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Sigala J, Poirey S, Robert J, Pouget O, Mura T, Huberlant S, Rougier N. First-line infertility treatment in normal or subnormal sperm: Interest of a simplified pre-IMSI test. PLoS One 2024; 19:e0307080. [PMID: 39008497 PMCID: PMC11249273 DOI: 10.1371/journal.pone.0307080] [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: 01/19/2024] [Accepted: 06/29/2024] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND In the field of male infertility, when sperm is normal/subnormal, a few "add-on" routine tests can complete the basic semen examination. OBJECTIVES The aim of this study was to develop and evaluate a faster, simplified motile sperm organelle morphology examination (MSOME) technique for selected infertile patients with apparently normal/subnormal sperm and, in their background: failure of two or three intrauterine insemination (IUI) cycles, repeatedly fragmented embryos, embryonic development to blastocyst-stage failures, repeated miscarriages, a long period of infertility or 2 or more IVF attempts without pregnancy. Our test results were correlated with IUI, conventional in vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI) and intracytoplasmic morphologically selected sperm injection (IMSI) outcomes. MATERIALS AND METHODS We validated an adapted version of the MSOME analysis called the pre-IMSI test (PIT), based on vacuole evaluation alone. 248 infertile patients from our assisted reproductive technology (ART) Center were retrospectively selected and split into three PIT score subgroups (patients with ≤8% (score I), 9 to 15% (score II) and ≥16% normal spermatozoa (score III)) based on the correlation between PIT results and each ART technique outcome. The choice of one or another of these ART techniques had been made according to the usual clinico-biological criteria. RESULTS Clinical outcomes for each of the three PIT subgroups were compared individually for the different ART techniques. For ICSI, the effect of the PIT score subgroup was significant for clinical pregnancies (p = 0.0054) and presented a trend for live births (p = 0.0614). Miscarriage rates of IVF attempts were statistically different depending on the PIT score (p = 0.0348). Furthermore, the odds ratios of clinical pregnancy rates were significantly different according to PIT score subgroup when comparing ICSI vs. IMSI or IVF vs. ICSI attempts. DISCUSSION IMSI appears to be recommended when sperm belongs to PIT score I, ICSI when it belongs to PIT score II and IVF or IUI when sperm is of PIT score III quality in selected infertile couples. The lack of statistical power in these PIT subgroups means that we must remain cautious in interpreting results. CONCLUSION Our results support the interest of this simplified test for certain couples with normal/subnormal sperm to help choose the most efficient ART technique, even as first-line treatment.
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Affiliation(s)
- Julien Sigala
- Department of Reproductive Biology, Nîmes University Hospital, Nîmes, France
| | - Sophie Poirey
- Department of Reproductive Biology, Nîmes University Hospital, Nîmes, France
| | - Julien Robert
- Department of Biostatistics, Epidemiology, Public Health and Innovation in Methodology, Nîmes University Hospital, Nîmes, France
| | - Olivier Pouget
- Department of Obstetrics and Gynecology, Nîmes University Hospital, Nîmes, France
| | - Thibault Mura
- Department of Biostatistics, Epidemiology, Public Health and Innovation in Methodology, Nîmes University Hospital, Nîmes, France
| | - Stephanie Huberlant
- Department of Obstetrics and Gynecology, Nîmes University Hospital, Nîmes, France
- University of Montpellier-Nîmes, Nîmes, France
| | - Nathalie Rougier
- Department of Reproductive Biology, Nîmes University Hospital, Nîmes, France
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van den Hoven L, van Vrouwerff NJ, Dijkstra IM, Weeteling J, Brinkman JW, Eliveld J, Wetzels AMM. Evaluation of structural problems in the application of strict criteria for sperm morphology assessment. Andrology 2024. [PMID: 38924385 DOI: 10.1111/andr.13684] [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: 11/03/2023] [Accepted: 05/26/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND The WHO manual for basic semen analysis and ISO 23162 describe sperm morphology assessment as a standard part of semen analysis. Older studies showed a correlation between morphology results and (artificial) conception. In more recent studies this relationship was less apparent and there is more emphasis on sperm morphology as a marker for healthy spermatogenesis (and general male health). Meantime, many laboratories ceased morphology assessment, probably due to unfamiliarity with this paradigmatic shift and to technical difficulties in the assessment, like the interpretation of morphological criteria. OBJECTIVES The aim of this study was to identify morphological criteria with high variability in results in the Dutch External Quality Control (EQC) program. MATERIAL AND METHODS Over the period 2015-2020, a total of 72 photos of sperm cells along with dichotomous propositions based on 14 criteria as defined in WHO5 (2010) were distributed in the Dutch EQC program for semen analysis. The EQC results were evaluated for variability per criterion and for trends in time. RESULTS Between 2015 and 2020, 40 to 60 laboratories assessed the photos. Criteria with low variability between participants were related to acrosomal vacuoles, excessive residual cytoplasm, and tail metrics. In contrast, head ovality, regularity of head and midpiece contours, and alignment of the major axis of the midpiece and head led to the highest variability in outcomes. In general, there was a slightly positive trend (lower variability) in time, except for the criteria with the highest variability (stable or declining trend). DISCUSSION AND CONCLUSION This study indicates that there are (high) variabilities in the interpretation of the morphological criteria, leading to inconsistent outcomes of morphology assessment. The results are discussed from the perspective of imperfections in definitions and examples of the criteria as given in the WHO manuals.
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Affiliation(s)
- Leonie van den Hoven
- Fertility Laboratory Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | | | - Ineke M Dijkstra
- Department of Clinical Chemistry, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Jasper Weeteling
- Fertility Laboratory Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Jacoline W Brinkman
- Department of Clinical Chemistry, Hospital St. Jansdal, Harderwijk, The Netherlands
| | - Jitske Eliveld
- Department of Obstetrics and Gynaecology, Section of reproductive medicine, University Medical Centre Groningen, Groningen, The Netherlands
| | - Alex M M Wetzels
- Fertility Laboratory Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, The Netherlands
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Michailov Y, Nemerovsky L, Ghetler Y, Finkelstein M, Schonberger O, Wiser A, Raziel A, Saar-Ryss B, Ben-Ami I, Kaplanski O, Miller N, Haikin Herzberger E, Mashiach Friedler Y, Levitas-Djerbi T, Amsalem E, Umanski N, Tamadaev V, Ovadia YS, Peretz A, Sacks G, Dekel N, Zaken O, Levi M. Stain-Free Sperm Analysis and Selection for Intracytoplasmic Sperm Injection Complying with WHO Strict Normal Criteria. Biomedicines 2023; 11:2614. [PMID: 37892988 PMCID: PMC10604130 DOI: 10.3390/biomedicines11102614] [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: 08/26/2023] [Revised: 09/19/2023] [Accepted: 09/22/2023] [Indexed: 10/29/2023] Open
Abstract
This multi-center study evaluated a novel microscope system capable of quantitative phase microscopy (QPM) for label-free sperm-cell selection for intracytoplasmic sperm injection (ICSI). Seventy-three patients were enrolled in four in vitro fertilization (IVF) units, where senior embryologists were asked to select 11 apparently normal and 11 overtly abnormal sperm cells, in accordance with current clinical practice, using a micromanipulator and 60× bright field microscopy. Following sperm selection and imaging via QPM, the individual sperm cell was chemically stained per World Health Organization (WHO) 2021 protocols and imaged via bright field microscopy for subsequent manual measurements by embryologists who were blinded to the QPM measurements. A comparison of the two modalities resulted in mean differences of 0.18 µm (CI -0.442-0.808 µm, 95%, STD-0.32 µm) for head length, -0.26 µm (CI -0.86-0.33 µm, 95%, STD-0.29 µm) for head width, 0.17 (CI -0.12-0.478, 95%, STD-0.15) for length-width ratio and 5.7 for acrosome-head area ratio (CI -12.81-24.33, 95%, STD-9.6). The repeatability of the measurements was significantly higher in the QPM modality. Surprisingly, only 19% of the subjectively pre-selected normal cells were found to be normal according to the WHO2021 criteria. The measurements of cells imaged stain-free through QPM were found to be in good agreement with the measurements performed on the reference method of stained cells imaged through bright field microscopy. QPM is non-toxic and non-invasive and can improve the clinical effectiveness of ICSI by choosing sperm cells that meet the strict criteria of the WHO2021.
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Affiliation(s)
- Yulia Michailov
- Obstetrics and Gynecology Department, Barzilai University Medical Center, Ashkelon 7830604, Israel
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva 8410501, Israel
| | - Luba Nemerovsky
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- IVF Unit, Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba 4428163, Israel
| | - Yehudith Ghetler
- IVF Unit, Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba 4428163, Israel
| | - Maya Finkelstein
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- IVF Unit, Wolfson Medical Center, Holon 5822012, Israel
| | - Oshrat Schonberger
- IVF Unit, Shaare Zedek Medical Center, Jerusalem 9103102, Israel
- Faculty of Medicine, Hebrew University, Jerusalem 9112102, Israel
| | - Amir Wiser
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- IVF Unit, Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba 4428163, Israel
| | - Arie Raziel
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- IVF Unit, Wolfson Medical Center, Holon 5822012, Israel
| | - Bozhena Saar-Ryss
- Obstetrics and Gynecology Department, Barzilai University Medical Center, Ashkelon 7830604, Israel
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva 8410501, Israel
| | - Ido Ben-Ami
- IVF Unit, Shaare Zedek Medical Center, Jerusalem 9103102, Israel
- Faculty of Medicine, Hebrew University, Jerusalem 9112102, Israel
| | - Olga Kaplanski
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- IVF Unit, Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba 4428163, Israel
| | - Netanella Miller
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- IVF Unit, Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba 4428163, Israel
| | - Einat Haikin Herzberger
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- IVF Unit, Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba 4428163, Israel
| | - Yardena Mashiach Friedler
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- IVF Unit, Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba 4428163, Israel
| | - Tali Levitas-Djerbi
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- IVF Unit, Wolfson Medical Center, Holon 5822012, Israel
| | - Eden Amsalem
- Obstetrics and Gynecology Department, Barzilai University Medical Center, Ashkelon 7830604, Israel
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva 8410501, Israel
| | - Natalia Umanski
- Obstetrics and Gynecology Department, Barzilai University Medical Center, Ashkelon 7830604, Israel
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva 8410501, Israel
| | - Valeria Tamadaev
- Obstetrics and Gynecology Department, Barzilai University Medical Center, Ashkelon 7830604, Israel
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva 8410501, Israel
| | - Yaniv S Ovadia
- Obstetrics and Gynecology Department, Barzilai University Medical Center, Ashkelon 7830604, Israel
| | - Aharon Peretz
- IVF Unit, Shaare Zedek Medical Center, Jerusalem 9103102, Israel
- Faculty of Medicine, Hebrew University, Jerusalem 9112102, Israel
| | - Gilat Sacks
- IVF Unit, Shaare Zedek Medical Center, Jerusalem 9103102, Israel
- Faculty of Medicine, Hebrew University, Jerusalem 9112102, Israel
| | - Nava Dekel
- IVF Unit, Shaare Zedek Medical Center, Jerusalem 9103102, Israel
- Faculty of Medicine, Hebrew University, Jerusalem 9112102, Israel
| | - Odelya Zaken
- IVF Unit, Shaare Zedek Medical Center, Jerusalem 9103102, Israel
- Faculty of Medicine, Hebrew University, Jerusalem 9112102, Israel
| | - Mattan Levi
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- IVF Unit, Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba 4428163, Israel
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Meng F, Deng S, Wang L, Zhou Y, Zhao M, Li H, Liu D, Gao G, Liao X, Wang J. Bibliometric analysis and visualization of literature on assisted reproduction technology. Front Med (Lausanne) 2022; 9:1063040. [DOI: 10.3389/fmed.2022.1063040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 11/14/2022] [Indexed: 12/02/2022] Open
Abstract
IntroductionAssisted reproductive technology (ART) is a method that uses various techniques to process sperm or ova. Assisted reproductive technology involves removing ova from a woman's ovaries, combining them with sperm in the laboratory, and returning them to the woman's body or donating them to another woman.MethodsBased on the web of science core collection database, we firstly analyzed the quantity and quality of publications in the field of ART, secondly profiled the publishing groups in terms of country, institution, author's publication and cooperation network, and finally sorted out and summarized the hot topics of research.ResultsIn total, 6,288 articles on ART were published between 2001 and 2022 in 1,013 journals. Most of these published articles represent the global research status, potential hotspots and future research directions. Publications and citations of research on assisted reproductive technology have steadily increased over the past few decades. Academic institutions in Europe and the United States have been leading in assisted reproductive technology research. The countries, institutions, journals, and authors with the most published articles were the United States (1864), Harvard Univ (108), Fertility and Sterility (819), and Stern, Judy E. (64). The most commonly used keywords are Assisted reproductive technology (3303) and in-vitro Fertilization (2139), Ivf (1140), Pregnancy (1140), Women (769), Intracytoplasmic Sperm injection (644), In Fertilization (632), Risk (545), and Outcome (423).ConclusionFrozen embryo transfer, intracytoplasmic sperm injection, and in vitro fertilization are the main research topics and hotspots in the field of assisted reproductive technology.
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