Successful establishment of pregnancy by superovulation and intrauterine insemination with sperm recovered by a modified Hotchkiss procedure from a patient with retrograde ejaculation

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Citations from the literature /International Journal of Gynecology & Obstetrics 53 (1996) 305-316

fertile semen in sperm-zona binding was examined under hemizona assay conditions. One droplet of a suspension of spermatozoawas exposed to sperm proteins and then tested for zona binding, while a parallel semen suspension droplet incubated with culture medium served as a control. The reliability of the test was increased by relating the number of spermatozoa bound to each inseminated hemizona to the surface area of the hemizona and expressedas the binding index. For spermatozoa incubated with extracted proteins, the binding index was greater than (jr = 0.001) that of: controls (125.2 l 45.1 vs. 63.6 * 29.2, respectively). As a first control, two other protein sources (fetal calf serum and human follicular fluid) were tested in the hemizona assay. No significant differenceswere found in zona binding for other proteinexposedspermatozoacompared with controls. As a secondand reverse control, exposure of one hemizona to sperm proteins before insemination with untreated spermatozoa induced a marked decmase(p = 0.0003)in sperm binding, compared with that of the matched hemizona not exposed to sperm proteins (control) (3.4 i 1.4 vs. 74.5 f 6.8, respectively). Taken together, these findings confirm the involvement of extracted sperm proteins in sperm-zona interactions. Therefore, in the easesin which fertilization in vitro fails because of a lack of sperm-zona binding, incubation of deficient spermatozoa with proteins extracted from spermatozoa of fertile ejaculates should restore their ability to interact with the oocyte and, thus, should enhance the prognosis for in vitro fertilization. -eata-ef p=!tP=Ybym~~~ intmtdm~t&nwIth~ncoveredbyamadiBed H~~fmmap8t&ntwitbrotmgradeejaenIotloo Ranieri D.M.; Siionetti S.; Vicino M.; Cormio L.; Selvaggi L. ITA FERTIL STERIL 19956415(1039-1042) Objective: To improve the quality of the sperm recovered from the bladder in a patient with retrograde ejaculation who already had failed to conceive after several attempts at IUI with sperm recovered by conventional techniques. Setting: University Hospital. Patients: A couple with male infertility due to retrograde ejaculation causedby the Zielke operation, a spinal fuation procedure performed to correct severe.kyphoscoliosis. Intervention: Superovulation and IUI of sperm recovered from the bladder using a modified Hotchkiss procedure involving the introduction into the bladder of Earle’s balanced salt solution (EBSS) buffered with Hepes in sufficient quantity to bring the urinary pH and osmolarity to those of fresh ejaculate. Main Outcome Measures: Urine pH and osmolarity at baseline and after dilution with EBSS buffered with HEPES. Concentration, motility, and progression scoreof the sperm recoveredfrom the bladder. Results: Good sperm samples were achieved. Pregnancy was established when IUI was performed in association with superovulation induction. Conclusions: Determination of urine pH and osmolarity appears to be a useful method for choosing the ideal sperm recovery procedure. The modified Hotchkiss procedure describedseemsto be a promising altemative method for recovering sperm for artificial insemination.

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Frederick J.L.; Ord T.; Kettel L.M.; Stone S.C.; Balmaceda J.P.; Asch R.H. USA FERTIL STERIL 199564/5 (987-990) Objective: To assessthe pregnancy outcome of freezing and storing all fresh embryos produced in a stimulated IVF cycle and replacing them in a subsequent nongonadotropinstimulated cycle. Design: Retrospective study. Setting: University-associated assisted reproductive technology program. Patients: We studied 36 patients (age range 23 to 44 years) who underwent cryopreservation of all fresh embryos in a controlled ovarian hyperstimulation (COH) cycle because of either the risk of severe ovarian hyperstimulation (24 patients, group 1) or the presenceof an endometrial lining c 8 mm in thickness (12 patients, group 2). Five hundred fifty-five embryos were gemrated for replacement in 63 cycles. All embryos were cryopreserved in 1.5 M propanediol at the pronuclear or hvocell stage, and 264 embryos subsequently were transferred into a hormone replacement cycle (79%) or natural ovulatory cycle (38%).The average number of embryos transferred per patient was 4.2. Results: Twenty-one clinical pregnancieswere achieved, giving a pregnancy rate (PR) of 58.3% per patient (33.3% per cycle). The live birth rate was 56% per patient (28.6% per cycle). The implantation rate was 9.1%. Groups 1 and 2 had a similar PR per patient (58.3%). With 208 cryopreserved embryos remaining and considering the 33.3% PR per cycle, we expect the overall extrapolated PR to be 63.9%. Conclusions: This is the first seriesshowing that freezing and storing all fresh embryos produced in a stimulated IVF cycle and replacing them in a subsequentnongonadotropin-stimulated cycle results in successfulPRs. These results underlie the importance of a successfulcryopreservation program in IVF and could be a possible approach to overcoming the alleged adverseeffects of COH on the endometrium, thereby improving the chances of pregnancy when numerous embryos are obtained simultaneously. llleeffectofspermpammeterswtbetmk!omeofintraCYw-kfJP-~ieetioll

Mansour R.T.; Abouighar M.A.; Serour G.I.; Amin Y.M.; Ramzi A.M. EG FERTIL STERIL 199564/5 (982-986) Objective: To investigate the infiuence of sperm parameters on the fertilization and pregnancy rates in intracytoplasmic sperm injection (ICSI). Design: A retrospective analysis of 130 cyclesof ICSI performed for the treatment of male factor infertility. Setting: The Egyptian IVF-ET Center. Participants: One hundred thirty couples with the diagnosis of male factor infertility or with previous failed fertilization in conventional IVF or subzonal sperm injection. Intervention: Ovum pick-up and ICSI. Main Outcome Measure: Fertilization and pregnancy rates in relation to different semenparameters. Results: A total of 1,433oocytes were retrieved and 1,071 metaphaseII occytes