessful in vitro fertilization (IVF) cycles and one miscarriage upon investigation. Our initial treatment attempt had failed, and upon assessment of the semen, it revealed a significantly increased sperm DNA fragmentation index, leading us to consider physiological intracytoplasmic sperm injection (PICSI). The couple then opted for a rescheduled ovum pick-up with PICSI over traditional ICS. PICSI involves selecting mature sperm with hyaluronic acid affinity, aiming to avoid immature, morphologically defective spermatozoa during microinjection. The couple then followed up for treatments; the husband continued with diabetes treatment, and the woman was advised to take progesterone supplements to ensure optimum uterine thickness. The PICSI procedure was followed by a successful embryo transfer, which subsequently led to a positive clinical pregnancy. This report highlights the importance of utilizing advanced technologies like PICSI in infertility cases after considering factors such as sperm quality to enhance the chances of a successful clinical pregnancy.
Collapse
Affiliation(s)
- Krushnali S Kadu
- Clinical Embryology, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Akash More
- Clinical Embryology, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Namrata Choudhary
- Clinical Embryology, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Shilpa Dutta
- Clinical Embryology, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Jarul Shrivastava
- Clinical Embryology, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Gauri Gajabe
- Clinical Embryology, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| |
Collapse
|
7
|
Gallagher MT, Krasauskaite I, Kirkman-Brown JC. Only the Best of the Bunch-Sperm Preparation Is Not Just about Numbers. Semin Reprod Med 2023; 41:273-278. [PMID: 38113923 DOI: 10.1055/s-0043-1777756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
In this Seminar, we present an overview of the current and emerging methods and technologies for optimizing the man and the sperm sample for fertility treatment. We argue that sperms are the secret to success, and that there are many avenues for improving both treatment and basic understanding of their role in outcomes. These outcomes encompass not just whether treatment is successful or not, but the wider intergenerational health of the offspring. We discuss outstanding challenges and opportunities of new technologies such as microfluidics and artificial intelligence, including potential pitfalls and advantages. This article aims to provide a comprehensive overview of the importance of sperm in fertility treatment and suggests future directions for research and innovation.
Collapse
Affiliation(s)
- Meurig T Gallagher
- Centre for Human Reproductive Science, Institute of Metabolism and Systems Research, University of Birmingham and Birmingham Women's Fertility Centre, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, B15 2TT, United Kingdom
- Centre for Systems Modelling and Quantitative Biomedicine, University of Birmingham, Birmingham, B15 2TT, United Kingdom
| | - Ingrida Krasauskaite
- Centre for Human Reproductive Science, Institute of Metabolism and Systems Research, University of Birmingham and Birmingham Women's Fertility Centre, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, B15 2TT, United Kingdom
| | - Jackson C Kirkman-Brown
- Centre for Human Reproductive Science, Institute of Metabolism and Systems Research, University of Birmingham and Birmingham Women's Fertility Centre, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, B15 2TT, United Kingdom
| |
Collapse
|
8
|
Inversetti A, Bossi A, Cristodoro M, Larcher A, Busnelli A, Grande G, Salonia A, Di Simone N. Recurrent pregnancy loss: a male crucial factor-A systematic review and meta-analysis. Andrology 2023. [PMID: 37881014 DOI: 10.1111/andr.13540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 08/12/2023] [Accepted: 09/27/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND Recurrent pregnancy loss (RPL), defined as two or more failed clinical pregnancies, affects 1%-3% of couples trying to conceive. Nowadays up to 50% of cases remain idiopathic. In this context, paternal factors evaluation is still very limited. The aim is to address the topic of the male factor in RPL with a broad approach, analyzing collectively data on sperm DNA fragmentation (SDF) and semen parameters. We systematically searched in Pubmed/MEDLINE and Google Scholar from inception to February 2023. A protocol has been registered on PROSPERO (ID number CRD42022278616). PRISMA guidelines were followed. METHODS Pooled results from 20 studies revealed a higher DNA fragmentation rate in the RPL group compared to controls (mean difference [MD] 9.21, 95% CI 5.58-12.85, p < 0.00001, I2 98%). Age, body mass index (BMI), smoking, and alcohol intake were not associated with DNA fragmentation. Subgroup analysis by different SDF assays (TUNEL and COMET at a neutral pH vs. indirect assessment with other assays) and ethnicity did not highlight different results (p = 0.25 and 0.44). RESULTS Results pooled from 25 studies showed a significant difference comparing RPL and control groups regarding ejaculation volume (MD -0.24, 95% CI -0.43; -0.06, p 0.01, I2 66%), total sperm number (MD -10.03, 95% CI -14.65; -5.41, p < 0.0001, I2 76%), total sperm motility (MD -11.20, 95% CI -16.15; -6.25, p < 0.0001, I2 96%), progressive sperm motility (MD -7.34, 95% CI -10.87; -3.80, p < 0.0001, I2 97%), and normal sperm morphology (MD -5.99, 95% CI -9.08; -2.90, p 0.0001, I2 98%). A sub-analysis revealed that Asian and Africans, but not white-European RPL men had lower progressive sperm motility compared to controls. CONCLUSION In conclusion, current review and meta-analysis findings suggested that SDF and some specific semen parameters were associated with RPL in a multi-ethnic evaluation. This effort opens future direction on a growing awareness of, first, how the male factor plays a key role and, second, how appropriate would be to establish a direct dialogue between the gynecologist and the urologist. PATIENT SUMMARY We performed a systematic review and meta-analysis on the male component of RPL. We found that sperm DNA fragmentation and some specific sperm parameters are significantly associated with RPL.
Collapse
Affiliation(s)
- Annalisa Inversetti
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Arianna Bossi
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | | | - Alessandro Larcher
- Department of Urology and Division of Experimental Oncology, URI Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Busnelli
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Giuseppe Grande
- Department of Medicine, Unit of Andrology and Reproductive Medicine, University of Padova, Padova, Italy
| | - Andrea Salonia
- Department of Urology and Division of Experimental Oncology, URI Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Division of Experimental Oncology/Unit of Urology, Vita-Salute San Raffaele University, Milan, Italy
| | - Nicoletta Di Simone
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- IRCCS Humanitas Research Hospital, Rozzano, Italy
| |
Collapse
|
9
|
Gómez-Torres MJ, Hernández-Falcó M, López-Botella A, Huerta-Retamal N, Sáez-Espinosa P. IZUMO1 Receptor Localization during Hyaluronic Acid Selection in Human Spermatozoa. Biomedicines 2023; 11:2872. [PMID: 38001873 PMCID: PMC10669769 DOI: 10.3390/biomedicines11112872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 10/13/2023] [Accepted: 10/22/2023] [Indexed: 11/26/2023] Open
Abstract
IZUMO1 is an acrosome transmembrane protein implicated in the adhesion and fusion of gametes. This study aims to describe the distribution of IZUMO1 in human sperm under different physiological conditions: before capacitation (NCS), at one-hour capacitation (CS1), after a hyaluronic acid (HA) selection test (mature, MS1 and immature, IS1), and induced acrosome reaction from one-hour-capacitated sperm (ARS1). The data obtained in NCS, CS1, and MS1 significantly highlight dotted fluorescence in the acrosomal region (P1) as the major staining pattern (~70%). Moreover, we describe a new distribution pattern (P2) with a dotted acrosomal region and a labelled equatorial region that significantly increases in HA-bound spermatozoa, suggesting the onset of the migration of IZUMO1. In contrast, unbound spermatozoa presented an increase in P3 (equatorial region labelled) and P4 (not labelled). Finally, costaining to observe IZUMO1 distribution and acrosome status was performed in ARS1. Interestingly, we reported a variety of combinations between the IZUMO1 staining patterns and the acrosomal stages. In conclusion, these data show as a novelty the diffusion of the IZUMO1 protein during different physiological conditions that could contribute to the improvement in sperm selection techniques.
Collapse
Affiliation(s)
- María José Gómez-Torres
- Department of Biotechnology, University of Alicante, 03690 Alicante, Spain; (M.J.G.-T.); (M.H.-F.)
- Human Fertility Cathedra, University of Alicante, 03690 Alicante, Spain
| | - Miranda Hernández-Falcó
- Department of Biotechnology, University of Alicante, 03690 Alicante, Spain; (M.J.G.-T.); (M.H.-F.)
| | - Andrea López-Botella
- Department of Biotechnology, University of Alicante, 03690 Alicante, Spain; (M.J.G.-T.); (M.H.-F.)
| | - Natalia Huerta-Retamal
- Department of Biotechnology, University of Alicante, 03690 Alicante, Spain; (M.J.G.-T.); (M.H.-F.)
| | - Paula Sáez-Espinosa
- Department of Biotechnology, University of Alicante, 03690 Alicante, Spain; (M.J.G.-T.); (M.H.-F.)
| |
Collapse
|
10
|
Choucair F, Avella M. Basic, translational and clinical studies in reproductive medicine and clinical reproductive sciences. J Transl Med 2023; 21:534. [PMID: 37563678 PMCID: PMC10416518 DOI: 10.1186/s12967-023-04108-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2023] Open
Affiliation(s)
- Fadi Choucair
- Reproductive Medicine Unit, Sidra Medicine, Doha, Qatar.
| | - Matteo Avella
- Maternal & Child Health Division, Sidra Medicine, Doha, Qatar.
| |
Collapse
|
11
|
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.
Collapse
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
| |
Collapse
|
12
|
Soto-Heras S, Sakkas D, Miller DJ. Sperm selection by the oviduct: perspectives for male fertility and assisted reproductive technologies†. Biol Reprod 2023; 108:538-552. [PMID: 36625382 PMCID: PMC10106845 DOI: 10.1093/biolre/ioac224] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 12/21/2022] [Accepted: 12/23/2022] [Indexed: 01/11/2023] Open
Abstract
The contribution of sperm to embryogenesis is gaining attention with up to 50% of infertility cases being attributed to a paternal factor. The traditional methods used in assisted reproductive technologies for selecting and assessing sperm quality are mainly based on motility and viability parameters. However, other sperm characteristics, including deoxyribonucleic acid integrity, have major consequences for successful live birth. In natural reproduction, sperm navigate the male and female reproductive tract to reach and fertilize the egg. During transport, sperm encounter many obstacles that dramatically reduce the number arriving at the fertilization site. In humans, the number of sperm is reduced from tens of millions in the ejaculate to hundreds in the Fallopian tube (oviduct). Whether this sperm population has higher fertilization potential is not fully understood, but several studies in animals indicate that many defective sperm do not advance to the site of fertilization. Moreover, the oviduct plays a key role in fertility by modulating sperm transport, viability, and maturation, providing sperm that are ready to fertilize at the appropriate time. Here we present evidence of sperm selection by the oviduct with emphasis on the mechanisms of selection and the sperm characteristics selected. Considering the sperm parameters that are essential for healthy embryonic development, we discuss the use of novel in vitro sperm selection methods that mimic physiological conditions. We propose that insight gained from understanding how the oviduct selects sperm can be translated to assisted reproductive technologies to yield high fertilization, embryonic development, and pregnancy rates.
Collapse
Affiliation(s)
- Sandra Soto-Heras
- Department of Animal Sciences and Institute of Genomic Biology, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | | | - David J Miller
- Department of Animal Sciences and Institute of Genomic Biology, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| |
Collapse
|
13
|
Gómez-Torres MJ, Huerta-Retamal N, Sáez-Espinosa P, Robles-Gómez L, Avilés M, Aizpurua J. Molecular Chaperone HSPA2 Distribution During Hyaluronic Acid Selection in Human Sperm. Reprod Sci 2023; 30:1176-1185. [PMID: 35819578 PMCID: PMC10160204 DOI: 10.1007/s43032-022-01031-9] [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: 03/15/2022] [Accepted: 07/02/2022] [Indexed: 10/17/2022]
Abstract
During fertilization, sperm hyaluronidase activity is essential for spermatozoa to successfully penetrate the hyaluronic acid-enriched extracellular matrix of the cumulus cells. Since molecular chaperones, as the heat shock protein A2, are typically involved in bringing hyaluronic acid receptors to the cell surface, here we evaluated the presence and spatial location of HSPA2 on human spermatozoa based on its hyaluronic acid binding capacity. This study included 16 normozoospermic sperm samples from volunteering donors. The location of HSPA2 was studied in cells before and after 1-h incubation under capacitating conditions, as well as in spermatozoa selected according to their ability of binding to hyaluronic acid. Our results showed no significant differences in HSPA2 immunofluorescent cells before and after 1 h of incubation in capacitating conditions. Nevertheless, after hyaluronic acid selection, the percentage of HSPA2-labelled cells increased significantly, indicating that the interaction with hyaluronic acid may induce the unmasking of HSPA2 epitopes. Furthermore, after swim-up and hyaluronic acid selection, spermatozoa presented a highly immunostained equatorial band with a homogeneous fluorescence throughout the acrosomal region. This distribution has been previously suggested to have important implications in male fertility. Noteworthy, a homogeneous fluorescence among the acrosomal region with a more intense labelling at the apical region was observed only in hyaluronic acid bound sperm cells, which may be associated with primary gamete recognition. Our findings suggest that the hyaluronic acid selection technique and HSPA2 biomarker should be considered candidates to complement the classic seminal analysis before recommending an appropriate assisted reproduction technique.
Collapse
Affiliation(s)
- María José Gómez-Torres
- Departamento de Biotecnología, Universidad de Alicante, 03690, Alicante, Spain.
- Cátedra Human Fertility, Universidad de Alicante, Alicante, Spain.
| | | | - Paula Sáez-Espinosa
- Departamento de Biotecnología, Universidad de Alicante, 03690, Alicante, Spain
| | - Laura Robles-Gómez
- Departamento de Biotecnología, Universidad de Alicante, 03690, Alicante, Spain
| | - Manuel Avilés
- Departamento de Biología Celular E Histología, Universidad de Murcia, Instituto Murciano de Investigación Sociosanitaria (IMIB-Arrixaca), 30003, Murcia, Spain
| | - Jon Aizpurua
- IVF Spain, Medicina Reproductiva, 03540, Alicante, Spain
- Cátedra Human Fertility, Universidad de Alicante, Alicante, Spain
| |
Collapse
|
14
|
Comparative study between SpermSlow™ hyaluronan and traditional sperm selection in ICSI outcome. ZYGOTE 2023; 31:180-187. [PMID: 36682887 DOI: 10.1017/s0967199422000685] [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: 01/24/2023]
Abstract
The role of hyaluronic acid (HA) as a 'physiologic selector' is also well recognized in vitro: it has been demonstrated that spermatozoa that bind to immobilized HA in vitro are those having completed their plasma membrane remodelling, and cytoplasmic and meiotic maturation. Sperm selection using HA has been expected to increase the implantation rate in intracytoplasmic sperm injection (ICSI) cycles. This work was designed to evaluate an alternative product for slowing sperm motility that contains HA and measures its outcomes: fertilization rate, embryo quality, and implantation and pregnancy rates. The present study found a positive drift in embryo quality that was statistically significant in the study group (SpermSlow™-ICSI) with teratozoospermia compared with PVP-ICSI in the same group. There were differences in the pregnancy rate (statistically insignificant in normozoospermia, asthenozoospermia, oligozoospermia, and teratozoospermia) in the SpermSlow-ICSI group compared with PVP-ICSI. The HA-ICSI technique in assisted reproduction technology (ART) is an important way to improve fertilization rate, embryo quality, and pregnancy rate.
Collapse
|
15
|
Emirdar V, Karatasli V, Tamer B, Pala I, Gunturkun F, Ozbaykus C, Işık AZ, Gode F. Influence of a hyaluronan-binding system for sperm selection in intracytoplasmic sperm injection cycles on embryo morphokinetic parameters and in vitro fertilization cycle outcomes. Arch Gynecol Obstet 2023; 307:1633-1639. [PMID: 36892604 DOI: 10.1007/s00404-023-06992-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 02/15/2023] [Indexed: 03/10/2023]
Abstract
PURPOSE Although the impact of the paternal contribution to embryo quality and blastocyst formation is a well-known phenomenon, the current literature provides insufficient evidence that hyaluronan-binding sperm selection methods improve assisted reproductive treatment outcomes. Thus, we compared the cycle outcomes of morphologically selected intracytoplasmic sperm injection (ICSI) with hyaluronan binding physiological intracytoplasmic sperm injection (PICSI) cycles. METHODS A total of 2415 ICSI and 400 PICSI procedures of 1630 patients who underwent in vitro fertilization cycles using a time-lapse monitoring system between 2014 and 2018 were analyzed retrospectively. Fertilization rate, embryo quality, clinical pregnancy rate, biochemical pregnancy rate and miscarriage rate were evaluated, differences in morphokinetic parameters and cycle outcomes were compared. RESULTS In total, 85.8 and 14.2% of the whole cohort were fertilized with standard ICSI and PICSI, respectively. The proportion of fertilized oocytes did not significantly differ between groups (74.53 ± 1.33 vs. 72.92 ± 2.64, p > 0.05). Similarly, the proportion of good-quality embryos according to the time-lapse parameters and the clinical pregnancy rate did not significantly differ between groups (71.93 ± 4.21 vs. 71.33 ± 2.64, p > 0.05 and 45.55 ± 2.91 vs. 44.96 ± 1.25, p > 0.05). No statistically significant differences were found between groups in clinical pregnancy rates (45.55 ± 2.91 vs. 44.96 ± 1.25, p > 0.05). Biochemical pregnancy rates (11.24 ± 2.12 vs. 10.85 ± 1.83, p > 0.05) and miscarriage rates (24.89 ± 3.74 vs. 27.91 ± 4.91, p > 0.05) were not significantly different between groups. CONCLUSION The effects of the PICSI procedure on fertilization rate, biochemical pregnancy rate, miscarriage rate, embryo quality, and clinical pregnancy outcomes were not superior. The effect of the PICSI procedure on embryo morphokinetics was not apparent when all parameters were considered.
Collapse
Affiliation(s)
- Volkan Emirdar
- Department of Obstetrics and Gynecology, Izmir Economy University School of Medicine, Medical Park Hospital, Yeni Girne Blv. 1825 Street No: 12 Karşıyaka, Izmir, Turkey. .,Izmir Economy University Medical Park Hospital In Vitro Fertilization Unit, Yeni Girne Blv. 1825 Street No: 12 Karşıyaka, Izmir, Turkey.
| | - Volkan Karatasli
- Department of Obstetrics and Gynecology, SBU. University of Health Science Tepecik Education and Research Hospital, Yenisehir, Gaziler St. No:468, Konak, 35020, Izmir, Turkey
| | - Burcu Tamer
- Izmir Economy University Medical Park Hospital In Vitro Fertilization Unit, Yeni Girne Blv. 1825 Street No: 12 Karşıyaka, Izmir, Turkey
| | - Ibrahim Pala
- Izmir Economy University Medical Park Hospital In Vitro Fertilization Unit, Yeni Girne Blv. 1825 Street No: 12 Karşıyaka, Izmir, Turkey
| | - Fatma Gunturkun
- Center for Biomedical Informatics, The University of Tennessee Health Science Center, 875 Monroe Avenue, Memphis, TN, USA
| | - Canberk Ozbaykus
- Intensive Care Unit, Taksim Education and Research Hospital, Katip Mustafa Celebi, Sıraselviler Street No:48, Beyoglu, 34433, Istanbul, Turkey
| | - Ahmet Zeki Işık
- Department of Obstetrics and Gynecology, Izmir Economy University School of Medicine, Medical Park Hospital, Yeni Girne Blv. 1825 Street No: 12 Karşıyaka, Izmir, Turkey.,Izmir Economy University Medical Park Hospital In Vitro Fertilization Unit, Yeni Girne Blv. 1825 Street No: 12 Karşıyaka, Izmir, Turkey
| | - Funda Gode
- Department of Obstetrics and Gynecology, Izmir Economy University School of Medicine, Medical Park Hospital, Yeni Girne Blv. 1825 Street No: 12 Karşıyaka, Izmir, Turkey.,Izmir Economy University Medical Park Hospital In Vitro Fertilization Unit, Yeni Girne Blv. 1825 Street No: 12 Karşıyaka, Izmir, Turkey
| |
Collapse
|
16
|
Bender Atik R, Christiansen OB, Elson J, Kolte AM, Lewis S, Middeldorp S, Mcheik S, Peramo B, Quenby S, Nielsen HS, van der Hoorn ML, Vermeulen N, Goddijn M. ESHRE guideline: recurrent pregnancy loss: an update in 2022. Hum Reprod Open 2023; 2023:hoad002. [PMID: 36873081 PMCID: PMC9982362 DOI: 10.1093/hropen/hoad002] [Citation(s) in RCA: 40] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Indexed: 03/06/2023] Open
Abstract
STUDY QUESTION What are the updates for the recommended management of women with recurrent pregnancy loss (RPL) based on the best available evidence in the literature from 2017 to 2022? SUMMARY ANSWER The guideline development group (GDG) updated 11 existing recommendations on investigations and treatments for RPL, and how care should be organized, and added one new recommendation on adenomyosis investigation in women with RPL. WHAT IS KNOWN ALREADY A previous ESHRE guideline on RPL was published in 2017 and needs to be updated. STUDY DESIGN SIZE DURATION The guideline was developed and updated according to the structured methodology for development and update of ESHRE guidelines. The literature searches were updated, and assessments of relevant new evidence were performed. Relevant papers published between 31 March 2017 and 28 February 2022 and written in English were included. Cumulative live birth rate, live birth rate, and pregnancy loss rate (or miscarriage rate) were considered the critical outcomes. PARTICIPANTS/MATERIALS SETTING METHODS Based on the collected evidence, recommendations were updated and discussed until consensus was reached within the GDG. A stakeholder review was organized after the updated draft was finalized. The final version was approved by the GDG and the ESHRE Executive Committee. MAIN RESULTS AND THE ROLE OF CHANCE The new version of the guideline provides 39 recommendations on risk factors, prevention, and investigation in couples with RPL, and 38 recommendations on treatments. These includes 62 evidence-based recommendations-of which 33 were formulated as strong recommendations and 29 as conditional-and 15 good practice points. Of the evidence-based recommendations, 12 (19.4%) were supported by moderate-quality evidence. The remaining recommendations were supported by low (34 recommendations; 54.8%), or very low-quality evidence (16 recommendations; 25.8%). Owing to the lack of evidence-based investigations and treatments in RPL care, the guideline also clearly mentions those investigations and treatments that should not be used for couples with RPL. LIMITATIONS REASONS FOR CAUTION The guidelines have been updated; however, several investigations and treatments currently offered to couples with RPL have not been well studied; for most of these investigations and treatments, a recommendation against using the intervention or treatment was formulated based on insufficient evidence. Future studies may require these recommendations to be revised. WIDER IMPLICATIONS OF THE FINDINGS The guideline provides clinicians with clear advice on best practice in RPL, based on the best and most recent evidence available. In addition, a list of research recommendations is provided to stimulate further studies in RPL. Still, the absence of a unified definition of RPL is one of the most critical consequences of the limited scientific evidence in the field. STUDY FUNDING/COMPETING INTERESTS The guideline was developed and funded by ESHRE, covering expenses associated with the guideline meetings, with the literature searches and with the dissemination of the guideline. The guideline group members did not receive payment.O.B.C. reports being a member of the executive board of the European Society for Reproductive Immunology and has received payment for honoraria for giving lectures about RPL in Australia in 2020. M.G. reports unconditional research and educational grant received by the Centre for Reproductive Medicine, Amsterdam UMC from Guerbet, Merck and Ferring, not related to the presented work. S.L. reports position funding from EXAMENLAB Ltd. and ownership interest by stock or partnership of EXAMENLAB Ltd (CEO). S.Q. reports being a deputy director of Tommy's National centre for miscarriage research, with payment received by the institution for research, staff time, and consumables for research. H.S.N. reports grants with payment to institution from Freya Biosciences ApS, Ferring Pharmaceuticals, BioInnovation Institute, the Danish ministry of Education, Novo Nordic Foundation, Augustinus Fonden, Oda og Hans Svenningsens Fond, Demant Fonden, Ole Kirks Fond, and Independent Research Fund Denmark and speakers' fees for lectures from Ferring Pharmaceuticals, Merck A/S, Astra Zeneca, IBSA Nordic and Cook Medical. She also reports to be an unpaid founder and chairman of a maternity foundation. M.-L.v.d.H. received small honoraria for lectures on RPL care. The other authors have no conflicts of interest to declare. DISCLAIMER This guideline represents the views of ESHRE, which were achieved after careful consideration of the scientific evidence available at the time of preparation. In the absence of scientific evidence on certain aspects, a consensus between the relevant ESHRE stakeholders has been obtained.Adherence to these clinical practice guidelines does not guarantee a successful or specific outcome, nor does it establish a standard of care. Clinical practice guidelines do not replace the need for application of clinical judgment to each individual presentation, nor variations based on locality and facility type.ESHRE makes no warranty, express or implied, regarding the clinical practice guidelines and specifically excludes any warranties of merchantability and fitness for a particular use or purpose. (Full disclaimer available at www.eshre.eu/guidelines.).
Collapse
Affiliation(s)
| | | | | | - Janine Elson
- Department of Gynaecology, Liverpool Women's Hospital, Liverpool, UK
| | - Astrid Marie Kolte
- Department of Obstetrics and Gynaecology, University Hospital Copenhagen, Rigshospitalet, Copenhagen, Denmark.,Recurrent Pregnancy Unit, Department of Obstetrics and Gynaecology, Amager and Hvidovre Hospitals, University Hospital Copenhagen, Hvidovre, Denmark
| | - Sheena Lewis
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queens University of Belfast, Belfast, UK
| | - Saskia Middeldorp
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | | | - Siobhan Quenby
- Division of Biomedical Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Henriette Svarre Nielsen
- Department of Clinical Medicine, University of Copenhagen & University Hospital Copenhagen Hvidovre, Hvidovre, Denmark
| | | | | | - Mariëtte Goddijn
- Department of Obstetrics and Gynaecology, Centre for Reproductive Medicine, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| |
Collapse
|
17
|
Nixon B, Schjenken JE, Burke ND, Skerrett-Byrne DA, Hart HM, De Iuliis GN, Martin JH, Lord T, Bromfield EG. New horizons in human sperm selection for assisted reproduction. Front Endocrinol (Lausanne) 2023; 14:1145533. [PMID: 36909306 PMCID: PMC9992892 DOI: 10.3389/fendo.2023.1145533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 02/08/2023] [Indexed: 02/24/2023] Open
Abstract
Male infertility is a commonly encountered pathology that is estimated to be a contributory factor in approximately 50% of couples seeking recourse to assisted reproductive technologies. Upon clinical presentation, such males are commonly subjected to conventional diagnostic andrological practices that rely on descriptive criteria to define their fertility based on the number of morphologically normal, motile spermatozoa encountered within their ejaculate. Despite the virtual ubiquitous adoption of such diagnostic practices, they are not without their limitations and accordingly, there is now increasing awareness of the importance of assessing sperm quality in order to more accurately predict a male's fertility status. This realization raises the important question of which characteristics signify a high-quality, fertilization competent sperm cell. In this review, we reflect on recent advances in our mechanistic understanding of sperm biology and function, which are contributing to a growing armory of innovative approaches to diagnose and treat male infertility. In particular we review progress toward the implementation of precision medicine; the robust clinical adoption of which in the setting of fertility, currently lags well behind that of other fields of medicine. Despite this, research shows that the application of advanced technology platforms such as whole exome sequencing and proteomic analyses hold considerable promise in optimizing outcomes for the management of male infertility by uncovering and expanding our inventory of candidate infertility biomarkers, as well as those associated with recurrent pregnancy loss. Similarly, the development of advanced imaging technologies in tandem with machine learning artificial intelligence are poised to disrupt the fertility care paradigm by advancing our understanding of the molecular and biological causes of infertility to provide novel avenues for future diagnostics and treatments.
Collapse
Affiliation(s)
- Brett Nixon
- Priority Research Centre for Reproductive Science, School of Environmental and Life Sciences, The University of Newcastle, Callaghan, NSW, Australia
- Infertility and Reproduction Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- *Correspondence: Brett Nixon,
| | - John E. Schjenken
- Priority Research Centre for Reproductive Science, School of Environmental and Life Sciences, The University of Newcastle, Callaghan, NSW, Australia
- Infertility and Reproduction Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Nathan D. Burke
- Priority Research Centre for Reproductive Science, School of Environmental and Life Sciences, The University of Newcastle, Callaghan, NSW, Australia
- Infertility and Reproduction Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - David A. Skerrett-Byrne
- Priority Research Centre for Reproductive Science, School of Environmental and Life Sciences, The University of Newcastle, Callaghan, NSW, Australia
- Infertility and Reproduction Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Hanah M. Hart
- Priority Research Centre for Reproductive Science, School of Environmental and Life Sciences, The University of Newcastle, Callaghan, NSW, Australia
- Infertility and Reproduction Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Geoffry N. De Iuliis
- Priority Research Centre for Reproductive Science, School of Environmental and Life Sciences, The University of Newcastle, Callaghan, NSW, Australia
- Infertility and Reproduction Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Jacinta H. Martin
- Priority Research Centre for Reproductive Science, School of Environmental and Life Sciences, The University of Newcastle, Callaghan, NSW, Australia
- Infertility and Reproduction Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Tessa Lord
- Priority Research Centre for Reproductive Science, School of Environmental and Life Sciences, The University of Newcastle, Callaghan, NSW, Australia
- Infertility and Reproduction Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Elizabeth G. Bromfield
- Priority Research Centre for Reproductive Science, School of Environmental and Life Sciences, The University of Newcastle, Callaghan, NSW, Australia
- Infertility and Reproduction Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| |
Collapse
|
18
|
Cao JX, Jiang WJ, Yan MH, Wang DD, Hou JW, Song JY, Sun ZG. Anxiety and depression among pregnant women undergoing IVF-ET and WeChat group peer support during the COVID-19 pandemic: Study protocol for a randomized controlled trial. Medicine (Baltimore) 2022; 101:e32515. [PMID: 36595832 PMCID: PMC9794246 DOI: 10.1097/md.0000000000032515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION The psychological well-being of pregnant women following assisted reproductive has increasingly gained attention in recent years. Anxiety and depression may be associated to pregnancy outcomes. This study aims to determine whether peer support and the WeChat group platform will reduce anxiety and depression among in vitro fertilization and embryo transfer (IVF-ET) women. METHODS AND ANALYSIS In the present randomized controlled study, 296 patients with confirmed clinical pregnancy following IVF-ET will be randomly assigned to receive standard intervention support or WeChat peer support on a 1:1 basis. The levels of anxiety and depression are the primary endpoints. Assessments will be performed at baseline measurements, first trimester, second trimester, and third trimester, and data will be collected. ETHICS AND DISSEMINATION This study has been approved as ethical by the affiliated hospital of Shandong University of Traditional Chinese Medicine's Reproductive Ethics Committee. Each patient will sign a written statement of informed permission. All information and biological samples will be legally protected. A peer-reviewed academic journal will publish the findings of this investigation. DISCUSSION Given the inconvenience of visits due to the current pandemic of COVID-19, this study addresses the patient's visit needs by combining WeChat, the most widely used social software in China, with peer support, while helping improve maternal anxiety, depression, and pregnancy outcomes following IVF-ET.
Collapse
Affiliation(s)
- Jing-Xian Cao
- The First Clinical College, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Wen-Jing Jiang
- The First Clinical College, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Meng-Han Yan
- College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Dan-Dan Wang
- The First Clinical College, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Jin-Wei Hou
- The First Clinical College, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Jing-Yan Song
- The First Clinical College, Shandong University of Traditional Chinese Medicine, Jinan, China
- Reproductive Center of Integrated Medicine, The Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
- * Correspondence: Jing-Yan Song, The First Clinical College, Shandong University of Traditional Chinese Medicine, 42, Wen Hua Xi Road, Lixia district, Jinan 250011, China (e-mail: )
| | - Zhen-Gao Sun
- The First Clinical College, Shandong University of Traditional Chinese Medicine, Jinan, China
- Reproductive Center of Integrated Medicine, The Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| |
Collapse
|
19
|
Mascarenhas M, Jeve Y, Polanski L, Sharpe A, Yasmin E, Bhandari HM. Management of recurrent implantation failure: British Fertility Society policy and practice guideline. HUM FERTIL 2022; 25:813-837. [PMID: 33820476 DOI: 10.1080/14647273.2021.1905886] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Recurrent implantation failure (RIF) is defined as the absence of a positive pregnancy test after three consecutive transfers of good quality embryos. There remains significant variation in clinical practice in the management of RIF. This British Fertility Society (BFS) Policy and Practice guideline analyses the evidence for investigations and therapies that are employed in RIF and provides recommendations for clinical practice and for further research. Evidence for investigations of sperm and egg quality, uterine and adnexal factors, immunological factors and thrombophilia, endocrine conditions and genetic factors and for associated therapies have been evaluated. This guideline has been devised to assist reproductive medicine specialists and patients in making shared decisions concerning management of RIF. Finally, suggestions for research towards improving understanding and management of RIF have also been provided.
Collapse
Affiliation(s)
- Mariano Mascarenhas
- Leeds Fertility, Leeds Teaching Hospitals NHS Trust, Leeds, UK.,Glasgow Centre for Reproductive Medicine, The Fertility Partnership, Glasgow, UK
| | - Yadava Jeve
- Birmingham Women's Fertility Centre, Birmingham Women's Hospital, Birmingham, UK
| | - Lukasz Polanski
- Assisted Conception Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Abigail Sharpe
- Leeds Fertility, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Ephia Yasmin
- Department of Women's Health, University College London Hospitals, London, UK
| | | | | |
Collapse
|
20
|
Ribas-Maynou J, Barranco I, Sorolla-Segura M, Llavanera M, Delgado-Bermúdez A, Yeste M. Advanced Sperm Selection Strategies as a Treatment for Infertile Couples: A Systematic Review. Int J Mol Sci 2022; 23:ijms232213859. [PMID: 36430331 PMCID: PMC9695162 DOI: 10.3390/ijms232213859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/04/2022] [Accepted: 11/07/2022] [Indexed: 11/12/2022] Open
Abstract
Assisted reproductive technology (ART) is an essential tool to overcome infertility, and is a worldwide disease that affects millions of couples at reproductive age. Sperm selection is a crucial step in ART treatment, as it ensures the use of the highest quality sperm for fertilization, thus increasing the chances of a positive outcome. In recent years, advanced sperm selection strategies for ART have been developed with the aim of mimicking the physiological sperm selection that occurs in the female genital tract. This systematic review sought to evaluate whether advanced sperm selection techniques could improve ART outcomes and sperm quality/functionality parameters compared to traditional sperm selection methods (swim-up or density gradients) in infertile couples. According to preferred reporting items for systematic reviews and meta-analyses (PRISMA guidelines), the inclusion and exclusion criteria were defined in a PICOS (population, intervention, comparator, outcome, study) table. A systematic search of the available literature published in MEDLINE-PubMed until December 2021 was subsequently conducted. Although 4237 articles were recorded after an initial search, only 47 studies were finally included. Most reports (30/47; 63.8%) revealed an improvement in ART outcomes after conducting advanced vs. traditional sperm selection methods. Among those that also assessed sperm quality/functionality parameters (12/47), there was a consensus (10/12; 83.3%) about the beneficial effect of advanced sperm selection methods on these variables. In conclusion, the application of advanced sperm selection methods improves ART outcomes. In spite of this, as no differences in the reproductive efficiency between advanced methods has been reported, none can be pointed out as a gold standard to be conducted routinely. Further research addressing whether the efficiency of each method relies on the etiology of infertility is warranted.
Collapse
Affiliation(s)
- Jordi Ribas-Maynou
- Unit of Cell Biology, Department of Biology, Faculty of Sciences, University of Girona, 17003 Girona, Spain
- Biotechnology of Animal and Human Reproduction (TechnoSperm), Institute of Food and Agricultural Technology, University of Girona, 17003 Girona, Spain
- Correspondence: (J.R.-M.); (I.B.); Tel.: +34-972-419-514 (J.R.-M.); +39-051-209-7011 (I.B.); Fax: +34-972-418-150 (J.R.-M.)
| | - Isabel Barranco
- Department of Veterinary Medical Sciences, University of Bologna, Ozzano dell’Emilia, 40126 Bologna, Italy
- Correspondence: (J.R.-M.); (I.B.); Tel.: +34-972-419-514 (J.R.-M.); +39-051-209-7011 (I.B.); Fax: +34-972-418-150 (J.R.-M.)
| | - Maria Sorolla-Segura
- Unit of Cell Biology, Department of Biology, Faculty of Sciences, University of Girona, 17003 Girona, Spain
- Biotechnology of Animal and Human Reproduction (TechnoSperm), Institute of Food and Agricultural Technology, University of Girona, 17003 Girona, Spain
| | - Marc Llavanera
- Unit of Cell Biology, Department of Biology, Faculty of Sciences, University of Girona, 17003 Girona, Spain
- Biotechnology of Animal and Human Reproduction (TechnoSperm), Institute of Food and Agricultural Technology, University of Girona, 17003 Girona, Spain
| | - Ariadna Delgado-Bermúdez
- Unit of Cell Biology, Department of Biology, Faculty of Sciences, University of Girona, 17003 Girona, Spain
- Biotechnology of Animal and Human Reproduction (TechnoSperm), Institute of Food and Agricultural Technology, University of Girona, 17003 Girona, Spain
| | - Marc Yeste
- Unit of Cell Biology, Department of Biology, Faculty of Sciences, University of Girona, 17003 Girona, Spain
- Biotechnology of Animal and Human Reproduction (TechnoSperm), Institute of Food and Agricultural Technology, University of Girona, 17003 Girona, Spain
- Catalan Institution for Research and Advanced Studies (ICREA), 08010 Barcelona, Spain
| |
Collapse
|
21
|
Gómez-Torres MJ, Sáez-Espinosa P, Manzano-Santiago P, Robles-Gómez L, Huerta-Retamal N, Aizpurua J. Sperm Adhesion Molecule 1 (SPAM1) Distribution in Selected Human Sperm by Hyaluronic Acid Test. Biomedicines 2022; 10:biomedicines10102553. [PMID: 36289815 PMCID: PMC9599839 DOI: 10.3390/biomedicines10102553] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 10/05/2022] [Accepted: 10/11/2022] [Indexed: 11/26/2022] Open
Abstract
The failures of binding to the oocyte zona pellucida are commonly attributed to defects in the sperm recognition, adhesion, and fusion molecules. SPAM1 (sperm adhesion molecule 1) is a hyaluronidase implicated in the dispersion of the cumulus-oocyte matrix. Therefore, the aim of this study was to characterize the SPAM1 distribution in the different physiological conditions of human sperm. Specifically, we evaluated the location of the SPAM1 protein in human sperm before capacitation, at one and four hours of capacitation and after hyaluronic acid (HA) selection test by fluorescence microscopy. Sperm bound to HA were considered mature and those that crossed it immature. Our results detected three SPAM1 fluorescent patterns: label throughout the head (P1), equatorial segment with acrosomal faith label (P2), and postacrosomal label (P3). The data obtained after recovering the mature sperm by the HA selection significantly (p < 0.05) highlighted the P1 in both capacitation times, being 79.74 and 81.48% after one hour and four hours, respectively. Thus, the HA test identified that human sperm require the presence of SPAM1 throughout the sperm head (P1) to properly contact the cumulus-oocyte matrix. Overall, our results provide novel insights into the physiological basis of sperm capacitation and could contribute to the improvement of selection techniques.
Collapse
Affiliation(s)
- María José Gómez-Torres
- Departamento de Biotecnología, Universidad de Alicante, 03690 Alicante, Spain
- Cátedra Human Fertility, Universidad de Alicante, 03690 Alicante, Spain
- Correspondence: ; Tel.: +34-965-903-878
| | - Paula Sáez-Espinosa
- Departamento de Biotecnología, Universidad de Alicante, 03690 Alicante, Spain
| | | | - Laura Robles-Gómez
- Departamento de Biotecnología, Universidad de Alicante, 03690 Alicante, Spain
| | | | - Jon Aizpurua
- IVF Spain, Reproductive Medicine, 03540 Alicante, Spain
| |
Collapse
|
22
|
Liperis G, Sharma K, Ammar OF, Fraire-Zamora JJ, Martins da Silva S, Thomson A, Pini T, Mincheva M. #ESHREjc report: are sperm selection techniques a panacea? Indications for the use of physiological intracytoplasmic sperm injection (PICSI) in medically assisted reproduction. Hum Reprod 2022; 37:2492-2496. [PMID: 35962973 DOI: 10.1093/humrep/deac182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Indexed: 11/14/2022] Open
Affiliation(s)
- George Liperis
- Westmead Fertility Centre, Institute of Reproductive Medicine, University of Sydney, Westmead, NSW, Australia
| | - Kashish Sharma
- ART Fertility Clinics LLC, Abu Dhabi, United Arab Emirates
| | - Omar Farhan Ammar
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
| | | | - Sarah Martins da Silva
- Reproductive Medicine Research Group, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Andrew Thomson
- Centre for Reproduction and Gynaecology Wales, Llantrisant, UK
| | - Taylor Pini
- School of Veterinary Science, The University of Queensland, Gatton, Australia
| | - Mina Mincheva
- Centre for Tumour Microenvironment, Barts Cancer Institute, Queen Mary University of London, London, UK
| |
Collapse
|
23
|
West R, Coomarasamy A, Frew L, Hutton R, Kirkman-Brown J, Lawlor M, Lewis S, Partanen R, Payne-Dwyer A, Román-Montañana C, Torabi F, Tsagdi S, Miller D. Sperm selection with hyaluronic acid improved live birth outcomes among older couples and was connected to sperm DNA quality, potentially affecting all treatment outcomes. Hum Reprod 2022; 37:1106-1125. [PMID: 35459947 PMCID: PMC9156852 DOI: 10.1093/humrep/deac058] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 02/13/2022] [Indexed: 11/23/2022] Open
Abstract
STUDY QUESTION What effects did treatment using hyaluronic acid (HA) binding/selection prior to ICSI have on clinical outcomes in the Hyaluronic Acid Binding sperm Selection (HABSelect) clinical trial? SUMMARY ANSWER Older women randomized to the trial's experimental arm (selection of sperm bound to immobilized (solid-state) HA) had the same live birth rates as younger women, most likely a result of better avoidance of sperm with damaged DNA. WHAT IS KNOWN ALREADY Recent randomized controlled trials (RCTs) investigating the efficacy of HA-based sperm selection prior to ICSI, including HABSelect, have consistently reported reductions in the numbers of miscarriages among couples randomized to the intervention, suggesting a pathological sperm-mediated factor mitigated by prior HA-binding/selection. The mechanism of that protection is unknown. STUDY DESIGN, SIZE, DURATION The original HABSelect Phase 3 RCT ran from 2014 to 2017 and included 2752 couples from whom sperm samples used in control (ICSI) and intervention (Physiological IntraCytoplasmic Sperm Injection; PICSI) arms of the trial were stored frozen for later assessment of DNA quality (DNAq). The trial overlapped with its mechanistic arm, running from 2016 to 2018. PARTICIPANTS/MATERIALS, SETTING, METHODS As miscarriage reduction was a significant secondary outcome of the trial, samples (n = 1247) selected for the mechanistic analysis were deliberately enriched for miscarriage outcomes (n = 92 or 7.4%) from a total of 154 miscarriages (5.6%) among all (n = 2752) couples randomized by stratified random sampling. Values from fresh semen samples for sperm concentration (mml), percentage forward progressive motility and percentage HA-binding score (HBS) were obtained before being processed by differential density gradient centrifugation or (rarely) by swim-up on the day of treatment. Surplus sperm pellets were recovered, aliquoted and cryopreserved for later analysis of DNAq using slide-based Comet, TUNEL, acridine orange (AO) and the sperm chromatin dispersion (SCD) assays. Following their classification into normal and abnormal sample subcategories based on reference values for sperm concentration and motility, relationships with HBS and DNAq were examined by Spearman correlation, Student's t-tests, Mann Whitney U tests, and logistic regression (univariable and multivariable). Parsimonious selection enabled the development of models for exploring and explaining data trends. Potential differences in future cumulative pregnancy rates relating to embryo quality were also explored. MAIN RESULTS AND THE ROLE OF CHANCE Results from the 1247 sperm samples assayed for HBS and/or DNAq, generated data that were considered in relation to standard physiological measures of (sperm) vitality and to treatment outcomes. All measures of HBS and DNAq discriminated normal from abnormal sperm samples (P < 0.001). SCD correlated negatively with the Comet (r = -0.165; P < 0.001) and TUNEL assays (r = -0.200; P < 0.001). HBS correlated negatively with AO (r = -0.211; P < 0.001), Comet (r = -0.127; P < 0.001) and TUNEL (r = -0.214; P < 0.001) and positively with SCD (r = 0.255; P < 0.001). A model for predicting live birth (and miscarriage) rates included treatment allocation (odds ratio: OR 2.167, 95% CI 1.084-4.464, P = 0.031), female age (OR 0.301, 95% CI 0.133-0.761, P = 0.013, per decade) and the AO assay (OR 0.79, 95% CI 0.60-1. 02.761, P = 0.073, per 10 points rise). A model predicting the expected rate of biochemical pregnancy included male age (OR 0.464, 95% CI 0.314-0.674, P < 0.001, per decade) and the SCD assay (OR 1.04, 95% CI 1.007-1.075, P = 0.018, per 10 point rise). A model for conversion from biochemical to clinical pregnancy did not retain any significant patient or assay variables. A model for post-injection fertilization rates included treatment allocation (OR 0.83, 95% CI 0.75-0.91, P < 0.001) and the Comet assay (OR 0.950, 95% CI 0.91-1.00, P = 0.041). LIMITATIONS, REASONS FOR CAUTION HABSelect was a prospective RCT and the mechanistic study group was drawn from its recruitment cohort for retrospective analysis, without the full benefit of randomization. The clinical and mechanistic aspects of the study were mutually exclusive in that measures of DNAq were obtained from residual samples and not from HA-selected versus unselected sperm. Models for fitting mechanistic with baseline and other clinical data were developed to compensate for variable DNAq data quality. HABSelect used a solid-state version of PICSI and we did not assess the efficacy of any liquid-state alternatives. PICSI reduced fertilization rates and did not improve the outlook for cumulative pregnancy rates. WIDER IMPLICATIONS OF THE FINDINGS Notwithstanding the interventional effect on fertilization rates and possibly blastocyst formation (neither of which influenced pregnancy rates), poor sperm DNAq, reflected by lower HBS, probably contributed to the depression of all gestational outcomes including live births, in the HABSelect trial. The interventional avoidance of defective sperm is the best explanation for the equalization in live birth rates among older couples randomized to the trial's PICSI arm. As patients going forward for assisted conception cycles globally in future are likely to be dominated by an older demographic, HA-based selection of sperm for ICSI could be considered as part of their treatment plan. STUDY FUNDING/COMPETING INTEREST(S) The study was supported by the National Institute for Health Research (NIHR) EME (Efficacy and Mechanism Evaluation)-11-14-34. National Research Ethics Service approval 11/06/2013: 13/YH/0162. S.L. is CEO of ExamenLab Ltd (company number NI605309). TRIAL REGISTRATION NUMBER ISRCTN99214271.
Collapse
Affiliation(s)
- Robert West
- Correspondence address. Leeds Institute of Health Sciences, Room 1.27, Level 10, Worsley Building, University of Leeds, Leeds LS2 9JT, UK. E-mail: (R.W.); Centre for Human Reproductive Science, University of Birmingham, Birmingham Women’s Fertility Centre, Birmingham Women’s NHS Foundation Trust, Birmingham B15 2TG, UK. E-mail: (J.K.-B.)
| | - Arri Coomarasamy
- Centre for Human Reproductive Science, University of Birmingham, Birmingham Women’s Fertility Centre, Birmingham Women’s NHS Foundation Trust, Birmingham, UK
| | - Lorraine Frew
- Centre for Human Reproductive Science, University of Birmingham, Birmingham Women’s Fertility Centre, Birmingham Women’s NHS Foundation Trust, Birmingham, UK
| | - Rachel Hutton
- Queen’s University Belfast, Centre for Public Health, Royal Groups of Hospitals, Belfast, UK
| | - Jackson Kirkman-Brown
- Correspondence address. Leeds Institute of Health Sciences, Room 1.27, Level 10, Worsley Building, University of Leeds, Leeds LS2 9JT, UK. E-mail: (R.W.); Centre for Human Reproductive Science, University of Birmingham, Birmingham Women’s Fertility Centre, Birmingham Women’s NHS Foundation Trust, Birmingham B15 2TG, UK. E-mail: (J.K.-B.)
| | - Martin Lawlor
- Queen’s University Belfast, Centre for Public Health, Royal Groups of Hospitals, Belfast, UK
| | - Sheena Lewis
- Queen’s University Belfast, Centre for Public Health, Royal Groups of Hospitals, Belfast, UK
| | - Riitta Partanen
- Department of Discovery and Translational Science, Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, UK
| | - Alex Payne-Dwyer
- Department of Discovery and Translational Science, Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, UK
| | - Claudia Román-Montañana
- Centre for Human Reproductive Science, University of Birmingham, Birmingham Women’s Fertility Centre, Birmingham Women’s NHS Foundation Trust, Birmingham, UK
| | - Forough Torabi
- Department of Discovery and Translational Science, Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, UK
| | - Sofia Tsagdi
- Centre for Human Reproductive Science, University of Birmingham, Birmingham Women’s Fertility Centre, Birmingham Women’s NHS Foundation Trust, Birmingham, UK
| | - David Miller
- Department of Discovery and Translational Science, Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, UK
| |
Collapse
|
24
|
Yu SX, Liu Y, Wu Y, Luo H, Huang R, Wang YJ, Wang X, Gao H, Shi H, Jing G, Liu YJ. Cervix chip mimicking cervical microenvironment for quantifying sperm locomotion. Biosens Bioelectron 2022; 204:114040. [PMID: 35151944 DOI: 10.1016/j.bios.2022.114040] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 01/21/2022] [Accepted: 01/22/2022] [Indexed: 12/14/2022]
Abstract
As the gate for sperm swimming into the female reproductive tract, cervix is full of cervical mucus, which plays an important role in sperm locomotion. The fact that sperm cannot pass through the cervical mucus-cervix microenvironment will cause the male infertility. However, how the sperm swim across the cervix microenvironment remains elusive. We used hyaluronic acid (HA), a substitute of cervical mucus to mimic cervix microenvironment and designed a cervix chip to study sperm selection and behavior. An accumulation of sperm in HA confirmed that HA served as a reservoir for sperm, similar to cervical mucus. We found that sperm escaping from HA exhibited higher motility than the sperm accessing into HA, suggesting that HA functions as a filter to select sperm with high activity. Our findings construct a practical platform to explore the sophisticated interaction of sperm with cervix microenvironment, with elaborate swimming indicators thus provide a promising cervix chip for sperm selection with kinematic features on-demand. What's more, the cervix chip allows the convenient use in clinical infertility diagnosis, owing to the advantage of simple, fast and high efficiency.
Collapse
Affiliation(s)
- Sai-Xi Yu
- Shanghai Institute of Cardiovascular Diseases, Shanghai Key Laboratory of Medical Epigenetics, International Co-laboratory of Medical Epigenetics and Metabolism (Ministry of Science and Technology), Institutes of Biomedical Sciences, Department of Systems Biology for Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Yanan Liu
- School of Physics, State Key Laboratory of Photon Technology in Western China Energy, Northwest University, Xi'an, 710069, China
| | - Yi Wu
- Shanghai Institute of Cardiovascular Diseases, Shanghai Key Laboratory of Medical Epigenetics, International Co-laboratory of Medical Epigenetics and Metabolism (Ministry of Science and Technology), Institutes of Biomedical Sciences, Department of Systems Biology for Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Hao Luo
- School of Physics, State Key Laboratory of Photon Technology in Western China Energy, Northwest University, Xi'an, 710069, China
| | - Rufei Huang
- NHC Key Lab. of Reproduction Regulation (Shanghai Institute of Planned Parenthood Research), Hospital of SIPPR, Fudan University, Shanghai, 200032, China
| | - Ya-Jun Wang
- Shanghai Institute of Cardiovascular Diseases, Shanghai Key Laboratory of Medical Epigenetics, International Co-laboratory of Medical Epigenetics and Metabolism (Ministry of Science and Technology), Institutes of Biomedical Sciences, Department of Systems Biology for Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Xuemei Wang
- NHC Key Lab. of Reproduction Regulation (Shanghai Institute for Biomedical and Pharmaceutical Technologies), Fudan University, Shanghai, 200032, China
| | - Hai Gao
- Shanghai Institute of Cardiovascular Diseases, Shanghai Key Laboratory of Medical Epigenetics, International Co-laboratory of Medical Epigenetics and Metabolism (Ministry of Science and Technology), Institutes of Biomedical Sciences, Department of Systems Biology for Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Huijuan Shi
- NHC Key Lab. of Reproduction Regulation (Shanghai Institute for Biomedical and Pharmaceutical Technologies), Fudan University, Shanghai, 200032, China.
| | - Guangyin Jing
- School of Physics, State Key Laboratory of Photon Technology in Western China Energy, Northwest University, Xi'an, 710069, China.
| | - Yan-Jun Liu
- Shanghai Institute of Cardiovascular Diseases, Shanghai Key Laboratory of Medical Epigenetics, International Co-laboratory of Medical Epigenetics and Metabolism (Ministry of Science and Technology), Institutes of Biomedical Sciences, Department of Systems Biology for Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
| |
Collapse
|
25
|
Rimmer MP, Howie RA, Subramanian V, Anderson RA, Bertolla RP, Beebeejaun Y, Bortoletto P, Sunkara SK, Mitchell RT, Pacey A, van Wely M, Farquhar CM, Duffy JMN, Niederberger C. Outcome reporting across randomized controlled trials evaluating potential treatments for male infertility: a systematic review. Hum Reprod Open 2022; 2022:hoac010. [PMID: 35386119 PMCID: PMC8982407 DOI: 10.1093/hropen/hoac010] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 02/18/2022] [Indexed: 11/12/2022] Open
Abstract
STUDY QUESTION What are the primary outcomes and outcome measures used in randomized controlled trials (RCTs) evaluating potential treatments for male infertility in the last 10 years? SUMMARY ANSWER Outcome reporting across male infertility trials is heterogeneous with numerous definitions and measures used to define similar outcomes. WHAT IS KNOWN ALREADY No core outcome set for male infertility trials has been developed. Male infertility trials are unique in that they have potentially three participants, a man, a female partner and their offspring and this will likely lead to significant variation in outcome reporting in randomized trials. STUDY DESIGN SIZE DURATION A systematic review of RCTs mapping outcomes and outcome measures evaluating potential treatments for men with infertility registered in the Cochrane Register of Controlled Trials (CENTRAL) between January 2010 and July 2021. PARTICIPANTS/MATERIALS SETTING METHODS Abstract screening and study selection was undertaken in duplicate using a review protocol that was developed prior to commencing the review. No risk of bias assessment was undertaken as this review aims to report on outcome reporting only. MAIN RESULTS AND THE ROLE OF CHANCE One hundred and seventy-five RCTs were identified, and given the large number of studies we limited our review to the 100 largest trials. Seventy-nine different treatments were reported across the 100 largest RCTs including vitamin and dietary supplements (18 trials), surgical treatments (18 trials) and sperm selection techniques (22 trials). When considering the largest 100 trials (range: 80-2772 participants), 36 primary and 89 secondary outcomes were reported. Forty-seven trials reported a primary outcome and 36 trials clearly defined their primary outcome. Pregnancy outcomes were inconsistently reported and included pregnancy rate (51 trials), pregnancy loss including miscarriage, ectopic pregnancy, stillbirth (9 trials) and live birth (13 trials). Trials consistently reporting the same outcome frequently used different definitions. For example, semen quality was reported by 75 trials and was defined in 7 different ways, including; the World Health Organization (WHO) 2010 criteria (32 trials), WHO 1999 criteria (18 trials), WHO 1992 criteria (3 trials), WHO 1999 and 1992 criteria (1 trial) and the Kruger strict morphology criteria (1 trial). LIMITATIONS REASONS FOR CAUTION We only evaluated the 100 largest trials published in the last 10 years and did not report outcomes on the remaining 75. An outcome was included as a primary outcome only if clearly stated in the manuscript and we did not contact authors to clarify this. As our review mapped outcomes and outcome measures, we did not undertake an integrity assessment of the trials included in our review. WIDER IMPLICATIONS OF THE FINDINGS Most randomized trials evaluating treatments for male infertility report different outcomes. Only half of the RCTs reported pregnancy rate and even fewer reported live birth; furthermore, the definitions of these outcomes varies across trials. Developing, disseminating and implementing a minimum data set, known as a core outcome set, for male infertility research could help to improve outcome selection, collection and reporting. STUDY FUNDING/COMPETING INTERESTS A.P.-chairman of external scientific advisory committee of Cryos International Denmark ApS, member of the scientific advisory board for Cytoswim LDT and ExSeed Health. Guest lecture at the 'Insights for Fertility Conference', funded by MERK SERONO Limited. M.v.W.-holds a ZON-MW research grant. No external funding was obtained for this study.
Collapse
Affiliation(s)
| | | | - Venkatesh Subramanian
- King’s Fertility, The Fetal Medicine Research Unit, King’s College London, London, UK
| | - Richard A Anderson
- MRC Centre for Reproductive Health, Queens Medical research Institute, University of Edinburgh, Edinburgh, UK,Edinburgh Fertility Centre, Simpsons Centre for Reproductive Health, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Ricardo Pimenta Bertolla
- Division of Urology, Department of Surgery, Universidade Federal de Sao Paulo, São Paulo, Brazil
| | - Yusuf Beebeejaun
- King’s Fertility, The Fetal Medicine Research Unit, King’s College London, London, UK
| | - Pietro Bortoletto
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Sesh K Sunkara
- Division of Women’s Health, Faculty of Life Sciences and Medicine, King’s College London, London, UK
| | - Rod T Mitchell
- MRC Centre for Reproductive Health, Queens Medical research Institute, University of Edinburgh, Edinburgh, UK
| | - Allan Pacey
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Madelon van Wely
- Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Cindy M Farquhar
- Cochrane Gynaecology and Fertility Group, Auckland, New Zealand,Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - James M N Duffy
- Correspondence address. King’s Fertility, The Fetal Medicine Research Unit, King’s College London, London, UK. Tel: +44-7949-066806; E-mail:
| | - Craig Niederberger
- Department of Urology, University of Illinois at Chicago, Chicago, IL, USA,Department of Bioengineering, University of Illinois at Chicago College of Engineering, Chicago, IL, USA
| |
Collapse
|
26
|
Glatthorn HN, Decherney A. The efficacy of add-ons: selected IVF "add-on" procedures and future directions. J Assist Reprod Genet 2022; 39:581-589. [PMID: 35066700 PMCID: PMC8995402 DOI: 10.1007/s10815-022-02410-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 01/19/2022] [Indexed: 01/04/2023] Open
Abstract
Since the advent of ART, technology has continuously evolved to improve embryology and pregnancy outcomes. However, not all technologies that are integrated into practice have convincing evidence of clinical effectiveness, and they often increase the financial burden of fertility care. We discuss here a selection of commonly utilized IVF "add-ons" and discuss the existing evidence for their utility. The procedures included in this review are time-lapse imaging of embryos, assisted hatching, EmbryoGlue, sperm DNA testing, egg activation with calcium ionophore, endometrial receptivity array, and physiological intracytoplasmic sperm injection (PICSI). While there is rather limited supporting evidence for nearly all IVF add-ons that we reviewed, there is strong demand from patients, physicians, and the biotechnology industry to continue further research and development in this arena. We propose that all add-on procedures should provide true efficacy for the patient, and reproductive endocrinologists should inform patients of the costs and benefits of utilizing various technologies before they undergo treatment. In the future, add-ons that show clear evidence of efficacy and justifiable cost should be incorporated into routine practice, while others that do not meet these criteria should be phased out entirely.
Collapse
Affiliation(s)
- Haley N. Glatthorn
- Department of Obstetrics, Gynecology and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, 125 Paterson Street, Room 2133, New Brunswick, NJ 08901 USA
| | - Alan Decherney
- Program in Reproductive Endocrinology and Gynecology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Hatfield Clinical Research Center, 10 Center Drive, Room 5-5570, Bethesda, MD 20892 USA
| |
Collapse
|
27
|
Metwally M, Chatters R, Pye C, Dimairo M, White D, Walters S, Cohen J, Young T, Cheong Y, Laird S, Mohiyiddeen L, Chater T, Pemberton K, Turtle C, Hall J, Taylor L, Brian K, Sizer A, Hunter H. Endometrial scratch to increase live birth rates in women undergoing first-time in vitro fertilisation: RCT and systematic review. Health Technol Assess 2022; 26:1-212. [PMID: 35129113 PMCID: PMC8859770 DOI: 10.3310/jnzt9406] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND In vitro fertilisation is a widely used reproductive technique that can be undertaken with or without intracytoplasmic sperm injection. The endometrial scratch procedure is an in vitro fertilisation 'add-on' that is sometimes provided prior to the first in vitro fertilisation cycle, but there is a lack of evidence to support its use. OBJECTIVES (1) To assess the clinical effectiveness, safety and cost-effectiveness of endometrial scratch compared with treatment as usual in women undergoing their first in vitro fertilisation cycle (the 'Endometrial Scratch Trial') and (2) to undertake a systematic review to combine the results of the Endometrial Scratch Trial with those of previous trials in which endometrial scratch was provided prior to the first in vitro fertilisation cycle. DESIGN A pragmatic, multicentre, superiority, open-label, parallel-group, individually randomised controlled trial. Participants were randomised (1 : 1) via a web-based system to receive endometrial scratch or treatment as usual using stratified block randomisation. The systematic review involved searching electronic databases (undertaken in January 2020) and clinicaltrials.gov (undertaken in September 2020) for relevant trials. SETTING Sixteen UK fertility units. PARTICIPANTS Women aged 18-37 years, inclusive, undergoing their first in vitro fertilisation cycle. The exclusion criteria included severe endometriosis, body mass index ≥ 35 kg/m2 and previous trauma to the endometrium. INTERVENTIONS Endometrial scratch was undertaken in the mid-luteal phase of the menstrual cycle prior to in vitro fertilisation, and involved inserting a pipelle into the cavity of the uterus and rotating and withdrawing it three or four times. The endometrial scratch group then received usual in vitro fertilisation treatment. The treatment-as-usual group received usual in vitro fertilisation only. MAIN OUTCOME MEASURES The primary outcome was live birth after completion of 24 weeks' gestation within 10.5 months of egg collection. Secondary outcomes included implantation, pregnancy, ectopic pregnancy, miscarriage, pain and tolerability of the procedure, adverse events and treatment costs. RESULTS One thousand and forty-eight (30.3%) women were randomised to treatment as usual (n = 525) or endometrial scratch (n = 523) and were followed up between July 2016 and October 2019 and included in the intention-to-treat analysis. In the endometrial scratch group, 453 (86.6%) women received the endometrial scratch procedure. A total of 494 (94.1%) women in the treatment-as-usual group and 497 (95.0%) women in the endometrial scratch group underwent in vitro fertilisation. The live birth rate was 37.1% (195/525) in the treatment-as-usual group and 38.6% (202/523) in the endometrial scratch group: an unadjusted absolute difference of 1.5% (95% confidence interval -4.4% to 7.4%; p = 0.621). There were no statistically significant differences in secondary outcomes. Safety events were comparable across groups. No neonatal deaths were recorded. The cost per successful live birth was £11.90 per woman (95% confidence interval -£134 to £127). The pooled results of this trial and of eight similar trials found no evidence of a significant effect of endometrial scratch in increasing live birth rate (odds ratio 1.03, 95% confidence interval 0.87 to 1.22). LIMITATIONS A sham endometrial scratch procedure was not undertaken, but it is unlikely that doing so would have influenced the results, as objective fertility outcomes were used. A total of 9.2% of women randomised to receive endometrial scratch did not undergo the procedure, which may have slightly diluted the treatment effect. CONCLUSIONS We found no evidence to support the theory that performing endometrial scratch in the mid-luteal phase in women undergoing their first in vitro fertilisation cycle significantly improves live birth rate, although the procedure was well tolerated and safe. We recommend that endometrial scratch is not undertaken in this population. TRIAL REGISTRATION This trial is registered as ISRCTN23800982. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 10. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
- Mostafa Metwally
- Assisted Conception Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Robin Chatters
- Sheffield Clinical Trials Research Unit (CTRU), School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | - Clare Pye
- Assisted Conception Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Munya Dimairo
- Sheffield Clinical Trials Research Unit (CTRU), School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | - David White
- Sheffield Clinical Trials Research Unit (CTRU), School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | - Stephen Walters
- Design, Trials and Statistics, School of Health and Related Research (ScHARR), Sheffield, UK
| | - Judith Cohen
- Hull Health Trials Unit, University of Hull, Hull, UK
| | - Tracey Young
- Health Economic and Decision Science, School of Health and Related Research (ScHARR), Sheffield, UK
| | - Ying Cheong
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Susan Laird
- Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, UK
| | - Lamiya Mohiyiddeen
- Saint Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Tim Chater
- Sheffield Clinical Trials Research Unit (CTRU), School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | - Kirsty Pemberton
- Sheffield Clinical Trials Research Unit (CTRU), School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | - Chris Turtle
- Sheffield Clinical Trials Research Unit (CTRU), School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | - Jamie Hall
- Sheffield Clinical Trials Research Unit (CTRU), School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | - Liz Taylor
- Assisted Conception Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | | | | | - Helen Hunter
- Department of Reproductive Medicine, Old St Mary's Hospital, Manchester, UK
| |
Collapse
|
28
|
Wilkinson J, Stocking K. Study design flaws and statistical challenges in evaluating fertility treatments. REPRODUCTION AND FERTILITY 2022; 2:C9-C21. [PMID: 35128452 PMCID: PMC8812412 DOI: 10.1530/raf-21-0015] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 05/21/2021] [Indexed: 12/16/2022] Open
Abstract
Health interventions should be tested before being introduced into clinical practice, to find out whether they work and whether they are harmful. However, research studies will only provide reliable answers to these questions if they are appropriately designed and analysed. But these are not trivial tasks. We review some methodological challenges that arise when evaluating fertility interventions and explain the implications for a non-statistical audience. These include flexibility in outcomes and analyses; use of surrogate outcomes instead of live birth; use of inappropriate denominators; evaluating cumulative outcomes and time to live birth; allowing each patient or couple to contribute to a research study more than once. We highlight recurring errors and present solutions. We conclude by highlighting the importance of collaboration between clinical and methodological experts, as well as people with experience of subfertility, for realising high-quality research. Lay summary We do research to find out whether fertility treatments are beneficial and to make sure they don't cause harm. However, research will only provide reliable answers if it is done properly. It is not unusual for researchers to make mistakes when they are designing research studies and analysing the data that we get from them. In this review, we describe some of the mistakes people make when they do research about fertility treatments and explain how to avoid them. These include challenges which arise due to the large number of things that can be measured and reported when looking to see if fertility treatments work; failure to check whether the treatment increases the number of live births; failing to include all study participants in calculations;challenges in studies where participants may have more than one treatment attempt. We conclude by highlighting the importance of collaboration between clinical and methodological experts, as well as people with experience of fertility problems.
Collapse
Affiliation(s)
- Jack Wilkinson
- Centre for Biostatistics, Division of Population Health, Health Services Research and Primary Care, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester, UK
| | - Katie Stocking
- Centre for Biostatistics, Division of Population Health, Health Services Research and Primary Care, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester, UK
| |
Collapse
|
29
|
Scaruffi P, Bovis F, Casciano I, Maccarini E, Gazzo I, De Leo C, Massarotti C, Sozzi F, Stigliani S, Anserini P. Hyaluronic acid‐sperm selection significantly improves the clinical outcome of couples with previous ICSI cycles failure. Andrology 2022; 10:677-685. [DOI: 10.1111/andr.13155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 01/15/2022] [Accepted: 01/15/2022] [Indexed: 12/01/2022]
Affiliation(s)
- Paola Scaruffi
- UOS Physiopathology of Human Reproduction IRCCS Ospedale Policlinico San Martino Genova Italy
| | - Francesca Bovis
- Department of Health Sciences (DISSAL) University of Genova Genova Italy
| | - Ida Casciano
- UOS Physiopathology of Human Reproduction IRCCS Ospedale Policlinico San Martino Genova Italy
| | - Elena Maccarini
- UOS Physiopathology of Human Reproduction IRCCS Ospedale Policlinico San Martino Genova Italy
| | - Irene Gazzo
- Academic Unit of Obstetrics and Gynecology University of Genova Genova Italy
| | - Caterina De Leo
- Department of Neuroscience Rehabilitation, Ophthalmology Genetics and Maternal‐Child Health (DiNOGMI) University of Genova Genova Italy
| | - Claudia Massarotti
- Department of Neuroscience Rehabilitation, Ophthalmology Genetics and Maternal‐Child Health (DiNOGMI) University of Genova Genova Italy
| | - Fausta Sozzi
- UOS Physiopathology of Human Reproduction IRCCS Ospedale Policlinico San Martino Genova Italy
| | - Sara Stigliani
- UOS Physiopathology of Human Reproduction IRCCS Ospedale Policlinico San Martino Genova Italy
| | - Paola Anserini
- UOS Physiopathology of Human Reproduction IRCCS Ospedale Policlinico San Martino Genova Italy
| |
Collapse
|
30
|
Abstract
Sperm selection in the female reproductive tract (FRT) is sophisticated. Only about 1,000 sperm out of millions in an ejaculate reach the fallopian tube and thus have a chance of fertilizing an oocyte. In assisted reproduction techniques, sperm are usually selected using their density or motility, characteristics that do not reflect their fertilization competence and, therefore, might result in failure to fertilize the oocyte. Although sperm processing in in vitro fertilization (IVF) and intrauterine insemination (IUI) bypasses many of the selection processes in the FRT, selection by the cumulus mass and the zona pellucida remain intact. By contrast, the direct injection of a sperm into an oocyte in intracytoplasmic sperm injection (ICSI) bypasses all natural selection barriers and, therefore, increases the risk of transferring paternal defects such as fragmented DNA and genomic abnormalities in sperm to the resulting child. Research into surrogate markers of fertilization potential and into simulating the natural sperm selection processes has progressed. However, methods of sperm isolation - such as hyaluronic acid-based selection and microfluidic isolation based on sperm tactic responses - use only one or two parameters and are not comparable with the multistep sperm selection processes naturally occurring within the FRT. Fertilization-competent sperm require a panel of molecules, including zona pellucida-binding proteins and ion channel proteins, that enable them to progress through the FRT to achieve fertilization. The optimal artificial sperm selection method will, therefore, probably need to use a multiparameter tool that incorporates the molecular signature of sperm with high fertilization potential, and their responses to external cues, within a microfluidic system that can replicate the physiological processes of the FRT in vitro.
Collapse
|
31
|
Morris G, Mavrelos D, Odia R, Viñals Gonzalez X, Cawood S, Yasmin E, Saab W, Serhal P, Seshadri S. Paternal age over 50 years decreases assisted reproductive technology (ART) success: A single UK center retrospective analysis. Acta Obstet Gynecol Scand 2021; 100:1858-1867. [PMID: 34405396 DOI: 10.1111/aogs.14221] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 06/23/2021] [Accepted: 06/24/2021] [Indexed: 12/15/2022]
Abstract
INTRODUCTION To study whether paternal age exerts an effect, independent of maternal age, on the outcomes of fresh in vitro fertilization/ intracytoplasmic sperm injection (IVF/ICSI) cycles. Semen quality deteriorates with increasing paternal age; however, there is conflicting evidence for any impact paternal age may have on the outcome of IVF/ICSI. Several retrospective and prospective cohort studies have shown that paternal age increases the miscarriage rate and reduces the live birth rate. Some studies have shown no effect of paternal age on live birth rate or miscarriage rate. Studies involving donor oocytes have tended to show no independent effect of paternal age on assisted reproductive technology (ART) outcomes. The age at which paternal age may exert a significant deleterious effect on outcome is not known and there is no limit to paternal age in IVF/ICSI treatment. MATERIAL AND METHODS A single-center retrospective cohort study was carried out at the Centre for Reproductive and Genetic Health, London, UK. Included in the analysis were all couples with primary or secondary infertility undergoing IVF/ICSI cycles in which the male partner produced a fresh semen sample and the cycle proceeded to fresh embryo transfer. All cycles of IVF/ICSI that used donor oocytes-donor sperm, frozen sperm, cycles leading to embryo storage and cycles including preimplantation genetic testing (PGT-A/PGT-M)-were excluded from analysis. The primary outcome was live birth rate and secondary outcomes were clinical pregnancy rate and miscarriage rate. Multivariate logistic regression analysis with live birth as a dependent variable and maternal and paternal age class as independent variables was performed. RESULTS During the study period there were 4833 cycles, involving 4271 men, eligible for analysis; 1974/4833 (40.8%, 95% confiene intervals [CI] 39.5-42.2%) cycles resulted in a live birth. A significantly lower proportion of men over 51 years met World Health Organization semen analysis criteria (56/133, [42.1%, 95% CI 34.1-50.6]) compared with men under 51 years of age (2530/4138 [61.1%, 95% CI 60.0-62.6]) (p = 0.001). Both maternal and paternal age were retained in the multivariate model and for all maternal age subgroups the probability of live birth decreased with paternal age over 50 years (odds ratio [OR] 0.674, 95% CI 0.482-0.943) (p = 0.021). Paternal age over 50 years was not an independent predictor of miscarriage (OR 0.678, 95% CI 0.369-1.250) (p = 0.214). CONCLUSIONS Paternal age over 50 significantly affects the chance of achieving a live birth following ART. Paternal age does not independently affect the risk of miscarriage following ART. There should be a public health message for men not to delay fatherhood.
Collapse
Affiliation(s)
- Guy Morris
- Centre for Reproductive and Genetic Health, London, UK.,Reproductive Medicine Unit, University College London Hospitals NHS Foundation Trust, London, UK
| | - Dimitrios Mavrelos
- Centre for Reproductive and Genetic Health, London, UK.,Reproductive Medicine Unit, University College London Hospitals NHS Foundation Trust, London, UK
| | - Rabi Odia
- Centre for Reproductive and Genetic Health, London, UK
| | | | | | - Ephia Yasmin
- Centre for Reproductive and Genetic Health, London, UK.,Reproductive Medicine Unit, University College London Hospitals NHS Foundation Trust, London, UK
| | - Wael Saab
- Centre for Reproductive and Genetic Health, London, UK
| | - Paul Serhal
- Centre for Reproductive and Genetic Health, London, UK
| | | |
Collapse
|
32
|
Dai C, Zhang Z, Shan G, Chu LT, Huang Z, Moskovtsev S, Librach C, Jarvi K, Sun Y. Advances in sperm analysis: techniques, discoveries and applications. Nat Rev Urol 2021; 18:447-467. [PMID: 34075227 DOI: 10.1038/s41585-021-00472-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2021] [Indexed: 02/05/2023]
Abstract
Infertility affects one in six couples worldwide, and fertility continues to deteriorate globally, partly owing to a decline in semen quality. Sperm analysis has a central role in diagnosing and treating male factor infertility. Many emerging techniques, such as digital holography, super-resolution microscopy and next-generation sequencing, have been developed that enable improved analysis of sperm motility, morphology and genetics to help overcome limitations in accuracy and consistency, and improve sperm selection for infertility treatment. These techniques have also improved our understanding of fundamental sperm physiology by enabling discoveries in sperm behaviour and molecular structures. Further progress in sperm analysis and integrating these techniques into laboratories and clinics requires multidisciplinary collaboration, which will increase discovery and improve clinical outcomes.
Collapse
Affiliation(s)
- Changsheng Dai
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, Canada
| | - Zhuoran Zhang
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, Canada
| | - Guanqiao Shan
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, Canada
| | - Lap-Tak Chu
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, Canada
| | - Zongjie Huang
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, Canada
| | | | | | - Keith Jarvi
- Division of Urology, Mount Sinai Hospital, Toronto, Canada. .,Department of Surgery, University of Toronto, Toronto, Canada.
| | - Yu Sun
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, Canada. .,Institute of Biomaterials & Biomedical Engineering, University of Toronto, Toronto, Canada. .,Department of Electrical and Computer Engineering, University of Toronto, Toronto, Canada. .,Department of Computer Science, University of Toronto, Toronto, Canada.
| |
Collapse
|
33
|
Abstract
Intracytoplasmic sperm injection (ICSI) is a commonly used in vitro fertilization technique. Selection of sperm for injection is currently done using subjective assessment of morphology, which may not accurately identify the best-quality sperm. Hyaluronic acid receptors on sperm plasma membranes are a marker of maturity, and sperms which are capable of binding immobilized hyaluronic acid in vitro are of higher quality. This can be used as an advanced sperm selection technique to choose sperm for ICSI, termed physiological ICSI (PICSI). Several studies reported improved fertility treatment outcomes when using PICSI compared with conventional ICSI; however, the majority of studies are underpowered. Recently, a large, multicenter, randomized controlled trial, known as the Hyaluronic Acid Binding Sperm Selection (HABSelect) trial, found a significant reduction in miscarriage rates with PICSI, but no significant effect on live birth rate. There are still many avenues through which PICSI may provide an advantage, subject to confirmation by future research, such as improved long-term health of offspring. Other advanced sperm selection techniques include intracytoplasmic morphologically selected sperm injection, magnetic-activated cell sorting, and Zeta potential sperm selection; however, the most recent Cochrane review concluded that there is currently insufficient evidence to ascertain whether these techniques improve clinical outcomes, such as live birth rates.
Collapse
Affiliation(s)
- Catherine Martin
- Salisbury Fertility Centre, Salisbury District Hospital, Salisbury, United Kingdom
| | - Emma Woodland
- Salisbury Fertility Centre, Salisbury District Hospital, Salisbury, United Kingdom
| |
Collapse
|
34
|
Reproductive Outcomes of Different Sperm Selection Techniques for ICSI Patients with Abnormal Sperm DNA Fragmentation: a Randomized Controlled Trial. Reprod Sci 2021; 29:220-228. [PMID: 34076869 DOI: 10.1007/s43032-021-00642-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 05/27/2021] [Indexed: 10/21/2022]
Abstract
The aim of the study is to compare the reproductive outcomes of different sperm selection techniques: density gradient centrifugation (DGC), testicular sperm (Testi), physiological ICSI (PICSI), and magnetic-activated cell sorting (MACS) in abnormal sperm DNA fragmentation (SDF) ICSI patients. A randomized controlled trial included 302 patients with abnormal SDF undergoing ICSI where they were randomized into 4 groups: a control group of DGC (n= 72), Testi (n=73), PICSI (n=78), and MACS (n=79). Results showed no significant differences in the male age, female age, or SDF between the four groups. Testi group had significantly lower cleavage and blastulation rates compared to PICSI, DGC, or MACS groups (p =0.001). For the high-quality blastocysts, DGC and MACS groups had significantly higher rate than the Testi group (p =0.014). The highest pregnancy rate was scored for the PICSI group (69.6%), while the lowest pregnancy rate was scored for the DGC group (51.4%) with (p =0.025). The PICSI group showed a significantly higher implantation rate compared to the other groups (p =0.003). Regarding the ongoing pregnancy rate, the significant difference was observed between the PICSI (62.8%) and MACS (62%) vs. DGC (45.8%). Besides, no significant differences were found in the miscarriage rates between the four groups. In conclusion, PICSI and MACS along with DGC showed significant improvement in embryological and clinical outcome over testicular sperm or sperm processed by DGC alone in patients with abnormal SDFRegistration number: NCT04482517.
Collapse
|
35
|
Vaughan DA, Tirado E, Garcia D, Datta V, Sakkas D. DNA fragmentation of sperm: a radical examination of the contribution of oxidative stress and age in 16 945 semen samples. Hum Reprod 2021; 35:2188-2196. [PMID: 32976601 DOI: 10.1093/humrep/deaa159] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 05/28/2020] [Indexed: 02/07/2023] Open
Abstract
STUDY QUESTION What is the relationship between sperm DNA fragmentation and oxidative stress (OS) with increasing male age? SUMMARY ANSWER Sperm DNA fragmentation increases with age and is likely related to both defective spermatogenesis and increasing OS levels. WHAT IS KNOWN ALREADY Sperm quality declines with age. The presence of DNA damage in a high fraction of spermatozoa from a raw semen sample is associated with lower male fertility in natural conception and intrauterine insemination. STUDY DESIGN, SIZE, DURATION A retrospective cohort study of 16 945 semen samples analysed at a single reference laboratory between January 2010 and December 2018. PARTICIPANTS/MATERIALS, SETTING, METHODS All males were undergoing an infertility evaluation. The cohort was divided into seven age categories: <30, 30-34, 35-39, 40-44, 45-49, 50 to <54 and ≥55 years. The mean age was 37.6 years (SD 6.8). Sperm DNA fragmentation index (DFI) and high DNA stainability (HDS) were calculated using flow cytometry. OS levels were measured using the oxidative stress adducts (OSA) test, by spectrophotometry. ANOVA with weighted polynomial contrast analysis was used to evaluate trends for DFI, OSA and HDS values across age categories. MAIN RESULTS AND THE ROLE OF CHANCE Mean DFI significantly increased across all age groups (Ptrend < 0.001). OSA was lowest in patients <30 years old (mean 3.6, SD 1.0) and also increased as age increased (Ptrend < 0.001). There was a statistically significant difference between age groups for each of the three parameters (P < 0.001). There was a significant linear trend for DFI, OSA and HDS across the seven age categories (P < 0.001). Among patients with high DFI, there was a decreasing age-dependent trend in the patients observed with high OSA (P < 0.001). LIMITATIONS, REASONS FOR CAUTION This is a retrospective study. All males included in the study were undergoing a work-up for infertility and may not be representative of a fertile population. Additional patient demographics and clinical data were not available. WIDER IMPLICATIONS OF THE FINDINGS DNA and/or oxidative damage in sperm may be just as important to understand as the chromosomal aberrations that are carried in the oocyte. Further studies are needed to evaluate the effect of advancing paternal age on the male genome and, ultimately, on the health of the offspring. STUDY FUNDING/COMPETING INTEREST(S) No funding was obtained for this study. V.D. is an employee of Reprosource/Quest Diagnostics. D.S. reports he was a Scientific Advisor to Cooper Surgical. TRIAL REGISTRATION NUMBER N/A.
Collapse
Affiliation(s)
- D A Vaughan
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA 02115, USA.,Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, MA 02115, USA.,Boston IVF, Waltham, MA 02445, USA
| | - E Tirado
- ReproSource Fertility Diagnostics, Marlborough, MA 01752, USA
| | - D Garcia
- Clinica EUGIN, Barcelona 08029, Spain
| | - V Datta
- ReproSource Fertility Diagnostics, Marlborough, MA 01752, USA
| | - D Sakkas
- Boston IVF, Waltham, MA 02445, USA
| |
Collapse
|
36
|
Shi ZD, Zhang YP, Zhai LP, Zhang MH, Dong YL, Yang HJ, Qiu Y. Sperm Parameters, ASAs and Apoptosis After Processing by the Double Tube and Swim up Methods. Am J Mens Health 2021; 15:15579883211001202. [PMID: 33759613 PMCID: PMC7995456 DOI: 10.1177/15579883211001202] [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: 11/15/2022] Open
Abstract
The aim of this study was to improve the quality of semen samples by using a novel double-tube (DT) method. The DT method was developed to select sperm and compared with traditional swim-up (SU) technique for 31 semen samples. Sperm DNA integrity were tested with TUNEL and SCSA. Content of antisperm antibodies (ASA) in the semen was measured by ELISA and MAR. Levels of the caspase-3 in the sperm were assessed by western blotting. After SU and DT, 15 couples and 16 couples were underwent IVF-ET. The number of RCDs, the percentage of SDF and DFI, ASA and the level of caspase-3 were significantly decreased after DT and SU (p = .001 and p< .001). When the DT and SU compared, there were significant changes in the number of RCD, the percentage of SDF and DFI, ASA and the level of caspase-3 (p< 0.05-0.001). There was a higher cleavage rate (p = .017) and a lower abortion rate (p< .05) in DT-IVF group than in SU-IVF group. DT selection yielded spermatozoa with low RCDs, DFI, ASA, and caspase-3 which would be benefit for ART.
Collapse
Affiliation(s)
- Zhi-Da Shi
- Key Laboratory of Birth Regulation and Control Technology of National Health Commission of China, Key Laboratory for Improving Birth Outcome Technique, Maternal and Child Health Care Hospital of Shandong Province, Jinan, Shandong, People's Republic of China
| | - Yan-Ping Zhang
- Key Laboratory of Birth Regulation and Control Technology of National Health Commission of China, Key Laboratory for Improving Birth Outcome Technique, Maternal and Child Health Care Hospital of Shandong Province, Jinan, Shandong, People's Republic of China
| | - Li-Ping Zhai
- Shandong Provincial Institute of Control of Endemic Disease, Jinan, Shandong, People's Republic of China
| | - Mei-Hua Zhang
- Key Laboratory of Birth Regulation and Control Technology of National Health Commission of China, Key Laboratory for Improving Birth Outcome Technique, Maternal and Child Health Care Hospital of Shandong Province, Jinan, Shandong, People's Republic of China
| | - Yun-Ling Dong
- Key Laboratory of Birth Regulation and Control Technology of National Health Commission of China, Key Laboratory for Improving Birth Outcome Technique, Maternal and Child Health Care Hospital of Shandong Province, Jinan, Shandong, People's Republic of China
| | - Hui-Jun Yang
- Key Laboratory of Birth Regulation and Control Technology of National Health Commission of China, Key Laboratory for Improving Birth Outcome Technique, Maternal and Child Health Care Hospital of Shandong Province, Jinan, Shandong, People's Republic of China
| | - Yi Qiu
- Key Laboratory of Birth Regulation and Control Technology of National Health Commission of China, Key Laboratory for Improving Birth Outcome Technique, Maternal and Child Health Care Hospital of Shandong Province, Jinan, Shandong, People's Republic of China
| |
Collapse
|
37
|
Novoselsky Persky M, Hershko-Klement A, Solnica A, Bdolah Y, Hurwitz A, Ketzin El Gilad M, Nefesh I, Esh-Broder E. Conventional ICSI vs. physiological selection of spermatozoa for ICSI (picsi) in sibling oocytes. Andrology 2021; 9:873-877. [PMID: 33523582 DOI: 10.1111/andr.12982] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 01/04/2021] [Accepted: 01/26/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Physiological selection of spermatozoa for ICSI (PICSI) is a sperm selection method based on sperm binding to hyaluronic acid. Previous studies on the effect of hyaluronic acid binding assays on fertilization and embryo quality have shown inconsistent results. Previous sibling oocyte studies have not found a significant improvement in fertilization or embryo development with hyaluronic acid binding assays. OBJECTIVE To compare fertilization and embryo development between standard intracytoplasmic sperm injection (ICSI) and PICSI in sibling oocytes. MATERIALS AND METHODS This is a retrospective analysis of all in vitro fertilization (IVF) cycles between January 2017 and April 2020 in which sibling oocytes were randomly fertilized by both ICSI and PICSI. Fertilization rate and the rate of embryos eligible for transfer were compared. RESULTS Forty-five IVF cycles, in which 257 oocytes were fertilized with PICSI and 294 with standard ICSI, were compared. Most of the patients included in the study had previous failures of fertilization, poor embryonic development, implantation failure, or miscarriage. All but two of the patients had at least one previous unsuccessful IVF cycle. Both fertilization rates (71% vs. 83%) and transfer eligible embryo rates (38% vs. 51%) were significantly higher in PICSI fertilized oocytes (p = 0.008 and p = 0.01 respectively). DISCUSSION Our study is the largest sibling oocyte study comparing ICSI and PICSI, and the first to find a significant improvement in fertilization and embryo quality with PICSI using sibling oocytes. The fact our cohort included almost exclusively couples with previous unsuccessful IVF cycles might suggest that PICSI should be used in selected cases. CONCLUSION PICSI improves fertilization rates and transfer eligible embryo rates in sibling oocytes in a selected study group.
Collapse
Affiliation(s)
- Michal Novoselsky Persky
- IVF Unit, Department of Obstetrics and Gynecology, Hadassah Mt. Scopus Hebrew University Medical Center, Jerusalem, Israel
| | - Anat Hershko-Klement
- IVF Unit, Department of Obstetrics and Gynecology, Hadassah Mt. Scopus Hebrew University Medical Center, Jerusalem, Israel
| | - Amy Solnica
- IVF Unit, Department of Obstetrics and Gynecology, Hadassah Mt. Scopus Hebrew University Medical Center, Jerusalem, Israel.,Henrietta Szold School of Nursing, Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Yuval Bdolah
- IVF Unit, Department of Obstetrics and Gynecology, Shaare Zedek Medical center, Jerusalem, Israel
| | - Arye Hurwitz
- IVF Unit, Department of Obstetrics and Gynecology, Shaare Zedek Medical center, Jerusalem, Israel
| | - Mali Ketzin El Gilad
- IVF Unit, Department of Obstetrics and Gynecology, Hadassah Mt. Scopus Hebrew University Medical Center, Jerusalem, Israel
| | - Iris Nefesh
- IVF Unit, Department of Obstetrics and Gynecology, Hadassah Mt. Scopus Hebrew University Medical Center, Jerusalem, Israel
| | - Efrat Esh-Broder
- IVF Unit, Department of Obstetrics and Gynecology, Hadassah Mt. Scopus Hebrew University Medical Center, Jerusalem, Israel
| |
Collapse
|
38
|
Awan MA, Arshad J, Rakha BA, Ansari MS, Waseem M, Fouladi-Nashta A, Miller D, Akhter S. Sperm binding to hyaluronan is an excellent predictor of Nili-Ravi buffalo bull fertility. Andrologia 2021; 53:e13991. [PMID: 33528065 DOI: 10.1111/and.13991] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 12/26/2020] [Accepted: 01/04/2021] [Indexed: 11/28/2022] Open
Abstract
This study reports the first evaluation of sperm hyaluronan binding assay (HBA) for predicting the fertility of Nili-Ravi buffalo bulls in relation to standard parameters of sperm quality. Cryopreserved semen doses of low (n = 6), medium (n = 3) and high fertility (n = 8) bulls based on their respective return rates were used. Significantly, more spermatozoa bound to hyaluronan from the most fertile bulls (57.15% ± 1.44) compared with medium (42.46% ± 1.08) and low fertility bulls (29.70% ± 0.78). A strongly positive correlation (r = .824, p < .01) was found between HBA and fertility that predicts a 67.9% variability (r2 = .679, p < .01) in fertility. HBA was also strongly positively correlated with sperm viability (r = .679, p < .01) followed by their live/dead ratio (r = .637, p < .01), uncapacitated spermatozoa (r = .631, p < .01), normal apical ridge (r = .459, p < .01), motility (r = .434, p < .01), mature spermatozoa with low residual histones (r = .364, p < .01), high plasma membrane integrity (r = .316, p < .01) and nonfragmented DNA levels (r = .236, p < .05). It was negatively correlated with spermatozoa having reacted acrosome (r = -.654, p < .01). A fertility model built using a combination of sperm HBA and either sperm livability or viability predicts, respectively, 86.1% (r2 = .861, p < .01) and 85.9% (r2 = .859, p < .01) variability in buffalo bull fertility. In conclusion, sperm HBA may prove to be a single robust predictor of Nili-Ravi buffalo bull fertility.
Collapse
Affiliation(s)
- Muhammad Amjad Awan
- Department of Zoology, Pir Mehr Ali Shah Arid Agriculture University, Rawalpindi, Pakistan
| | - Javeria Arshad
- Department of Zoology, Pir Mehr Ali Shah Arid Agriculture University, Rawalpindi, Pakistan
| | - Bushra Allah Rakha
- Department of Wildlife Management, Pir Mehr Ali Shah Arid Agriculture University, Rawalpindi, Pakistan
| | | | | | - Ali Fouladi-Nashta
- Reproduction Research Group, Royal Veterinary College, Hatfield, United Kingdom
| | - David Miller
- LIGHT Laboratories, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Shamim Akhter
- Department of Zoology, Pir Mehr Ali Shah Arid Agriculture University, Rawalpindi, Pakistan
| |
Collapse
|
39
|
Male Factors: the Role of Sperm in Preimplantation Embryo Quality. Reprod Sci 2020; 28:1788-1811. [DOI: 10.1007/s43032-020-00334-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 09/25/2020] [Indexed: 12/19/2022]
|
40
|
IVF, from the past to the future: the inheritance of the Capri Workshop Group. Hum Reprod Open 2020; 2020:hoaa040. [PMID: 33005753 PMCID: PMC7508025 DOI: 10.1093/hropen/hoaa040] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 07/07/2020] [Indexed: 12/26/2022] Open
Abstract
Today IVF use is booming all over the world and has even started to play a role in demographic analyses. Prognosis-adjusted estimates suggest that up to two-thirds of couples could achieve a live birth. However, the scenario is less exciting in reality. Discontinuation during the cycles is common, and age and ovarian response continue to be crucial in modulating this rate of success. A growing interest is now given to the risk of abuses and in particular to overtreatment and to prescriptions of useless, if not harmful, expensive additional treatments (‘add-ons’). A more rational, evidence-based and wise approach is needed. From a scientific perspective, several obscure aspects remain and warrant future investigations. Of particular interest are the neglected role of sperm selection, the potential adult implications of early embryo life in vitro and the issue of sustainability.
Collapse
|
41
|
Bosch E, Espinós JJ, Fabregues F, Fontes J, García-Velasco J, Llácer J, Requena A, Checa MA, Bellver J. ALWAYS ICSI? A SWOT analysis. J Assist Reprod Genet 2020; 37:2081-2092. [PMID: 32578032 PMCID: PMC7492350 DOI: 10.1007/s10815-020-01836-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 05/17/2020] [Indexed: 12/21/2022] Open
Abstract
PURPOSE Intracytroplasmatic sperm injection (ICSI) is a common procedure used to improve reproductive results, even among couples without male factor infertility. However, the evidence available is still uncertain on the possible advantages and deficiencies that this procedure may have in patients with no formal indication for ICSI. METHODS A SWOT (strengths, weaknesses, opportunities, threats) analysis examines the possible advantages and deficiencies of performing ICSI in these patients with no formal indication. RESULTS The evidence suggests that ICSI is not justified for non-male factor infertile couples requiring in vitro conception. One of the major strengths associated to the procedure is the virtual elimination of cases further complicated by total fertilization failure and a combination between IVF and ICSI on sibling oocytes has been advised in the literature. Greater technical difficulties, higher costs and performing an unnecessary invasive technique in some cases represent some of the weaknesses of the procedure, and questions regarding safety issues should not be ruled out. CONCLUSION Despite the widespread use of ICSI in patients without a formal diagnosis of male factor infertility, evidence demonstrating its effectiveness in this population is still lacking. Additional large and well-designed randomized controlled trials are needed to clarify definitive indications for ICSI in non-male factor infertility.
Collapse
Affiliation(s)
- E Bosch
- IVI RMA Valencia, Plaza de la Policía Local, 3, 46015, Valencia, Spain.
| | - J J Espinós
- Fertty, Ausiàs March 25, 08010, Barcelona, Spain
- Universidad Autónoma de Barcelona, Campus de la UAB, Plaza Cívica, s/n, 08193, Bellaterra (Barcelona), Spain
| | - F Fabregues
- Institut Clinic Gynecology, Obstetrics and Neonatology (ICGON), Hospital Clinic, C/Villarroel 160, 08036, Barcelona, Spain
| | - J Fontes
- Hospital Universitario Virgen de las Nieves, Avd Fuerzas Armadas s/n, 18014, Granada, Spain
| | | | - J Llácer
- Instituto Bernabeu Alicante, Av. Albufereta, 31, 03540, Alacant (Alicante), Spain
| | - A Requena
- IVI RMA Madrid, Avda. del Talgo 68, 28023, Madrid, Spain
| | - M A Checa
- Hospital del Mar-Parc de Salut Mar, Paseo Maritimo 25-29, 08005, Barcelona, Spain
| | - J Bellver
- IVI RMA Valencia, Plaza de la Policía Local, 3, 46015, Valencia, Spain
- Departamento de Pediatría, Obstetricia y Ginecología. Facultad de Medicina, Universidad de Valencia, Valencia, Spain
| |
Collapse
|
42
|
Hasanen E, Elqusi K, ElTanbouly S, Hussin AE, AlKhadr H, Zaki H, Henkel R, Agarwal A. PICSI vs. MACS for abnormal sperm DNA fragmentation ICSI cases: a prospective randomized trial. J Assist Reprod Genet 2020; 37:2605-2613. [PMID: 32772268 DOI: 10.1007/s10815-020-01913-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 08/03/2020] [Indexed: 12/11/2022] Open
Abstract
PURPOSE To know which sperm selection technique, physiological intracytoplasmic sperm injection (PICSI) or magnetic-activated cell sorting (MACS), is better for the selection of sperm with abnormal sperm DNA fragmentation (SDF) in patients undergoing intracytoplasmic sperm injection (ICSI). METHODS A prospective randomized trial included 413 ICSI cases with abnormal SDF (> 20.3%) by TUNEL assay. Patients with at least 1 million total progressive motile sperm count were randomized to PICSI or MACS groups on the day of ICSI. PICSI depends on the hyaluronan binding of better SDF sperm where individual sperm was selected, while MACS selects non-apoptotic sperm population using Annexin V magnetic beads. All pre-implantation embryogenic parameters were observed and the main outcome was the ongoing pregnancy rate. RESULTS There were no significant differences between patients allocated to PICSI and MACS in the studied parameters including pre-implantation embryological data, implantation, clinical pregnancy, and ongoing pregnancy rates. Meanwhile, sub-analysis according to the female age has shown that female patients with less than 30 years of age in the MACS group had significantly higher good-quality blastocyst, clinical pregnancy, and ongoing pregnancy rates than the PICSI group. However, the higher implantation (p = 0.051), clinical pregnancy (p = 0.078), and ongoing pregnancy (p = 0.097) rates observed in females between 30 and 35 years of age in the PICSI group did not reach significance level. CONCLUSIONS PICSI and MACS are efficient techniques for sperm selection in cases with abnormal sperm DNA fragmentation. However, MACS is preferred when the females are younger than 30 years, while PICSI is preferred in older females. CLINICAL TRIAL REGISTRATION NUMBER NCT03398317 (retrospectively registered).
Collapse
Affiliation(s)
- Eman Hasanen
- IVF Laboratory, Ganin Fertility Center, Cairo, 11728, Egypt.
| | - Khaled Elqusi
- IVF Laboratory, Ganin Fertility Center, Cairo, 11728, Egypt
| | | | | | - Hanaa AlKhadr
- IVF Laboratory, Ganin Fertility Center, Cairo, 11728, Egypt
| | - Hosam Zaki
- IVF Laboratory, Ganin Fertility Center, Cairo, 11728, Egypt
| | - Ralf Henkel
- University of the Western Cape, Cape Town, South Africa.,American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Ashok Agarwal
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
| |
Collapse
|
43
|
Maheshwari A, Healey J, Bhattacharya S, Cooper K, Saraswat L, Horne AW, Daniels J, Breeman S, Brian K, Burns G, Hudson J, Gillies K. Surgery for women with endometrioma prior to in vitro fertilisation: proposal for a feasible multicentre randomised clinical trial in the UK. Hum Reprod Open 2020; 2020:hoaa012. [PMID: 32529045 PMCID: PMC7275637 DOI: 10.1093/hropen/hoaa012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 01/15/2020] [Accepted: 02/10/2020] [Indexed: 12/27/2022] Open
Abstract
STUDY QUESTION Is it feasible to undertake a randomised controlled trial to establish whether surgical removal of endometrioma or not, improves live birth rates from IVF? SUMMARY ANSWER A randomised controlled trial (RCT) comparing surgery versus no surgery to endometrioma prior to IVF is only feasible in UK if an adaptive rather than traditional study design is used; this would minimise resource wastage and complete the trial in an acceptable time frame. WHAT IS KNOWN ALREADY There is wide variation in the management of endometriomas prior to IVF, with decisions about treatment being influenced by personal preferences. STUDY DESIGN, SIZE, AND DURATION This was a mixed-methods study consisting of an online survey of clinicians, a focus group and individual interviews with potential trial participants. PARTICIPANTS/MATERIALS, SETTING, METHODS Endometriosis and fertility experts across the UK were invited to participate in an online anonymised questionnaire. Potential future trial participants were recruited from a tertiary care fertility centre and invited to participate in either individual interviews or focus groups. MAIN RESULTS AND THE ROLE OF CHANCE Clinicians and potential trial participants confirmed the need for an RCT to inform the management of an endometrioma prior to IVF. There were 126 clinicians who completed the survey, and the majority (70%) were willing to recruit to a trial. Half of those who responded indicated that they see at least 10 eligible women each year. The main barriers to recruitment were waiting lists for surgery and access to public funding for IVF. One focus group (n = 7) and five interviews were conducted with potential trial participants (n = 3) and their partners (n = 2). The findings from these discussions highlighted that recruitment and retention in a potential RCT could be improved by coordination between IVF and surgical services such that an operation does not delay IVF or affect access to public funding. Live birth was considered the most important outcome with an improvement of at least 10% considered the minimum acceptable by both patients and clinicians. LIMITATIONS, REASONS FOR CAUTION This feasibility study captured views of clinicians across the UK, but as patients were from a single Scottish centre, their views may not be representative of other areas with limited public funding for IVF. WIDER IMPLICATIONS OF THE FINDINGS There is a need for an appropriately powered RCT to establish whether or not surgical treatment of endometrioma prior to IVF improves live birth rates. There are logistical issues to be considered due to limited number of participants, funding of IVF and waiting times. These could be overcome in a RCT by using an adaptive design which would include a prospectively planned opportunity for modification of specified aspects of the study design based on interim analysis of the data, coordination of IVF treatments and endometriosis surgeries and international collaboration. Similar principles could be used for other questions in fertility where a traditional approach for randomised trials is not feasible. STUDY FUNDING/COMPETING INTEREST(S) Funding was received from the NHS Grampian R&D pump priming fund (RG14437-12). S.B. is Editor-in-Chief of HROPEN, and A.W.H. is Deputy Editor of HROPEN. Neither was involved in the review of this manuscript. L.S. reports grants from CSO and NIHR to do endometriosis research, outside the submitted work. K.C. reports grants from NIHR/HTA and CSO during the conduct of the study. J.H.e., A.W.H., J.D., S.B.r., K.B., G.B., J.H.u. and K.G. report no conflict of interest.
Collapse
Affiliation(s)
- Abha Maheshwari
- Aberdeen Fertility Centre, NHS Grampian, Aberdeen AB25 2ZL, UK
| | - Jemma Healey
- Health Service Research Unit, University of Aberdeen, Aberdeen AB25 2ZD, UK
| | - Siladitya Bhattacharya
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | | | | | - Andrew W Horne
- The Queen's Medical Research InstituteEdinburgh, EH16 4TJ, UK
| | - Jane Daniels
- Faculty of Medical & Health Sciences, Nottingham, NG7 2UH, UK
| | - Suzanne Breeman
- Clinical Trials Unit, Health Services Research Unit, University of Aberdeen, Aberdeen AB25 2ZD, UK
| | - Kate Brian
- Women's Voices, Royal College of Obstetricians and Gynaecologists, London, UK
| | | | - Jemma Hudson
- Health Services Research Unit, University of Aberdeen, Aberdeen AB25 2ZD, UK
| | - Katie Gillies
- Health Services Research Unit, University of Aberdeen, Aberdeen AB25 2ZD, UK
| |
Collapse
|
44
|
Venetis C, d'Hooghe T, Barnhart KT, Bossuyt PMM, Mol BWJ. Methodologic considerations in randomized clinical trials in reproductive medicine. Fertil Steril 2020; 113:1107-1112. [PMID: 32482246 DOI: 10.1016/j.fertnstert.2020.04.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 04/14/2020] [Accepted: 04/16/2020] [Indexed: 10/24/2022]
Abstract
Randomized controlled trials (RCTs) are the cornerstone of evidence-based medicine. In this series in Fertility and Sterility, several aspects of RCTs are discussed, with contributions on multicenter RCTs, different international settings, and integrity of RCTs. The present contribution deals with methodologic issues. We discuss different types of RCTs based on null hypothesis (superiority vs. noninferiority vs. equivalence) as well as frequentist versus Bayesian interpretation. We also discuss the use of RCTs in the era of personalized medicine and RCTs to address diagnostic and prognostic questions. Finally, we address the use of big data compared with the use of RCTs.
Collapse
Affiliation(s)
- Christos Venetis
- Centre for Big Data Research in Health, University of New South Wales Medicine, New South Wales, Australia; School of Women's and Children's Health, University of New South Wales Medicine, New South Wales, Australia; IVF Australia, Sydney, New South Wales, Australia
| | - Thomas d'Hooghe
- Global Medical Affairs Fertility, Research and Development, Merck Healthcare KGaA, Darmstadt, Germany; Reproductive Medicine Research Group, Department of Development and Regeneration, Organ Systems, Group Biomedical Sciences, KU Leuven (University of Leuven), Leuven, Belgium; Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
| | - Kurt T Barnhart
- Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Patrick M M Bossuyt
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Ben Willem J Mol
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia.
| |
Collapse
|
45
|
Abstract
Sperm DNA damage reduces pregnancy rates in couples undergoing in vitro fertilization (IVF). Because it has been shown that testicular sperm have lower DNA damage than ejaculated sperm, it is an attractive idea to consider using testicular sperm for IVF for men with high sperm DNA damage. In fact, there are multiple centers throughout the world now offering sperm retrieval for IVF to manage this condition. However, there is insufficient evidence to conclude that testicular sperm improves pregnancy/live birth rates. Further studies are required before offering sperm retrieval as a standard of care to manage high sperm DNA damage.
Collapse
|
46
|
Kim SJ, Kim H, Kim TH, Jeong J, Lee WS, Lyu SW. Effect of sperm selection using hyaluronan on fertilization and quality of cleavage-stage embryos in intracytoplasmic sperm injection (ICSI) cycles of couples with severe teratozoospermia. Gynecol Endocrinol 2020; 36:456-459. [PMID: 31657242 DOI: 10.1080/09513590.2019.1681960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
This study aimed to evaluate the effect of hyaluronan-selected/physiological intracytoplasmic sperm injection (PICSI) on fertilization and quality of cleavage-stage embryos in infertile couples with ≤1% of spermatozoa with normal strict morphology (severe teratozoospermia). Seventy-seven couples underwent PICSI between October 2017 and December 2018 (PICSI group), while 75 couples underwent conventional intracytoplasmic sperm injection (ICSI) between January 2016 and September 2017 (ICSI group). Good quality embryos (GQEs) were evaluated based on morphology. Patient and cycle characteristics were comparable between the PICSI and ICSI groups, except for age and anti-Müllerian hormone (AMH) level (38.4 ± 3.9 years vs. 36.3 ± 4.3 years, p = .002 and 2.06 ± 1.99 ng/mL vs. 2.97 ± 3.25 ng/mL, p = .040). The fertilization rate per oocyte inseminated and GQE rate were significantly higher in the PICSI group than in the ICSI group (82.7% vs. 71.7%, p ˂ .001 and 52.8% vs. 34.0%, p ˂ .001). Furthermore, the absence of GQEs was found to be lower in the PICSI group (13.0% vs. 30.7%, p = .008). Multivariate analysis adjusted for age and AMH level identified PICSI as an unfavorable and independent factor for the absence of GQEs (adjusted odds ratio, 0.333; 95% confidence interval, 0.125-0.890). PICSI seems to be superior to ICSI in terms of fertilization and embryo quality in couples with severe teratozoospermia.
Collapse
Affiliation(s)
- Se Jeong Kim
- Department of Obstetrics and Gynecology, Fertility Center of CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, Republic of Korea
| | - Hyunjin Kim
- Department of Obstetrics and Gynecology, Fertility Center of CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, Republic of Korea
| | - Tae Hyung Kim
- Department of Obstetrics and Gynecology, Fertility Center of CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, Republic of Korea
| | - Jihye Jeong
- Department of Obstetrics and Gynecology, Fertility Center of CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, Republic of Korea
| | - Woo Sik Lee
- Department of Obstetrics and Gynecology, Fertility Center of CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, Republic of Korea
| | - Sang Woo Lyu
- Department of Obstetrics and Gynecology, Fertility Center of CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, Republic of Korea
| |
Collapse
|
47
|
The current status and future of andrology: A consensus report from the Cairo workshop group. Andrology 2019; 8:27-52. [PMID: 31692249 DOI: 10.1111/andr.12720] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 10/24/2019] [Accepted: 10/24/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND In attempting to formulate potential WHO guidelines for the diagnosis of male infertility, the Evidence Synthesis Group noted a paucity of high-quality data on which to base key recommendations. As a result, a number of authors suggested that key areas of research/evidence gaps should be identified, so that appropriate funding and policy actions could be undertaken to help address key questions. OBJECTIVES The overall objective of this Consensus workshop was to clarify current knowledge and deficits in clinical laboratory andrology, so that clear paths for future development could be navigated. MATERIALS AND METHODS Following a detailed literature review, each author, prior to the face-to-face meeting, prepared a summary of their topic and submitted a PowerPoint presentation. The topics covered were (a) Diagnostic testing in male fertility and infertility, (b) Male fertility/infertility in the modern world, (c) Clinical management of male infertility, and (d) The overuse of ICSI. At the meeting in Cairo on February 18, 2019, the evidence was presented and discussed and a series of consensus points agreed. RESULTS The paper presents a background and summary of the evidence relating to these four topics and addresses key points of significance. Following discussion of the evidence, a total of 36 consensus points were agreed. DISCUSSION The Discussion section presents areas where there was further debate and key areas that were highlighted during the day. CONCLUSION The consensus points provide clear statements of evidence gaps and/or potential future research areas/topics. Appropriate funding streams addressing these can be prioritized and consequently, in the short and medium term, answers provided. By using this strategic approach, andrology can make the rapid progress necessary to address key scientific, clinical, and societal challenges that face our discipline now and in the near future.
Collapse
|
48
|
Oseguera-López I, Ruiz-Díaz S, Ramos-Ibeas P, Pérez-Cerezales S. Novel Techniques of Sperm Selection for Improving IVF and ICSI Outcomes. Front Cell Dev Biol 2019; 7:298. [PMID: 31850340 PMCID: PMC6896825 DOI: 10.3389/fcell.2019.00298] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 11/07/2019] [Indexed: 12/12/2022] Open
Abstract
Almost 50% of the infertility cases are due to male factors. Assisted reproductive technologies (ARTs) allow to overcome the incapacity of these patients' spermatozoa to fertilize the oocyte and produce a viable and healthy offspring, but the efficiency of the different techniques has still the potential to improve. According to the latest reports of the European Society of Human Reproduction and Embryology (ESHRE) and the Centers for Disease Control and Prevention of the United States (CDC), the percentages of deliveries per ART cycle in 2014 and 2016 were 21 and 22%, respectively. Among the reasons for this relatively low efficiency, the quality of the spermatozoa has been pointed out as critical, and the presence of high percentages of DNA-damaged spermatozoa in patients' ejaculates is possibly one of the main factors reducing the ARTs outcomes. Thus, one of the main challenges in reproductive medicine is to ensure the highest quality of the spermatozoa used in ARTs, and specifically, in terms of genetic integrity. The latest techniques for the preparation and selection of human spermatozoa are herein discussed focusing on those proven to improve one or several of the following parameters: sperm genetic integrity, fertilization capacity, embryo production, and in vitro survival, as well as pregnancy and delivery rates following in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI). In addition, we discuss the potential of techniques developed in non-human mammals that could be further transferred to the clinic.
Collapse
Affiliation(s)
| | - Sara Ruiz-Díaz
- Mistral Fertility Clinics S.L., Clínica Tambre, Madrid, Spain
- Department of Animal Reproduction, Instituto Nacional de Investigación y Tecnología Agraria y Alimentaria, Madrid, Spain
| | - Priscila Ramos-Ibeas
- Department of Animal Reproduction, Instituto Nacional de Investigación y Tecnología Agraria y Alimentaria, Madrid, Spain
| | - Serafín Pérez-Cerezales
- Department of Animal Reproduction, Instituto Nacional de Investigación y Tecnología Agraria y Alimentaria, Madrid, Spain
| |
Collapse
|
49
|
Kirshenbaum M, Orvieto R. Should We Offer In Vitro Fertilization to Couples with Unexplained Recurrent Pregnancy Loss? J Clin Med 2019; 8:E2001. [PMID: 31744073 PMCID: PMC6912379 DOI: 10.3390/jcm8112001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 11/08/2019] [Accepted: 11/14/2019] [Indexed: 01/11/2023] Open
Abstract
In clinical practice, empirical treatments are often offered to couples with recurrent pregnancy loss, including in vitro fertilization. Given that most patients with recurrent pregnancy loss are fertile, the scientific rationale of in vitro fertilization for these couple is debatable. This review will discuss the potential benefits of using in vitro fertilization in couples with recurrent pregnancy loss, such as shortening the time to conceive, optimizing the timing of conception, improving gamete and embryo quality, endometrial receptivity and the use of "adds-on". At present, there is not enough evidence to justify IVF as a treatment option in couples with unexplained recurrent pregnancy loss.
Collapse
Affiliation(s)
- Michal Kirshenbaum
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel-Hashomer, Ramat Gan 52621, Israel;
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 39040, Israel
| | - Raoul Orvieto
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel-Hashomer, Ramat Gan 52621, Israel;
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 39040, Israel
- The Tarnesby-Tarnowski Chair for Family Planning and Fertility Regulation, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv 39040, Israel
| |
Collapse
|
50
|
Netherton J, Ogle R, Hetherington L, Velkov T, Rose R, Baker M. DNA variants are an unlikely explanation for the changing quality of spermatozoa within the same individual. HUM FERTIL 2019; 24:376-388. [PMID: 31642381 DOI: 10.1080/14647273.2019.1679397] [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: 10/25/2022]
Abstract
It has recently been suggested that the human sperm genome is highly unstable, which may be a reasonable explanation as to why men, even fertile men, produce defective spermatozoa. Furthermore, an unstable genome may also explain why the semen profile of the same man changes from one ejaculate to the next. As such, we took multiple ejaculates (between 3 and 6) from 7 individuals over a 6-month period and isolated sperm through density gradients. We then compared the DNA of: (i) good and poor-quality spermatozoa within the same ejaculate; and (ii) from multiple ejaculates from the same individual. Our results suggest that on a global level, DNA present within spermatozoa is actually quite stable and similar between both good and poor sperm. This is important information for the assisted reproductive community when it comes to sperm selection.
Collapse
Affiliation(s)
- Jacob Netherton
- Department of Environmental and Life Sciences, University of Newcastle , Callaghan , New South Wales , Australia
| | - Rachel Ogle
- Department of Environmental and Life Sciences, University of Newcastle , Callaghan , New South Wales , Australia
| | - Louise Hetherington
- Department of Environmental and Life Sciences, University of Newcastle , Callaghan , New South Wales , Australia
| | - Tony Velkov
- Department of Pharmacology & Therapeutics, School of Biomedical Sciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne , Victoria , Australia
| | - Ryan Rose
- Fertility SA, St. Andrews Hospital , Adelaide , South Australia , Australia.,Adelaide Health and Medical Sciences, Robinson Research Institute, The University of Adelaide , Adelaide , South Australia , Australia
| | - Mark Baker
- Department of Environmental and Life Sciences, University of Newcastle , Callaghan , New South Wales , Australia
| |
Collapse
|