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Intracytoplasmic Sperm Injection: A Systematic Review and Meta-Analysis
MALE INFERTILITY
170
Re: Sperm Vacuoles Cannot Help to Differentiate Fertile Men from Infertile Men with Normal Sperm Parameter Values andri, L. Marino, C. Esquerre-Lamare and J. Parinaud N. Gatimel, R. D. Le Me´decine de la Reproduction, Hoˆpital Paule de Viguier, CHU de Toulouse and Universite´ de Toulouse, UPS, Groupe de Recherche en Fertilite´ Humaine (EA 3694, Human Fertility Research Group), Toulouse, France Hum Reprod 2014; 29: 2359e2367.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2015.04.004 available at http://jurology.com/ Editorial Comment: In the never dying quest to link visible sperm structure to something useful for reproductive medicine investigators have turned to high magnification Nomarski interference contrast microscopy. If good sperm could be separated from bad using this optical technology, we would have a nondestructive way to select the best gametes for intracytoplasmic sperm injection. Such a method is called intracytoplasmic morphologically selected sperm injection (IMSI). Unfortunately the sperm vacuoles visible within the enlarged sperm head appear to be physiological artifacts and not pathological clues, calling into question the usefulness of IMSI. These authors report results of comparing proved fertile men to infertile ones with unexplained infertility. They found no difference in any way they measured vacuoles observed with high magnification microscopy. Additionally they found no relationship between the vacuoles and conventional bulk seminal parameters or 2 assays of sperm DNA integrity, which calls into question the role of IMSI in reproductive medicine. Unfortunately evidence continues to accumulate that the ability of high magnification Nomarski interference contrast microscopy to improve assisted reproductive outcomes is limited at best. Craig Niederberger, MD
Re: Whether Sperm Deoxyribonucleic Acid Fragmentation has an Effect on Pregnancy and Miscarriage after In Vitro Fertilization/Intracytoplasmic Sperm Injection: A Systematic Review and Meta-Analysis J. Zhao, Q. Zhang, Y. Wang and Y. Li Reproductive Medicine Center, Xiangya Hospital, Central South University, Hunan, People’s Republic of China Fertil Steril 2014; 102: 998e1005.e8.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2015.04.005 available at http://jurology.com/ Editorial Comment: Sperm DNA structural testing, which takes several forms to determine how fragmented DNA can be with different chemical conditions, still seeks a place in clinical use. Enough studies have been performed to combine them into meta-analyses, and authors are now reporting results of analyses of correlations between so-called DNA integrity assays and pregnancy and miscarriage outcomes after in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI). These investigators report decreased pregnancy with poor DNA integrity after IVF but not ICSI, and increased miscarriage after ICSI but not IVF. When the assay technique was considered, only TUNEL was correlated with pregnancy, and all test methods were correlated with miscarriage. Since a previous meta-analysis focusing on miscarriage only revealed TUNEL to correlate with that outcome, it seems that the evidence is tilting toward TUNEL as perhaps the most revealing assay of DNA integrity when considering pregnancy and miscarriage. However, the problem remains that ultimately a single sperm is selected in ICSI, and these assays destroy the gametes they interrogate. Although we can perhaps now say with a TUNEL assay that the sperm of an individual may be more or less likely to result in pregnancy or miscarriage, we still have no way of translating that knowledge into a truly useful clinical outcome, that of a baby born. Craig Niederberger, MD
170
Re: Sperm Vacuoles Cannot Help to Differentiate Fertile Men from Infertile Men with Normal Sperm Parameter Values andri, L. Marino, C. Esquerre-Lamare and J. Parinaud N. Gatimel, R. D. Le Me´decine de la Reproduction, Hoˆpital Paule de Viguier, CHU de Toulouse and Universite´ de Toulouse, UPS, Groupe de Recherche en Fertilite´ Humaine (EA 3694, Human Fertility Research Group), Toulouse, France Hum Reprod 2014; 29: 2359e2367.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2015.04.004 available at http://jurology.com/ Editorial Comment: In the never dying quest to link visible sperm structure to something useful for reproductive medicine investigators have turned to high magnification Nomarski interference contrast microscopy. If good sperm could be separated from bad using this optical technology, we would have a nondestructive way to select the best gametes for intracytoplasmic sperm injection. Such a method is called intracytoplasmic morphologically selected sperm injection (IMSI). Unfortunately the sperm vacuoles visible within the enlarged sperm head appear to be physiological artifacts and not pathological clues, calling into question the usefulness of IMSI. These authors report results of comparing proved fertile men to infertile ones with unexplained infertility. They found no difference in any way they measured vacuoles observed with high magnification microscopy. Additionally they found no relationship between the vacuoles and conventional bulk seminal parameters or 2 assays of sperm DNA integrity, which calls into question the role of IMSI in reproductive medicine. Unfortunately evidence continues to accumulate that the ability of high magnification Nomarski interference contrast microscopy to improve assisted reproductive outcomes is limited at best. Craig Niederberger, MD
Re: Whether Sperm Deoxyribonucleic Acid Fragmentation has an Effect on Pregnancy and Miscarriage after In Vitro Fertilization/Intracytoplasmic Sperm Injection: A Systematic Review and Meta-Analysis J. Zhao, Q. Zhang, Y. Wang and Y. Li Reproductive Medicine Center, Xiangya Hospital, Central South University, Hunan, People’s Republic of China Fertil Steril 2014; 102: 998e1005.e8.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2015.04.005 available at http://jurology.com/ Editorial Comment: Sperm DNA structural testing, which takes several forms to determine how fragmented DNA can be with different chemical conditions, still seeks a place in clinical use. Enough studies have been performed to combine them into meta-analyses, and authors are now reporting results of analyses of correlations between so-called DNA integrity assays and pregnancy and miscarriage outcomes after in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI). These investigators report decreased pregnancy with poor DNA integrity after IVF but not ICSI, and increased miscarriage after ICSI but not IVF. When the assay technique was considered, only TUNEL was correlated with pregnancy, and all test methods were correlated with miscarriage. Since a previous meta-analysis focusing on miscarriage only revealed TUNEL to correlate with that outcome, it seems that the evidence is tilting toward TUNEL as perhaps the most revealing assay of DNA integrity when considering pregnancy and miscarriage. However, the problem remains that ultimately a single sperm is selected in ICSI, and these assays destroy the gametes they interrogate. Although we can perhaps now say with a TUNEL assay that the sperm of an individual may be more or less likely to result in pregnancy or miscarriage, we still have no way of translating that knowledge into a truly useful clinical outcome, that of a baby born. Craig Niederberger, MD