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Romano M, Cirillo F, Ravaioli N, Morenghi E, Negri L, Ozgur B, Albani E, Levi-Setti PE. Reproductive and obstetric outcomes in TESE-ICSI cycles: A comparison between obstructive and non-obstructive azoospermia. Andrology 2023. [PMID: 38108554 DOI: 10.1111/andr.13568] [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: 06/16/2023] [Revised: 11/23/2023] [Accepted: 11/27/2023] [Indexed: 12/19/2023]
Abstract
PURPOSE Comparison of intracytoplasmic sperm injection cycles with testicular sperm extraction in obstructive azoospermia and non-obstructive azoospermia are limited, and few studies have addressed obstetric and neonatal outcomes. DESIGN This study analyzed couples who underwent testicular sperm extraction-intracytoplasmic sperm injection cycles for obstructive azoospermia and non-obstructive azoospermia to determine whether impaired spermatogenesis in non-obstructive azoospermia patients would lead to worse reproductive outcomes and higher rates of pregnancy complications and fetal anomalies. This study is a retrospective, single-center analysis of all testicular sperm cycles performed between January 1, 2001 and December 31, 2020. RESULTS A total of 392 couples were considered in the study, leading to 1066 induction cycles, 620 (58.2%) from patients with obstructive azoospermia and 446 (41.8%) from non-obstructive azoospermia. The cumulative delivery rate did not significantly differ between the two groups (34% vs. 31%; p = 0.326). The miscarriage rate was similar between obstructive azoospermia and non-obstructive azoospermia patients. Fertilization rate instead showed a statistically significant difference (obstructive azoospermia: 66.1 ± 25.7 vs. non-obstructive azoospermia: 56.1 ± 27.0; p < 0.001). The overall maternal complication rate in the non-obstructive azoospermia group was higher (10.7% vs. 18.4%; p = 0.035), but there was no statistical significance for each pathology. There was no statistical difference in gestational age between the two groups for both single and twin pregnancies. Seven cases of congenital defects occurred in the obstructive azoospermia group, while two cases occurred in the non-obstructive azoospermia group. CONCLUSIONS Despite impaired spermatogenesis in non-obstructive azoospermia patients, there were no substantial differences in reproductive outcomes compared to patients with obstructive azoospermia, even in terms of obstetric safety and neonatal well-being.
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Affiliation(s)
- Massimo Romano
- Department of Gynecology, Division of Gynecology and Reproductive Medicine, Fertility Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Federico Cirillo
- Department of Gynecology, Division of Gynecology and Reproductive Medicine, Fertility Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Noemi Ravaioli
- Department of Gynecology and Obstetrics, Hospital of Lugo (RA), Lugo, Italy
| | - Emanuela Morenghi
- Biostatistics Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Luciano Negri
- Department of Gynecology, Division of Gynecology and Reproductive Medicine, Fertility Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Bulbul Ozgur
- Department of Gynecology, Division of Gynecology and Reproductive Medicine, Fertility Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Elena Albani
- Department of Gynecology, Division of Gynecology and Reproductive Medicine, Fertility Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Paolo Emanuele Levi-Setti
- Department of Gynecology, Division of Gynecology and Reproductive Medicine, Fertility Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
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Kanatsu-Shinohara M, Shiromoto Y, Ogonuki N, Inoue K, Hattori S, Miura K, Watanabe N, Hasegawa A, Mochida K, Yamamoto T, Miyakawa T, Ogura A, Shinohara T. Intracytoplasmic sperm injection induces transgenerational abnormalities in mice. J Clin Invest 2023; 133:e170140. [PMID: 37966118 PMCID: PMC10645388 DOI: 10.1172/jci170140] [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: 03/01/2023] [Accepted: 09/12/2023] [Indexed: 11/16/2023] Open
Abstract
In vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) are 2 major assisted reproductive techniques (ARTs) used widely to treat infertility. Recently, spermatogonial transplantation emerged as a new ART to restore fertility to young patients with cancer after cancer therapy. To examine the influence of germ cell manipulation on behavior of offspring, we produced F1 offspring by a combination of two ARTs, spermatogonial transplantation and ICSI. When these animals were compared with F1 offspring produced by ICSI using fresh wild-type sperm, not only spermatogonial transplantation-ICSI mice but also ICSI-only control mice exhibited behavioral abnormalities, which persisted in the F2 generation. Furthermore, although these F1 offspring appeared normal, F2 offspring produced by IVF using F1 sperm and wild-type oocytes showed various types of congenital abnormalities, including anophthalmia, hydrocephalus, and missing limbs. Therefore, ARTs can induce morphological and functional defects in mice, some of which become evident only after germline transmission.
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Affiliation(s)
- Mito Kanatsu-Shinohara
- Department of Molecular Genetics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- AMED-CREST, Chiyodaku, Tokyo, Japan
| | - Yusuke Shiromoto
- Department of Molecular Genetics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Narumi Ogonuki
- Bioresource Engineering Division, RIKEN BioResource Research Center, Ibaraki, Japan
| | - Kimiko Inoue
- Bioresource Engineering Division, RIKEN BioResource Research Center, Ibaraki, Japan
| | - Satoko Hattori
- Division of Systems Medical Science, Center for Medical Science, Fujita Health University, Toyoake, Japan
| | - Kento Miura
- Bioresource Engineering Division, RIKEN BioResource Research Center, Ibaraki, Japan
| | - Naomi Watanabe
- Bioresource Engineering Division, RIKEN BioResource Research Center, Ibaraki, Japan
| | - Ayumi Hasegawa
- Bioresource Engineering Division, RIKEN BioResource Research Center, Ibaraki, Japan
| | - Keiji Mochida
- Bioresource Engineering Division, RIKEN BioResource Research Center, Ibaraki, Japan
| | - Takuya Yamamoto
- Department of Life Science Frontiers, Center for iPS Cell Research and Application, Kyoto University, Kyoto, Japan
- Institute for the Advanced Study of Human Biology (WPI-ASHBi), Kyoto University, Kyoto, Japan
| | - Tsuyoshi Miyakawa
- Division of Systems Medical Science, Center for Medical Science, Fujita Health University, Toyoake, Japan
| | - Atsuo Ogura
- Bioresource Engineering Division, RIKEN BioResource Research Center, Ibaraki, Japan
| | - Takashi Shinohara
- Department of Molecular Genetics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Esteves SC, Coimbra I, Hallak J. Surgically retrieved spermatozoa for ICSI cycles in non-azoospermic males with high sperm DNA fragmentation in semen. Andrology 2023; 11:1613-1634. [PMID: 36734283 DOI: 10.1111/andr.13405] [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: 11/08/2022] [Revised: 01/16/2023] [Accepted: 01/29/2023] [Indexed: 02/04/2023]
Abstract
Intracytoplasmic sperm injection (ICSI) using surgically retrieved spermatozoa outside the classic context of azoospermia has been increasingly used to overcome infertility. The primary indications include high levels of sperm DNA damage in ejaculated spermatozoa and severe oligozoospermia or cryptozoospermia, particularly in couples with ICSI failure for no apparent reason. Current evidence suggests that surgically retrieved spermatozoa for ICSI in the above context improves outcomes, mainly concerning pregnancy and miscarriage rates. The reasons are not fully understood but may be related to the lower levels of DNA damage in spermatozoa retrieved from the testis compared with ejaculated counterparts. These findings are consistent with the notion that excessive sperm DNA damage can be a limiting factor responsible for the failure to conceive. Using testicular in preference of low-quality ejaculated spermatozoa bypasses post-testicular sperm DNA damage caused primarily by oxidative stress, thus increasing the likelihood of oocyte fertilization by genomically intact spermatozoa. Despite the overall favorable results, data remain limited, and mainly concern males with confirmed sperm DNA damage in the ejaculate. Additionally, information regarding the health of ICSI offspring resulting from the use of surgically retrieved spermatoa of non-azoospermic males is still lacking. Efforts should be made to improve the male partner's reproductive health for safer ICSI utilization. A comprehensive andrological evaluation aiming to identify and treat the underlying male infertility factor contributing to sperm DNA damage is essential for achieving this goal.
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Affiliation(s)
- Sandro C Esteves
- ANDROFERT, Andrology and Human Reproduction Clinic, Av. Dr. Heitor Penteado, Campinas, SP, Brazil
- Department of Surgery (Division of Urology), Faculty of Medical Sciences, University of Campinas (UNICAMP), Campinas, SP, Brazil
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Igor Coimbra
- Department of Surgery, Division of Urology, University of São Paulo Medical School, São Paulo, SP, Brazil
| | - Jorge Hallak
- Department of Surgery, Division of Urology, University of São Paulo Medical School, São Paulo, SP, Brazil
- Department of Pathology, Reproductive Toxicology Unit, University of São Paulo Medical School, São Paulo, SP, Brazil
- Men's Health Study Group, Institute for Advanced Studies, University of São Paulo, São Paulo, SP, Brazil
- Androscience, Science and Innovation Center in Andrology and High-Complex Clinical and Andrology Research Laboratory, São Paulo, SP, Brazil
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Vloeberghs V, De Munck N, Racca A, Mateizel I, Wouters K, Tournaye H. Enzymatic tissue processing after testicular biopsy in non-obstructive azoospermia enhances sperm retrieval. Hum Reprod Open 2023; 2023:hoad039. [PMID: 37936829 PMCID: PMC10627277 DOI: 10.1093/hropen/hoad039] [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: 07/15/2023] [Revised: 10/01/2023] [Indexed: 11/09/2023] Open
Abstract
STUDY QUESTION What is the added value of enzymatic processing of testicular biopsies on testicular sperm retrieval (SR) rates for patients with non-obstructive azoospermia (NOA)? SUMMARY ANSWER In addition to mechanical mincing, enzymatic digestion increased SR rates in testicular biopsies of NOA patients. WHAT IS KNOWN ALREADY Many studies focus on the surgical approach to optimize recovery of testicular sperm in NOA, and in spite of that, controversy still exists about whether the type of surgery makes any difference as long as multiple biopsies are taken. Few studies, however, focus on the role of the IVF laboratory and the benefit of additional lab procedures, e.g. enzymatic digestion, in order to optimize SR rates. STUDY DESIGN SIZE DURATION This retrospective single-center cohort study included all patients who underwent their first testicular sperm extraction (TESE) by open multiple-biopsy method between January 2004 and July 2022. Only patients with a normal karyotype, absence of Y-q deletions and a diagnosis of NOA based on histology were included. The primary outcome was SR rate after mincing and/or enzymes. The secondary outcome was cumulative live birth (CLB) after ICSI with fresh TESE and subsequent ICSI cycles with frozen TESE. PARTICIPANTS/MATERIALS SETTING METHODS Multiple biopsies were obtained from the testis, unilaterally or bilaterally, on the day of oocyte retrieval. Upon mechanical mincing, biopsies were investigated for 30 min; when no or insufficient numbers of spermatozoa were observed, enzymatic treatment was performed using Collagenase type IV. Multivariable regression analysis was performed to predict CLB per TESE by adjusting for the following confounding factors: male FSH level, female age, and requirement of enzymatic digestion to find sperm. MAIN RESULTS AND THE ROLE OF CHANCE We included 118 patients, of whom 72 (61.0%) had successful SR eventually. Spermatozoa were retrieved after mechanical mincing for 28 patients (23.7%; 28/118) or after additional enzymatic digestion for another 44 patients (37.2%; 44/118). Thus, of the 90 patients requiring enzymatic digestion, sperm were retrieved for 44 (48.9%). Male characteristics were not different between patients with SR after mincing or enzymatic digestion, in regard to mean age (34.5 vs 34.5 years), testis volume (10.2 vs 10.6 ml), FSH (17.8 vs 16.9 IU/l), cryptorchidism (21.4 vs 34.1%), varicocele (3.6 vs 4.6%), or histological diagnosis (Sertoli-cell only 53.6 vs 47.7%, maturation arrest 21.4 vs 38.6%, sclerosis/atrophy 25.0 vs 13.6%).Of the 72 patients with sperm available for ICSI, 23/72 (31.9%) achieved a live birth (LB) after the injection with fresh testicular sperm (and fresh or frozen embryo transfers). Of the remaining 49 patients without LB, 34 (69.4%) had supernumerary testicular sperm frozen. Of these 34 patients, 19 (55.9%) continued ICSI with frozen testicular sperm, and 9/19 (47.4%) had achieved an LB after ICSI with frozen testicular sperm. Thus, the total CLB was 32/118 (27.1%) per TESE or 32/72 (44.4%) per TESE with sperm retrieved.Of the female characteristics (couples with sperm available), only female age (30.3 vs 32.7 years; P = 0.042) was significantly lower in the group with a LB, compared to those without.The CLB with testicular sperm obtained after enzymatic digestion was 31.8% (14/44), while the CLB with sperm obtained after mincing alone was 64.3% (18/28). Multivariable logistic regression analysis showed that when enzymatic digestion was required, it was associated with a significant decrease in CLB per TESE (OR: 0.23 (0.08-0.7); P = 0.01). LIMITATIONS REASONS FOR CAUTION Limitations of the study are related to the retrospective design. However, the selection of only patients with NOA, and specific characteristics (normal karyotype and absence Y-q deletion) and having their first TESE, strengthens our findings. WIDER IMPLICATIONS OF THE FINDINGS Enzymatic processing increases the SR rate from testicular biopsies of NOA patients compared to mechanical mincing only, demonstrating the importance of an appropriate laboratory protocol. However, NOA patients should be counseled that when sperm have been found after enzymatic digestion, their chances to father a genetically own child may be lower compared to those not requiring enzymatic digestion. STUDY FUNDING/COMPETING INTERESTS None reported. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- V Vloeberghs
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - N De Munck
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - A Racca
- Department of Obstetrics, Gynaecology and Reproductive Medicine, Dexeus University Hospital, Barcelona, Spain
| | - I Mateizel
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - K Wouters
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - H Tournaye
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
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Yu C, Zhou C, Lin F, Zhang W, Wang X, Hu L, Lu R. Analysis of the Growth and Development of Children Born with ICSI of Epididymal and Testicular Spermatozoa: A Propensity Matching Study. Curr Pharm Des 2023; 29:2668-2678. [PMID: 37929741 DOI: 10.2174/0113816128264448231022201641] [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: 07/16/2023] [Revised: 09/10/2023] [Accepted: 09/21/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVE The study aimed to evaluate whether singleton live births (at 0, 1, 6, 12, and 24 months) following intracytoplasmic sperm injection (ICSI) using sperm of different origins (ejaculated or non-ejaculated sperm) are associated with the growth and development of children born. METHODS This was a retrospective cohort study conducted at a single center from January 2016 to December 2019. Follow-up data of the children were obtained from the Jiangsu Province Maternal and Child database. A total of 350 singleton live births after fresh embryo transfer (ET) with ICSI were included. Based on the origin of the sperm, the patients were divided into two groups: the ejaculated group (n = 310) and the non-ejaculated group (n = 40). Propensity score matching was used to control for multiple baseline covariates, resulting in 80 singleton live births (ejaculated sperm) matched to 40 singleton live births (non-ejaculated). The non-ejaculated group was further divided into two subgroups: the PESA group (n = 23) and the TESA group (n = 17). The primary outcome of the study was the growth and development of children. Secondary outcomes included the 2PN rate, high-cleavage embryo rate, blastocyst formation rate, and others. RESULTS After matching parental age, BMI, occupation, and maternal serum AMH level, there was no significant difference found in the growth and development of children between the non-ejaculated and ejaculated group or the PESA group and TESA group, respectively. However, the 2PN rate and the blastocyst formation rate were higher in the ejaculated group compared to the non-ejaculated group (91.02 and 85.45, P = 0.002) and (67.37 and 56.06, P = 0.019), respectively. The high-quality cleavage embryo rate was also higher in the TESA group compared to the PESA group (85.06 and 65.63, P = 0.001). CONCLUSION This study suggests that there are no significant differences in the growth and development of children born following ICSI using sperm of different origins (ejaculated or non-ejaculated). For nonobstructive azoospermia (OA) patients, sperm derived from the testis may be more effective than derived from the epididymis. However, due to the limited sample size of the non-ejaculated group in this study, further investigations with larger sample sizes are needed to validate these findings.
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Affiliation(s)
- Chunmei Yu
- Changzhou Medical Center, Changzhou Maternal and Child Health Care Hospital, Nanjing Medical University, Jiangsu, Changzhou, China
| | - Chao Zhou
- Reproduction Medical Center, Nanxishan Hospital of Guangxi Zhuang Autonomous Region, Guilin, China
| | - Feng Lin
- Department of Wuqia County People Hospital, The Xinjiang Uygur Autonomous Region, China
| | - Wanchao Zhang
- Department of Wuqia County People Hospital, The Xinjiang Uygur Autonomous Region, China
| | - Xiaoyu Wang
- Changzhou Medical Center, Changzhou Maternal and Child Health Care Hospital, Nanjing Medical University, Jiangsu, Changzhou, China
| | - Lingmin Hu
- Changzhou Medical Center, Changzhou Maternal and Child Health Care Hospital, Nanjing Medical University, Jiangsu, Changzhou, China
| | - Renjie Lu
- Changzhou Medical Center, Changzhou Third People's Hospital, Nanjing Medical University, Jiangsu, China
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Chan SY, Wan CWT, Law TYS, Chan DYL, Fok EKL. The Sperm Small RNA Transcriptome: Implications beyond Reproductive Disorder. Int J Mol Sci 2022; 23:ijms232415716. [PMID: 36555356 PMCID: PMC9779749 DOI: 10.3390/ijms232415716] [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: 11/01/2022] [Revised: 12/05/2022] [Accepted: 12/08/2022] [Indexed: 12/14/2022] Open
Abstract
Apart from the paternal half of the genetic material, the male gamete carries assorted epigenetic marks for optimal fertilization and the developmental trajectory for the early embryo. Recent works showed dynamic changes in small noncoding RNA (sncRNA) in spermatozoa as they transit through the testicular environment to the epididymal segments. Studies demonstrated the changes to be mediated by epididymosomes during the transit through the adluminal duct in the epididymis, and the changes in sperm sncRNA content stemmed from environmental insults significantly altering the early embryo development and predisposing the offspring to metabolic disorders. Here, we review the current knowledge on the establishment of the sperm sncRNA transcriptome and their role in male-factor infertility, evidence of altered offspring health in response to the paternal life experiences through sperm sncRNA species and, finally, their implications in assisted reproductive technology in terms of epigenetic inheritance.
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Affiliation(s)
- Sze Yan Chan
- School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Crystal Wing Tung Wan
- School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Tin Yu Samuel Law
- School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - David Yiu Leung Chan
- Department of Obstetrics and Gynecology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Correspondence: (D.Y.L.C.); (E.K.L.F.)
| | - Ellis Kin Lam Fok
- School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- The Chinese University of Hong Kong Joint Laboratory for Reproductive Medicine, West China Second University Hospital, Sichuan University, Chengdu 610017, China
- Correspondence: (D.Y.L.C.); (E.K.L.F.)
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7
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Smits RM, Xavier MJ, Oud MS, Astuti GDN, Meijerink AM, de Vries PF, Holt GS, Alobaidi BKS, Batty LE, Khazeeva G, Sablauskas K, Vissers LELM, Gilissen C, Fleischer K, Braat DDM, Ramos L, Veltman JA. De novo mutations in children born after medical assisted reproduction. Hum Reprod 2022; 37:1360-1369. [PMID: 35413117 PMCID: PMC9156847 DOI: 10.1093/humrep/deac068] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 03/08/2022] [Indexed: 01/23/2023] Open
Abstract
STUDY QUESTION Are there more de novo mutations (DNMs) present in the genomes of children born through medical assisted reproduction (MAR) compared to spontaneously conceived children? SUMMARY ANSWER In this pilot study, no statistically significant difference was observed in the number of DNMs observed in the genomes of MAR children versus spontaneously conceived children. WHAT IS KNOWN ALREADY DNMs are known to play a major role in sporadic disorders with reduced fitness such as severe developmental disorders, including intellectual disability and epilepsy. Advanced paternal age is known to place offspring at increased disease risk, amongst others by increasing the number of DNMs in their genome. There are very few studies reporting on the effect of MAR on the number of DNMs in the offspring, especially when male infertility is known to be affecting the potential fathers. With delayed parenthood an ongoing epidemiological trend in the 21st century, there are more children born from fathers of advanced age and more children born through MAR every day. STUDY DESIGN, SIZE, DURATION This observational pilot study was conducted from January 2015 to March 2019 in the tertiary care centre at Radboud University Medical Center. We included a total of 53 children and their respective parents, forming 49 trios (mother, father and child) and two quartets (mother, father and two siblings). One group of children was born after spontaneous conception (n = 18); a second group of children born after IVF (n = 17) and a third group of children born after ICSI combined with testicular sperm extraction (ICSI-TESE) (n = 18). In this pilot study, we also subdivided each group by paternal age, resulting in a subgroup of children born to younger fathers (<35 years of age at conception) and older fathers (>45 years of age at conception). PARTICIPANTS/MATERIALS, SETTING, METHODS Whole-genome sequencing (WGS) was performed on all parent-offspring trios to identify DNMs. For 34 of 53 trios/quartets, WGS was performed twice to independently detect and validate the presence of DNMs. Quality of WGS-based DNM calling was independently assessed by targeted Sanger sequencing. MAIN RESULTS AND THE ROLE OF CHANCE No significant differences were observed in the number of DNMs per child for the different methods of conception, independent of parental age at conception (multi-factorial ANOVA, f(2) = 0.17, P-value = 0.85). As expected, a clear paternal age effect was observed after adjusting for method of conception and maternal age at conception (multiple regression model, t = 5.636, P-value = 8.97 × 10-7), with on average 71 DNMs in the genomes of children born to young fathers (<35 years of age) and an average of 94 DNMs in the genomes of children born to older fathers (>45 years of age). LIMITATIONS, REASONS FOR CAUTION This is a pilot study and other small-scale studies have recently reported contrasting results. Larger unbiased studies are required to confirm or falsify these results. WIDER IMPLICATIONS OF THE FINDINGS This pilot study did not show an effect for the method of conception on the number of DNMs per genome in offspring. Given the role that DNMs play in disease risk, this negative result is good news for IVF and ICSI-TESE born children, if replicated in a larger cohort. STUDY FUNDING/COMPETING INTEREST(S) This research was funded by the Netherlands Organisation for Scientific Research (918-15-667) and by an Investigator Award in Science from the Wellcome Trust (209451). The authors have no conflicts of interest to declare. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- R M Smits
- Department of Obstetrics and Gynaecology, Radboudumc, Nijmegen, the Netherlands
| | - M J Xavier
- Biosciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - M S Oud
- Department of Human Genetics, Donders Institute for Brain, Cognition and Behaviour, Radboudumc, Nijmegen, the Netherlands
| | - G D N Astuti
- Department of Human Genetics, Donders Institute for Brain, Cognition and Behaviour, Radboudumc, Nijmegen, the Netherlands
| | - A M Meijerink
- Department of Obstetrics and Gynaecology, Radboudumc, Nijmegen, the Netherlands
| | - P F de Vries
- Department of Human Genetics, Donders Institute for Brain, Cognition and Behaviour, Radboudumc, Nijmegen, the Netherlands
| | - G S Holt
- Biosciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - B K S Alobaidi
- Biosciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - L E Batty
- Biosciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - G Khazeeva
- Department of Human Genetics, Radboud Institute for Molecular Life Sciences, Radboudumc, Nijmegen, the Netherlands
| | - K Sablauskas
- Department of Human Genetics, Radboud Institute for Molecular Life Sciences, Radboudumc, Nijmegen, the Netherlands
| | - L E L M Vissers
- Department of Human Genetics, Donders Institute for Brain, Cognition and Behaviour, Radboudumc, Nijmegen, the Netherlands
| | - C Gilissen
- Department of Human Genetics, Radboud Institute for Molecular Life Sciences, Radboudumc, Nijmegen, the Netherlands
| | - K Fleischer
- Department of Obstetrics and Gynaecology, Radboudumc, Nijmegen, the Netherlands
| | - D D M Braat
- Department of Obstetrics and Gynaecology, Radboudumc, Nijmegen, the Netherlands
| | - L Ramos
- Department of Obstetrics and Gynaecology, Radboudumc, Nijmegen, the Netherlands
| | - J A Veltman
- Biosciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
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8
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Yuan S, Guo L, Cheng D, Li X, Hu H, Hu L, Lu G, Lin G, Gong F, Tan YQ. The de novo aberration rate of prenatal karyotype was comparable between 1496 fetuses conceived via IVF/ICSI and 1396 fetuses from natural conception. J Assist Reprod Genet 2022; 39:1683-1689. [PMID: 35616756 DOI: 10.1007/s10815-022-02500-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 04/20/2022] [Indexed: 10/18/2022] Open
Abstract
PURPOSE To evaluate the cytogenetic risk of assisted reproductive technology (ART) by comparing the incidence of de novo chromosomal abnormalities between fetuses conceived via in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) and natural conception. MATERIALS AND METHODS Prenatal invasive diagnostic testing (amniocentesis and cytogenetic analysis) was performed on 1496 fetuses conceived via IVF/ICSI (IVF/ICSI group) and 1396 fetuses from natural conception (NC group). The incidence of de novo chromosomal abnormalities (including aneuploidy and chromosomal structure abnormalities) was used to evaluate the cytogenetic risk of ART. For statistical analysis, χ2-test was used for binary dependent variable. The significance level was P < 0.05 and confidence interval was 95%. RESULT(S) The IVF/ICSI group displayed a modest increase in the overall de novo chromosomal abnormality rate compared with that in the NC group but with no statistical significance (6.75% vs. 6.16%; χ2 = 0.42, P > 0.05). The incidence of abnormal karyotypes was also not significantly different between the IVF/ICSI and NC groups in different maternal ages, including ≥ 35 years group (7.55% vs. 9.60%, χ2 = 1.40, P > 0.05) and < 35 years group (6.20% vs. 4.54%, χ2 = 2.51, P > 0.05). Moreover, there was no difference in the proportion of aneuploid and structural abnormalities in detected karyotypes between the IVF/ICSI and NC groups. Logistic regression analysis showed no significant association between the method of pregnancy and de novo chromosomal abnormalities (odds ratio (OR) 1.03; 95% CI 0.71-1.50; P = 0.86) after adjusting for other confounding factors. CONCLUSION(S) Fetuses conceived via IVF/ICSI had a slight but not statistically significant increase in de novo abnormal karyotypes compared to those in naturally conceived fetuses. Our findings indicate no significant association between de novo fetal chromosomal abnormalities and the pregnancy method in high-risk pregnancies in the second trimester. For these pregnancies with a high risk but with a normal karyotype, further genetic testing is required for diagnosis.
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Affiliation(s)
- Shimin Yuan
- Clinical Research Center for Reproduction and Genetics in Hunan Province, Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha, 410008, Hunan, China
| | - Liuliang Guo
- Hospital of Hunan Guangxiu, Medical College of Hunan Normal University, Hunan Normal University, Changsha, 410008, Hunan, China
| | - Dehua Cheng
- Clinical Research Center for Reproduction and Genetics in Hunan Province, Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha, 410008, Hunan, China
| | - Xiurong Li
- Clinical Research Center for Reproduction and Genetics in Hunan Province, Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha, 410008, Hunan, China
| | - Hao Hu
- Clinical Research Center for Reproduction and Genetics in Hunan Province, Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha, 410008, Hunan, China
| | - Liang Hu
- Clinical Research Center for Reproduction and Genetics in Hunan Province, Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha, 410008, Hunan, China.,Hospital of Hunan Guangxiu, Medical College of Hunan Normal University, Hunan Normal University, Changsha, 410008, Hunan, China.,Institute of Reproductive and Stem Cell Engineering, NHC Key Laboratory of Human Stem Cell and Reproductive Engineering, School of Basic Medical Science, Central South University, Changsha, 410008, Hunan, China.,Hunan International Scientific and Technological Cooperation Base of Development and Carcinogenesis, Changsha, 410008, Hunan, China
| | - Guangxiu Lu
- Clinical Research Center for Reproduction and Genetics in Hunan Province, Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha, 410008, Hunan, China.,Hospital of Hunan Guangxiu, Medical College of Hunan Normal University, Hunan Normal University, Changsha, 410008, Hunan, China.,Institute of Reproductive and Stem Cell Engineering, NHC Key Laboratory of Human Stem Cell and Reproductive Engineering, School of Basic Medical Science, Central South University, Changsha, 410008, Hunan, China.,Hunan International Scientific and Technological Cooperation Base of Development and Carcinogenesis, Changsha, 410008, Hunan, China
| | - Ge Lin
- Clinical Research Center for Reproduction and Genetics in Hunan Province, Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha, 410008, Hunan, China.,Hospital of Hunan Guangxiu, Medical College of Hunan Normal University, Hunan Normal University, Changsha, 410008, Hunan, China.,Institute of Reproductive and Stem Cell Engineering, NHC Key Laboratory of Human Stem Cell and Reproductive Engineering, School of Basic Medical Science, Central South University, Changsha, 410008, Hunan, China.,Hunan International Scientific and Technological Cooperation Base of Development and Carcinogenesis, Changsha, 410008, Hunan, China
| | - Fei Gong
- Clinical Research Center for Reproduction and Genetics in Hunan Province, Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha, 410008, Hunan, China. .,Hospital of Hunan Guangxiu, Medical College of Hunan Normal University, Hunan Normal University, Changsha, 410008, Hunan, China. .,Institute of Reproductive and Stem Cell Engineering, NHC Key Laboratory of Human Stem Cell and Reproductive Engineering, School of Basic Medical Science, Central South University, Changsha, 410008, Hunan, China. .,Hunan International Scientific and Technological Cooperation Base of Development and Carcinogenesis, Changsha, 410008, Hunan, China.
| | - Yue-Qiu Tan
- Clinical Research Center for Reproduction and Genetics in Hunan Province, Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha, 410008, Hunan, China. .,Hospital of Hunan Guangxiu, Medical College of Hunan Normal University, Hunan Normal University, Changsha, 410008, Hunan, China. .,Institute of Reproductive and Stem Cell Engineering, NHC Key Laboratory of Human Stem Cell and Reproductive Engineering, School of Basic Medical Science, Central South University, Changsha, 410008, Hunan, China. .,Hunan International Scientific and Technological Cooperation Base of Development and Carcinogenesis, Changsha, 410008, Hunan, China.
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9
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Cirillo F, Costa P, Romano M, Negri L, Morenghi E, Albani E, Setti PEL. Is the lack of prior exposure to sperm antigens associated with worse neonatal and maternal outcomes? A 10 years single-center experience comparing ICSI-TESE pregnancies to ICSI pregnancies. Andrology 2022; 10:931-943. [PMID: 35485252 DOI: 10.1111/andr.13194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 04/07/2022] [Accepted: 04/25/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Nowadays pathogenesis of preeclampsia is still unknown. Among the different etiological hypotheses, some authors proposed that it might be due to an abnormal immunologic response to foreign fetal antigen derived from the father's sperm. Indeed, the fetus is considered a semi allograft, being one half paternally derived in its antigenicity, and the first pathogenic insult of preeclampsia may be an abnormal maternal immune response towards this semi-allogenic implant. In the context of Artificial Reproductive Techniques, it has been shown that the use of donor and surgically retrieved spermatozoa (e.g. Testicular Sperm Extraction) increases the risk of preeclampsia, confirming the protective effect of sperm exposure on maternal complications. OBJECTIVE Determining whether the lack of exposure to sperm antigens is associated with worse maternal and neonatal outcomes in pregnancies obtained through intracytoplasmic sperm injection after testicular sperm extraction for obstructive azoospermia. MATERIAL AND METHODS This is a single-center case-control retrospective study, focusing on all first pregnancies obtained through intracytoplasmic sperm injection after testicular sperm extraction for obstructive azoospermia at Humanitas Fertility Center between January 1st, 2010 and December 31st, 2019. Controls included patients that achieved their first pregnancy with intracytoplasmic sperm injection and ejaculated sperm, for a diagnosis other than azoospermia, in the same time period. Cases were matched with controls in a 1:2 ratio, considering female age, female BMI and year of controlled ovarian stimulation. The primary outcome measure was the delivery rate, defined as the number of deliveries divided by the total number of clinical pregnancies. Secondary outcome measures focused on maternal and neonatal complications, such as miscarriage rate, rate of main obstetric complications, prematurity rate and rate of congenital malformations. RESULTS By analyzing overall 113 pregnancies among cases and 214 pregnancies among controls, this study showed that the delivery rate was higher in controls with respect to cases (92.06% vs 84.07%, p = 0.026); among deliveries, live births were respectively 98.95% and 100%, while only one stillbirth occurred in cases. The first trimester miscarriage rate was higher in the cases than controls (13.27% vs 6.07%, p = 0.027), while no difference was found among rate of second trimester miscarriages, therapeutic abortions and ectopic pregnancies. There was no difference regarding the rate of maternal complications, including gestational hypertension, preeclampsia, HELLP syndrome, gestational diabetes, placenta previa, placental abruption and premature rupture of the membranes. Considering neonatal complications, it was shown that twins belonging to controls had a higher prematurity rate with respect to cases (65.79% vs 50.00%) but without a statistical relevance. Lastly, the rate of congenital malformations did not differ among the two groups. DISCUSSION This study showed that, once couples diagnosed with obstructive azoospermia achieve a pregnancy, they have a much higher risk of miscarriage in the first trimester in respect to non-azoospermic patients. Moreover, controls had a higher delivery rate in respect to cases; however, when the fetal status at birth was compared, no difference was found between live births and stillbirths. CONCLUSIONS Differently from the findings in the literature, no association with preeclampsia was found. This might be related to a collider bias/left truncation bias: since azoospermic patients are at higher risk of early termination of pregnancy, it results that they do not have the possibility to develop preeclampsia and other adverse outcomes. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Federico Cirillo
- Department of Gynecology- Division of Gynecology and Reproductive Medicine- Fertility Center, Humanitas Clinical and Research Center IRCCS-, via Manzoni 56, Rozzano, Milan, 20089, Italy
| | - Paola Costa
- Department of Gynecology- Division of Gynecology and Reproductive Medicine- Fertility Center, Humanitas Clinical and Research Center IRCCS-, via Manzoni 56, Rozzano, Milan, 20089, Italy
| | - Massimo Romano
- Department of Gynecology- Division of Gynecology and Reproductive Medicine- Fertility Center, Humanitas Clinical and Research Center IRCCS-, via Manzoni 56, Rozzano, Milan, 20089, Italy
| | - Luciano Negri
- Department of Gynecology- Division of Gynecology and Reproductive Medicine- Fertility Center, Humanitas Clinical and Research Center IRCCS-, via Manzoni 56, Rozzano, Milan, 20089, Italy
| | - Emanuela Morenghi
- Biostatistics Unit, Humanitas Clinical and Research Center IRCCS-, via Manzoni 56, Rozzano, Milan, 20089, Italy
| | - Elena Albani
- Department of Gynecology- Division of Gynecology and Reproductive Medicine- Fertility Center, Humanitas Clinical and Research Center IRCCS-, via Manzoni 56, Rozzano, Milan, 20089, Italy
| | - Paolo Emanuele Levi Setti
- Department of Gynecology- Division of Gynecology and Reproductive Medicine- Fertility Center, Humanitas Clinical and Research Center IRCCS-, via Manzoni 56, Rozzano, Milan, 20089, Italy
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10
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Cai J, Liu L, Chen J, Liu Z, Wang W, Jiang X, Chen H, Ren J. The effect of epididymal sperm cryopreservation on neonatal birthweight following PESA-ICSI. Arch Gynecol Obstet 2021; 305:1233-1239. [DOI: 10.1007/s00404-021-06350-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 11/24/2021] [Indexed: 10/19/2022]
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11
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Deepti MK, Reka K, Chinta P, Karthikeyan M, Kunjummen AT, Kamath MS. Perinatal Outcomes Using Ejaculate versus Surgical Sperm Retrieval in Patients Undergoing Intracytoplasmic Sperm Injection for Male Infertility - A Retrospective Analysis of 628 Cycles. J Hum Reprod Sci 2021; 14:49-55. [PMID: 34083992 PMCID: PMC8057148 DOI: 10.4103/jhrs.jhrs_197_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 12/17/2020] [Accepted: 01/27/2021] [Indexed: 12/02/2022] Open
Abstract
Background: Men with azoospermia undergoing a surgical sperm retrieval are anxious about the well-being of the baby. It is therefore important to study the perinatal outcomes in this group compared to the ejaculate sample group. Aim: The aim of the study was to compare the perinatal outcomes between ejaculate and surgical sperm retrieval (SSR) groups in couples undergoing intracytoplasmic sperm injection for male factor. Study Setting and Design: This was a retrospective cohort study conducted in a university-level infertility unit. Materials and Methods: It is a retrospective cohort study analysis of 628 assisted reproductive technique (ART) cycles with male factor and combined (male and female) factor infertility over a period of 5 years (January 2011–December 2015). All women who underwent a fresh embryo ART cycle were followed up. The study population included the ejaculate and SSR groups. The perinatal outcomes of these two groups were compared. The congenital anomaly risks among the two groups were also analyzed. Statistical Analysis: Chi-square test, Fisher's exact test and Logistic regression Results: A total of 628 ART cycles were included in the current study, of which 478 cycles used ejaculate sperm, while SSR was done in 150 cycles. The analysis was restricted to singletons, and the risk of preterm birth was 22.9% in the ejaculate group, 5.9% in the epididymal group, and 12% in the testicular group (epididymal vs. ejaculate odds ratio [OR], 0.21; 95% confidence interval [CI]: 0.02–1.66) (testicular vs. ejaculate OR, 0.46; 95% CI: 0.12–1.65). The risk of low birth weight was 23.7% in the ejaculate group, 11.8% in the epididymal group, and 20.0% in the testicular group (epididymal vs. ejaculate OR, 0.42; 95% CI: 0.09–1.9) (testicular vs. ejaculate OR, 0.80; 95% CI: 0.27–2.3). The incidence of congenital anomalies was 7.3% in the ejaculate group, 0 in the epididymal group, and 3.5% in the testicular group (epididymal vs. ejaculate OR, 0.28; 95% CI: 0.01–5.2) (testicular vs. ejaculate OR, 0.63; 95% CI: 0.10–3.7) which was not significantly different. Conclusion: The current study showed no significant differences in the risk of adverse perinatal outcomes in the ejaculate group versus the surgically retrieved sperm groups.
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Affiliation(s)
- Mogili Krishna Deepti
- Department of Obstetrics and Gynaecology, NRI Medical College and General Hospital, Chinakakani, Andhra Pradesh, India
| | - Karuppusami Reka
- Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, India
| | - Parimala Chinta
- Department of Reproductive Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Muthukumar Karthikeyan
- Department of Reproductive Medicine, Christian Medical College, Vellore, Tamil Nadu, India
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12
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Berntsen S, Laivuori H, la Cour Freiesleben N, Loft A, Söderström-Anttila V, B Oldereid N, Romundstad LB, Magnusson Å, Petzold M, Bergh C, Pinborg A. A systematic review and meta-analysis on the association between ICSI and chromosome abnormalities. Hum Reprod Update 2021; 27:801-847. [PMID: 33956940 DOI: 10.1093/humupd/dmab005] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 01/22/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND In the decade following the introduction of ICSI, a higher prevalence of de novo chromosome abnormalities, in particular sex chromosome and autosomal structural abnormalities, as well as inherited abnormalities was described in children conceived by ICSI compared to both naturally conceived (NC) children and children conceived by standard IVF. The explanation for the observed increase in prevalence is not clear and has been suggested to reflect parental factors (e.g. age or sperm quality) or to be a result of the ICSI procedure itself. Over the years, the procedure, as well as the patient group, and indications for ICSI treatment have changed. OBJECTIVE AND RATIONALE The objective of this systematic review and meta-analysis was to assess the prevalence of chromosome abnormalities in ICSI pregnancies and children and to examine any potentially increased risk compared to standard IVF and NC. SEARCH METHODS Pubmed, Embase, Cochrane Libraries and Web of Science up to October 2020 were searched. Primary outcome measures were overall chromosome abnormalities and de novo abnormalities (including sex chromosome abnormalities and autosomal abnormalities). The secondary outcome was inherited abnormalities. We followed the PRISMA guidelines and relevant meta-analyses were performed. OUTCOMES The search included 4648 articles, out of which 27 met the inclusion criteria, and 19 were included in quantitative synthesis (meta-analyses). The prevalence of chromosome abnormalities varied considerably between studies, possibly explained by large differences in sample size and patient demographics. Only five studies were eligible for pooled analyses on adjusted data. All studies had a critical risk of bias. Results from pooled adjusted data showed no evidence of an increased risk of overall chromosome abnormalities when comparing ICSI to either standard IVF (aOR 0.75 (95% CI 0.41-1.38)) or NC (aOR 1.29 (95% CI 0.69-2.43)). In contrast, meta-analyses on unadjusted data showed an increased risk of overall chromosome abnormalities in ICSI compared to both standard IVF (OR 1.42 (95% CI 1.09-1.85)) and NC (OR 2.46 (95% CI 1.52-3.99)) and an increased risk of de novo abnormalities in ICSI compared to NC (OR 2.62 (95% CI 2.07-3.31)). Yet, based on a very low certainty of evidence, the conclusion remains, that no indication of an increased risk of chromosome abnormalities in ICSI offspring could be found. If an increased risk of chromosome abnormalities in selected ICSI offspring should exist, the absolute risk continues to be small. WIDER IMPLICATIONS This review provides an extensive overview of the existing evidence on the relationship between ICSI and chromosome abnormalities in the offspring. We highlight the need for well-designed large, prospective, controlled studies with systematic cytogenetic testing. Existing data are limited and, in many cases, marred by critical levels of bias.
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Affiliation(s)
- Sine Berntsen
- Department of Obstetrics and Gynaecology, The Fertility Clinic, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Hannele Laivuori
- Department of Obstetrics and Gynecology, Tampere University Hospital, Elämänaukio, Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Medical and Clinical Genetics, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Institute for Molecular Medicine Finland, Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland
| | - Nina la Cour Freiesleben
- Department of Obstetrics and Gynaecology, The Fertility Clinic, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Anne Loft
- Fertility Clinic, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Viveca Söderström-Anttila
- Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | | | - Liv Bente Romundstad
- Spiren Fertility Clinic, Norwegian Institute of Public Health, Oslo, Norway.,Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Åsa Magnusson
- Department of Gynaecology and Reproductive Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Max Petzold
- School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Christina Bergh
- Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Reproductive Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anja Pinborg
- Fertility Clinic, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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13
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Sharma A, Minhas S, Dhillo WS, Jayasena CN. Male infertility due to testicular disorders. J Clin Endocrinol Metab 2021; 106:e442-e459. [PMID: 33295608 PMCID: PMC7823320 DOI: 10.1210/clinem/dgaa781] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Indexed: 12/13/2022]
Abstract
CONTEXT Male infertility is defined as the inability to conceive following 1 year of regular unprotected intercourse. It is the causative factor in 50% of couples and a leading indication for assisted reproductive techniques (ART). Testicular failure is the most common cause of male infertility, yet the least studied to date. EVIDENCE ACQUISITION The review is an evidence-based summary of male infertility due to testicular failure with a focus on etiology, clinical assessment, and current management approaches. PubMed-searched articles and relevant clinical guidelines were reviewed in detail. EVIDENCE SYNTHESIS/RESULTS Spermatogenesis is under multiple levels of regulation and novel molecular diagnostic tests of sperm function (reactive oxidative species and DNA fragmentation) have since been developed, and albeit currently remain as research tools. Several genetic, environmental, and lifestyle factors provoking testicular failure have been elucidated during the last decade; nevertheless, 40% of cases are idiopathic, with novel monogenic genes linked in the etiopathogenesis. Microsurgical testicular sperm extraction (micro-TESE) and hormonal stimulation with gonadotropins, selective estrogen receptor modulators, and aromatase inhibitors are recently developed therapeutic approaches for men with the most severe form of testicular failure, nonobstructive azoospermia. However, high-quality clinical trials data is currently lacking. CONCLUSIONS Male infertility due to testicular failure has traditionally been viewed as unmodifiable. In the absence of effective pharmacological therapies, delivery of lifestyle advice is a potentially important treatment option. Future research efforts are needed to determine unidentified factors causative in "idiopathic" male infertility and long-term follow-up studies of babies conceived through ART.
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Affiliation(s)
- Aditi Sharma
- Section of Endocrinology and Investigative Medicine, Imperial College London, UK
| | - Suks Minhas
- Department of Urology, Charing Cross Hospital, London, UK
| | - Waljit S Dhillo
- Section of Endocrinology and Investigative Medicine, Imperial College London, UK
| | - Channa N Jayasena
- Section of Endocrinology and Investigative Medicine, Imperial College London, UK
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14
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Du M, Zhang J, Li Z, Liu Y, Wang K, Guan Y. Clinical and Neonatal Outcomes of Children Born After ICSI With or Without Surgically Acquired Sperm: A Retrospective Cohort Study. Front Endocrinol (Lausanne) 2021; 12:788050. [PMID: 35145477 PMCID: PMC8823095 DOI: 10.3389/fendo.2021.788050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 12/31/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The purpose of this study was to explore the effects of different methods of obtaining sperm for intracytoplasmic sperm injection (ICSI) cycles on the live birth rate (LBR) and neonatal outcomes. METHODS This was a single-center retrospective cohort study conducted from January 2016 to December 2019. A total of 3557 ICSI cycles were included in the analysis, including 540 cycles in the surgically acquired sperm group and 3017 cycles in the ejaculated sperm group. The main outcome measure was the LBR. RESULTS The clinical pregnancy rate in the surgically acquired sperm group was 69.4%, which was significantly higher than the 59.7% clinical pregnancy rate in the ejaculated sperm group (P=0.01). The LBR of the surgically acquired sperm group was significantly higher than that of the ejaculated sperm group (63.1% vs. 51.2%, P<0.01). Similarly, the singleton LBR was also higher in the surgically acquired sperm group than in the ejaculated sperm group (45.4% vs. 39.2%, P=0.04). Due to differences in the baseline characteristics of the two groups, multiple logistic regression analysis was performed. After multiple logistic regression analysis, the different methods of obtaining sperm were independent risk factors influencing the clinical pregnancy rate (adjusted odds ratio (AOR)=0.73, 95% confidence (CI)=0.56-0.95, P=0.02) and LBR (AOR=0.69, 95% CI=0.54-0.89, P=0.01). The preterm birth rate (AOR=1.42, 95% CI=0.62-3.25, P=0.41) and the incidence of low birth weight (AOR=1.03, 95% CI=0.45-2.34, P=0.95), small for gestational age (AOR=0.81, 95% CI=0.39-1.68, P=0.57), macrosomia (AOR=0.88, 95% CI=0.47-1.66, P=0.70) and large for gestational age (AOR=1.08, 95% CI=0.65-1.82, P=0.76) were not affected by the different methods. CONCLUSION The clinical pregnancy rate and LBR of the surgically acquired sperm group were higher than those of the ejaculated sperm group. There was no significant difference between the neonatal outcomes of the two groups.
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Long R, Wang M, Yang QY, Hu SQ, Zhu LX, Jin L. Risk of birth defects in children conceived by artificial oocyte activation and intracytoplasmic sperm injection: a meta-analysis. Reprod Biol Endocrinol 2020; 18:123. [PMID: 33308238 PMCID: PMC7731535 DOI: 10.1186/s12958-020-00680-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 12/06/2020] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Whether artificial oocyte activation (ICSI-AOA) will increase the risk of birth defects remains controversial. Thus, we performed this study to evaluate the risk of birth defects and further compare the incidence of different birth defects types (chromosomal aberrations and non-chromosomal aberrations) in children conceived by ICSI-AOA and conventional intracytoplasmic sperm injection (ICSI) in an enlarged sample size. METHOD A comprehensive review of the literatures comparing birth defects in children conceived by ICSI-AOA and conventional ICSI by October 2020 was performed in PubMed, Embase, Cochrane Libraries, Web of Science, and Chinese databases including China National Knowledge Infrastructure, China Biology Medicine disc and Wan Fang. Risk ratios (RR) and 95% confidence intervals (CI) were calculated. RESULTS Five studies were included in the final analysis. Compared with conventional ICSI, ICSI-AOA did not increase the birth defects rate (RR = 1.27, 95%CI 0.70-2.28) of children. Furthermore, in a subgroup analysis, birth defects were classified into two types (chromosomal aberrations and non-chromosomal aberrations) in four studies and no statistical difference were revealed. CONCLUSION Our analysis indicates that ICSI-AOA represents no significant difference in the prevalence of major birth defects or types of birth defects (chromosomal aberrations and non-chromosomal aberrations) comparing with conventional ICSI. This conclusion may provide clinicians evidence-based support in patient counseling and instruction of the application and safety concern about ICSI-AOA.
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Affiliation(s)
- Rui Long
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave, Wuhan, 430030, China
| | - Meng Wang
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave, Wuhan, 430030, China
| | - Qi Yu Yang
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave, Wuhan, 430030, China
| | - Shi Qiao Hu
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave, Wuhan, 430030, China
| | - Li Xia Zhu
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave, Wuhan, 430030, China.
| | - Lei Jin
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave, Wuhan, 430030, China.
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Liu L, Wang H, Li Z, Niu J, Tang R. Obstetric and perinatal outcomes of intracytoplasmic sperm injection versus conventional in vitro fertilization in couples with nonsevere male infertility. Fertil Steril 2020; 114:792-800. [PMID: 32896391 DOI: 10.1016/j.fertnstert.2020.04.058] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 04/22/2020] [Accepted: 04/25/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine whether intracytoplasmic sperm injection (ICSI) is associated with improved outcomes compared with conventional in vitro fertilization (IVF) for patients with nonsevere male factor infertility. DESIGN Retrospective cohort. SETTING University-affiliated reproductive endocrinology unit. PATIENT(S) Couples who received their first-cycle embryo transfer without severe oligoasthenozoospermia (OA) between January 2012 and December 2016 were included in this study. INTERVENTION(S) Six subgroup analyses were performed according to the proposed indications for the use of ICSI as follows: non-male factor infertility, advanced maternal age (≥38 years), unexplained infertility, low oocyte yield (≤6), mild OA, and moderate OA. MAIN OUTCOME MEASURE(S) Live birth rates and selected perinatal outcomes. RESULT(S) ICSI resulted in live birth rates similar to those achieved with IVF (41.68% vs. 44.31%). There were no significant differences in the incidences of gestational diabetes mellitus, hypertension disorder of pregnancy, placental previa, postpartum hemorrhage, cesarean delivery, fetal macrosomia, small for gestational age, large for gestational age, neonatal intensive care unit (NICU) admission, and congenital anomalies between the two groups. Subgroup analyses showed that ICSI resulted in a lower rate of NICU admission in couples with moderate OA. CONCLUSION(S) Our results suggested that routine use of ICSI for all causes of infertility did not result in better pregnancy and perinatal outcomes compared with conventional IVF in the first cycle. ICSI might be associated with a lower risk of NICU admission when used in couples with moderate OA. Large prospective studies are required to validate our current findings.
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Affiliation(s)
- Lu Liu
- Reproductive Medical Hospital Affiliated to Shandong University, Jinan, People's Republic of China
| | - Hongmei Wang
- Department of Obstetrics and Gynecology, Provincial Hospital affiliated to Shandong University, Jinan, People's Republic of China
| | - Zhongyuan Li
- Reproductive Medical Hospital Affiliated to Shandong University, Jinan, People's Republic of China
| | - Jinlei Niu
- Reproductive Medical Hospital Affiliated to Shandong University, Jinan, People's Republic of China
| | - Rong Tang
- Reproductive Medical Hospital Affiliated to Shandong University, Jinan, People's Republic of China; Department of Obstetrics and Gynecology, Provincial Hospital affiliated to Shandong University, Jinan, People's Republic of China.
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Abstract
Over the past 40 years access and effectiveness of assisted reproductive technologies (ART) have increased, and to date more than 8 million children have been conceived after ART globally. Most pregnancies resulting from ART are uncomplicated and result in the birth of healthy children. Yet, it is well known that pregnancies following ART are more likely to be affected by obstetric complications such as hypertensive disorders in pregnancy, preterm birth, and low birth weight compared with spontaneously conceived pregnancies. ART children are also at increased risk of birth defects. The majority of the problems arise as a result of multiple pregnancies and can be reduced by transferring a single embryo, thereby avoiding multiple pregnancies. New ART technologies are constantly introduced, and monitoring of the health of ART children is crucial.
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Affiliation(s)
- Ulla-Britt Wennerholm
- Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Sahlgrenska University Hospital East, Gothenburg, Sweden
- CONTACT Ulla-Britt Wennerholm Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Sahlgrenska University Hospital East, GothenburgSE 416 85, Sweden
| | - Christina Bergh
- Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Reproductive Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
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Leary C, Sturmey RG. Metabolic profile of in vitro derived human embryos is not affected by the mode of fertilization. Mol Hum Reprod 2020; 26:277-287. [PMID: 32059054 PMCID: PMC8598873 DOI: 10.1093/molehr/gaaa015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 02/05/2020] [Indexed: 11/24/2022] Open
Abstract
The pattern of metabolism by early embryos in vitro has been linked to a range of phenotypes, including viability. However, the extent to which metabolic function of embryos is modified by specific methods used during ART has yet to be fully described. This study has sought to determine if the mode of fertilization used to create embryos affects subsequent embryo metabolism of substrates. A metabolic profile, including consumption of key substrates and the endogenous triglyceride content of individual IVF and ICSI supernumerary embryos, was assessed and compared. Embryo development and quality was also recorded. All embryos were donated at a single clinical IVF center, on Day 5, from 36 patients aged 18-38 years, The data revealed that consumption of glucose and pyruvate, and production of lactate, did not differ between embryos created by IVF or ICSI. Similarly, the mode of insemination did not impact on the triglyceride content of embryos. However, ICSI-derived embryos displayed a more active turnover of amino acids (P = 0.023), compared to IVF embryos. The specific amino acids produced in higher quantities from ICSI compared to IVF embryos were aspartate (P = 0.016), asparagine (P = 0.04), histidine (P = 0.021) and threonine (P = 0.009) while leucine consumption was significantly lower (P = 0.04). However, importantly neither individual nor collective differences in amino acid metabolism were apparent for sibling oocytes subjected to either mode of fertilization. Embryo morphology (the number of top grade embryos) and development (proportion reaching the blastocyst stage) were comparable in patients undergoing IVF and ICSI. In conclusion, the microinjection of spermatozoa into oocytes does not appear to have an impact on subsequent metabolism and viability. Observed differences in amino acid metabolism may be attributed to male factor infertility of the patients rather than the ICSI procedure per se.
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Affiliation(s)
- Christine Leary
- Centre for Atherothrombosis and Metabolic Disease, Hull York Medical School, Faculty of Health Sciences, The University of Hull, Hull, HU6 7RX, UK
- The Hull IVF Unit, The Women and Children’s Hospital, Hull Royal Infirmary, Anlaby Road, Hull, HU3 2JZ, UK
| | - Roger G Sturmey
- Centre for Atherothrombosis and Metabolic Disease, Hull York Medical School, Faculty of Health Sciences, The University of Hull, Hull, HU6 7RX, UK
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20
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Jin L, Li Z, Gu L, Huang B. Neonatal outcome of children born after ICSI with epididymal or testicular sperm: A 10-year study in China. Sci Rep 2020; 10:5145. [PMID: 32198466 PMCID: PMC7083972 DOI: 10.1038/s41598-020-62102-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 03/03/2020] [Indexed: 11/09/2022] Open
Abstract
Some studies show that children born after ICSI with non-ejaculated sperm are at increased risk of birth defects, other studies hold the opposite view. Does neonatal outcome including congenital malformations in children born after ICSI with percutaneous epididymal sperm aspiration (PESA) and testicular sperm aspiration (TESA) differ from neonatal outcome in children born after ICSI with ejaculated sperm? In this study, we examined the data from our IVF center from 2006 to 2016, to compare neonatal outcomes and rates of congenital malformations in children born after ICSI with different sperm origin. The results showed the clinical pregnancy rate and implantation rate of non-ejaculated sperm group were significantly higher (P < 0.001) than ejaculated sperm group. There were 775 clinical pregnancies from non-ejaculated sperm group and 2,486 clinical pregnancies from ejaculated sperm group. Most of the clinical pregnancy outcomes were comparable between non-ejaculated sperm group and ejaculated sperm group (p > 0.05): the miscarriage rate per transfer, ectopic pregnancy rate per clinical pregnancy, induced abortion rate per clinical pregnancy and fetal deaths per clinical pregnancy. However, the live delivery rate per transfer of non-ejaculated sperm group was significantly higher than that of ejaculated sperm group (45.4% vs 36.7%, P < 0.001). Moreover, the comparison between the epididymal sperm, testicular sperm and ejaculated sperm groups showed there were no difference in the incidence of congenital malformations of babies live birth. Among singleton gestation live births, there were more girls than boys in both non-ejaculated sperm and ejaculated sperm group. In conclusion, the present study clearly showed no statistical increased risk in neonatal outcomes of newborns were found in the ICSI treatment with epididymal or testicular sperm. It may provide information for consultation for ICSI treatment in PESA or TESA patients.
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Affiliation(s)
- Lei Jin
- Reproductive Medicine Center, Tongji Hospital, Tongji Medicine College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Zhou Li
- Reproductive Medicine Center, Tongji Hospital, Tongji Medicine College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Longjie Gu
- Reproductive Medicine Center, Tongji Hospital, Tongji Medicine College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Bo Huang
- Reproductive Medicine Center, Tongji Hospital, Tongji Medicine College, Huazhong University of Science and Technology, Wuhan, People's Republic of China.
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Esteves SC. Are specialized sperm function tests clinically useful in planning assisted reproductive technology? Int Braz J Urol 2020; 46:116-123. [PMID: 31851468 PMCID: PMC6968890 DOI: 10.1590/s1677-5538.ibju.2020.01.03] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
40-year-old male patient and 32-year-old female partner, with a history of primary infertility of two years duration. The workup revealed idiopathic mild oligoasthenotheratozoospermia, and no apparent female infertility factors. The couple has failed three intrauterine insemination (IUI) cycles, planning more IUI cycles but also considering in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI).
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Affiliation(s)
- Sandro C Esteves
- ANDROFERT, Clínica de Andrologia e Reprodução Humana, Centro de Referência para Reprodução Masculina, Campinas, SP, Brasil.,Departamento de Cirurgia (Disciplina de Urologia), Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brasil.,Faculty of Health, Aarhus University, Aarhus, Denmark
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22
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Abstract
Sperm retrieval combined with intracytoplasmic sperm injection (ICSI) is the treatment of choice for couples with untreatable azoospermia-related infertility. However, an increasing body of evidence has been mounting, suggesting that ICSI with testicular sperm instead of ejaculated sperm (when both are available) increases pregnancy outcomes in some specific scenarios. This has led to the exploration of extended indications for sperm retrieval. This review summarizes the current literature concerning sperm retrieval and ICSI for non-azoospermic men with elevated sperm DNA fragmentation, oligozoospermia, and cryptozoospermia.
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Affiliation(s)
- Sandro C Esteves
- ANDROFERT, Andrology and Human Reproduction Clinic, Referral Center for Male Reproduction, Campinas, SP, Brazil.,Department of Surgery (Division of Urology), University of Campinas (UNICAMP), Campinas, SP, Brazil.,Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Matheus Roque
- MATER PRIME, Reproductive Medicine, São Paulo, SP, Brazil
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23
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Berntsen S, Söderström-Anttila V, Wennerholm UB, Laivuori H, Loft A, Oldereid NB, Romundstad LB, Bergh C, Pinborg A. The health of children conceived by ART: ‘the chicken or the egg?’. Hum Reprod Update 2019; 25:137-158. [DOI: 10.1093/humupd/dmz001] [Citation(s) in RCA: 177] [Impact Index Per Article: 35.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Revised: 10/31/2018] [Accepted: 01/08/2019] [Indexed: 12/11/2022] Open
Affiliation(s)
- Sine Berntsen
- Department of Obstetrics and Gynaecology, Hvidovre Hospital, University of Copenhagen, Kettegaard Alle 30, Hvidovre, Denmark
| | - Viveca Söderström-Anttila
- Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 2, Helsinki, Finland
| | - Ulla-Britt Wennerholm
- Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Sahlgrenska University Hospital East, Gothenburg, Sweden
| | - Hannele Laivuori
- Department of Obstetrics and Gynecology, Tampere University Hospital, Teiskontie 35, Tampere, Finland
- Faculty of Medicine and Life Sciences, University of Tampere, Arvo Ylpön Katu 34, Tampere, Finland
- Medical and Clinical Genetics, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 8, Helsinki, Finland
- Institute for Molecular Medicine Finland, Helsinki Institute of Life Science, University of Helsinki, Tukhomankatu 8, Helsinki, Finland
| | - Anne Loft
- Fertility Clinic, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen, Denmark
| | - Nan B Oldereid
- Livio IVF-klinikken Oslo, Sørkedalsveien 10A, Oslo, Norway
| | - Liv Bente Romundstad
- Spiren Fertility Clinic, Norwegian Institute of Public Health, PO Box 222 Skøyen, Oslo, Norway
- Centre for Fertility and Health, Norwegian Institute of Public Health, PO Box 222 Skøyen, Oslo, Norway
| | - Christina Bergh
- Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Reproductive Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anja Pinborg
- Fertility Clinic, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen, Denmark
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24
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Blok JM, Roekel C, Oude Ophuis RJA, Lock TMTW. Open epididymal spermatozoa aspiration for obstructive azoospermia. Andrologia 2018; 51:e13218. [DOI: 10.1111/and.13218] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Revised: 11/07/2018] [Accepted: 11/20/2018] [Indexed: 11/27/2022] Open
Affiliation(s)
- Joost M. Blok
- Department of Urology University Medical Center Utrecht Utrecht The Netherlands
| | - Caren Roekel
- Department of Urology University Medical Center Utrecht Utrecht The Netherlands
| | - Ralph J. A. Oude Ophuis
- Department of Reproduction and Gynaecology University Medical Center Utrecht Utrecht The Netherlands
| | - Tycho M. T. W. Lock
- Department of Urology University Medical Center Utrecht Utrecht The Netherlands
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25
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Yu Y, Xi Q, Pan Y, Jiang Y, Zhang H, Li L, Liu R. Pregnancy and Neonatal Outcomes in Azoospermic Men After Intracytoplasmic Sperm Injection Using Testicular Sperm and Donor Sperm. Med Sci Monit 2018; 24:6968-6974. [PMID: 30270922 PMCID: PMC6178868 DOI: 10.12659/msm.912613] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background The safety of intracytoplasmic sperm injection (ICSI) with testicular sperm in azoospermic men has been a concern. We evaluated ICSI outcomes, including neonatal outcomes, in children born using testicular sperm or donor sperm. Material/Methods Ninety-nine males with nonobstructive azoospermia (NOA) who underwent microdissection testicular sperm extraction (micro-TESE) and 126 males with obstructive azoospermia (OA) were included in this study. Sixty-one patients with NOA used donor sperm for ICSI on the day of oocyte retrieval when no spermatozoa were identified by micro-TESE on the day before oocyte retrieval. ICSI outcomes were compared among OA, donor, and NOA groups. Results There was no statistical difference in terms of female partner characteristics among OA, donor, and NOA groups. The normal fertilization rate (P=0.005), high quality embryo rate (P=0.014), implantation rate (P<0.001), clinical pregnancy rate (P=0.015), live birth rate (P=0.043) were significant lower in the NOA group, compared with the donor sperm group. The normal fertilization rate was significant lower in the NOA group than the OA group (P<0.001), but the live birth rate was not significantly lower (P=0.058). The high-quality embryo rate (P=0.014) and implantation rate (P=0.009) were lower in the OA group than the donor group. No differences between groups were observed in our study regarding neonatal parameters of the infants born. Conclusions The fertilization and pregnancy outcomes were negatively affected by using testicular sperm from males with NOA. Once a live birth was achieved, there was no difference in neonatal outcomes.
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Affiliation(s)
- Yang Yu
- Center for Reproductive Medicine, Center for Prenatal Diagnosis, The First Hospital, Jilin University, Changchun, Jilin, China (mainland)
| | - Qi Xi
- Center for Reproductive Medicine, Center for Prenatal Diagnosis, The First Hospital, Jilin University, Changchun, Jilin, China (mainland)
| | - Yuan Pan
- Center for Reproductive Medicine, Center for Prenatal Diagnosis, The First Hospital, Jilin University, Changchun, Jilin, China (mainland)
| | - Yuting Jiang
- Center for Reproductive Medicine, Center for Prenatal Diagnosis, The First Hospital, Jilin University, Changchun, Jilin, China (mainland)
| | - Hongguo Zhang
- Center for Reproductive Medicine, Center for Prenatal Diagnosis, The First Hospital, Jilin University, Changchun, Jilin, China (mainland)
| | - Linlin Li
- Center for Reproductive Medicine, Center for Prenatal Diagnosis, The First Hospital, Jilin University, Changchun, Jilin, China (mainland)
| | - Ruizhi Liu
- Center for Reproductive Medicine, Center for Prenatal Diagnosis, The First Hospital, Jilin University, Changchun, Jilin, China (mainland)
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26
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Hu X, Ding Z, Hong Z, Zou Z, Feng Y, Zhu R, Ma J, Ge X, Li C, Yao B. Spermatogenesis improved by suppressing the high level of endogenous gonadotropins in idiopathic non-obstructive azoospermia: a case control pilot study. Reprod Biol Endocrinol 2018; 16:91. [PMID: 30243299 PMCID: PMC6150963 DOI: 10.1186/s12958-018-0401-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Accepted: 08/21/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Elevated plasma gonadotropins were associated with desensitization of Sertoli and Leydig cells in the male testis. Testis spermatogenesis ability would be improved via inhibiting high endogenous gonadotropin in patients with severe oligozoospermia. Whether it would be beneficial for non-obstructive azoospermia (NOA) patients was still unclear. METHODS Goserelin, a gonadotropin releasing hormone agonist (GnRHα) was used to suppress endogenous gonadotropin levels (gonadotropin reset) in the NOA patients, improving the sensitization of the Sertoli and Leydig cells. Then human menopausal gonadotropin (hMG) and human chorionic gonadotropin (hCG) were injected to stimulate them to ameliorate the ability of testicular spermatogenesis. The main outcome measure was the existence of spermatozoa in the semen or by testicular sperm extraction (TESE). Elevation of inhibin B and/or ameliorative expression pattern of ZO-1 was the secondary objective. RESULTS A total of 35 NOA men who failed to retrieve sperm via TESE were enrolled. Among these, 10 patients without treatment were selected as control group and secondary TESE was performed 6 months later. Of the 25 treated men, inhibin B was elevated in 11 patients in the first 4 weeks (Response group), while only 5 patients had constant increase in the following 20 weeks (Response group 2). Of the 5 men, 2 men acquired sperm (Response group 2B), while 3 failed (Response group 2A). Immunofluorescence of mouse vasa homologue (MVH) and ZO-1 showed that both positive MVH signals and ZO-1 expression were significantly increased in the Response group 2, but only Response group 2B showed ameliorative ZO-1 distribution. CONCLUSIONS Gonadotropin reset, a new therapeutic protocol with GnRHα, was able to improve the ability of testicular spermatogenesis in the NOA patients through restoring the sensitivity of Sertoli and Leydig cells, which were reflected by elevated inhibin B and ameliorative ZO-1 expression and distribution. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02544191 .
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Affiliation(s)
- Xuechun Hu
- Center of Reproductive Medicine, Nanjing Jinling Hospital, the Medical School of Nanjing University, Nanjing, 210002, China
| | - Zheng Ding
- Nanjing Jiangning Hospital, the Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, 210000, China
| | - Zhiwei Hong
- Center of Reproductive Medicine, Nanjing Jinling Hospital, the Medical School of Nanjing University, Nanjing, 210002, China
- Department of Urology, Fujian Provincial Hospital, Fuzhou, 350000, China
| | - Zhichuan Zou
- Center of Reproductive Medicine, Nanjing Jinling Hospital, the Medical School of Nanjing University, Nanjing, 210002, China
| | - Yuming Feng
- Center of Reproductive Medicine, Nanjing Jinling Hospital, the Medical School of Nanjing University, Nanjing, 210002, China
| | - Ruilou Zhu
- MOE Key Laboratory of Model Animals for Disease Study, Model Animal Research Center and the Medical School of Nanjing University, National Resource Center for Mutant Mice, Nanjing, 210061, China
| | - Jinzhao Ma
- Center of Reproductive Medicine, Nanjing Jinling Hospital, the Medical School of Nanjing University, Nanjing, 210002, China
| | - Xie Ge
- Center of Reproductive Medicine, Nanjing Jinling Hospital, the Medical School of Nanjing University, Nanjing, 210002, China
| | - Chaojun Li
- MOE Key Laboratory of Model Animals for Disease Study, Model Animal Research Center and the Medical School of Nanjing University, National Resource Center for Mutant Mice, Nanjing, 210061, China.
| | - Bing Yao
- Center of Reproductive Medicine, Nanjing Jinling Hospital, the Medical School of Nanjing University, Nanjing, 210002, China.
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O'Neill CL, Parrella A, Keating D, Cheung S, Rosenwaks Z, Palermo GD. A treatment algorithm for couples with unexplained infertility based on sperm chromatin assessment. J Assist Reprod Genet 2018; 35:1911-1917. [PMID: 30056595 PMCID: PMC6150896 DOI: 10.1007/s10815-018-1270-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 07/17/2018] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE To design a reproductive treatment algorithm based on the sperm DNA fragmentation (SDF) for couples with unexplained infertility following a poor intrauterine insemination (IUI) outcome. DESIGN Couples that failed IUI with no apparent reproductive issue in both partners were allocated to diverse reproductive treatments on the basis of SDF. SETTING Reproductive medical center in an academic setting. PATIENT(S) Over 4 years, couples with an unexpected poor IUI outcome and no apparent female or male partner reproductive issues were recruited. INTERVENTION(S) IUI, IVF, and ICSI were performed in the standard fashion following sperm SDF assays. MAIN OUTCOMES MEASURE(S) Fertilization rate, implantation rate, pregnancy characteristics, and delivery rates. RESULT(S) A total of 354 couples with unexplained infertility and normal semen parameters underwent 1133 IUI cycles. Clinical pregnancy rate (CPR) with IUI at our center in an age-matched cohort is 23.9% while the study cohort had 1.8%. Following SDF assessment, couples with failed IUI attempts but normal SDF (SCSA 9.8 ± 4.6%; TUNEL 11.8 ± 6.2%) underwent IVF with a CPR of 12.7%; those with abnormal SDF underwent ICSI with ejaculated spermatozoa, resulting in a CPR of 18.7%. This group included couples with normal SDF that had failed IVF. Couples with abnormal SDF that failed ICSI with ejaculated spermatozoa achieved a CPR of 31.0% with surgically retrieved spermatozoa. CONCLUSION(S) Couples with unexplained infertility that present with unexpectedly poor IUI outcomes can be funneled into a treatment algorithm guided by the integrity of the sperm genome for higher chances of pregnancy using an alternate method of insemination.
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Affiliation(s)
- C L O'Neill
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, 1305 York Avenue, Suite Y-720, New York, NY, 10021, USA
| | - A Parrella
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, 1305 York Avenue, Suite Y-720, New York, NY, 10021, USA
| | - D Keating
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, 1305 York Avenue, Suite Y-720, New York, NY, 10021, USA
| | - S Cheung
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, 1305 York Avenue, Suite Y-720, New York, NY, 10021, USA
| | - Z Rosenwaks
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, 1305 York Avenue, Suite Y-720, New York, NY, 10021, USA
| | - G D Palermo
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, 1305 York Avenue, Suite Y-720, New York, NY, 10021, USA.
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Fang J, Zhu L, Li D, Xu Z, Yan G, Sun H, Zhang N, Chen L. Effect of embryo and blastocyst transfer on the birthweight of live-born singletons from FET cycles. J Assist Reprod Genet 2018; 35:1905-1910. [PMID: 30030709 DOI: 10.1007/s10815-018-1257-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Accepted: 07/02/2018] [Indexed: 10/28/2022] Open
Abstract
PURPOSE To evaluate the effect of culture duration (embryo (day 3) transfer vs. blastocyst (day 5-6) transfer) on the birthweight of singletons from frozen embryo transfer (FET) cycles. METHODS A total of 1092 singletons were analyzed in this retrospective study. The distribution of large for gestational age (LGA) infants, the mean birthweight, and z scores of singletons were compared between the day 3 and day 5-6 transfer groups. Multiple linear regression analysis was performed to evaluate the relationships between confounding factors and singleton birthweight. RESULTS The proportion of LGA infants significantly increased with BMI (BMI < 20, 12.8%; 20 ≤ BMI ≤ 25, 23.2%; BMI > 25, 32.3%; P < 0.0001). However, the proportions of small for gestational age (SGA) and LGA infants were not significantly different between day 3 and day 5-6 transfers. The absolute mean birthweight of singletons was not significantly different between day 3 transfer (3422 ± 547 g) and day 5-6 transfer (3433 ± 559 g; P = 0.732). The z scores (calculated from a reference population) of singletons were also not significantly different between the two groups (0.499 vs. 0.533, P = 0.625). Multiple linear regression analysis showed that maternal BMI, gestational age, and infant gender had significant effects on singleton birthweight, while culture duration (P = 0.731) did not significantly affect singleton birthweight. CONCLUSIONS In vitro culture duration did not affect the birthweight of newborns resulting from day 3 to day 5-6 transfers in FET cycles.
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Affiliation(s)
- Junshun Fang
- Reproductive Medical Center, Drum Tower Hospital Affiliated with Nanjing University Medical College, Road 321#, Zhongshan, 210008, Nanjing, People's Republic of China
| | - Lihua Zhu
- Reproductive Medical Center, Drum Tower Hospital Affiliated with Nanjing University Medical College, Road 321#, Zhongshan, 210008, Nanjing, People's Republic of China
| | - Dong Li
- Reproductive Medical Center, Drum Tower Hospital Affiliated with Nanjing University Medical College, Road 321#, Zhongshan, 210008, Nanjing, People's Republic of China
| | - Zhipeng Xu
- Reproductive Medical Center, Drum Tower Hospital Affiliated with Nanjing University Medical College, Road 321#, Zhongshan, 210008, Nanjing, People's Republic of China
| | - Guijun Yan
- Reproductive Medical Center, Drum Tower Hospital Affiliated with Nanjing University Medical College, Road 321#, Zhongshan, 210008, Nanjing, People's Republic of China
| | - Haixiang Sun
- Reproductive Medical Center, Drum Tower Hospital Affiliated with Nanjing University Medical College, Road 321#, Zhongshan, 210008, Nanjing, People's Republic of China
| | - Ningyuan Zhang
- Reproductive Medical Center, Drum Tower Hospital Affiliated with Nanjing University Medical College, Road 321#, Zhongshan, 210008, Nanjing, People's Republic of China.
| | - Linjun Chen
- Reproductive Medical Center, Drum Tower Hospital Affiliated with Nanjing University Medical College, Road 321#, Zhongshan, 210008, Nanjing, People's Republic of China.
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Chen L, Zhu L, Cai C, Yan G, Sun H. Clinical and neonatal outcomes of intrauterine insemination with frozen donor sperm. Syst Biol Reprod Med 2018; 64:240-245. [PMID: 29600727 DOI: 10.1080/19396368.2018.1453563] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Linjun Chen
- Reproductive Medical Center, Drum Tower Hospital, Nanjing University Medical College, Nanjing, People’s Republic of China
| | - Lihua Zhu
- Reproductive Medical Center, Drum Tower Hospital, Nanjing University Medical College, Nanjing, People’s Republic of China
| | - Changming Cai
- Reproductive Medical Center, Drum Tower Hospital, Nanjing University Medical College, Nanjing, People’s Republic of China
| | - Guijun Yan
- Reproductive Medical Center, Drum Tower Hospital, Nanjing University Medical College, Nanjing, People’s Republic of China
| | - Haixiang Sun
- Reproductive Medical Center, Drum Tower Hospital, Nanjing University Medical College, Nanjing, People’s Republic of China
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Obstetric and neonatal outcome following ICSI with assisted oocyte activation by calcium ionophore treatment. J Assist Reprod Genet 2018; 35:1005-1010. [PMID: 29392515 DOI: 10.1007/s10815-018-1124-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 01/18/2018] [Indexed: 10/18/2022] Open
Abstract
PURPOSE Calcium ionophore treatment is being used in assisted reproductive technology (ART) for cases with previous low fertilization rate or total absence of fertilization after insemination by intracytoplasmic sperm injection or when a specific indication such as globozoospermia is present. As this technique is more invasive and differs from the physiological process of fertilization, a thorough investigation of the health of the children born following this procedure is required. We intent to report the medical outcome of all children conceived following calcium ionophore treatment in our IVF center. METHODS One-armed descriptive study is performed to report the obstetrical and neonatal outcome of children born after using calcium ionophore treatment during the intracytoplasmic sperm injection procedure in our center. RESULTS A number of 237 cycles were included in this study, with 74 pregnancies reported, from which 47 children (31 singletons and 16 twin children) were born. No major malformations were detected in singletons. In twins, three children were diagnosed with major malformations. Minor malformations were present in seven singletons and in one twin. CONCLUSIONS In conclusion, our results regarding birth characteristics and congenital malformations are within the expected range but, although reassuring, should be interpreted with caution due to the small number of children included.
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Tournaye H, Krausz C, Oates RD. Concepts in diagnosis and therapy for male reproductive impairment. Lancet Diabetes Endocrinol 2017; 5:554-564. [PMID: 27395770 DOI: 10.1016/s2213-8587(16)30043-2] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 04/08/2016] [Indexed: 12/13/2022]
Abstract
An accurate medical history and directed physical examination are essential in diagnosis of male infertility. We review the hormonal assessments and specific genetic analyses that are useful additional tests, and detail other evidence-based examinations that are available to help guide therapeutic strategies. By contrast with female infertility treatments-especially hormonal manipulations to stimulate or enhance oocyte production-spermatogenesis and sperm quality abnormalities are much more difficult to affect positively. In general, a healthy lifestyle can improve sperm quality. A few men have conditions in which evidence-based therapies can increase their chances for natural conception. In this second of two papers in The Lancet Diabetes and Endocrinology Series on male reproductive impairment, we examine the agreements and controversies that surround several of these conditions. When we are not able to cure, correct, or mitigate the cause of conditions such as severe oligozoospermia, non-remedial ductal obstruction, and absence of sperm fertilising ability, assisted reproductive technologies, such as in-vitro fertilisation (IVF) with intracytoplasmic sperm injection (ICSI), can be used as an adjunctive measure to allow for biological paternity. Not considered possible just two decades ago, azoospermia due to testicular failure, including 47,XXY (Klinefelter syndrome), is now treatable in approximately 50% of cases when combining surgical harvesting of testicular sperm and ICSI. Although genetic fatherhood is now possible for many men previously considered sterile, it is crucial to discover and abrogate causes as best possible, provide reliable and evidenced-based therapy, consider seriously the health and wellness of any offspring conceived, and always view infertility as a possible symptom of a more general or constitutional disease.
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Affiliation(s)
- Herman Tournaye
- Centre for Reproductive Medicine, University Hospital of the Free University Brussels, Brussels, Belgium.
| | - Csilla Krausz
- Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Robert D Oates
- Department of Urology, Boston University School of Medicine, Boston, MA, USA
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Meijerink AM, Ramos L, Janssen AJ, Maas–van Schaaijk NM, Meissner A, Repping S, Mochtar MH, Braat DD, Fleischer K. Behavioral, cognitive, and motor performance and physical development of five-year-old children who were born after intracytoplasmic sperm injection with the use of testicular sperm. Fertil Steril 2016; 106:1673-1682.e5. [DOI: 10.1016/j.fertnstert.2016.09.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 08/26/2016] [Accepted: 09/07/2016] [Indexed: 11/25/2022]
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Moradi SZ, Masoudi N, Mohseni Meybodi A, Anisi Hemaseh K, Mozafari Kermani R, Shahzadeh Fazeli A, Gourabi H. Cord Blood Karyotyping: A Safe and Non-Invasive Method for Postnatal Testing of Assisted Reproductive Technology Children. INTERNATIONAL JOURNAL OF FERTILITY & STERILITY 2016; 10:297-302. [PMID: 27695612 PMCID: PMC5023040 DOI: 10.22074/ijfs.2016.5046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Accepted: 05/03/2016] [Indexed: 11/16/2022]
Abstract
Background: To verify the hypothesis that the incidence of chromosomal abnormalities
increases in babies conceived by different assisted reproduction procedures. The availability of the umbilical cord blood encouraged us to study this hypothesis via this method. Materials and Methods: This is a descriptive study, umbilical cord blood samples of assisted reproductive technology (ART) children were analyzed with standard cytogenetic
techniques (G banding). Karyotyping was possible in 109 cases. Results: The number of abnormal cases was four (3.7%), among which, three cases
(2.8%) were inherited and only 1 case (0.9%) was a de novo translocation. In total, the
incidence of de novo chromosomal abnormalities was in the range observed in all live
births in the general population (0.7-1%). Conclusion: No significant difference in the incidence of chromosomal abnormality was
found between ART and naturally conceived babies. To date, several studies have examined the medical and developmental outcome of ART children and still have not reached
a definite conclusion. Genetic counseling is recommended as an integral part of planning
of treatment strategies for couples wishing to undergo ART.
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Affiliation(s)
- Shabnam Zarei Moradi
- Department of Genetics , Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Najmehsadat Masoudi
- Department of Genetics , Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Anahita Mohseni Meybodi
- Department of Genetics , Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Khadijeh Anisi Hemaseh
- Department of Genetics , Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Ramin Mozafari Kermani
- Child Health and Development Research Center, Iran Medical Science Branch of ACECR, Tehran, Iran
| | - Abolhasan Shahzadeh Fazeli
- Department of Genetics , Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran; Child Health and Development Research Center, Iran Medical Science Branch of ACECR, Tehran, Iran
| | - Hamid Gourabi
- Department of Genetics , Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
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Esteves SC. Novel concepts in male factor infertility: clinical and laboratory perspectives. J Assist Reprod Genet 2016; 33:1319-1335. [PMID: 27423664 PMCID: PMC5065546 DOI: 10.1007/s10815-016-0763-8] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 06/22/2016] [Indexed: 12/22/2022] Open
Abstract
In recent years, the management of male factor infertility has undergone important changes with the introduction of novel concepts, advanced testing, and therapeutic interventions. This review highlights some of these changes and discusses their impact to routine clinical practice. First, we discuss the recent changes in the World Health Organization (WHO) laboratory methods and reference values for the examination of human semen. Second, we examine the role of sperm chromatin integrity tests in light of increasing evidence of the detrimental effect of sperm DNA fragmentation on reproductive outcomes. Third, we summarize the main findings of varicocele-related infertility and the outcomes of microsurgical varicocele repair to different case scenarios. Lastly, we critically discuss the current management of men with nonobstructive azoospermia seeking fertility and the new opportunities that emerged to help these men achieve biological fatherhood.
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Affiliation(s)
- Sandro C Esteves
- ANDROFERT, Andrology and Human Reproduction Clinic, Referral Center for Male Reproduction, Av. Dr. Heitor Penteado, 1464, Campinas, SP, 13075-460, Brazil.
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35
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Jefferys AE, Griffith H, Wilson P, Gordon UD. Cohort study of perinatal outcomes of children born following surgical sperm recovery. HUM FERTIL 2016; 19:207-11. [PMID: 27662417 DOI: 10.1080/14647273.2016.1218071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
There is a relative paucity of data on perinatal outcomes following Intracytoplasmic Sperm Injection using surgically retrieved sperm. In this retrospective cohort study, data were collected on couples who conceived following Intracytoplasmic Sperm Injection using surgically retrieved sperm from 1996 to 2014. Outcome measures included live birth, miscarriage, congenital abnormality, birthweight, gestation at delivery, stillbirth and neonatal death. Outcome measures were compared according to male diagnosis and sperm source. Live birth rates were similar between groups (obstructive azoospermia 90%, non-obstructive azoospermia 83%, p = 0.55). There was a trend towards higher miscarriage rates in the non-obstructive azoospermia group (17% versus 9%, p = 0.45). Other perinatal outcomes were similar between groups. In those with obstructive azoospermia, live birth rates were similar regardless of source of sperm (epididymal 89%, testicular 91%, p = 0.79). Median gestation at delivery was earlier in the epididymal sperm group (39 weeks versus 40 weeks, p = 0.02). Other perinatal outcomes were unaffected by sperm source. Overall these results are reassuring, suggesting high live birth rates regardless of diagnosis or sperm source, although there may be higher miscarriage rates in cases of non-obstructive azoospermia. Other perinatal outcomes were not affected by diagnosis or sperm source.
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Affiliation(s)
- Amanda E Jefferys
- a Bristol Centre for Reproductive Medicine , Southmead Hospital , Bristol , UK
| | - Heather Griffith
- a Bristol Centre for Reproductive Medicine , Southmead Hospital , Bristol , UK
| | - Paul Wilson
- a Bristol Centre for Reproductive Medicine , Southmead Hospital , Bristol , UK
| | - Uma D Gordon
- a Bristol Centre for Reproductive Medicine , Southmead Hospital , Bristol , UK
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Maas K, Galkina E, Thornton K, Penzias AS, Sakkas D. No change in live birthweight of IVF singleton deliveries over an 18-year period despite significant clinical and laboratory changes. Hum Reprod 2016; 31:1987-96. [DOI: 10.1093/humrep/dew173] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 06/10/2016] [Indexed: 11/14/2022] Open
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Lewis SEM, Kumar K. The paternal genome and the health of the assisted reproductive technology child. Asian J Androl 2016; 17:616-22. [PMID: 25926606 PMCID: PMC4492053 DOI: 10.4103/1008-682x.153301] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
As a number of children born by assisted reproductive technology (ART) are increasing each year across the developed world, the health of such offspring is a matter of public concern. Does the integrity of the paternal genome impact on offspring health? In societal terms, as birth rates fall, and the Western population become unsustainable, do the benefits outweigh the costs of creating and providing for this ART conceived subpopulation? There are little data to date to answer these questions. The long-term health of such children has largely been ignored, and success measured only by early (prebirth) outcomes such as embryo quality or pregnancy. However, there are powerful paradigms such as ageing and smoking that give vital clues as to the potential impact of unhealthy spermatozoa on disease risk, mental and physical health, fertility and mortality of these offspring.
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Affiliation(s)
- Sheena E M Lewis
- Centre for Public Health, Queen's University Belfast, Grosvenor Road, BT12 6BJ,NI, UK
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38
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Faramarzi M, Golsorkhtabaramiri M, Esmaeilzadeh S, Ghofrani F, Sorkhi H. Are children born through Intra-Cytoplasmic Sperm Injection (ICSI) having a lower intelligence quotient? MIDDLE EAST FERTILITY SOCIETY JOURNAL 2016. [DOI: 10.1016/j.mefs.2015.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Abstract
The clinical management of men with nonobstructive azoospermia (NOA) seeking fertility has been a challenge for andrologists, urologists, and reproductive medicine specialists alike. This review presents a personal perspective on the clinical management of NOA, including the lessons learned over 15 years dealing with this male infertility condition. A five-consecutive-step algorithm is proposed to manage such patients. First, a differential diagnosis of azoospermia is made to confirm/establish that NOA is due to spermatogenic failure. Second, genetic testing is carried out not only to detect the males in whom NOA is caused by microdeletions of the long arm of the Y chromosome, but also to counsel the affected patients about their chances of having success in sperm retrieval. Third, it is determined whether any intervention prior to a surgical retrieval attempt may be used to increase sperm production. Fourth, the most effective and efficient retrieval method is selected to search for testicular sperm. Lastly, state-of-art laboratory techniques are applied in the handling of retrieved gametes and cultivating the embryos resulting from sperm injections. A coordinated multidisciplinary effort is key to offer the best possible chance of achieving a biological offspring to males with NOA.
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Affiliation(s)
- Sandro C Esteves
- ANDROFERT, Center for Male Reproduction, Campinas 13075-460, Brazil
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40
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Meijerink AM, Oomen RE, Fleischer K, IntHout J, Woldringh GH, Braat DDM. Effect of maternal and treatment-related factors on the prevalence of birth defects after PESA-ICSI and TESE-ICSI: a retrospective cohort study. Acta Obstet Gynecol Scand 2015; 94:1245-53. [PMID: 26265143 DOI: 10.1111/aogs.12728] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 08/03/2015] [Indexed: 11/29/2022]
Abstract
INTRODUCTION We performed a retrospective cohort study with the aim to evaluate the effect of maternal and treatment-related factors on the prevalence of birth defects after intracytoplasmic sperm injection (ICSI) using percutaneous epididymal sperm aspiration (PESA) and testicular sperm extraction (TESE). MATERIAL AND METHODS 643 newborns born after PESA-ICSI (n = 406) and TESE-ICSI (n = 237) in Radboud University Medical Center, after a gestational age of 12 weeks, 1 January 2002-1 January 2011 and 1 March-1 November 2014, respectively, were included in this study. Three sources of data were used for analysis: questionnaires, national obstetrics registration forms, and a lab-database of all ICSI treatments. Data were analyzed using generalized estimating equations and logistic regression analysis. RESULTS The prevalence of major birth defects in newborns born after PESA-ICSI was 6.9% and after TESE-ICSI was 5.9% (odds ratio 0.89, 95% confidence interval 0.46-1.75). No significant association was found between maternal or treatment-related factors and the prevalence of birth defects. CONCLUSIONS We found a similar overall prevalence of birth defects in newborns born after PESA-ICSI and TESE-ICSI. The maternal and treatment-related factors investigated did not show a significantly increased cumulative risk of birth defects.
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Affiliation(s)
- Aukje M Meijerink
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Reinoud E Oomen
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Kathrin Fleischer
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Joanna IntHout
- Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Gwendolyn H Woldringh
- Department of Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Didi D M Braat
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands
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Esteves SC, Prudencio C, Seol B, Verza S, Knoedler C, Agarwal A. Comparison of sperm retrieval and reproductive outcome in azoospermic men with testicular failure and obstructive azoospermia treated for infertility. Asian J Androl 2015; 16:602-6. [PMID: 24759580 PMCID: PMC4104090 DOI: 10.4103/1008-682x.126015] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
We assessed the rates of sperm retrieval and intracytoplasmic sperm injection outcomes, including the neonatal profile of infants conceived, in men with testicular failure. Three-hundred and sixty-five men with testicular failure who underwent micro-dissection testicular sperm extraction were included in this study. We compared their outcomes with 40 men with testicular failure who used donor sperm for injections due to failed retrieval, and 146 men with obstructive azoospermia who underwent percutaneous sperm retrieval. The retrieval rate in testicular failure was 41.4%, and the results were lower than the obstructed azoospermia (100%; adjusted odds ratio: 0.033; 95% CI: 0.007–0.164; P < 0.001). Live birth rates after sperm injections were lower in men with testicular failure (19.9%) compared with donor sperm (37.5%; adjusted OR: 0.377 (95% CI: 0.233–0.609, P < 0.001)) and obstructive azoospermia (34.2%; adjusted OR: 0.403 (95% CI: 0.241–0.676, P = 0.001). Newborn parameters of infants conceived were not significantly different among the groups. We concluded that the chances of obtaining sperm on retrieval and achieving a live birth after intracytoplasmic sperm injection (ICSI) are reduced in men with testicular failure. The profile of infants conceived after sperm injection does not seem to be negatively affected by testicular failure.
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42
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Ebner T, Montag M, Montag M, Van der Ven K, Van der Ven H, Ebner T, Shebl O, Oppelt P, Hirchenhain J, Krüssel J, Maxrath B, Gnoth C, Friol K, Tigges J, Wünsch E, Luckhaus J, Beerkotte A, Weiss D, Grunwald K, Struller D, Etien C. Live birth after artificial oocyte activation using a ready-to-use ionophore: a prospective multicentre study. Reprod Biomed Online 2015; 30:359-65. [DOI: 10.1016/j.rbmo.2014.11.012] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Revised: 11/19/2014] [Accepted: 11/27/2014] [Indexed: 11/24/2022]
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Hansen M, Bower C. The impact of assisted reproductive technologies on intra-uterine growth and birth defects in singletons. Semin Fetal Neonatal Med 2014; 19:228-33. [PMID: 24746981 DOI: 10.1016/j.siny.2014.03.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Pooled odds ratios from meta-analyses of infants born following assisted reproductive technologies (ART) compared with non-ART singletons show increases in low birth weight, preterm birth, small for gestational age, and birth defects. Although there have been small reductions in recent data, odds associated with these outcomes are still higher for ART singletons. Both ART procedures and underlying infertility contribute to these increased risks. Outcomes appear better for frozen-thawed compared with fresh embryo transfers, but are poorer than for non-ART infants. There is a concerning increase in large-for-gestational-age infants born following frozen-thawed embryo transfer and limited data on the effects of embryo vitrification used instead of slow-freezing techniques. Using large datasets, we now need to investigate risks of individual birth defects and disentangle the inter-related effects of different types of infertility and the multiple aspects of ART. Greater understanding of the causes of adverse ART outcomes and identification of modifiable risk factors may lead to further reductions in the disparities in outcome between ART and non-ART infants.
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Affiliation(s)
- Michèle Hansen
- Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - Carol Bower
- Telethon Kids Institute, University of Western Australia, Perth, Australia; Western Australian Register of Developmental Anomalies, Perth, Australia.
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Oldereid NB, Hanevik HI, Bakkevig I, Romundstad LB, Magnus Ø, Hazekamp J, Hentemann M, Eikeland SN, Skrede S, Reitan IR, Tanbo TG. Pregnancy outcome according to male diagnosis after ICSI with non-ejaculated sperm compared with ejaculated sperm controls. Reprod Biomed Online 2014; 29:417-23. [PMID: 25131554 DOI: 10.1016/j.rbmo.2014.06.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 06/11/2014] [Accepted: 06/12/2014] [Indexed: 12/22/2022]
Abstract
The aim of this study was to describe pregnancy outcome in couples who had undergone ICSI using non-ejaculated sperm from men with non-obstructive azoospermia, obstructive azoospermia and aspermia compared with the outcome of ICSI with ejaculated sperm from men with severe oligozoospermia, treated during the same time period. This nationwide cohort study included all children born after ICSI with non-ejaculated sperm in Norway, from when the method was first permitted in Norway in April 2004 to the end of 2010, resulting in 420 pregnancies and a total of 359 children. In 235 of these children, the father was diagnosed with obstructive azoospermia, in 72 with non-obstructive azoospermia, in 31 with aspermia, and in 21 the male cause was unclassifiable. The control group consisted of 760 children from 939 pregnancies conceived by ICSI with ejaculated sperm. Sex ratio, birth weight, rate of pregnancy loss and congenital malformations were not significantly associated with sperm origin or the cause of male factor infertility.
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Affiliation(s)
- Nan B Oldereid
- Department of Gynaecology, Oslo University Hospital, 0424 Oslo, Norway;.
| | - Hans I Hanevik
- Fertilitetsklinikken Sør, Postbox 263, 3901 Porsgrunn, Norway
| | | | - Liv B Romundstad
- Department of Obstetrics and Gynecology, Fertility Clinic, St Olav's University Hospital, Trondheim, Norway;; Department of Public Health, NTNU, Trondheim, Norway
| | | | | | - Martha Hentemann
- Department of Obstetrics and Gynecology, University Hospital of Northern Norway, 9019 Tromsø, Norway
| | | | - Siren Skrede
- Department of Obstetrics and Gynaecology, Haukeland University Hospital, 5053 Bergen, Norway
| | | | - Tom G Tanbo
- Department of Gynaecology, Oslo University Hospital, 0424 Oslo, Norway;; Institute of Clinical Medicine, University of Oslo, 0424 Oslo, Norway
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Chen L, Xu Z, Zhang N, Wang B, Chen H, Wang S, Sun H. Neonatal outcome of early rescue ICSI and ICSI with ejaculated sperm. J Assist Reprod Genet 2014; 31:823-8. [PMID: 24824350 DOI: 10.1007/s10815-014-0245-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Accepted: 05/05/2014] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To evaluate the impact of early rescue ICSI on neonatal outcome. METHODS This retrospective study compared the neonatal outcome of early rescue ICSI and ICSI with ejaculated sperm, including 233 children who were conceived after early rescue ICSI and a control group of 906 children who were conceived after ICSI with ejaculated sperm, and all of the children had a gestational age of 20 weeks or more. The numbers of live and stillbirths, perinatal deaths, prematurity, birthweights and birth defects of the children were compared. RESULTS Children in the early rescue ICSI group showed no increased risk of stillbirths, perinatal death or birth defects. Those children also did not differ from those of the ICSI with ejaculated sperm group in gender rate, birthweight, gestational age or prematurity. CONCLUSIONS Early rescue ICSI did not increase the adverse effect on the neonatal outcome when compared to that of ICSI with ejaculated sperm.
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Affiliation(s)
- Linjun Chen
- Reproductive Medicine Center, Drum Tower Hospital Affiliated to Nanjing University Medical College, Nanjing, Jiangsu, 210008, China,
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46
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Okun N, Sierra S, Douglas Wilson R, Audibert F, Brock JA, Campagnolo C, Carroll J, Cartier L, Chitayat D, Gagnon A, Johnson JA, Langlois S, Murphy-Kaulbeck L, Kim MacDonald W, Okun N, Pastuck M, Tan LY, Poplak V, Robson H. Pregnancy Outcomes After Assisted Human Reproduction. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2014; 36:64-83. [DOI: 10.1016/s1701-2163(15)30685-x] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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47
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Parmegiani L, Cognigni GE, Filicori M. Sperm selection: effect on sperm DNA quality. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2014; 791:151-72. [PMID: 23955678 DOI: 10.1007/978-1-4614-7783-9_10] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The selection of spermatozoa without DNA fragmentation and chromosomal diseases prior to assisted reproductive techniques helps to optimize the outcome of the treatment; in particular, sperm selection prior to in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) is crucial. In fact, although ICSI has been successfully and safely applied worldwide for almost 20 years, at the present time we have no real knowledge regarding the hypothetical long-term side effects on ICSI adults, given the increased likelihood of spermatozoa with defective nuclear content fertilizing oocytes.In the case of DNA damage, the basal sperm DNA fragmentation rate can be significantly reduced by some sperm processing procedures that improve the percentage of spermatozoa with normal chromatin structure by filtering out DNA-damaged spermatozoa. After this first step, new advances in micromanipulation can be performed to choose the "ideal" mature spermatozoa for ICSI, reducing potential damage to the gametes. In fact, it is possible to prevent fertilization by DNA-damaged and chromosomal-unbalanced spermatozoa by selecting ICSI sperm by maturation markers such as hyaluronic acid or other zona pellucida receptors. Furthermore, novel noninvasive imaging techniques can be valid tools for helping in the morphological selection of ICSI spermatozoa.
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Affiliation(s)
- Lodovico Parmegiani
- GynePro Medical Centers, Reproductive Medicine Unit, Via T. Cremona, 8-40137, Bologna, Italy,
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Fauser BCJM, Devroey P, Diedrich K, Balaban B, Bonduelle M, Delemarre-van de Waal HA, Estella C, Ezcurra D, Geraedts JPM, Howles CM, Lerner-Geva L, Serna J, Wells D. Health outcomes of children born after IVF/ICSI: a review of current expert opinion and literature. Reprod Biomed Online 2013; 28:162-82. [PMID: 24365026 DOI: 10.1016/j.rbmo.2013.10.013] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Revised: 10/03/2013] [Accepted: 10/08/2013] [Indexed: 01/28/2023]
Abstract
The Sixth Evian Annual Reproduction (EVAR) Workshop Group Meeting was held to evaluate the impact of IVF/intracytoplasmic sperm injection on the health of assisted-conception children. Epidemiologists, reproductive endocrinologists, embryologists and geneticists presented data from published literature and ongoing research on the incidence of genetic and epigenetic abnormalities and congenital malformations in assisted-conception versus naturally conceived children to reach a consensus on the reasons for potential differences in outcomes between these two groups. IVF-conceived children have lower birthweights and higher peripheral fat, blood pressure and fasting glucose concentrations than controls. Growth, development and cognitive function in assisted-conception children are similar to controls. The absolute risk of imprinting disorders after assisted reproduction is less than 1%. A direct link between assisted reproduction and health-related outcomes in assisted-conception children could not be established. Women undergoing assisted reproduction are often older, increasing the chances of obtaining abnormal gametes that may cause deviations in outcomes between assisted-conception and naturally conceived children. However, after taking into account these factors, it is not clear to what extent poorer outcomes are due to the assisted reproduction procedures themselves. Large-scale, multicentre, prospective epidemiological studies are needed to investigate this further and to confirm long-term health consequences in assisted-conception children. Assisted reproduction treatment is a general term used to describe methods of achieving pregnancy by artificial means and includes IVF and sperm implantation. The effect of assisted reproduction treatment on the health of children born using these artificial methods is not fully understood. In April 2011, fertility research experts met to give presentations based on research in this area and to look carefully at the evidence for the effects of assisted reproduction treatment on children's health. The purpose of this review was to reach an agreement on whether there are differences in the health of assisted-conception children with naturally conceived children. The researchers discovered no increased risk in birth defects in assisted-conception children compared with naturally conceived children. They found that IVF-conceived children have lower birth weights and higher fat under the skin, higher blood pressure and higher fasting glucose concentrations than naturally conceived children; however, growth, development and cognitive function are similar between groups. A very low risk of disorders of genetic control was observed in assisted-conception children. Overall, there did not appear to be a direct link between assisted reproduction treatment and children's health. The researchers concluded that the cause of some differences in the health of children conceived using assisted reproduction treatment may be due to the age of the woman receiving treatment. Large-scale, research studies are needed to study the long-term health of children conceived using assisted reproduction treatment.
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Affiliation(s)
- B C J M Fauser
- Department of Reproductive Medicine and Gynaecology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
| | - P Devroey
- Center for Reproductive Medicine, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - K Diedrich
- Department of Obstetrics and Gynecology, University Clinic of Schleswig-Holstein, Campus Luebeck, 23538 Luebeck, Germany
| | - B Balaban
- Assisted Reproduction Unit, American Hospital of Istanbul, Guzelbahce Sokak No 20, Nisantasi, Istanbul 34365, Turkey
| | - M Bonduelle
- Centre for Medical Genetics, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium
| | | | - C Estella
- Fundación Instituto Valenciano de Infertilidad (FIVI), Valencia University, and Instituto Universitario IVI/INCLIVA, Parc Científic Universitat de València C/Catedrático Agustín Escardino n(o) 9, Edificio 3, 46980 Paterna, Spain; Departamento de Biología Molecular and Centro de Biología Molecular 'Severo Ochoa' (CSIC-UAM), Universidad Autónoma de Madrid, Madrid, Spain
| | - D Ezcurra
- Global Development and Medical Unit, Merck Serono SA Geneva, Chemin des Mines 9, 1202 Geneva, Switzerland
| | - J P M Geraedts
- Department of Genetics and Cell Biology, Research Institute GROW, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - C M Howles
- Global Development and Medical Unit, Merck Serono SA Geneva, Chemin des Mines 9, 1202 Geneva, Switzerland
| | - L Lerner-Geva
- Woman and Child Health Research Unit, Gertner Institute for Epidemiology and Health Policy Research, Tel Hashomer 52621, Israel
| | - J Serna
- Instituto Valenciano de Infertilidad (IVI) Zaragoza, C/María Zambrano, 31, 50018 Zaragoza, Spain
| | - D Wells
- University of Oxford, Nuffield Department of Obstetrics and Gynaecology, Women's Centre, John Radcliffe Hospital, Oxford OX3 9DU, UK
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Ashraf MC, Singh S, Raj D, Ramakrishnan S, Esteves SC. Micro-dissection testicular sperm extraction as an alternative for sperm acquisition in the most difficult cases of Azoospermia: Technique and preliminary results in India. J Hum Reprod Sci 2013; 6:111-23. [PMID: 24082652 PMCID: PMC3778600 DOI: 10.4103/0974-1208.117175] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Revised: 04/13/2013] [Accepted: 06/11/2013] [Indexed: 11/24/2022] Open
Abstract
CONTEXT: Non-obstructive azoospermia (NOA) is an unfavorable prognostic condition for male infertility since spermatogenesis is disrupted. Sperm retrieval (SR) coupled with intracytoplasmic sperm injection (ICSI) is the only option for men with NOA who seek fertility. Among the SR techniques, microdissection testicular sperm extraction (micro-TESE) has been applied with encouraging results. AIMS: We describe how we implemented the micro-TESE procedure and present initial micro-TESE experience in a group of men with NOA and poor prognosis for SR. SETTINGS AND DESIGN: Case series of men with NOA treated in a tertiary healthcare center. MATERIALS AND METHODS: An Assisted Reproductive Technology (ART) facility was setup to perform SR using microsurgery. Fourteen men with NOA and previous failed retrievals or unfavorable histologic results underwent micro-TESE while their female partners received ovarian stimulation for oocyte pickup (OCP). Micro-TESE was performed the day prior to OCP and testicular sperm were used for sperm injections. We assessed retrieval rates and ICSI outcomes. STATISTICAL ANALYSIS: Outcomes of SR and ICSI were analyzed descriptively. Mann-Whitney and Fisher exact test were used to compare characteristics of men with successful and failed SR. RESULTS: The success of micro-TESE was 50.0% with no major complications. A clear microscopic distinction between enlarged and collapsed seminiferous tubules was seen in 35.7% of the cases, and sperm were retrieved in all but one of these cases. Patients with successful and failed retrieval did not differ with respect to baseline characteristics, use of medical therapy, presence of varicocele, and testicular histology. Sperm injections resulted in normal fertilization and embryo cleavage of 64% and 75%, respectively. A total of five transfers with an average of 1.5 embryos resulted in a cumulative clinical pregnancy rate per ICSI cycle of 28.6%, with an implantation rate of 33.3%. CONCLUSIONS: We were successful in integrating the micro-TESE procedures to the in vitro fertilization (IVF) laboratory. Our initial experience with micro-TESE applied to the most difficult cases of azoospermia is reassuring.
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Nouri K, Ott J, Stoegbauer L, Pietrowski D, Frantal S, Walch K. Obstetric and perinatal outcomes in IVF versus ICSI-conceived pregnancies at a tertiary care center--a pilot study. Reprod Biol Endocrinol 2013; 11:84. [PMID: 24004836 PMCID: PMC3844416 DOI: 10.1186/1477-7827-11-84] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Accepted: 08/28/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although most pregnancies after IVF result in normal healthy outcomes, an increased risk for a number of obstetric and neonatal complications, compared to naturally conceived pregnancies, has been reported. While there are many studies that compare pregnancies after assisted reproductive techniques with spontaneously conceived pregnancies, fewer data are available that evaluate the differences between IVF and ICSI-conceived pregnancies. The aim of our present study was, therefore, to compare obstetric and perinatal outcomes in pregnancies conceived after in vitro fertilization (IVF) versus intracytoplasmatic sperm injection (ICSI). METHODS Three-hundred thirty four women who had become pregnant after an IVF or ICSI procedure resulted in a total of 530 children referred between 2003 und 2009 to the Department of Obstetrics and Gynecology of the Medical University of Vienna, a tertiary care center, and were included in this retrospective cohort study. We assessed maternal and fetal parameters in both groups (IVF and ICSI). The main study outcomes were preterm delivery, the need for neonatal intensive care, and congenital malformations. Moreover, we compared the course of pregnancy between both groups and the occurrence of complications that led to maternal hospitalization during pregnancy. RESULTS There were 80 children conceived via ICSI and 450 children conceived via IVF.Mean gestational age was significantly lower in the ICSI group (p = 0.001). After ICSI, the birth weight (p = 0.008) and the mean APGAR values after 1 minute and after 10 minutes were lower compared to that of the IVF group (p = 0.016 and p = 0.047, respectively). Moreover, ICSI-conceived children had to be hospitalized more often at a neonatal intensive care unit (p = 0.004). There was no difference in pH of the umbilical artery or in major congenital malformations between the two groups. Pregnancy complications (i.e., premature rupture of membranes, cervical insufficiency, and premature uterine contractions) and the need for maternal hospitalization during pregnancy were found significantly more often after IVF (p = 0.0016 and p = 0.0095, respectively), compared to the ICSI group. CONCLUSIONS When comparing IVF versus ICSI-conceived pregnancies at a tertiary care center, we found the course of pregnancy to be more complicated after IVF, whereas the primary fetal outcome seemed to be better in this group than after ICSI treatment.
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Affiliation(s)
- Kazem Nouri
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Johannes Ott
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Lucia Stoegbauer
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Detlef Pietrowski
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Sophie Frantal
- Center for Medical Statistics, Informatics and Intelligent Systems, Section for Medical Statistics of the Medical University of Vienna, Vienna, Austria
| | - Katharina Walch
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
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