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The objective of this study was to compare (i) the intracytoplasmic sperm injection outcomes among groups with different total motile sperm count ranges, (ii) the intracytoplasmic sperm injection outcomes between groups with normal and abnormal total motile sperm count, and (iii) the predictive values of WHO 2010 cut-off values and pre-wash total motile sperm count for the intracytoplasmic sperm injection outcomes, in couples with male infertility. This study included data from 518 patients undergoing their first intracytoplasmic sperm injection cycle as a result of male infertility. Couples were divided into five groups according to their total motile sperm count: Group I, total motile sperm count <1 × 10(6) ; group II, total motile sperm count 1-5 × 10(6) ; group III, total motile sperm count 5-10 × 10(6) ; group IV, total motile sperm count 10-20 × 10(6) ; and group V, total motile sperm count >20 × 10(6) (which was considered a normal total motile sperm count value). Then, couples were grouped into an abnormal and normal total motile sperm count group. The groups were compared regarding intracytoplasmic sperm injection outcomes. The predictive values of WHO 2010 cut-off values and total motile sperm count for the intracytoplasmic sperm injection outcomes were also investigated. The fertilization rate was lower in total motile sperm count group I compared to total motile sperm count group V (72.5 ± 17.6 vs. 84.9 ± 14.4, p = 0.011). The normal total motile sperm count group had a higher fertilization rate (84.9 ± 14.4 vs. 81.1 ± 15.8, p = 0.016) and lower miscarriage rate (17.9% vs. 29.5%, p = 0.041) compared to the abnormal total motile sperm count group. The total motile sperm count was the only parameter that demonstrated a predictive value for the formation of high-quality embryos on D2 (OR: 1.18, p = 0.013), formation of high-quality embryos on D3 (OR: 1.12, p = 0.037), formation of blastocysts on D5 (OR: 1.16, p = 0.011), blastocyst expansion grade on D5 (OR: 1.27, p = 0.042), and the odds of miscarriage (OR: 0.52, p < 0.045). The total motile sperm count has a greater predictive value than the WHO 2010 cut-off values for laboratory results and pregnancy outcomes in couples undergoing intracytoplasmic sperm injection as a result of male infertility.

Background Acupuncture has recently been used as a complementary technique in the management of infertility. It has physiological and psychological effects and may be considered an alternative for stress reduction in women undergoing infertility treatments. Objective To examine the hypothesis that acupuncture treatment may increase the pregnancy rate in patients undergoing intracytoplasmic sperm injection cycles. Methods Patients enrolled in the study were stratifi ed according to age and randomised to either a control group (n=208) or acupuncture group, (n=208). The pregnancy, implantation and abortion rates of the two groups were compared.Results No infl uence of acupuncture treatment on clinical outcomes was seen; however, when cycles in which the causes of infertility were exclusively tubaluterine or idiopathic were evaluated separately, a positive infl uence of acupuncture on pregnancy (OR=5.15, 95% CI 1.03 to 34.5; p=0.048) was noted. Moreover, trends toward an increase in implantation were seen when acupuncture was performed (regression coeffi cient: 0.645; p=0.092). ConclusionThe results suggest that acupuncture treatment had no infl uence when performed immediately before and immediately after embryo transfer, on clinical outcomes overall. In a subgroup analysis, when the embryo was not affected by an ovarian or seminal infl uence, a benefi t was noted.

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The aim of this study was to evaluate the influence of patients' lifestyle factors and eating habits on embryo development. A total of 2659 embryos recovered from 269 patients undergoing intracytoplasmic sperm injection cycles were included. The frequency of intake of food items and social habits were registered and its influences on embryo development evaluated. The consumption of cereals, vegetables and fruits positively influenced the embryo quality at the cleavage stage. The quality of the embryo at the cleavage stage was also negatively correlated with the consumption of alcoholic drinks and smoking habits. The consumption of fruits influenced the likelihood of blastocyst formation, which was also positively affected by the consumption of fish. Being on a weight-loss diet and consumption of red meat had a negative influence on the likelihood of blastocyst formation. The likelihood of blastocyst formation was also negatively influenced by the consumption of alcoholic drinks and by smoking habits. The consumption of red meat and body mass index had a negative effect on the implantation rate and the likelihood of pregnancy. In addition, being on a weight-loss diet had a negative influence on implantation rate. Our evidence suggests a possible relationship between environmental factors and ovary biology.

A bottom-up label-free mass spectrometric proteomic strategy was used to analyse the protein profiles of the human embryonic secretome. Culture media samples used for embryonic culture of patients undergoing intracytoplasmic sperm injection cycles were selected as a test case for this exploratory proof-of-principle study. The media were stored after embryo transfer and then pooled into positive (n = 8) and negative (n = 8) implantation groups. The absolute quantitative bottom-up technique employed a multidimensional protein identification technology based on separation by nano-ultra-high pressure chromatography and identification via tandem nano-electrospray ionization mass spectrometry with data-independent scanning in a hydrid QqTOF mass spectrometer. By applying quantitative bottom-up proteomics, unique proteins were found exclusively in both the positive- and negative-implantation groups, which suggest that competent embryos express and secrete unique biomarker proteins into the surrounding culture medium. The selective monitoring of these possible secretome biomarkers could make viable procedures using single-embryo transfer.

There are many studies in the literature suggesting an acquired, apparently progressive infertility due to varicocele. In fact, varicocelectomy has become the most commonly performed male infertility surgery. Assisted reproductive technologies such as intracytoplasmic sperm injection (ICSI) are also important for couples with male factor infertility associated with varicocele. Therefore, the aim of this study was to evaluate the effect of varicocelectomy on sperm quality and pregnancy rate with ICSI. Data were analyzed from 248 patients who had varicocele or underwent a previous varicocelectomy and were treated with ICSI between 2000 and 2008. Patients with varicocele were divided into two groups: men with clinical varicocele (group 1, n 5 79) and men who underwent varicocelectomy before ICSI (group 2, n 5 169). In all cases, female infertility was not detected. We evaluated and compared the two groups' semen characteristics as defined by the World Health Organization and Tygerberg's strict criteria: the female partner's age; the number of oocytes retrieved; and the fertilization, implantation, pregnancy, and miscarriage rates. We used the Wilcoxon signed rank test or the Mann-Whitney test for these analyses. No differences were detected in the age of the female partners between group 1 (33.0 6 0.46 years) and group 2 (33.8 6 0.38 years; P 5 .1872). Semen volume was higher in group 1 (3.3 6 0.3 mL) than it was in group 2 (2.5 6 0.14; P 5 .0043). No differences were detected between groups 1 and 2 with regard to sperm concentration (30.08 6 4.01 million/mL and 24.1 6 2.42 million/mL, respectively; P 5 .138), sperm motility (38.2% 6 2.69% and 38.7% 6 2.08%, respectively; P 5 .881), and morphology according to Tygerberg's strict criteria (2.6% 6 0.44% and 2.4% 6 0.37%, respectively; P 5 .7202). Also, no differences were detected in the number of oocytes retrieved between group 1 (14.8 6 1.74) and group 2 (14.9 6 1.04; P 5 .9515). The fertilization rate was higher in group 1 (73.2%) than it was in group 2 (64.9%; P 5 .0377); however, no differences were detected in the pregnancy rates (31.1% vs 30.9%; P 5 .9806), implantation rates (22.1% vs 17.3%; P 5 .5882), or miscarriage rates (21.7% vs 23.9%; P 5 .8401) between groups 1 and 2. Although a varicocelectomy should always be performed before assisted reproduction is pursued, this surgery does not increase pregnancy rates or decrease miscarriage rates following ICSI.

ObjectiveThis study aimed to identify a possible correlation between serum levels of anti-Müllerian hormone (AMH) and oocyte quality, embryo developmental competence, and implantation potential.Methods4488 oocytes obtained from 408 patients undergoing ICSI cycles were evaluated. Oocyte dimorphisms, embryo quality on days two and three, blastocyst formation competence, fertilization rates, implantation rates, and pregnancy rates were correlated with serum levels of AMH using Pearson's correlation coefficient and regression analysis.ResultsA positive correlation was observed between serum levels of AMH and number of retrieved oocytes (CC: 0.600, p<0.001), fertilization rate (CC:0.595, p=0.048), and number of obtained embryos (CC:0.495, p<0.001). AMH did not affect the quality of cleavage stage embryos or the chance of blastocyst formation. However, AMH levels affected oocyte quality (OR:0.75, CI 0.44-0.96, p<0.001), and implantation (CC:0,116, p=0.031) and pregnancy (OR:1.22, CI:1.03-1.53, p<0.001) rates.ConclusionSerum levels of AMH are a useful predictor of ovarian response to COS, oocyte quality, and fertilization. However, AMH levels may also compromise clinical outcomes; lower AMH levels did not impair embryo development.