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Fertilization and pregnancy rates after intracytoplasmic sperm injection using ejaculate semen and surgically retrieved sperm
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Citutiorrs from the literuhrre / It~ternutiotrul Joumul of Gynecology & Obstetrics 60 (1998) 95-105
surgery primarily for pelvic organ prolapse is low, increases with worsening pelvic organ prolapse and is lower in patients with vaginal vault prolapse than in those with uterine prolapse. Double uterus, blind hemivagina and ipsilateral renal agenesis: Thirty-six cases and long-term follow-up Candiani G.B.; Fedele L.; Candiani M. ITA OBSTET GYNECOL lYY7 YO/ I (26-32) Objective: To review the experience of the Milan University First Department of Obstetrics and Gynecology in patients with double, didelphic, or bicornuate uterus, blind hemivagina and ipsilateral renal agenesis and to consider the frequently unsatisfactory surgical approach. Methods: Thirty-six women with double, didelphic, or bicornuate uterus, blind hemivagina and ipsilateral renal agenesis were identified from clinical records for the period lY62- lYY2. We evaluated demographic data, disease, symptoms, correctness of therapeutic approach and definitive treatment. Results: Seventeen patients previously had undergone incomplete surgery in other hospitals and 19 were treated by us for the first time. Total hysterectomy was performed on two of the 36 women and hemihysterectomy and hemicolpectomy were performed on four. In the other 30, the vaginal septum was excised and marsupialization was done. The pregnancy rate in the IS women wanting children was 87% and the live birth rate was 77%. Serial biopsy specimens were obtained from the lateral fornix after the excision of the septum in 13 of the 30 non-hysterectomized patients over I-Y years and revealed progressively more extensive areas of squamous metaplasia of mullerian epithelium. In some isolated cases. papillary hyperplasia, mild dysplasia and vaginal adenosis were found. At the end of followup, Ih patients still did not want children. Follow-up was possible in 34 cases. Conclusion: Early accurate diagnosis after menarche followed by excision and marsupialization of the blind hemivagina offers complete relief of symptoms and preserves reproductive potential. Partial morphologic changes are evident but metabolic modifications comparable to those of the adjacent normal vagina have not yet been documented.
FERTILITY
AND STERILITY
Failure of oocyte activation after intracytoplasmic sperm injection using round-headed sperm Battaglia D.E.: Koehler J.K.; Klein N.A.; Tucker M.J. USA FERTIL STERIL lYY7 6X/l (11X-122) Objective: To examine the outcome of intracytoplasmic sperm injection (ICSI) with round-headed sperm (globozoospermia). Design: Retrospective analysis. Setting: In vitro fertilization laboratory with extensive ICSI experience. Patient(s): A patient
couple with infertility because of globozoospermia seeking ICSI treatment. Main outcome measure(s): Fertilization. cleavage and pregnancy rates. Intervention(s): Intracytoplasmic sperm injection and calcium ionophore. Result(s): This couple experienced only 7%~ fertilization after ICSI in their first cycle. Treatment of the unfertilized oocytes with calcium ionophore 20 h after ICSI-induced fertilization and cleavage of 7Y% of the oocytes. Embryo quality was fair to good. On the second cycle, eight of the injected oocytes were treated with ionophore immediately after ICSI and the remaining 20 oocytes were untreated. Normal fertilization was achieved in 75% of the treated and 10% of the untreated oocytes. Treatment of these unfertilized oocytes with ionophore 20 h after ICSI resulted in fertilization in 73%. Pregnancy was not achieved after either ICSI cycle. Ultrastructural analysis indicated multiple structural abnormalities in the sperm. Conclusion(s): These results indicate that the round-headed sperm from this patient were incapable of oocyte activation after ICSI. This may be the reason for the frequent ICSI fertilization failure seen with this condition. Current ICSI procedures may not always overcome the infertility associated with globozoospermia and further study of the etiology of this condition is needed. Fertilization and pregnancy rates after intracytoplasmic sperm injection using ejaculate semen and surgically retrieved sperm Aboulghar M.A.; Mansour R.T.; Setour G.I.; Fdhmy I.; Kamal A.; Tawab N.A.; Amin Y.M. EGY FERTIL STERIL lYY7 6X/I (10X-111) Objective: To compare the fertilization rates and pregnancy rates (PRs) in intracytoplasmic sperm injection (ICSI) using sperm from ejaculates of normal and abnormal semen. epididymal sperm and testicular sperm of obstructive and nonobstructive azoospermic patients. Design: Retrospective study. Setting: The Egyptian IVF-ET Center. Patient(s): Threehundred and fifty patients underwent 366 ICSI cycles. Intervention(s): ICSI. epididymal sperm aspiration and testicular biopsy. Main outcome measure(s): Fertilization rates and PRs. Result(s): Patients were divided into five groups according to the quality and source of sperm. Patients in group I underwent 102 cycles of ICSI using ejaculated abnormal semen, group 2 underwent 44 cycles using epididymal sperm, group 3 underwent X2 cycles using testicular sperm from obstructive azoospermia. group 4 undenvent X0 cycles using testicular sperm from non-obstructive azoospermia and group 5 underwent 5X cycles using normal semen. There was no significant diffcrcnce in the fertilization rata and PRs among groups I. 2 and 3. In group 4, the fertilization rate and PR were significantly lower than in all other groups. In group 5. the fertilization rate was significantly higher than in all other groups. Conclusion(s): The fertilizing ability of sperm in ICSI is highcst with normal semen and lowest with sperm extracted from a testicular biopsy in non-obstructive azoospermia. There was no significant difference in fertilization rates and PRs between ejaculated sperm of different parameters and surgically retrieved sperm in obstructive azoospermia.
Citutiorrs from the literuhrre / It~ternutiotrul Joumul of Gynecology & Obstetrics 60 (1998) 95-105
surgery primarily for pelvic organ prolapse is low, increases with worsening pelvic organ prolapse and is lower in patients with vaginal vault prolapse than in those with uterine prolapse. Double uterus, blind hemivagina and ipsilateral renal agenesis: Thirty-six cases and long-term follow-up Candiani G.B.; Fedele L.; Candiani M. ITA OBSTET GYNECOL lYY7 YO/ I (26-32) Objective: To review the experience of the Milan University First Department of Obstetrics and Gynecology in patients with double, didelphic, or bicornuate uterus, blind hemivagina and ipsilateral renal agenesis and to consider the frequently unsatisfactory surgical approach. Methods: Thirty-six women with double, didelphic, or bicornuate uterus, blind hemivagina and ipsilateral renal agenesis were identified from clinical records for the period lY62- lYY2. We evaluated demographic data, disease, symptoms, correctness of therapeutic approach and definitive treatment. Results: Seventeen patients previously had undergone incomplete surgery in other hospitals and 19 were treated by us for the first time. Total hysterectomy was performed on two of the 36 women and hemihysterectomy and hemicolpectomy were performed on four. In the other 30, the vaginal septum was excised and marsupialization was done. The pregnancy rate in the IS women wanting children was 87% and the live birth rate was 77%. Serial biopsy specimens were obtained from the lateral fornix after the excision of the septum in 13 of the 30 non-hysterectomized patients over I-Y years and revealed progressively more extensive areas of squamous metaplasia of mullerian epithelium. In some isolated cases. papillary hyperplasia, mild dysplasia and vaginal adenosis were found. At the end of followup, Ih patients still did not want children. Follow-up was possible in 34 cases. Conclusion: Early accurate diagnosis after menarche followed by excision and marsupialization of the blind hemivagina offers complete relief of symptoms and preserves reproductive potential. Partial morphologic changes are evident but metabolic modifications comparable to those of the adjacent normal vagina have not yet been documented.
FERTILITY
AND STERILITY
Failure of oocyte activation after intracytoplasmic sperm injection using round-headed sperm Battaglia D.E.: Koehler J.K.; Klein N.A.; Tucker M.J. USA FERTIL STERIL lYY7 6X/l (11X-122) Objective: To examine the outcome of intracytoplasmic sperm injection (ICSI) with round-headed sperm (globozoospermia). Design: Retrospective analysis. Setting: In vitro fertilization laboratory with extensive ICSI experience. Patient(s): A patient
couple with infertility because of globozoospermia seeking ICSI treatment. Main outcome measure(s): Fertilization. cleavage and pregnancy rates. Intervention(s): Intracytoplasmic sperm injection and calcium ionophore. Result(s): This couple experienced only 7%~ fertilization after ICSI in their first cycle. Treatment of the unfertilized oocytes with calcium ionophore 20 h after ICSI-induced fertilization and cleavage of 7Y% of the oocytes. Embryo quality was fair to good. On the second cycle, eight of the injected oocytes were treated with ionophore immediately after ICSI and the remaining 20 oocytes were untreated. Normal fertilization was achieved in 75% of the treated and 10% of the untreated oocytes. Treatment of these unfertilized oocytes with ionophore 20 h after ICSI resulted in fertilization in 73%. Pregnancy was not achieved after either ICSI cycle. Ultrastructural analysis indicated multiple structural abnormalities in the sperm. Conclusion(s): These results indicate that the round-headed sperm from this patient were incapable of oocyte activation after ICSI. This may be the reason for the frequent ICSI fertilization failure seen with this condition. Current ICSI procedures may not always overcome the infertility associated with globozoospermia and further study of the etiology of this condition is needed. Fertilization and pregnancy rates after intracytoplasmic sperm injection using ejaculate semen and surgically retrieved sperm Aboulghar M.A.; Mansour R.T.; Setour G.I.; Fdhmy I.; Kamal A.; Tawab N.A.; Amin Y.M. EGY FERTIL STERIL lYY7 6X/I (10X-111) Objective: To compare the fertilization rates and pregnancy rates (PRs) in intracytoplasmic sperm injection (ICSI) using sperm from ejaculates of normal and abnormal semen. epididymal sperm and testicular sperm of obstructive and nonobstructive azoospermic patients. Design: Retrospective study. Setting: The Egyptian IVF-ET Center. Patient(s): Threehundred and fifty patients underwent 366 ICSI cycles. Intervention(s): ICSI. epididymal sperm aspiration and testicular biopsy. Main outcome measure(s): Fertilization rates and PRs. Result(s): Patients were divided into five groups according to the quality and source of sperm. Patients in group I underwent 102 cycles of ICSI using ejaculated abnormal semen, group 2 underwent 44 cycles using epididymal sperm, group 3 underwent X2 cycles using testicular sperm from obstructive azoospermia. group 4 undenvent X0 cycles using testicular sperm from non-obstructive azoospermia and group 5 underwent 5X cycles using normal semen. There was no significant diffcrcnce in the fertilization rata and PRs among groups I. 2 and 3. In group 4, the fertilization rate and PR were significantly lower than in all other groups. In group 5. the fertilization rate was significantly higher than in all other groups. Conclusion(s): The fertilizing ability of sperm in ICSI is highcst with normal semen and lowest with sperm extracted from a testicular biopsy in non-obstructive azoospermia. There was no significant difference in fertilization rates and PRs between ejaculated sperm of different parameters and surgically retrieved sperm in obstructive azoospermia.