1
|
Jijo A, Munshi I, Uppangala S, Rajendran R, LakshmiKumar RVP, Kalthur G, Kovacic B, Sachdeva G, Adiga SK. Secretomes from Conventional Insemination and Intra-Cytoplasmic Sperm Injection Derived Embryos Differentially Modulate Endometrial Cells In Vitro. Reprod Sci 2024; 31:2080-2091. [PMID: 38472711 PMCID: PMC11217100 DOI: 10.1007/s43032-024-01504-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 02/22/2024] [Indexed: 03/14/2024]
Abstract
Conventional Insemination (CI) and Intra-Cytoplasmic Sperm Injection (ICSI) are routinely used insemination methods in clinical Assisted Reproductive Technologies (ART) settings. However, the existing data on the developmental competence and implantation potential of CI and ICSI derived embryos are not unequivocal. This prospective study on 23 patients undergoing ART treatment explored whether the secretomes of CI- and ICSI-derived embryo differentially alter the expression of integrins (αv and β3 integrin) and MUCIN-1 (MUC-1) in a human endometrial epithelial cell line (Ishikawa). Immunocytochemical data demonstrated that the secretome of CI-derived top quality (GI) embryos induced higher (p < 0.05) expression of ɑv β3 compared to sibling ICSI derived G1 embryos in Ishikawa cells. Though, relative levels of the transcript for MUC-1, anti-adhesion molecule did not show a significant difference between the study groups, immunocytochemical analysis demonstrated significantly (p < 0.0001) higher expression of MUC-1 in cells treated with ICSI-derived embryo secretome, compared to that treated with CI -derived embryo secretome. These results suggest that secretomes from CI and ICSI embryos differentially modulate the endometrial cells in vitro. This hints at differences in the ability of CI- and ICSI- derived embryos to alter endometrial profile.
Collapse
Affiliation(s)
- Ameya Jijo
- Centre of Excellence in Clinical Embryology, Department of Reproductive Science, Kasturba Medical College, Manipal Manipal Academy of Higher Education, Manipal, 576 104, India
| | - Itti Munshi
- Cell Physiology and Pathology Laboratory, Indian Council of Medical Research - National Institute for Research in Reproductive and Child Health, Mumbai, India
| | - Shubhashree Uppangala
- Division of Reproductive Genetics, Department of Reproductive Science, Kasturba Medical College, Manipal. Manipal Academy of Higher Education, 576 104, Manipal, India
| | - Rithika Rajendran
- Cell Physiology and Pathology Laboratory, Indian Council of Medical Research - National Institute for Research in Reproductive and Child Health, Mumbai, India
| | - R Vani Pratap LakshmiKumar
- Department of Data Science, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, 576104, India
- Department of Reproductive Medicine and Surgery, Kasturba Medical College, Manipal. Manipal Academy of Higher Education, 576 104, Manipal, India
| | - Guruprasad Kalthur
- Division of Reproductive Biology, Department of Reproductive Science, Kasturba Medical College, Manipal. Manipal Academy of Higher Education, 576 104, Manipal, India
| | - Borut Kovacic
- Department of Reproductive Medicine, University Medical Centre, Maribor, Maribor, Slovenia
| | - Geetanjali Sachdeva
- Cell Physiology and Pathology Laboratory, Indian Council of Medical Research - National Institute for Research in Reproductive and Child Health, Mumbai, India.
| | - Satish Kumar Adiga
- Centre of Excellence in Clinical Embryology, Department of Reproductive Science, Kasturba Medical College, Manipal Manipal Academy of Higher Education, Manipal, 576 104, India.
| |
Collapse
|
2
|
Tozour JN, Arnott A, Akerman M, Sung L, Vintzileos A, Fritz R. Comparison of outcomes between intracytoplasmic sperm injection and in vitro fertilization inseminations with preimplantation genetic testing for aneuploidy, analysis of Society for Assisted Reproductive Technology Clinic Outcome Reporting System data. Fertil Steril 2024; 121:799-805. [PMID: 38185201 DOI: 10.1016/j.fertnstert.2023.12.041] [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: 01/19/2023] [Revised: 12/22/2023] [Accepted: 12/29/2023] [Indexed: 01/09/2024]
Abstract
OBJECTIVE To evaluate whether insemination via intracytoplasmic sperm injection (ICSI) provides any benefit over in vitro fertilization (IVF) insemination for nonmale factor infertility with respect to preimplantation genetic testing (PGT) results and pregnancy outcome. DESIGN Retrospective cohort study of the Society for Assisted Reproductive Technology database. SETTINGS US-based fertility clinics reporting to the Society for Assisted Reprodcutive Technology. PATIENTS Patients undergoing IVF or ICSI inseminations in nonmale factor PGT for aneuploidy cycles. INTERVENTION In vitro fertilization vs. ICSI inseminations. MAIN OUTCOME MEASURES Primary outcomes were the percentage of embryos suitable for transfer and live birth rates (LBRs). Secondary outcomes included subgroup analysis for embryos suitable for transfer on cycles from patients ≥35-year-old vs. <35-year-old, ≤6 oocytes retrieved vs. >6 oocytes retrieved, and unexplained infertility. Additionally, gestational age at delivery and birth weight between IVF and ICSI inseminations were evaluated. RESULTS A total of 30,446 nonmale factor PGT diagnoses for aneuploidy cycles were evaluated, of which 4,867 were IVF inseminations and 25,579 were ICSI inseminations. Following exclusion criteria and adjustment for any necessary confounding variables, no significant differences existed in embryos suitable for transfer between IVF and ICSI treatment cycles, 41.6% (40.6%, 42.6%) vs. 42.5% (42.0%, 42.9%), respectively, or in LBRs, 50.1% (37.8, 62.4%) vs. 50.8% (38.5%, 62.9%), respectively. CONCLUSION There were no significant differences in the rates of embryos suitable for transfer and LBRs between IVF and ICSI inseminations in nonmale factor cycles undergoing PGT for aneuploidy.
Collapse
Affiliation(s)
- Jessica N Tozour
- Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Philadelphia
| | - Alicia Arnott
- NYU Langone Reproductive Specialists of New York, NYU Langone Long Island School of Medicine, Mineola, New York
| | - Meredith Akerman
- Department of Foundations of Medicine, NYU Langone Long Island School of Medicine, Mineola, New York
| | - Linda Sung
- NYU Langone Reproductive Specialists of New York, NYU Langone Long Island School of Medicine, Mineola, New York; Department of Obstetrics and Gynecology, NYU Langone Long Island School of Medicine, Mineola, New York
| | - Anthony Vintzileos
- Department of Obstetrics and Gynecology, Lenox Hill Hospital, Northwell Health, New York, New York
| | - Rani Fritz
- NYU Langone Reproductive Specialists of New York, NYU Langone Long Island School of Medicine, Mineola, New York; Department of Obstetrics and Gynecology, NYU Langone Long Island School of Medicine, Mineola, New York.
| |
Collapse
|
3
|
Curchoe CL, Tarafdar O, Aquilina MC, Seifer DB. SART CORS IVF registry: looking to the past to shape future perspectives. J Assist Reprod Genet 2022; 39:2607-2616. [PMID: 36269502 PMCID: PMC9722991 DOI: 10.1007/s10815-022-02634-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 10/03/2022] [Indexed: 10/24/2022] Open
Abstract
PURPOSE The SART CORS database is an informative source of IVF clinic-specific linked data that provides cumulative live birth rates from medically assisted reproduction in the United States (US). These data are used to develop best practice guidelines, for research, quality assurance, and post-market surveillance of assisted reproductive technologies. Here, we sought to investigate the key areas of current research focus (higher-order categories), discover gaps or underserved areas of ART research, and examine the potential application and impact of newer ART adjuvants, future data collection, and analysis needs. METHODS We conducted a systematic review (PRISMA guidelines) to quantify unique output metrics of the SART CORS database. Included were SART member reporting clinics: full-length publications from 2004 to 2021 and conference abstracts from 2015 to 2021, the two key timepoints when the SART CORS database underwent transformative shifts in data collection. RESULTS We found 206 abstracts presented from 2015 to 2021, 189 full-length peer-reviewed publications since 2004, with 654 unique authors listed on these publications. A total of 19 publications have been highly impactful, garnering over 100 citations at the time of writing. Several higher-order categories, such as endometriosis and tubal infertility, have few publications. The conversion of conference abstracts to full-length papers ranged from 15 to 35% from 2015 to 2021. CONCLUSIONS A substantial body of literature has been generated by analyzing the SART CORS database. Full-length publications have increased year over year. Some topic areas, such as endometriosis and tubal infertility, may be underrepresented. Conversion of conference abstracts to full-length publications has been low, indicating that more organizational support may be needed to ensure that research is methodologically sound and researchers supported to reach full publication status.
Collapse
Affiliation(s)
| | | | | | - David B Seifer
- Gynecology and Reproductive Sciences, Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Yale University School of Medicine, New Haven, CT, USA
| |
Collapse
|
4
|
Isikoglu M, Ceviren AK, Cetin T, Avci A, Aydinuraz B, Akgul OK, Karaca M. Comparison of ICSI and conventional IVF in non-male factor patients with less than four oocytes. Arch Gynecol Obstet 2022; 306:493-499. [DOI: 10.1007/s00404-022-06471-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 02/16/2022] [Indexed: 12/30/2022]
|
5
|
Franasiak JM, Polyzos NP, Neves AR, Yovich JL, Ho TM, Vuong LN, Norman RJ. Intracytoplasmic sperm injection for all or for a few? Fertil Steril 2022; 117:270-284. [DOI: 10.1016/j.fertnstert.2021.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 12/02/2021] [Indexed: 11/04/2022]
|
6
|
Benammar A, Derisoud E, Vialard F, Palmer E, Ayoubi JM, Poulain M, Chavatte-Palmer P. The Mare: A Pertinent Model for Human Assisted Reproductive Technologies? Animals (Basel) 2021; 11:2304. [PMID: 34438761 PMCID: PMC8388489 DOI: 10.3390/ani11082304] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 07/28/2021] [Accepted: 08/01/2021] [Indexed: 12/12/2022] Open
Abstract
Although there are large differences between horses and humans for reproductive anatomy, follicular dynamics, mono-ovulation, and embryo development kinetics until the blastocyst stage are similar. In contrast to humans, however, horses are seasonal animals and do not have a menstrual cycle. Moreover, horse implantation takes place 30 days later than in humans. In terms of artificial reproduction techniques (ART), oocytes are generally matured in vitro in horses because ovarian stimulation remains inefficient. This allows the collection of oocytes without hormonal treatments. In humans, in vivo matured oocytes are collected after ovarian stimulation. Subsequently, only intra-cytoplasmic sperm injection (ICSI) is performed in horses to produce embryos, whereas both in vitro fertilization and ICSI are applied in humans. Embryos are transferred only as blastocysts in horses. In contrast, four cells to blastocyst stage embryos are transferred in humans. Embryo and oocyte cryopreservation has been mastered in humans, but not completely in horses. Finally, both species share infertility concerns due to ageing and obesity. Thus, reciprocal knowledge could be gained through the comparative study of ART and infertility treatments both in woman and mare, even though the horse could not be used as a single model for human ART.
Collapse
Affiliation(s)
- Achraf Benammar
- Université Paris-Saclay, UVSQ, INRAE, BREED, 78350 Jouy-en-Josas, France; (A.B.); (E.D.); (F.V.); (J.M.A.); (M.P.)
- Ecole Nationale Vétérinaire d’Alfort, BREED, 94700 Maisons-Alfort, France
- Department of Gynaecology and Obstetrics, Foch Hospital, 92150 Suresnes, France
| | - Emilie Derisoud
- Université Paris-Saclay, UVSQ, INRAE, BREED, 78350 Jouy-en-Josas, France; (A.B.); (E.D.); (F.V.); (J.M.A.); (M.P.)
- Ecole Nationale Vétérinaire d’Alfort, BREED, 94700 Maisons-Alfort, France
| | - François Vialard
- Université Paris-Saclay, UVSQ, INRAE, BREED, 78350 Jouy-en-Josas, France; (A.B.); (E.D.); (F.V.); (J.M.A.); (M.P.)
- Ecole Nationale Vétérinaire d’Alfort, BREED, 94700 Maisons-Alfort, France
| | - Eric Palmer
- Académie d’Agriculture de France, 75007 Paris, France;
| | - Jean Marc Ayoubi
- Université Paris-Saclay, UVSQ, INRAE, BREED, 78350 Jouy-en-Josas, France; (A.B.); (E.D.); (F.V.); (J.M.A.); (M.P.)
- Ecole Nationale Vétérinaire d’Alfort, BREED, 94700 Maisons-Alfort, France
- Department of Gynaecology and Obstetrics, Foch Hospital, 92150 Suresnes, France
| | - Marine Poulain
- Université Paris-Saclay, UVSQ, INRAE, BREED, 78350 Jouy-en-Josas, France; (A.B.); (E.D.); (F.V.); (J.M.A.); (M.P.)
- Ecole Nationale Vétérinaire d’Alfort, BREED, 94700 Maisons-Alfort, France
- Department of Gynaecology and Obstetrics, Foch Hospital, 92150 Suresnes, France
| | - Pascale Chavatte-Palmer
- Université Paris-Saclay, UVSQ, INRAE, BREED, 78350 Jouy-en-Josas, France; (A.B.); (E.D.); (F.V.); (J.M.A.); (M.P.)
- Ecole Nationale Vétérinaire d’Alfort, BREED, 94700 Maisons-Alfort, France
| |
Collapse
|
7
|
The Impact of Intracytoplasmic Sperm Injection in Non-Male Factor Infertility-A Critical Review. J Clin Med 2021; 10:jcm10122616. [PMID: 34198564 PMCID: PMC8231975 DOI: 10.3390/jcm10122616] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 06/03/2021] [Accepted: 06/10/2021] [Indexed: 11/20/2022] Open
Abstract
Intracytoplasmic sperm injection (ICSI) was originally designed to overcome barriers due to male factor infertility. However, a surveillance study found that ICSI use in non-male factor infertility increased from 15.4% to 66.9% between 1996 and 2012. Numerous studies have investigated fertilization rate, total fertilization failure, and live birth rate per cycle (LBR), comparing the use of ICSI versus conventional in vitro fertilization (IVF) for non-male factor infertility. The overwhelming conclusion shows no increase in fertilization rate or LBR per cycle with the use of ICSI for non-male factor infertility. The overuse of ICSI is likely related to the desire to avoid a higher rate of total fertilization failure in IVF. However, data supporting the benefit of using ICSI for non-male factor infertility is lacking, and 33 couples would need to be treated with ICSI unnecessarily to avoid one case of total fertilization failure. Such practice increases the cost to the patient, increases the burden on embryologist’s time, and is a misapplication of resources. Additionally, there remains conflicting data regarding the safety of offspring conceived by ICSI and potential damage to the oocyte. Thus, the use of ICSI should be limited to those with male factor infertility or a history of total fertilization factor infertility due to uncertainties of potential adverse impact and lack of proven benefit in non-male factor infertility.
Collapse
|
8
|
De Munck N, El Khatib I, Abdala A, El-Damen A, Bayram A, Arnanz A, Melado L, Lawrenz B, Fatemi HM. Intracytoplasmic sperm injection is not superior to conventional IVF in couples with non-male factor infertility and preimplantation genetic testing for aneuploidies (PGT-A). Hum Reprod 2021; 35:317-327. [PMID: 32086522 DOI: 10.1093/humrep/deaa002] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 12/25/2019] [Indexed: 11/14/2022] Open
Abstract
STUDY QUESTION Does the insemination method impact the euploidy outcome in couples with non-male factor infertility? SUMMARY ANSWER Conventional IVF can be applied in cycles with preimplantation genetic testing for aneuploidies (PGT-A), as both IVF and ICSI generate equal numbers of euploid blastocysts. WHAT IS KNOWN ALREADY Ever since its introduction, the popularity of ICSI has increased tremendously, even in couples with non-male factor infertility. The use of conventional IVF is a contraindication for couples undergoing PGT to ensure monospermic fertilisation and to eliminate potential paternal contamination from extraneous sperm attached to the zona pellucida. Despite this, it has recently been shown that sperm DNA fails to amplify under the conditions used for trophectoderm biopsy samples. STUDY DESIGN, SIZE, DURATION This single-centre prospective pilot study included 30 couples between November 2018 and April 2019. PARTICIPANTS/MATERIALS, SETTING, METHOD Arab couples, with a female age between 18-40 years, body mass index ≤30 kg/m2, at least 10 cumulus oocyte complexes (COCs) following oocyte retrieval (OR) and normal semen concentration and motility (WHO) in the fresh ejaculate on the day of OR, were eligible for the study. Half of the sibling oocytes were assigned to conventional IVF, and the other half were assigned to ICSI. All embryos were cultured in a time-lapse imaging system in Global Total LP media. Blastocysts were subjected to trophectoderm biopsy on Day 5, 6 or 7 and next-generation sequencing (NGS) to determine blastocyst ploidy status. The primary objective was to determine the euploid rate in blastocysts from sibling oocytes. MAIN RESULTS AND THE ROLE OF CHANCE A total of 568 COCs were randomly allocated between IVF (n = 283; 9.4 ± 4.0) and ICSI (n = 285; 9.5 ± 4.1). While the incidence of normal fertilisation per cycle (6.1 ± 3.8 (64.0%) vs 6.3 ± 3.5 (65.4%); P = 0.609) was distributed equally between IVF and ICSI, the degeneration rate (0.1 ± 0.3 vs 0.7 ± 0.8; P = 0.0003) was significantly higher after ICSI and the incidence of abnormal fertilisation (≥3 pronuclei) was significantly higher after IVF (0.9 ± 1.2 vs 0.2 ± 0.4; P = 0.005). For all fertilised oocytes, there were no differences in the number of good-quality embryos on Day 3 (74% vs 78%; P = 0.467), nor in the blastulation rate on Day 5 (80.4% vs 70.8%; P = 0.076). The total number of blastocysts biopsied per cycle on Days 5, 6 and 7 was not significantly different between IVF or ICSI (4.0 ± 2.8 vs 3.9 ± 2.5; P = 0.774). With euploid rates of 49.8 and 44.1% (P = 0.755; OR: 1.05664 [0.75188-1.48494), respectively, there was no significant difference identified between IVF and ICSI (2.0 ± 1.8 vs 1.9 ± 1.7; P = 0.808) and all couples had at least one euploid blastocyst available for transfer. When considering only euploid blastocysts, the male/female ratio was 61/39 in IVF and 43/57 in ICSI (P = 0.063). LIMITATIONS, REASON FOR CAUTION This is a pilot study with a limited patient population of 30 couples (and 568 COCs) with a normal ovarian response. The results of our study should not be extrapolated to other patient populations. WIDER IMPLICATIONS OF THE FINDINGS It is safe to apply conventional IVF in couples with non-male factor infertility undergoing PGT-A. STUDY FUNDING/COMPETING INTEREST(S) No funding was obtained. There are no competing interests. TRIAL REGISTRATION NUMBER NCT03708991.
Collapse
Affiliation(s)
- Neelke De Munck
- IVIRMA Middle East Fertility Clinic, IVF laboratory, Abu Dhabi, United Arab Emirates
| | - Ibrahim El Khatib
- IVIRMA Middle East Fertility Clinic, IVF laboratory, Abu Dhabi, United Arab Emirates
| | - Andrea Abdala
- IVIRMA Middle East Fertility Clinic, IVF laboratory, Abu Dhabi, United Arab Emirates
| | - Ahmed El-Damen
- IVIRMA Middle East Fertility Clinic, IVF laboratory, Abu Dhabi, United Arab Emirates
| | - Aşina Bayram
- IVIRMA Middle East Fertility Clinic, IVF laboratory, Abu Dhabi, United Arab Emirates
| | - Ana Arnanz
- IVIRMA Middle East Fertility Clinic, IVF laboratory, Abu Dhabi, United Arab Emirates
| | - Laura Melado
- IVIRMA Middle East Fertility Clinic, IVF laboratory, Abu Dhabi, United Arab Emirates
| | - Barbara Lawrenz
- IVIRMA Middle East Fertility Clinic, IVF laboratory, Abu Dhabi, United Arab Emirates.,Obstetrical Department, Women's University Hospital Tuebingen, Tuebingen, Germany
| | - Human M Fatemi
- IVIRMA Middle East Fertility Clinic, IVF laboratory, Abu Dhabi, United Arab Emirates
| |
Collapse
|
9
|
Tremellen K, Woodman R, Hill A, Shehadeh H, Lane M, Zander-Fox D. Use of a male antioxidant nutraceutical is associated with superior live birth rates during IVF treatment. Asian J Androl 2021; 23:16-23. [PMID: 32769234 PMCID: PMC7831842 DOI: 10.4103/aja.aja_41_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Oxidative stress is prevalent among infertile men and is a significant cause of sperm DNA damage. Since sperm DNA damage may reduce embryo quality and increase miscarriage rates, it is possible that untreated sperm oxidative stress may impair in vitro fertilization (IVF) live birth rates. Given that the antioxidant Menevit is reported to reduce sperm DNA damage, it was hypothesized that men's consumption of this supplement may alter IVF outcomes. Therefore, a retrospective cohort study was conducted analyzing outcomes for couples undergoing their first fresh embryo transfer. Men were classified as controls if they were taking no supplements, health conscious controls if taking “general health” supplements, or Menevit users. Men with karyotype abnormalities, or cycles using donated, frozen and surgically extracted sperm were excluded. Among the final study cohort of 657 men, live birth rates were significantly higher in Menevit users than controls (multivariate adjusted odds ratio [OR]: 1.57, 95% confidence interval [CI]: 1.01–2.45, P = 0.046), but not between controls taking no supplements and those using general health supplements, thereby suggesting that potential health conscious behavior in supplement users is unlikely responsible for the superior outcomes in Menevit users. Interestingly, in a post hoc sensitivity analysis, live birth rates among Menevit users were statistically superior to controls for lean men (OR: 2.73, 95% CI: 1.18–6.28; P = 0.019), not their overweight/obese counterparts (OR: 1.29, 95% CI: 0.75–2.22, P = 0.37). The results of this large cohort study therefore support a positive association between men's use of the Menevit antioxidant during IVF treatment and live birth rates, especially in lean individuals.
Collapse
Affiliation(s)
- Kelton Tremellen
- Repromed, 180 Fullarton Road Dulwich, South Australia 5065, Australia.,Department of Obstetrics Gynaecology and Reproductive Medicine, Flinders University, Bedford Park, South Australia 5042, Australia
| | - Richard Woodman
- Flinders Centre for Epidemiology and Biostatistics, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia 5042, Australia
| | - Amy Hill
- Repromed, 180 Fullarton Road Dulwich, South Australia 5065, Australia
| | - Helana Shehadeh
- Repromed, 180 Fullarton Road Dulwich, South Australia 5065, Australia.,Robinson Research Institute, University of Adelaide, Adelaide, South Australia 5000, Australia
| | - Michelle Lane
- Repromed, 180 Fullarton Road Dulwich, South Australia 5065, Australia.,Robinson Research Institute, University of Adelaide, Adelaide, South Australia 5000, Australia
| | - Deirdre Zander-Fox
- Repromed, 180 Fullarton Road Dulwich, South Australia 5065, Australia.,Future Industries Institute, University of South Australia, Adelaide, South Australia 5000, Australia
| |
Collapse
|
10
|
Geng T, Cheng L, Ge C, Zhang Y. The effect of ICSI in infertility couples with non-male factor: a systematic review and meta-analysis. J Assist Reprod Genet 2020; 37:2929-2945. [PMID: 33073301 PMCID: PMC7714870 DOI: 10.1007/s10815-020-01970-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 10/05/2020] [Indexed: 12/24/2022] Open
Abstract
PURPOSE We performed a systematic review and meta-analysis of available literature to investigate the efficacy of the intracytoplasmic sperm injection (ICSI) in couples with non-male factor with respect to the clinical outcomes. METHODS The literature search was based on EMBASE, PubMed, and the Cochrane Library. All studies published after 1992 until February 2020 and written in English addressing patients in the presence of normal semen parameters subjected to ICSI and in vitro fertilization (IVF) were eligible. Reference lists of retrieved articles were hand-searched for additional studies. The primary outcomes were fertilization rate, clinical pregnancy rate, and implantation rate; the secondary outcomes were good-quality embryo rate, miscarriage rate, and live birth rate. RESULTS Four RCTs and twenty-two cohort studies fulfilling the inclusion criteria were included. Collectively, a meta-analysis of the outcomes in RCTs showed that compared to IVF, ICSI has no obvious advantage in fertilization rate (RR = 1.16, 95% CI: 0.83-1.62), clinical pregnancy rate (RR = 1.04, 95% CI: 0.66-1.64), implantation rate (RR = 1.12, 95% CI: 0.67-1.86), and live birth rate (RR = 1.17, 95% CI: 0.43-3.15). Pooled results of cohort studies demonstrated a statistically significant higher fertilization rate (RR = 1.16, 95% CI: 1.03-1.31) and miscarriage rate (RR = 1.04, 95% CI: 1.01-1.06) in the ICSI group; furthermore, higher clinical pregnancy rate (RR = 0.85, 95% CI: 0.77-0.94), implantation rate (RR = 0.78, 95% CI: 0.65-0.95), and live birth rate (RR = 0.86, 95% CI: 0.79-0.94) was founded in the IVF group; no statistically significant difference was observed in good-quality embryo rate (RR = 0.98, 95% CI: 0.93-1.04). CONCLUSION ICSI has no obvious advantage in patients with normal semen parameters. Enough information is still not available to prove the efficacy of ICSI in couples with non-male factor infertility comparing to IVF.
Collapse
Affiliation(s)
- Ting Geng
- Reproductive Medicine Center, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, People's Republic of China
- Hubei Clinical Research Center for Prenatal Diagnosis and Birth Health, Wuhan, 430071, Hubei, People's Republic of China
- Department of Obstetrics and Gynecology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, People's Republic of China
| | - Lin Cheng
- Reproductive Medicine Center, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, People's Republic of China
- Hubei Clinical Research Center for Prenatal Diagnosis and Birth Health, Wuhan, 430071, Hubei, People's Republic of China
- Department of Obstetrics and Gynecology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, People's Republic of China
| | - Caiyun Ge
- Reproductive Medicine Center, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, People's Republic of China
- Hubei Clinical Research Center for Prenatal Diagnosis and Birth Health, Wuhan, 430071, Hubei, People's Republic of China
- Department of Obstetrics and Gynecology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, People's Republic of China
| | - Yuanzhen Zhang
- Reproductive Medicine Center, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, People's Republic of China.
- Hubei Clinical Research Center for Prenatal Diagnosis and Birth Health, Wuhan, 430071, Hubei, People's Republic of China.
- Department of Obstetrics and Gynecology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, People's Republic of China.
| |
Collapse
|
11
|
Zheng D, Nguyen QN, Li R, Dang VQ. Is Intracytoplasmic Sperm Injection the Solution for all in Unexplained Infertility? Semin Reprod Med 2020; 38:36-47. [PMID: 33152769 DOI: 10.1055/s-0040-1719085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Intracytoplasmic sperm injection (ICSI) was first introduced as a supplemental method to conventional in vitro fertilization (c-IVF) for couples with severe male factor infertility to overcome the poor fertilization rate, while its indications expanded in current clinical practice and gained worldwide popularity. However, ICSI is invasive and crosses all natural barriers, raising several unresolved concerns regarding procedure-dependent and procedure-independent risks, as well as the characteristic of being labor-intensive and more expensive than c-IVF. This review is aimed to draw readers' attention, to the widespread use of ICSI worldwide, with its effectiveness in different indications of infertility, especially in those with unexplained infertility, as well as the cost-effectiveness of the ICSI-for-all strategy. Also, we covered current evidence on the short- and long-term safety of children born thanks to ICSI-aided conception. Further well-designed, adequately powered, and randomized controlled clinical trials are absolutely needed to arrive at a consensus on the use of ICSI over c-IVF in different populations.
Collapse
Affiliation(s)
- Danni Zheng
- Department of Obstetrics and Gynecology, Center for Reproductive Medicine, Peking University Third Hospital, Beijing, China.,National Clinical Research Center for Obstetrics and Gynecology, Beijing, China.,Key Laboratory of Assisted Reproduction, Ministry of Education, Beijing, China.,Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, China.,Beijing Advanced Innovation Center for Genomics, Beijing, China.,Peking-Tsinghua Center for Life Sciences, Peking University, Beijing, China
| | | | - Rong Li
- Department of Obstetrics and Gynecology, Center for Reproductive Medicine, Peking University Third Hospital, Beijing, China.,National Clinical Research Center for Obstetrics and Gynecology, Beijing, China.,Key Laboratory of Assisted Reproduction, Ministry of Education, Beijing, China.,Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, China.,Beijing Advanced Innovation Center for Genomics, Beijing, China.,Peking-Tsinghua Center for Life Sciences, Peking University, Beijing, China
| | - Vinh Q Dang
- IVFMD, My Duc Hospital, Ho Chi Minh, Vietnam.,HOPE Research Center, My Duc Hospital, Ho Chi Minh, Vietnam
| |
Collapse
|
12
|
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.
Collapse
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.
| |
Collapse
|
13
|
When do we use intracytoplasmic sperm injection? Fertil Steril 2020; 114:746-747. [PMID: 32732106 DOI: 10.1016/j.fertnstert.2020.05.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 05/22/2020] [Indexed: 11/23/2022]
|
14
|
Intracytoplasmic sperm injection (ICSI) for non-male factor indications: a committee opinion. Fertil Steril 2020; 114:239-245. [PMID: 32654822 DOI: 10.1016/j.fertnstert.2020.05.032] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 05/27/2020] [Indexed: 12/21/2022]
Abstract
Intracytoplasmic sperm injection, while typically effective for overcoming low or absent fertilization in couples with a clear abnormality of semen parameters, is frequently used in combination with assisted reproductive technologies for other etiologies of infertility in the presence of semen parameters that meet the World Health Organization 2010 normative reference values. This committee opinion provides a critical review of the literature, where available, to identify situations where this may or may not be of benefit. This document replaces the previously published document of the same name, last published in 2012 (Fertil Steril 2012;98:1395-9).
Collapse
Affiliation(s)
-
- American Society for Reproductive Medicine and Society for Assisted Reproductive Technology, Birmingham, Alabama
| |
Collapse
|
15
|
Supramaniam PR, Granne I, Ohuma EO, Lim LN, McVeigh E, Venkatakrishnan R, Becker CM, Mittal M. ICSI does not improve reproductive outcomes in autologous ovarian response cycles with non-male factor subfertility. Hum Reprod 2020; 35:583-594. [DOI: 10.1093/humrep/dez301] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Revised: 12/12/2019] [Accepted: 12/18/2019] [Indexed: 12/27/2022] Open
Abstract
Abstract
STUDY QUESTION
Does the method of fertilisation improve reproductive outcomes in poor ovarian response (POR) cycles when compared to all other ovarian response categories in the absence of male factor subfertility?
SUMMARY ANSWER
ICSI does not confer any benefit in improving the clinical pregnancy or live birth (LB) outcome in autologous ovarian response cycles in the absence of male factor subfertility when compared to IVF.
WHAT IS KNOWN ALREADY
ICSI is associated with an improved outcome when compared to IVF in patients with severe male factor subfertility.
STUDY DESIGN, SIZE, DURATION
A retrospective study involving 1 376 454 ART cycles, of which 569 605 (41.4%) cycles fulfilled the inclusion and exclusion criteria for all autologous ovarian response categories: 272 433 (47.8%) IVF cycles and 297 172 (52.2%) ICSI cycles. Of these, the POR cohort represented 62 641 stimulated fresh cycles (11.0%): 33 436 (53.4%) IVF cycles and 29 205 (46.6%) ICSI cycles.
PARTICIPANTS/MATERIALS, SETTING, METHOD
All cycles recorded on the anonymised Human Fertilisation and Embryology Authority (HFEA) registry database between 1991 and 2016 were analysed. All fresh cycles with normal sperm parameters, performed after 1998 were included: frozen cycles, donor oocyte and sperm usage, intrauterine insemination cycles, preimplantation genetic testing (PGT) for aneuploidies (PGT-A), PGT for monogenic/single gene defects (PGT-M), PGT for chromosomal structural arrangements (PGT-SR) cycles, where the reason for stimulation was for storage and unstimulated cycles were excluded.
MAIN RESULTS AND THE ROLE OF CHANCE
ICSI did not confer any benefit in improving the LB outcome when compared to conventional IVF per treatment cycle (PTC), when adjusted for female age, number of previous ART treatment cycles, number of previous live births through ART, oocyte yield, stage of transfer, method of fertilisation and number of embryos transferred in the POR cohort (adjusted odds ratio [a OR] 1.03, 99.5% confidence interval [CI] 0.96–1.11, P = 0.261) and all autologous ovarian response categories (aOR 1.00, 99.5% CI 0.98–1.02, P = 0.900). The mean fertilisation rate was statistically lower for IVF treatment cycles (64.7%) when compared to ICSI treatment cycles (67.2%) in the POR cohort (mean difference −2.5%, 99.5% CI −3.3 to −1.6, P < 0.001). The failed fertilisation rate was marginally higher in IVF treatment cycles (17.3%, 95% binomial exact 16.9 to 17.7%) when compared to ICSI treatment cycles (17.0%, 95% binomial exact 16.6 to 17.4%); however, this did not reach statistical significance (P = 0.199). The results followed a similar trend when analysed for all autologous ovarian response categories with a higher rate of failed fertilisation in IVF treatment cycles (4.8%, 95% binomial exact 4.7 to 4.9%) when compared to ICSI treatment cycles (3.2%, 95% binomial exact 3.1 to 3.3%) (P < 0.001).
LIMITATIONS, REASONS FOR CAUTION
The quality of data is reliant on the reporting system. Furthermore, success rates through ART have improved since 1991, with an increased number of blastocyst-stage embryo transfers. The inability to link the treatment cycle to the individual patient meant that we were unable to calculate the cumulative LB outcome per patient.
WIDER IMPLICATIONS OF THE FINDINGS
This is the largest study to date which evaluates the impact of method of fertilisation in the POR patient and compares this to all autologous ovarian response categories. The results demonstrate that ICSI does not confer any benefit in improving reproductive outcomes in the absence of male factor subfertility, with no improvement seen in the clinical pregnancy or LB outcomes following a fresh treatment cycle.
STUDY FUNDING/COMPETING INTEREST(S)
The study received no funding. C.M.B. is a member of the independent data monitoring group for a clinical endometriosis trial by ObsEva. He is on the scientific advisory board for Myovant and medical advisory board for Flo Health. He has received research grants from Bayer AG, MDNA Life Sciences, Volition Rx and Roche Diagnostics as well as from Wellbeing of Women, Medical Research Council UK, the NIH, the UK National Institute for Health Research and the European Union. He is the current Chair of the Endometriosis Guideline Development Group for ESHRE and was a co-opted member of the Endometriosis Guideline Group by the UK National Institute for Health and Care Excellence (NICE). I.G. has received research grants from Bayer AG, Wellbeing of Women, the European Union and Finox.
TRIAL REGISTRATION NUMBER
Not applicable.
Collapse
Affiliation(s)
- P R Supramaniam
- John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, UK
| | - I Granne
- John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, UK
- Oxford Endometriosis CaRe Centre, Nuffield Department of Women’s and Reproductive Health, University of Oxford, Oxford OX3 9DU, UK
- Oxford Reproductive Medicine, The Manor Hospital, Oxford OX3 7RP, UK
| | - E O Ohuma
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford OX3 7BN, UK
- Centre for Global Child Health & Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, Canada M5G 2L3
| | - L N Lim
- John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, UK
- Oxford Reproductive Medicine, The Manor Hospital, Oxford OX3 7RP, UK
| | - E McVeigh
- John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, UK
- Oxford Endometriosis CaRe Centre, Nuffield Department of Women’s and Reproductive Health, University of Oxford, Oxford OX3 9DU, UK
- Oxford Reproductive Medicine, The Manor Hospital, Oxford OX3 7RP, UK
| | - R Venkatakrishnan
- Department of Obstetrics and Gynaecology, University Hospitals of Derby and Burton NHS Foundation Trust, Derby DE22 3NE, UK
| | - C M Becker
- John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, UK
- Oxford Endometriosis CaRe Centre, Nuffield Department of Women’s and Reproductive Health, University of Oxford, Oxford OX3 9DU, UK
- Oxford Reproductive Medicine, The Manor Hospital, Oxford OX3 7RP, UK
| | - M Mittal
- Department of Obstetrics and Gynaecology, Wolfson Fertility Center, St Mary’s and Hammersmith Hospitals, Imperial College Healthcare NHS Trust, London W2 1NY, UK
| |
Collapse
|
16
|
Stimpfel M, Jancar N, Vrtacnik-Bokal E, Virant-Klun I. Conventional IVF improves blastocyst rate and quality compared to ICSI when used in patients with mild or moderate teratozoospermia. Syst Biol Reprod Med 2019; 65:458-464. [PMID: 31522570 DOI: 10.1080/19396368.2019.1666436] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The ICSI procedure was invented to treat severe male infertility but is often used even if the sperm quality parameters are normal. This practice has recently been called into question, but there is still no clear answer especially in terms of sperm morphology, regarding when it is necessary to perform ICSI and when conventional IVF is indeed more beneficial. In borderline cases it seems logical to fertilize oocytes using ICSI and conventional IVF at the same time. Since we also use this approach we performed a retrospective analysis of such cycles to elucidate, which procedure results in a better clinical outcome in terms of fertilization rate, the quality of day 3 and day 5 embryos, and the pregnancy rate. The data from fifty-one couples who were treated with ART and whose male factor of infertility was defined as teratozoospermia were included. The fertilization rates were similar between ICSI and conventional IVF groups (per COCs: 54.5% vs. 58.2%, P = 0.322; per MII oocytes: 63.9% vs. 67.2%; P = 0.399), but more oocytes degenerated after ICSI (11.7% vs. 4.3%; P = 0.0003). The quality of cleaved embryos was similar between the groups, but more embryos reached the blastocyst stage after conventional IVF (43.7% vs. 55.0%; P = 0.032) and furthermore, more of them were of good quality (19.8% vs. 29.2%; P = 0.037). The pregnancy rate did not significantly differ between the groups (21.4% vs. 45.5%; P = 0.175), although there was a trend in favor of conventional IVF. This retrospective analysis suggests that when sperm morphology is not severely impaired and sperm concentration and motility are normal, it is better to use conventional IVF to fertilize oocytes and not ICSI. The main advantage of conventional IVF is reflected in improved blastocyst rate and quality.Abbreviations: ICSI: intracytoplasmic sperm injection; IVF: in vitro fertilization; COC: cumulus-oocyte complex; COH: controlled ovarian hyperstimulation.
Collapse
Affiliation(s)
- Martin Stimpfel
- Department of Human Reproduction, Division of Gynaecology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Nina Jancar
- Department of Human Reproduction, Division of Gynaecology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Eda Vrtacnik-Bokal
- Department of Human Reproduction, Division of Gynaecology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Irma Virant-Klun
- Department of Human Reproduction, Division of Gynaecology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| |
Collapse
|
17
|
Simerly CR, Takahashi D, Jacoby E, Castro C, Hartnett C, Hewitson L, Navara C, Schatten G. Fertilization and Cleavage Axes Differ In Primates Conceived By Conventional (IVF) Versus Intracytoplasmic Sperm Injection (ICSI). Sci Rep 2019; 9:15282. [PMID: 31653971 PMCID: PMC6814755 DOI: 10.1038/s41598-019-51815-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 10/03/2019] [Indexed: 12/14/2022] Open
Abstract
With nearly ten million babies conceived globally, using assisted reproductive technologies, fundamental questions remain; e.g., How do the sperm and egg DNA unite? Does ICSI have consequences that IVF does not? Here, pronuclear and mitotic events in nonhuman primate zygotes leading to the establishment of polarity are investigated by multidimensional time-lapse video microscopy and immunocytochemistry. Multiplane videos after ICSI show atypical sperm head displacement beneath the oocyte cortex and eccentric para-tangential pronuclear alignment compared to IVF zygotes. Neither fertilization procedure generates incorporation cones. At first interphase, apposed pronuclei align obliquely to the animal-vegetal axis after ICSI, with asymmetric furrows assembling from the male pronucleus. Furrows form within 30° of the animal pole, but typically, not through the ICSI injection site. Membrane flow drives polar bodies and the ICSI site into the furrow. Mitotic spindle imaging suggests para-tangential pronuclear orientation, which initiates random spindle axes and minimal spindle:cortex interactions. Parthenogenetic pronuclei drift centripetally and assemble astral spindles lacking cortical interactions, leading to random furrows through the animal pole. Conversely, androgenotes display cortex-only pronuclear interactions mimicking ICSI. First cleavage axis determination in primates involves dynamic cortex-microtubule interactions among male pronuclei, centrosomal microtubules, and the animal pole, but not the ICSI site.
Collapse
Affiliation(s)
- Calvin R Simerly
- Pittsburgh Development Center, Division of Developmental & Regenerative Medicine, and Obstetrics-Gynecology-Reproductive Sciences, Cell Biology, and Bioengineering, University of Pittsburgh Cancer Institute, University of Pittsburgh School of Medicine, 204 Craft Avenue Pittsburgh, Pennsylvania, 15213, USA
| | - Diana Takahashi
- Division of Cardiometabolic Health, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, Oregon, 97006, USA
| | - Ethan Jacoby
- CCRM Houston Main Center Memorial City, 929 Gessner Rd, Suite 2300, Houston, Texas, 77024, USA
| | - Carlos Castro
- Pittsburgh Development Center, Division of Developmental & Regenerative Medicine, and Obstetrics-Gynecology-Reproductive Sciences, Cell Biology, and Bioengineering, University of Pittsburgh Cancer Institute, University of Pittsburgh School of Medicine, 204 Craft Avenue Pittsburgh, Pennsylvania, 15213, USA
| | - Carrie Hartnett
- Pittsburgh Development Center, Division of Developmental & Regenerative Medicine, and Obstetrics-Gynecology-Reproductive Sciences, Cell Biology, and Bioengineering, University of Pittsburgh Cancer Institute, University of Pittsburgh School of Medicine, 204 Craft Avenue Pittsburgh, Pennsylvania, 15213, USA
| | - Laura Hewitson
- The Johnson Center for Child Health and Development, Austin, Texas, 78701, USA
| | - Christopher Navara
- Department of Biology, South Texas Center for Emerging Infectious Disease, University of Texas at San Antonio, San Antonio, Texas, 78249, USA
| | - Gerald Schatten
- Pittsburgh Development Center, Division of Developmental & Regenerative Medicine, and Obstetrics-Gynecology-Reproductive Sciences, Cell Biology, and Bioengineering, University of Pittsburgh Cancer Institute, University of Pittsburgh School of Medicine, 204 Craft Avenue Pittsburgh, Pennsylvania, 15213, USA.
| |
Collapse
|
18
|
Esteves SC, Roque M, Bedoschi G, Haahr T, Humaidan P. Intracytoplasmic sperm injection for male infertility and consequences for offspring. Nat Rev Urol 2019; 15:535-562. [PMID: 29967387 DOI: 10.1038/s41585-018-0051-8] [Citation(s) in RCA: 127] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Intracytoplasmic sperm injection (ICSI) has become the most commonly used method of fertilization in assisted reproductive technology. The primary reasons for its popularity stem from its effectiveness, the standardization of the procedure, which means that it can easily be incorporated into the routine practice of fertility centres worldwide, and the fact that it can be used to treat virtually all forms of infertility. ICSI is the clear method of choice for overcoming untreatable severe male factor infertility, but its (over)use in other male and non-male factor infertility scenarios is not evidence-based. Despite all efforts to increase ICSI efficacy and safety through the application of advanced sperm retrieval and cryopreservation techniques, as well as methods for selecting sperm with better chromatin integrity, the overall pregnancy rates from infertile men remain suboptimal. Treating the underlying male infertility factor before ICSI seems to be a promising way to improve ICSI outcomes, but data remain limited. Information regarding the health of ICSI offspring has accumulated over the past 25 years, and there are reasons for concern as risks of congenital malformations, epigenetic disorders, chromosomal abnormalities, subfertility, cancer, delayed psychological and neurological development, and impaired cardiometabolic profile have been observed to be greater in infants born as a result of ICSI than in naturally conceived children. However, as subfertility probably influences the risk estimates, it remains to be determined to what extent the observed adverse outcomes are related to parental factors or associated with ICSI.
Collapse
Affiliation(s)
- Sandro C Esteves
- ANDROFERT, Andrology and Human Reproduction Clinic, Campinas, Brazil. .,Department of Surgery (Division of Urology), Faculty of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil. .,Faculty of Health, Aarhus University, Aarhus, Denmark.
| | - Matheus Roque
- ORIGEN, Center for Reproductive Medicine, Rio de Janeiro, Brazil
| | - Giuliano Bedoschi
- Division of Reproductive Medicine, Department of Gynecology and Obstetrics, University of São Paulo (USP), São Paulo, Brazil
| | - Thor Haahr
- Faculty of Health, Aarhus University, Aarhus, Denmark.,Fertility Clinic, Skive Regional Hospital, Skive, Denmark
| | - Peter Humaidan
- Faculty of Health, Aarhus University, Aarhus, Denmark.,Fertility Clinic, Skive Regional Hospital, Skive, Denmark
| |
Collapse
|
19
|
Weiss JM. Schilddrüseneinstellung bei Kinderwunsch und in der Schwangerschaft. GYNAKOLOGISCHE ENDOKRINOLOGIE 2019. [DOI: 10.1007/s10304-018-0225-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
20
|
Biliangady R, Kinila P, Pandit R, Tudu NK, Sundhararaj UM, Gopal IST, Swamy AG. Are we Justified Doing Routine Intracytoplasmic Sperm Injection in Nonmale Factor Infertility? A Retrospective Study Comparing Reproductive Outcomes between In vitro Fertilization and Intracytoplasmic Sperm Injection in Nonmale Factor Infertility. J Hum Reprod Sci 2019; 12:210-215. [PMID: 31576078 PMCID: PMC6764219 DOI: 10.4103/jhrs.jhrs_8_19] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Introduction: Intracytoplasmic sperm insemination (ICSI) came into use in 1992 to improve fertilization in couples with male factor infertility undergoing in vitro fertilization (IVF) or in couples with fertilization failure in a prior IVF cycle. Our aim was to find out if routine ICSI has any additional benefit over conventional IVF in non male factor cases in modern Assisted Reproductive Technology (ART). Methods: This is a retrospective single centre study undertaken at a private IVF center. A total of 350 patients with normal male factor were included in the study of which 186 underwent conventional IVF and 134 were subjected to ICSI. They were then compared for various reproductive parameters with Live Birth Rate (LBR) being the primary outcome. P value < 0.05 was considered statistically significant. Results: Fertilization rates (89.99% vs 85.1%), Blastocyst formation rates (62.86% vs 50.61%) and clinical pregnancy rates (37.85% vs 32.35%) were found to be higher in the IVF group compared to the ICSI group though not statistically significant. The live birth rates in the IVF group was also higher than the ICSI group (32.71% vs 24.26%). Conclusion: IVF edged over ICSI in all aspects resulting in better clinical outcome with higher take home babies in non-male factor infertility. Our results show that routine ICSI should not be used as a blanket therapy for all cases in ART.
Collapse
Affiliation(s)
- Reeta Biliangady
- Department of Reproductive Medicine, Cloudnine Fertility, Bengaluru, Karnataka, India
| | - Poornima Kinila
- Department of Reproductive Medicine, Cloudnine Fertility, Bengaluru, Karnataka, India
| | - Rubina Pandit
- Department of Reproductive Medicine, Cloudnine Fertility, Bengaluru, Karnataka, India
| | - Nutan Kumari Tudu
- Department of Embryology, Cloudnine Fertility, Bengaluru, Karnataka, India
| | | | - Indu S T Gopal
- Department of Reproductive Medicine, Cloudnine Fertility, Bengaluru, Karnataka, India
| | - Ambika G Swamy
- Department of Embryology, Cloudnine Fertility, Bengaluru, Karnataka, India
| |
Collapse
|
21
|
Dyer S, Archary P, de Mouzon J, Fiadjoe M, Ashiru O. Assisted reproductive technologies in Africa: first results from the African Network and Registry for Assisted Reproductive Technology, 2013. Reprod Biomed Online 2018; 38:216-224. [PMID: 30553656 DOI: 10.1016/j.rbmo.2018.11.001] [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: 08/02/2018] [Revised: 11/07/2018] [Accepted: 11/07/2018] [Indexed: 10/27/2022]
Abstract
RESEARCH QUESTION What were utilization, outcomes and practices in assisted reproductive technology (ART) in Africa in 2013? DESIGN To initiate a data registry in Africa, retrospective summary data were collected in a cross-sectional survey. RESULTS Forty ART centres from 13 countries collectively reported 25,770 initiated cycles. Regional ART utilization could not be established due to large inter-country variations and insufficient data. The pregnancy rate per aspiration for fresh non-donor IVF and intracytoplasmic sperm injection was 28.0% and 35.8%, with a preponderance of women under 35 years (57.3%). Deliveries were reported for only 56.1% of pregnancies; the remainder were lost to follow-up. A mean of 2.41 embryos were transferred. The multiple delivery rate was 26.7% (25.5% twins and 1.2% triplets). Most twins (52.7%) and triplets (73.7%) were born pre-term. Oocyte donation represented 7% of all fresh and frozen transfers. CONCLUSION This marks the beginning of an ART registry in Africa, Since ART utilization could not be established, the degree of access to ART remains speculative. Pregnancy rates were favourable but underpinned by a preponderance of young women and the transfer of multiple embryos. Efforts are needed to explore treatment barriers, improve pregnancy follow-up and reduce the high rate of multiples. This inaugural report from the African Network and Registry for Assisted Reproductive Technology (ANARA) indicates a willingness and ability of ART centres to voluntarily report and monitor utilization and outcomes of ART, which reflects a rising standard of ART in Africa. It is anticipated that more centres and countries will join ANARA to continue this trend.
Collapse
Affiliation(s)
- Silke Dyer
- Department of Obstetrics and Gynaecology, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; African Network and Registry for Assisted Reproductive Technology.
| | - Paversan Archary
- Department of Obstetrics and Gynaecology, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; African Network and Registry for Assisted Reproductive Technology
| | - Jacques de Mouzon
- Institut National de la Santé et de la Recherche Médicale Service de Gynécologie Obstétrique II et de Médecine de la Reproduction, Groupe Hospitalier Cochin-Saint Vincet de Paul, Paris, France
| | - Moise Fiadjoe
- Groupe Interafricain d'Etude, de Recherche et d'Application sur la Fertilité
| | | | | |
Collapse
|
22
|
Li Z, Wang AY, Bowman M, Hammarberg K, Farquhar C, Johnson L, Safi N, Sullivan EA. ICSI does not increase the cumulative live birth rate in non-male factor infertility. Hum Reprod 2018; 33:1322-1330. [DOI: 10.1093/humrep/dey118] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 05/14/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Z Li
- Sydney Medical School, The University of Sydney, Sydney NSW, Australia
- Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney NSW, Australia
| | - A Y Wang
- Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney NSW, Australia
| | - M Bowman
- Sydney Medical School, The University of Sydney, Sydney NSW, Australia
| | - K Hammarberg
- Victorian Assisted Reproductive Treatment Authority, Melbourne Vic, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne Vic, Australia
| | - C Farquhar
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - L Johnson
- Victorian Assisted Reproductive Treatment Authority, Melbourne Vic, Australia
| | - N Safi
- Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney NSW, Australia
| | - E A Sullivan
- Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney NSW, Australia
| |
Collapse
|
23
|
Rosenwaks Z, Pereira N. The pioneering of intracytoplasmic sperm injection: historical perspectives. Reproduction 2017; 154:F71-F77. [DOI: 10.1530/rep-17-0308] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 09/19/2017] [Accepted: 10/09/2017] [Indexed: 11/08/2022]
Abstract
Intracytoplasmic sperm injection (ICSI) has often been heralded as a ground-breaking technique that has transformed the treatment of couples with infertility. By injecting a single spermatozoon into the cytoplasm of the oocyte, ICSI bypasses the zona pellucida and increases the chances of fertilization and subsequent embryo development, independent of semen parameters. Ever since the first live births using ICSI were reported in 1992, ICSI has become the mainstay of treating male factor infertility as well as overcoming fertilization failure associated with conventional in vitro insemination. Today, ICSI is utilized in nearly 66% of all assisted reproductive treatments worldwide and has resulted in the birth of millions of babies. The primary goal of this review is to provide historical perspectives about the pioneering of ICSI. We begin by highlighting the scientific work of early investigators who elucidated the mechanisms central to mammalian fertilization. Furthermore, we briefly discuss how these findings contributed to the development of IVF for the treatment of infertility. We then emphasize the shortcomings of IVF in treating severe forms of male factor infertility and enumerate the micromanipulation techniques that were developed to circumvent these shortcomings. Finally, we indicate how the inadequacies of these micromanipulation techniques lead to the inception, application and popularity of ICSI.
Collapse
|
24
|
Harper J, Jackson E, Sermon K, Aitken RJ, Harbottle S, Mocanu E, Hardarson T, Mathur R, Viville S, Vail A, Lundin K. Adjuncts in the IVF laboratory: where is the evidence for 'add-on' interventions? Hum Reprod 2017; 32:485-491. [PMID: 28158511 DOI: 10.1093/humrep/dex004] [Citation(s) in RCA: 102] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Accepted: 01/05/2017] [Indexed: 01/20/2023] Open
Abstract
Globally, IVF patients are routinely offered and charged for a selection of adjunct treatments and tests or 'add-ons' that they are told may improve their chance of a live birth, despite there being no clinical evidence supporting the efficacy of the add-on. Any new IVF technology claiming to improve live birth rates (LBR) should, in most cases, first be tested in an appropriate animal model, then in clinical trials, to ensure safety, and finally in a randomized controlled trial (RCT) to provide high-quality evidence that the procedure is safe and effective. Only then should the technique be considered as 'routine' and only when applied to the similar patient population as those studied in the RCT. Even then, further pediatric and long-term follow-up studies will need to be undertaken to examine the long-term safety of the procedure. Alarmingly, there are currently numerous examples where adjunct treatments are used in the absence of evidence-based medicine and often at an additional fee. In some cases, when RCTs have shown the technique to be ineffective, it is eventually withdrawn from the clinic. In this paper, we discuss some of the adjunct treatments currently being offered globally in IVF laboratories, including embryo glue and adherence compounds, sperm DNA fragmentation, time-lapse imaging, preimplantation genetic screening, mitochondria DNA load measurement and assisted hatching. We examine the evidence for their safety and efficacy in increasing LBRs. We conclude that robust studies are needed to confirm the safety and efficacy of any adjunct treatment or test before they are offered routinely to IVF patients.
Collapse
Affiliation(s)
- Joyce Harper
- Embryology, IVF and Reproductive Genetics, Institute for Women's Health, University College London, London, UK
| | - Emily Jackson
- Law Department, London School of Economics and Political Science, London, UK
| | - Karen Sermon
- Research Group Reproduction and Genetics, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Robert John Aitken
- Priority Research Centre for Reproductive Science, University of Newcastle, NSW, Australia
| | - Stephen Harbottle
- Cambridge IVF, Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - Edgar Mocanu
- Rotunda Hospital and RCSI, Parnell Square, Dublin 1, Ireland
| | - Thorir Hardarson
- Fertilitetscentrum, Carlanders Hospital, 402 29Gothenburg, Sweden
| | - Raj Mathur
- Department of Reproductive Medicine, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester M13 9WL, UK
| | - Stephane Viville
- Institut de Parasitologie et Pathologie Tropicale, EA 7292, three rue Koeberlé, 67000 Strasbourg, France and Laboratoire de diagnostic génétique, UF3472-génétique de l'infertilité, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France
| | - Andy Vail
- Centre for Biostatistics, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK
| | - Kersti Lundin
- Reproductive Medicine, Sahlgrenska University Hospital, Goteborg, Sweden
| |
Collapse
|
25
|
Schwarze JE, Jeria R, Crosby J, Villa S, Ortega C, Pommer R. Is there a reason to perform ICSI in the absence of male factor? Lessons from the Latin American Registry of ART. Hum Reprod Open 2017; 2017:hox013. [PMID: 30895229 PMCID: PMC6276656 DOI: 10.1093/hropen/hox013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Revised: 06/19/2017] [Accepted: 08/09/2017] [Indexed: 11/12/2022] Open
Abstract
Study question Does the use of ICSI offer any outcome advantage over IVF in patients with non-male factor infertility? Summary answer We did not find any outcome improvement that justifies the routine use of ICSI over IVF in non-male factor ART cycles. What is already known Since its introduction in Latin America, the use of ICSI has increased substantially, even among patients without male factor infertility. However, it is not clear whether ICSI provides an advantage over IVF in non-male factor infertility. Study design size duration A retrospective cohort study of fresh cycles performed in 155 ART clinics located in 15 Latin American countries between 2012 and 2014. Records were assessed for 49,813 ART cycles (39,564 ICSI and 10,249 IVF) performed in infertile couples who did not have male factor infertility. Student's t-test was used to analyze normally distributed data, Wilcoxon test to analyze non-normally distributed data, and Fisher's exact test for categorical data. Logistic regression was used to quantify the effect of ICSI on delivery rate, adjusting for age of female partner, number of oocytes inseminated, number of embryos transferred, and transfer at blastocyst stage as possible confounding factors. Poisson regression analysis was used to quantify the effect of ICSI on fertilization rate, adjusting for age of female partner. Participants/materials setting method Cycles with the diagnosis of male factor and use of cryopreserved semen and with a freeze-all strategy were excluded. Main results and the role of chance After correcting for age of female partner, number of oocytes inseminated, number of embryos transferred and transfer at blastocyst stage, we found that the use of ICSI was associated with a significant decrease in the odds of delivery compared to IVF (odds ratio 0.88, 95% CI 0.84 to 0.93; P < 0.0001). Limitations reasons for caution An important limitation of this study is the lack of randomization owing to its retrospective nature. This could result in selection bias, i.e. couples with the worst prognosis undergoing ICSI, or patients with a history of fertilization failure in IVF cycles undergoing ICSI. More than one cycle from the same couple may be included in the study. Wider implications of the findings The lack of an outcome benefit-and, indeed, a reduced likelihood of delivery-following ICSI in non-male factor infertile couples suggests that ICSI may not be the most appropriate clinical approach in these patients. Study funding/competing interests None.
Collapse
Affiliation(s)
- Juan-Enrique Schwarze
- Reproductive Medicine Unit, Clinica Monteblanco, Camino a Farellones 18780, Lo Barnechea, Santiago 7690000, Chile.,Obstetrics and Gynecology, Universidad de Santiago, Av Libertador Bernardo O'Higgins 3363, Santiago, Estación Central, Chile
| | - Rodrigo Jeria
- Obstetrics and Gynecology, Universidad de Santiago, Av Libertador Bernardo O'Higgins 3363, Santiago, Estación Central, Chile
| | - Javier Crosby
- Reproductive Medicine Unit, Clinica Las Condes, Estoril 450, Las Condes, Santiago, Chile
| | - Sonia Villa
- Reproductive Medicine Unit, Clinica Monteblanco, Camino a Farellones 18780, Lo Barnechea, Santiago 7690000, Chile
| | - Carolina Ortega
- Reproductive Medicine Unit, Clinica Monteblanco, Camino a Farellones 18780, Lo Barnechea, Santiago 7690000, Chile
| | - Ricardo Pommer
- Reproductive Medicine Unit, Clinica Monteblanco, Camino a Farellones 18780, Lo Barnechea, Santiago 7690000, Chile
| |
Collapse
|
26
|
Zagadailov P, Hsu A, Seifer DB, Stern JE. Differences in utilization of Intracytoplasmic sperm injection (ICSI) within human services (HHS) regions and metropolitan megaregions in the U.S. Reprod Biol Endocrinol 2017; 15:45. [PMID: 28606175 PMCID: PMC5469007 DOI: 10.1186/s12958-017-0263-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 06/04/2017] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Anecdotal evidence suggests that US practice patterns for ART differ by geographical region. The purpose of this study was to determine whether use of ICSI differs by region and to evaluate whether these rates are correlated with differences in live birth rates. METHODS Public data for 2012 were obtained from the Centers for Disease Control and Prevention. Clinics with ≥100 fresh, non-donor cycles were grouped by 10 nationally recognized Department of Health & Human Services regions and 11 metropolitan Megaregions and were compared for use of ICSI, frequency of male factor infertility, and live birth rate in women <35 years. RESULTS There were 274 clinics in the Health & Human Services regions and 247 in the Megaregions. ICSI utilization rates in Health & Human Services groups ranged between 52.5-78.2% (P < 0.0001). Live birth rates per cycle in women <35 years differed (34.1-47.6%; P < 0.0001) but did not correlate with rates of ICSI (R2 = 0.2096; P = 0.18) per cycle. For Megaregions, rates of ICSI per cycle differed (63.4%-93.5%, P < 0.0001) as did live birth rates per cycle for women <35 (36.0%-59.0%, P = 0.001) but there was only minimal correlation between them (R2 = 0.5347; P = 0.01). Highest rates of ICSI occurred in Front Range (93.5%) and Gulf Coast (83.1%) Megaregions. Lowest rates occurred in the Northeast (63.4%) and Florida (64.8%) Megaregions. Male factor infertility rates did not differ across regions. CONCLUSIONS ICSI utilization and live birth rates per cycle for each clinic group were significantly different across geographical regions of the U.S. However, higher ICSI utilization rate was not associated with higher rates of male factor infertility nor were they strongly correlated with higher live birth rates per cycle. Studies are needed to understand factors that may influence ICSI overutilization in the U.S.
Collapse
Affiliation(s)
- Pavel Zagadailov
- 0000 0004 0440 749Xgrid.413480.aDepartment of Ob/Gyn, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756 USA
| | - Albert Hsu
- 0000 0001 2179 2404grid.254880.3Department of Ob/Gyn, Dartmouth-Hitchcock Medical Center and the Geisel School of Medicine at Dartmouth, One Medical Center Dr, Lebanon, NH 03756 USA
| | - David B. Seifer
- 0000 0001 2179 2404grid.254880.3Department of Ob/Gyn, Dartmouth-Hitchcock Medical Center and the Geisel School of Medicine at Dartmouth, One Medical Center Dr, Lebanon, NH 03756 USA
| | - Judy E. Stern
- 0000 0001 2179 2404grid.254880.3Department of Ob/Gyn, Dartmouth-Hitchcock Medical Center and the Geisel School of Medicine at Dartmouth, One Medical Center Dr, Lebanon, NH 03756 USA
| |
Collapse
|