ObjectiveThe purpose of this study was to evaluate the efficacy of frozen mixed double-embryo transfer (MDET; the simultaneous transfer of day 3 and day 5 embryos) in comparison with frozen blastocyst double-embryo transfer (BDET; transfer of two day 5 blastocysts) in patients with repeated implantation failure (RIF).MethodsA total of 104 women with RIF who underwent frozen MDET (n=48) or BDET (n=56) with excellent-quality embryos were included in this retrospective analysis. All frozen embryo transfers were performed in natural cycles. The main outcome measures were the implantation rate, clinical pregnancy rate, multiple pregnancy rate, and miscarriage rate. These measures were compared between the patients who underwent MDET or BDET using the chi-square test or the Fisher exact test, as appropriate.ResultsThe implantation and clinical pregnancy rates were significantly higher in patients who underwent MDET than in those who underwent BDET (60.4% vs. 39.3%, p=0.03 and 52.1% vs. 30.4%, p=0.05, respectively). A significantly lower miscarriage rate was observed in the MDET group (6.9% vs. 10.7%, p=0.05). In addition, the multiple pregnancy rate was slightly, but not significantly, higher in the MDET group (27.1% vs. 25.0%).ConclusionMDET was found to be significantly superior to double blastocyst transfer. It could be regarded as an appropriate approach to improve in vitro fertilization success rates in RIF patients.
OBJECTIVE: To investigate the effectiveness of immobilized acid-solubilized zonae pellucidae in the selection of spermatozoa for intracytoplasmic sperm injection (ICSI).DESIGN: A prospective sibling oocytes study. MATERIALS AND METHODS: In this study were included 113 couples who fulfilled the inclusion criteria: 1) unexplained infertility factor; 2) good quality oocytes; 3) fertilization failure for 3-5 consecutive ICSI procedures; 4) at least one oocyte at germinal vesicle stage (GV) and 5) at least four metaphase II oocytes retrieved during follicular puncture. Zonae pellucidae were isolated from the patient's own GVs. Zonae were acid solubilized and diluted in carbonate buffer (pH 9.6) for air dry immobilization on glass petri dishes. The partner's semen was washed and placed in the dishes. The spermatozoa that adhered on the immobilized surface were used for ICSI in the half of the retrieved oocytes from each woman. The other half of the oocytes was fertilized by conventional ICSI. In total, 312 oocytes were injected with zonaselected spermatozoa (zona-selection group) and 366 oocytes were injected with conventionally-selected spermatozoa (control group). The resulted embryos from the zona-selection and the control group were used in 43 and 50 single embryo transfers, respectively. Main outcomes were fertilization rate, embryo quality, implantation rate and pregnancy rate. Statistical analysis was performed using SPSS Software ver.21.RESULTS: Slightly higher fertilization rate was observed among the oocytes injected with zona-bound spermatozoa in comparison to the conventional ICSI group (75.6% vs. 72.3%, p¼0.38). Also no significant differences were observed in the embryo quality and in the implantation rates between the zona-selection and the control group (p¼0.24 and p¼0.59, respectively). However, the pregnancy rate was considerably higher in the zona-selection group when compared with the control group (34.8% vs. 16.4%, p¼0.02). Moreover the miscarriage rate also differed significantly (7% in zona-selection vs. 18% in control group, p¼0.03).CONCLUSIONS: The use of patient's zona pellucida immobilized proteins in selection of spermatozoa for ICSI increases pregnancy rates and reduces the risk of miscarriage in couples with unexplained infertility and good quality oocytes.
Background Sperm abnormalities may negatively affect embryo development. Objectives To determine the influence of sperm abnormalities (morphology, motility, DNA fragmentation) on embryo morphokinetic variables and clinical outcome of conventional IVF. Materials and methods Participants were 86 couples undergoing in vitro fertilization (IVF). Sperm morphology was evaluated according to the strict criteria proposed by Kruger/Tygerberg. CASA system was applied for sperm motility assessment. Sperm DNA fragmentation was assessed by the chromatin structure assay (SCSA). Morphokinetic parameters were determined in 223 embryos obtained from conventional IVF only and cultured in a single‐step medium using time‐lapse imaging technology. Results Time‐lapse variables from the initial embryo development, such as time of pronuclei fading (tPNf) and time for two cells (t2), were those more strongly related with abnormalities of sperm motility, morphology, and DNA fragmentation. Sperm morphological abnormalities rather than sperm motility were more closely associated with embryo morphokinetics. Sperm head defects were mainly correlated with the last stages of embryonic development (t9 to tHB), sperm midpiece defects with intermediate cleaving embryos (t5‐t9), and sperm tail defects with the initial stages of embryonic development (tPNa‐t4). Excess residual cytoplasm was positively correlated with all embryo morphokinetic parameters except t2 and tM. Absence of acrosomes, pinheads, coiled tails, and multiple sperm morphological defects correlated negatively with time‐lapse embryo morphokinetic variables. Discussion A large number of sperm‐related variables, including frequency of specific morphological defects, morphological indexes, DNA fragmentation and motility, and time‐lapse embryo variables, such as time intervals based mainly of 15 time points were recorded. Conclusion There were strong associations between specific sperm defects of the head, midpiece, and tail with certain stages of embryonic development from observation of pronuclei to the hatched blastocyst. Coiled tail, cumulative head defects, and multiple abnormalities index (MAI) were associated both with embryo morphokinetics and the implantation success.
The process of embryo implantation is carried out during the receptive stage of the endometrium in the midluteal phase of the menstrual cycle, known as window of implantation (WOI). It has been assumed that the WOI is not a constant variable in all women and the determination of its displacement is of crucial importance, especially for patients with recurrent implantation failure (RIF). Furthermore, in rare cases it could have different duration and position in the menstrual cycle even in the same woman but during different periods. Here, we report a 37-year-old woman with RIF, who was previously classified as idiopathic but has now been diagnosed as having a variable WOI. This interpretation was done after the performance of immunohistochemical and histomorphological analyses of endometrial biopsies taken in the midluteal phase during three sequential menstrual cycles. In order to solve the problem with pinpointing a variable WOI, a specific type of embryo transfer, called mixed double embryo transfer (MDET), was done where one Day 3 and one Day 5 good quality embryos were transferred simultaneously 7 days after ovulation. A viable single pregnancy was confirmed by ultrasound scan and a healthy girl was born. This case showed a unique approach in overcoming the problem in RIF patients with variable WOI.
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