STUDY QUESTIONDoes the selection of sperm for ICSI based on their ability to bind to hyaluronan improve the clinical pregnancy rates (CPR) (primary end-point), implantation (IR) and pregnancy loss rates (PLR)?SUMMARY ANSWERIn couples where ≤65% of sperm bound hyaluronan, the selection of hyaluronan-bound (HB) sperm for ICSI led to a statistically significant reduction in PLR.WHAT IS KNOWN AND WHAT THIS PAPER ADDSHB sperm demonstrate enhanced developmental parameters which have been associated with successful fertilization and embryogenesis. Sperm selected for ICSI using a liquid source of hyaluronan achieved an improvement in IR. A pilot study by the primary author demonstrated that the use of HB sperm in ICSI was associated with improved CPR. The current study represents the single largest prospective, multicenter, double-blinded and randomized controlled trial to evaluate the use of hyaluronan in the selection of sperm for ICSI.DESIGNUsing the hyaluronan binding assay, an HB score was determined for the fresh or initial (I-HB) and processed or final semen specimen (F-HB). Patients were classified as >65% or ≤65% I-HB and stratified accordingly. Patients with I-HB scores ≤65% were randomized into control and HB selection (HYAL) groups whereas patients with I-HB >65% were randomized to non-participatory (NP), control or HYAL groups, in a ratio of 2:1:1. The NP group was included in the >65% study arm to balance the higher prevalence of patients with I-HB scores >65%. In the control group, oocytes received sperm selected via the conventional assessment of motility and morphology. In the HYAL group, HB sperm meeting the same visual criteria were selected for injection. Patient participants and clinical care providers were blinded to group assignment.PARTICIPANTS AND SETTINGEight hundred two couples treated with ICSI in 10 private and hospital-based IVF programs were enrolled in this study. Of the 484 patients stratified to the I-HB > 65% arm, 115 participants were randomized to the control group, 122 participants were randomized to the HYAL group and 247 participants were randomized to the NP group. Of the 318 patients stratified to the I-HB ≤ 65% arm, 164 participants were randomized to the control group and 154 participants were randomized to the HYAL group.MAIN RESULTS AND THE ROLE OF CHANCEHYAL patients with an F-HB score ≤65% demonstrated an IR of 37.4% compared with 30.7% for control [n = 63, 58, P > 0.05, (95% CI of the difference −7.7 to 21.3)]. In addition, the CPR associated with patients randomized to the HYAL group was 50.8% when compared with 37.9% for those randomized to the control group (n = 63, 58, P > 0.05). The 12.9% difference was associated with a risk ratio (RR) of 1.340 (RR 95% CI 0.89–2.0). HYAL patients with I-HB and F-HB scores ≤65% revealed a statistically significant reduction in their PLR (I-HB: 3.3 versus 15.1%, n = 73, 60, P = 0.021, RR of 0.22 (RR 95% CI 0.05–0.96) (F-HB: 0.0%, 18.5%, n = 27, 32, P = 0.016, RR not applicable due to 0.0% value) over control patients. The study was ori...

These experiments were designed to define and optimize the efficiency of a system whereby bovine oocytes could be fertilized in vitro. The frequency of ova penetrated and the stage of fertilization were the end points examined. All experiments utilized cumulus-oocyte complexes from 1- to 5-mm follicles which were matured in vitro prior to fertilization. The experiments were designed to examine the effects of the following factors on fertilization: 1) pretreatment of sperm with ionomycin (a Ca++ ionophore), 2) preincubation of sperm at a high concentration and the presence of hypotaurine and epinephrine during fertilization, 3) the use of either follicle-stimulating hormone (FSH) or cAMP for the induction of cumulus expansion prior to fertilization, and 4) the need for the presence of cumulus cells during fertilization. Sperm exposure to ionomycin or preincubation at high sperm concentrations was not necessary for fertilization. The presence of hypotaurine and epinephrine during fertilization improved (P less than 0.05) the quality of fertilization (i.e., higher frequencies of oocytes with both female and male pronuclei were observed). However, they did not increase the percentage of ova penetrated (P greater than 0.05). Fertilization frequencies were not different (P greater than 0.05) between oocytes with cumulus expansion induced by FSH or cAMP. However, the use of either treatment resulted in higher fertilization rates when compared to untreated controls (P less than 0.05). Finally, while the presence of cumulus cells was not necessary for penetration of ova, increased frequencies of ova with both male and female pronuclei were found when cumuli were present (P less than 0.05).

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The Society for Assisted Reproductive Technology (SART) was established within a few years of assisted reproductive technology (ART) in the United States, and has not only reported on the evolution of infertility care, but also guided it toward improved success and safety. Moving beyond its initial role as a registry, SART has expanded its role to include quality assurance, data validation, practice and advertising guidelines, research, patient education and advocacy, and membership support. The success of ART in this country has greatly benefited from SART's role, as highlighted by a series of graphs. SART continues to set the standard and lead the way.

Standardization of morphological assessment for embryo grading system was developed and is being implemented by the Society for Assisted Reproductive Technology (SART). A recent European consensus conference of embryologists from Europe and America is working toward adopting an embryo classification system modeled similarly to that of SART which, if adopted, would produce a de facto international standard to aid cross border collaboration.Keywords Embryo . Grading . Evaluation . Standardization . SARTWe write with regards to implementation of international standards for grading and reporting embryo quality in assisted reproductive technology (ART) laboratories. This year marks a turning point in the history of grading preimplantation embryos. First, in the United States, the Society for Assisted Reproductive Technology (SART) mandated reporting of embryo grade. This resulted from efforts of a SART Embryo Morphology Subcommittee, comprised of embryologists and a clinician, who devised a simple standardized grading system that can be easily implemented in any ART laboratory. Second, last February, Capsule An embryo grading system was developed and implemented by SART in 2006. A similar system is under development in Europe. International standardization of morphology assessments will aid cross border collaboration.