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Results of ICSI in different categories of male factor infertility
TABLE 1
Spindle position
P-241 Tuesday, October 20, 2009
#2pn
#R6cell/grade 3 on Day 3
(In ref. to polar body)
N
Normal ferti.rate (%)
Good progression (%)
0 30 60 90 >120 inside FPB
75 40 18 19 3 5
43 (57.3) 28 (70) 12 (66.7) 14 (73.7) 2 (66.7) 2 (40)
28 (65.1) 20 (71.4) 6 (50) 5 (35.7) 0 0
No significant association was detected between spindle retardance and fertilization rate or embryo development. FPB morphology, classified as normal (normal size and smooth surface) and abnormal (irregular size or fragmented) was not related to fertilization rate (62.3 versus 59.3%) and embryo quality (61.9 versus 68.8%) on day 3. CONCLUSIONS: An association was observed between increasing degree of FPB and spindle separation and reduced embryo development, although this association did not reach statistical significance. Spindle retardance and FPB morphology did not correlate with fertilization rate and embryo development.
IMPROVEMENT IN IVF OUTCOME AFTER CHANGE OF CO2 SUPPLIES TO INCUBATORS. A. Younis, D. Carnovale, W. Butler. GYN/OB & Central GA Fertility Institute, Mercer University School of Medicine, Macon, GA. OBJECTIVE: To determine the effects of specific corrective actions taken after surprising consecutive failed IVF-ICSI cycles in a group of patients. Compare IVF outcome of the same group of patients before and after change of CO2 supplies to incubators. DESIGN: Retrospective study. MATERIALS AND METHODS: We performed analysis of embryo development and pregnancy rate for a group of 15 patients undergoing fresh ART procedures at our institution from March 2008 to Feb 2009. The 15 patients (ages 28-42 yrs) were offered a significantly discounted second fresh IVFICSI cycles after lack of pregnancy from a previous cycle. Corrective action taken as follow; the use of ultra pure CO2 supply (99.99% purity), and installation of in-line CODA filters between CO2 cylinders and incubators. We used 5% CO2 and air with no change on IVF-ICSI procedures. Fertilization was performed using a standard IVF- ICSI protocol. Main outcome measures were fertilization rate, percentage of good quality embryos and blastocysts, and pregnancy rate. Collected data were divided into two groups: (1) Original cycle; (2) Second cycle, after change of CO2 grade and installations of in-line coda. Data were analyzed by Chi. RESULTS: The use of high grade CO2 supply and in-line coda filter have dramatically increased good quality embryo, development to blastocyst stage and clinical pregnancies. Main results are shown in the table. Values are express as mean SD. Comparison Of IVF Success For The Same Groups Of Patients In Two Different Incubator Conditions
P-240 Tuesday, October 20, 2009 RESULTS OF ICSI IN DIFFERENT CATEGORIES OF MALE FACTOR INFERTILITY. I. Carmona, G. Garcia, P. Galache, V. Batiza, R. Santos, P. Patrizio. Instituto para el Estudio de la Concepcion Humana, Monterrey, Nuevo Leon, Mexico; Yale Fertility Center, New Haven, CT. OBJECTIVE: To report on the ICSI outcomes when specifically used for treating cases of male factor infertility. DESIGN: Retrospective and comparative analysis of ART database. MATERIALS AND METHODS: A total of 350 cycles, years 2004-2009, were analyzed. All patients were stimulated with standard protocols based on exogenous gonadotrophins and GnRH agonists. Patients were divided into five groups according to sperm concentration: Group I, less than 5 million sperm per mL; Group II, 5-10 million; Group III, 10-20 million; Group IV azoospermia and use of epididymal sperm retrieved by PESA; Group V azoospermia and use of testicular sperm retrieved by TESE. Data analyzed were: Female age, Male age, Total embryos transferred, Fertilization rate, Pregnancy rate and Implantation rate. RESULTS: There were no significant differences for female age, male age and fertilization rate (table 1). The mean number total embryos transferred per patient was 2.44 (range 2.3-2.6). There was significant difference in the pregnancy and implantation rate among groups. TABLE 1
Outcomes Female Age (mean) Male Age (mean) Total Embryos Transferred (mean) Fertilization Rate (%) Pregnancy Rate (%) Implantation Rate (%)
Group 1 Group 2 Group 3 Group 4 Group 5 P 31.2 35.2 2.5
33.2 36.6 2.3
34.7 36.4 2.4
30.7 39.1 2.4
31.9 39.8 2.6
NS NS NS
52 40.3 20.4
56.9 29.5 14.6
57.2 40.4 22.2
58.6 36.6 18.5
58.2 25 12.7
NS S S
CONCLUSIONS: For cases of male infertility it is reasonable to expect good fertilization rates with ICSI regardless of sperm counts or the source of sperm. However, embryos derived from the use of testicular sperm had the lowest implantation rate and the lowest likelihood of generating a pregnancy. These observations are an indirect confirmation that testicular sperm may harbor DNA damage that does not impair fertilization rate but implantation rate.
FERTILITY & STERILITYÒ
No of cycles % 2 PN (Fertilized) SD % Good quality embryo @Day-3 SD % Blastocyst @ Day5-6 SD % Initial þve hCG % Clinical Pregnancy
Original Cycle
Second cycle
P-value
15 76.0 3.16 70.0 2.7
15 82.0 18.8 84.0 19.8
NS NS 0.03
0 0 0
48.0 27.8 71.5 53.5
0.001 0.001 0.001
CONCLUSIONS: Our data demonstrates the benefit of using an ultra high grade CO2 supply, and in-line CODA filters on IVF success.
P-242 Tuesday, October 20, 2009 OUTCOME OF INTRACYTOPLASMIC MORPHOLOGICALLY SELECTED SPERM INJECTION WITH SURGICALLY RETRIEVED SPERMATOZOA. T. Takeuchi, M. Tanaka, K. Seida, S. Oshima, H. Iwamoto, A. Yoshida. Reproduction Center, Kiba Park Clinic, Koto-ku, Tokyo, Japan. OBJECTIVE: It has been reported that ICSI with morphologically selected sperm under a high magnification (IMSI) ensures a better pregnancy rate (PR) than the conventional ICSI. However, the efficacy of IMSI on surgically retrieved sperm has not been investigated. We aimed to assess the effect of sperm selection based on nuclear morphology on ICSI outcome with immature sperm. DESIGN: Clinical outcome was compared between the ICSI and IMSI with immature sperm on sibling oocytes. MATERIALS AND METHODS: Among 43 obstructive azoospermic patients 16 underwent epididymal sperm (EPI) aspiration and 27 testicular sperm (TES) extraction. One half the MII oocytes was inseminated by conventional ICSI and the other by IMSI. During the IMSI, motile sperm with best available morphology were selected. Embryo transfers were performed with only ICSI or IMSI derived embryos. RESULTS: Total of 18 oocyte retrievals were performed in 16 EPI patients, and 27 in TES patients. With EPI, the fertilization rate (FR) by IMSI (63.6%) was comparable with ICSI (69.4%), so was the rate of full blastocysts (BR: 42.8% vs. 33.8%). Although statistically not significant, the clinical PR in the IMSI was 45.5% (5/11) higher than that of the ICSI (28.6% 2/7). Similarly there were trends of higher implantation (IR) and delivery rates (DR) in the IMSI. In the TES, the FR by IMSI was similar to ICSI
S155
Spindle position
P-241 Tuesday, October 20, 2009
#2pn
#R6cell/grade 3 on Day 3
(In ref. to polar body)
N
Normal ferti.rate (%)
Good progression (%)
0 30 60 90 >120 inside FPB
75 40 18 19 3 5
43 (57.3) 28 (70) 12 (66.7) 14 (73.7) 2 (66.7) 2 (40)
28 (65.1) 20 (71.4) 6 (50) 5 (35.7) 0 0
No significant association was detected between spindle retardance and fertilization rate or embryo development. FPB morphology, classified as normal (normal size and smooth surface) and abnormal (irregular size or fragmented) was not related to fertilization rate (62.3 versus 59.3%) and embryo quality (61.9 versus 68.8%) on day 3. CONCLUSIONS: An association was observed between increasing degree of FPB and spindle separation and reduced embryo development, although this association did not reach statistical significance. Spindle retardance and FPB morphology did not correlate with fertilization rate and embryo development.
IMPROVEMENT IN IVF OUTCOME AFTER CHANGE OF CO2 SUPPLIES TO INCUBATORS. A. Younis, D. Carnovale, W. Butler. GYN/OB & Central GA Fertility Institute, Mercer University School of Medicine, Macon, GA. OBJECTIVE: To determine the effects of specific corrective actions taken after surprising consecutive failed IVF-ICSI cycles in a group of patients. Compare IVF outcome of the same group of patients before and after change of CO2 supplies to incubators. DESIGN: Retrospective study. MATERIALS AND METHODS: We performed analysis of embryo development and pregnancy rate for a group of 15 patients undergoing fresh ART procedures at our institution from March 2008 to Feb 2009. The 15 patients (ages 28-42 yrs) were offered a significantly discounted second fresh IVFICSI cycles after lack of pregnancy from a previous cycle. Corrective action taken as follow; the use of ultra pure CO2 supply (99.99% purity), and installation of in-line CODA filters between CO2 cylinders and incubators. We used 5% CO2 and air with no change on IVF-ICSI procedures. Fertilization was performed using a standard IVF- ICSI protocol. Main outcome measures were fertilization rate, percentage of good quality embryos and blastocysts, and pregnancy rate. Collected data were divided into two groups: (1) Original cycle; (2) Second cycle, after change of CO2 grade and installations of in-line coda. Data were analyzed by Chi. RESULTS: The use of high grade CO2 supply and in-line coda filter have dramatically increased good quality embryo, development to blastocyst stage and clinical pregnancies. Main results are shown in the table. Values are express as mean SD. Comparison Of IVF Success For The Same Groups Of Patients In Two Different Incubator Conditions
P-240 Tuesday, October 20, 2009 RESULTS OF ICSI IN DIFFERENT CATEGORIES OF MALE FACTOR INFERTILITY. I. Carmona, G. Garcia, P. Galache, V. Batiza, R. Santos, P. Patrizio. Instituto para el Estudio de la Concepcion Humana, Monterrey, Nuevo Leon, Mexico; Yale Fertility Center, New Haven, CT. OBJECTIVE: To report on the ICSI outcomes when specifically used for treating cases of male factor infertility. DESIGN: Retrospective and comparative analysis of ART database. MATERIALS AND METHODS: A total of 350 cycles, years 2004-2009, were analyzed. All patients were stimulated with standard protocols based on exogenous gonadotrophins and GnRH agonists. Patients were divided into five groups according to sperm concentration: Group I, less than 5 million sperm per mL; Group II, 5-10 million; Group III, 10-20 million; Group IV azoospermia and use of epididymal sperm retrieved by PESA; Group V azoospermia and use of testicular sperm retrieved by TESE. Data analyzed were: Female age, Male age, Total embryos transferred, Fertilization rate, Pregnancy rate and Implantation rate. RESULTS: There were no significant differences for female age, male age and fertilization rate (table 1). The mean number total embryos transferred per patient was 2.44 (range 2.3-2.6). There was significant difference in the pregnancy and implantation rate among groups. TABLE 1
Outcomes Female Age (mean) Male Age (mean) Total Embryos Transferred (mean) Fertilization Rate (%) Pregnancy Rate (%) Implantation Rate (%)
Group 1 Group 2 Group 3 Group 4 Group 5 P 31.2 35.2 2.5
33.2 36.6 2.3
34.7 36.4 2.4
30.7 39.1 2.4
31.9 39.8 2.6
NS NS NS
52 40.3 20.4
56.9 29.5 14.6
57.2 40.4 22.2
58.6 36.6 18.5
58.2 25 12.7
NS S S
CONCLUSIONS: For cases of male infertility it is reasonable to expect good fertilization rates with ICSI regardless of sperm counts or the source of sperm. However, embryos derived from the use of testicular sperm had the lowest implantation rate and the lowest likelihood of generating a pregnancy. These observations are an indirect confirmation that testicular sperm may harbor DNA damage that does not impair fertilization rate but implantation rate.
FERTILITY & STERILITYÒ
No of cycles % 2 PN (Fertilized) SD % Good quality embryo @Day-3 SD % Blastocyst @ Day5-6 SD % Initial þve hCG % Clinical Pregnancy
Original Cycle
Second cycle
P-value
15 76.0 3.16 70.0 2.7
15 82.0 18.8 84.0 19.8
NS NS 0.03
0 0 0
48.0 27.8 71.5 53.5
0.001 0.001 0.001
CONCLUSIONS: Our data demonstrates the benefit of using an ultra high grade CO2 supply, and in-line CODA filters on IVF success.
P-242 Tuesday, October 20, 2009 OUTCOME OF INTRACYTOPLASMIC MORPHOLOGICALLY SELECTED SPERM INJECTION WITH SURGICALLY RETRIEVED SPERMATOZOA. T. Takeuchi, M. Tanaka, K. Seida, S. Oshima, H. Iwamoto, A. Yoshida. Reproduction Center, Kiba Park Clinic, Koto-ku, Tokyo, Japan. OBJECTIVE: It has been reported that ICSI with morphologically selected sperm under a high magnification (IMSI) ensures a better pregnancy rate (PR) than the conventional ICSI. However, the efficacy of IMSI on surgically retrieved sperm has not been investigated. We aimed to assess the effect of sperm selection based on nuclear morphology on ICSI outcome with immature sperm. DESIGN: Clinical outcome was compared between the ICSI and IMSI with immature sperm on sibling oocytes. MATERIALS AND METHODS: Among 43 obstructive azoospermic patients 16 underwent epididymal sperm (EPI) aspiration and 27 testicular sperm (TES) extraction. One half the MII oocytes was inseminated by conventional ICSI and the other by IMSI. During the IMSI, motile sperm with best available morphology were selected. Embryo transfers were performed with only ICSI or IMSI derived embryos. RESULTS: Total of 18 oocyte retrievals were performed in 16 EPI patients, and 27 in TES patients. With EPI, the fertilization rate (FR) by IMSI (63.6%) was comparable with ICSI (69.4%), so was the rate of full blastocysts (BR: 42.8% vs. 33.8%). Although statistically not significant, the clinical PR in the IMSI was 45.5% (5/11) higher than that of the ICSI (28.6% 2/7). Similarly there were trends of higher implantation (IR) and delivery rates (DR) in the IMSI. In the TES, the FR by IMSI was similar to ICSI
S155