No abstract

Bérengère Ducrocq and Nathalie Rives both contributed as last co-authors.

Background Two meta-analyses have shown that pregnancy and birth rates are significantly higher after blastocyst transfer than after cleaved embryo transfer. Other studies have revealed that a serum progesterone level > 1.5 ng/ml on the trigger day is responsible for premature luteinization and is associated with a low pregnancy rate. The objectives of this retrospective study were to determine whether blastocyst transfer gave higher pregnancy rates than cleaved embryo transfer at day 3 in both the general and selected IVF/ICSI populations, and whether the serum progesterone level influenced the pregnancy rate. Method We studied IVF/ICSI cycles with GnRH antagonist - FSH/hMG protocols in a general population (n = 1210) and a selected “top cycle” population (n = 677), after blastocyst transfer on day 5 or cleaved embryo transfer on day 3. The selected couples had to meet the following criteria: female age < 35, first or second cycle, and one or two embryos transferred. We recorded predictive factors for pregnancy and calculated the progesterone to oocyte index (POI), the progesterone:estradiol ratio (P:E2 ratio), and the progesterone to follicle (> 14 mm) index (PFI). Results In the general population, the clinical pregnancy rate was significantly higher after blastocyst transfer (33.3%) than after cleaved embryo transfer (25.3%; p <  0.01); the same was true for the birth rate (32.1 and 22.8%, respectively, p <  0.01). The differences between blastocyst and embryo transfer groups were not significant in the selected population (respectively 35.7% vs. 35.8% for the clinical pregnancy rate, and 33.9 and 34.9% for the birth rate). The serum progesterone levels on the eve of the trigger day and on the day itself were significantly lower in the pregnant women (p <  0.01). We found a serum progesterone threshold of 0.9 ng/ml, as also reported by other researchers. The POI and the PFI appear to have predictive value for cleaved embryos transfers. Conclusions Blastocyst transfers were associated with higher clinical pregnancy and birth rates than cleaved embryo transfers in a general population but not in a selected population. The serum progesterone levels on the eve of the trigger day and on the day itself predicted the likelihood of pregnancy.

We question whether, in men with an abnormal rate of sperm DNA fragmentation, the magnetic-activated cell sorting (MACS) could select spermatozoa with lower rates of DNA fragmentation as well as spermatozoa with unbalanced chromosome content. Cryopreserved spermatozoa from six males were separated into nonapoptotic and apoptotic populations. We determined the percentages of spermatozoa with (i) externalization of phosphatidylserine (EPS) by annexin V-Fluorescein isothiocyanate (FITC) labeling, (ii) DNA fragmentation by TdT-mediated-dUTP nick-end labeling (TUNEL), and (iii) numerical abnormalities for chromosomes X, Y, 13, 18, and 21 by fluorescence in situ hybridization (FISH), on the whole ejaculate and selected spermatozoa in the same patient. Compared to the nonapoptotic fraction, the apoptotic fraction statistically showed a higher number of spermatozoa with EPS, with DNA fragmentation, and with numerical chromosomal abnormalities. Compared to the whole ejaculate, we found a significant decrease in the percentage of spermatozoa with EPS and decrease tendencies of the DNA fragmentation rate and the sum of disomy levels in the nonapoptotic fraction. Conversely, we observed statistically significant higher rates of these three parameters in the apoptotic fraction. MACS may help to select spermatozoa with lower rates of DNA fragmentation and unbalanced chromosome content in men with abnormal rates of sperm DNA fragmentation.

Background: Many studies have suggested that female obesity has an impact on oocyte quality, embryo quality, and endometrial maturation in couples undergoing in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI). In contrast, there are few data on the management of intrauterine insemination (IUI) in obese women. The objectives of the present study were to evaluate the clinical pregnancy and live birth rates in IVF/ICSI and IUI for overweight or obese women and to determine positive or negative predictive factors for pregnancy. Method: We analyzed long GnRH agonist or GnRH antagonist protocols with FSH/hMG for IVF/ICSI, and FSH/hMG alone for IUI. We classified the women into three groups: normal weight, overweight, and obesity. The latter group was divided into two obesity subgroups: class 1 and class 2/3. We recorded data on the patients' demographic, stimulation cycles, embryo cultures, and ongoing pregnancies obtained. For IVF/ICSI and IUI, we performed a univariate analysis of factors that were predictive of pregnancy and then selected a number for inclusion in a multivariate analysis. Results: The study included 1153 IVF/ICSI cycles and 541 IUI cycles. The clinical pregnancy and live birth rates in IVF/ICSI did not vary as a function of the female BMI. In IUI, the clinical pregnancy and live birth rates were significantly higher among obese women (21.6% and 17.7%, respectively) than among women of normal weight (12.2% and 9.3%, respectively; p<0.05). In IVF/ICSI and IUI, we did not observe an association between the spontaneous miscarriage rate and the BMI. In a univariate analysis, several predictive factors were found for IVF/ICSI and IUI. However, in a multivariate analysis, pregnancy in IVF/ICSI was notably predicted by the number of embryos obtained (≥5), whereas the absence of pregnancy in IUI was notably predicted by a monofollicular response to ovarian stimulation (p<0.001 for both). Conclusions: Our study did not find differences in clinical pregnancy and live birth rates as a function of female BMI in IVF/ICSI, and even evidenced higher rates among obese women in IUI. Nevertheless, women should be encouraged to lose weight if allowed by the setting and their age; this may decrease the incidence of obstetric complications during assisted reproductive technology programs.