Our results suggest that oocyte collection in IVM cycles should be performed when the DF is 14 mm diameter or less. Sibling immature oocytes may be affected detrimentally if a DF >14 mm is present at oocyte collection.

BACKGROUNDOur aim was to evaluate whether extending the interval between human chorionic gonadotrophin (hCG) priming and immature oocyte retrieval increases the oocyte maturation rate following in vitro maturation (IVM).METHODSThis study was performed retrospectively. IVM was performed on 113 polycystic ovary syndrome patients (n = 120 cycles). Oocyte collection was performed either 35 h (Group 1; n = 76) or 38 h (Group 2; n = 44) after 10 000 IU of hCG priming. Following oocyte retrieval, oocyte maturity was assessed and the remaining immature oocytes were cultured in IVM medium up to Day 2.RESULTSThe number of in vivo matured oocytes collected was significantly higher in Group 2 (13.6%, 114/840 versus 7.3%, 96/1312 in Group 1) (P < 0.01); the oocyte maturation rate after Day 1 was significantly higher (P < 0.01) in Group 2 (46.3 versus 36.0% in Group 1); and clinical pregnancy (40.9 versus 25%) and implantation rates (15.6 versus 9.6%) were better in Group 2 than those in Group 1.CONCLUSIONSThe results suggest that extending the period of hCG priming time from 35 to 38 h for immature oocyte retrieval promotes oocyte maturation in vivo and increases the IVM rate of immature oocytes. Therefore, oocyte retrieval after 38 h of hCG priming may improve subsequent pregnancy outcome in cycles programmed for IVM treatment.

BackgroundThe use of testicular over ejaculated spermatozoa for ICSI has been presented as an alternative to overcome infertility in men with poor semen parameters or high levels of sperm DNA fragmentation.ObjectiveTo evaluate the efficacy of testicular ICSI outcomes in couples with no previous live birth and recurrent ICSI failure using ejaculated spermatozoa by comparison to the outcomes of couples with similar history of recurrent ICSI using ejaculated spermatozoa only.Materials and MethodsA total of 145 couples undergoing ejaculated or testicular ICSI cycles with no previous live births and with at least two previous failed ICSI cycles with ejaculated spermatozoa were evaluated retrospectively. ICSI was performed either with ejaculated (E‐ICSI) or with testicular (T‐ICSI) spermatozoa. Semen parameters and sperm DNA quality were assessed prior to the oocyte collection day. Primary outcomes included cumulative live birth and pregnancy rates. Secondary analysis included percentage of DNA fragmentation in ejaculated spermatozoa (SCSA® and TUNEL).ResultsPatients undergoing T‐ICSI (n = 77) had a significantly higher clinical pregnancy rate/fresh embryo transfer (ET) (27.9%; 17/61) and cumulative live birth rate (23.4%; 15/64) compared to patients using E‐ICSI (n = 68) (clinical pregnancy rate/fresh ET: 10%; 6/60 and cumulative live birth rate: 11.4%; 7/61). Further, T‐ICSI yield significantly better cumulative live birth rates than E‐ICSI for men with high TUNEL (≥36%) (T‐ICSI: 20%; 3/15 vs. E‐ICSI: 0%; 0/7, p < 0.025), high SCSA® (≥25%) scores (T‐ICSI: 21.7%; 5/23 vs. E‐ICSI: 9.1%; 1/11, p < 0.01), or abnormal semen parameters (T‐ICSI: 28%; 7/25 vs. E‐ICSI: 6.7%; 1/15, p < 0.01).ConclusionsThe use of testicular spermatozoa for ICSI in non‐azoospermic couples with no previous live births, recurrent ICSI failure, and high sperm DNA fragmentation yields significantly better live birth outcomes than a separate cohort of couples with similar history of ICSI failure entering a new ICSI cycle with ejaculated spermatozoa.

Cryopreservation seems to be deleterious for the integrity of human sperm DNA and compaction. However, the sperm DFI was not affected during cryopreservation under the various methods of storage tested. Clinicians and investigators should take this information into consideration when using cryopreserved sperm for assisted reproduction.

Purpose The goal of this study was to determine whether high E2 levels after controlled ovarian hyperstimulation affect TSH. Methods Patients completing ART cycles between AprilOctober 2010 were eligible for this cohort study. 180 patients were recruited however those with known thyroid disease were excluded. The final analysis included 154 subjects. Blood was collected at each visit during the ART cycle as well as at the pregnancy test. Samples were frozen at −20°C and analyzed together for E2 and TSH using the same assay kit once all patients had completed their cycles. All participants were treated at the McGill University Health Center. A paired t-test was used to study the difference in TSH levels recorded at maximal and minimal Estradiol levels during ovarian stimulation. Multiple regression analysis was then used to determine if factors such as anti-thyroid antibodies and ovarian reserve measures affect this change in TSH. We used multiple imputation methods to account for missing data. Results As E2 levels rose from low to supra-physiologic levels during treatment, TSH levels also rose significantly. This increase was clinically significant by the time of pregnancy test. The factors that potentially affected the change in TSH were: male factor/tubal factor infertility, type of protocol used as well as the presence of thyroid antibodies. Conclusions Although TSH increases during ART, this change only becomes clinically significant on the day of pregnancy test. Future studies should examine TSH changes specifically in certain "at-risk" sub-groups such as those with antibodies and known thyroid disease.Capsule As estradiol levels rise during ART, TSH also rises. This rise may be affected by: cause of infertility, type of protocol used as well as the presence of anti-thyroid antibodies.

Background: In Argentina, approximately 9,000 new cases of tuberculosis (TB) are recorded every year, representing an incidence rate of 22 cases per 100,000 inhabitants. There are no reported studies in Argentina examining the factors that influence the unequal distribution of the disease. The aim of the study was to identify the relationship between the distribution of social and economic factors and TB in Argentina between 2008 and 2012. Method: An ecologic study involving 525 departmental jurisdictions was conducted. Simple linear regression analysis was performed, followed by multiple linear regression for each group of determinants. A final model of determinants of TB’s incidence was constructed from a model of multiple linear regression. Results: The following determinants explain 43% of the variability of TB’s incidence rate among different jurisdictions: overcrowding, proportion of households with a sewage network, proportion of examined patients with respiratory symptoms and proportion of patients who discontinued treatment. Discussion: This study makes an important contribution to a better understanding of the factors influencing the TB occurrence in Argentina, which is the result of a multidimensional and complex process. Thesefactors make part of this disease’s social determination. Conclusion: TB incidence is associated with different determinants, from multiple levels. Inequalities in its distribution in Argentina are driven by the unequal distribution of key social determinants.

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