The present study was designed to determine the efficacy of intracytoplasmic sperm injection (ICSI) using spermatozoa with abnormal head morphology in 17 cases with total teratozoospermia. A total of 160 oocytes were retrieved and 144 metaphase II oocytes were injected. The fertilization and cleavage rates were 50.7 and 93.2% respectively. Fertilization failure occurred in two couples. A total of 54 embryos were transferred and pregnancy rates per initiated and per embryo transfer cycle were 17.6 and 20.0% respectively, while the clinical pregnancy rates per initiated and embryo transfer cycle were 11.8 and 13.3%. The implantation rate was 3.7% (2/54). Out of two pregnancies achieved, one resulted in abortion in the first trimester. The ongoing pregnancy rates per initiated and embryo transfer cycle were 5.88% (1/17) and 6.6% (1/15) respectively. Although the implantation and ongoing pregnancy rates are very low, ICSI seems to be the only treatment modality in cases where teratozoospermia was total with 100% abnormal head morphology.
The rational of transferring two instead of three embryos was studied through 468 in-vitro fertilization (IVF) treatment cycles in 287 couples. The quality of 1224 embryos was determined according to the fragmentation rate and the morphology as good (A) and poor (B). The influence of the number of embryos transferred (two or three) on the pregnancy rate when the same quality or combinations of good and poor quality embryos transferred was examined. When only good quality embryos were transferred the pregnancy rates in double (AA) and triple (AAA) embryo transfer were 40.5 (17/42) and 42.9% (30/70) respectively (not significant). When only poor quality embryos were transferred, the pregnancy rates in double (BB) and triple (BBB) embryo transfers were 11.0% (11/100) and 22.9% (16/70) respectively (P < 0.001). On the other hand, when good and poor quality embryos were transferred together as AB in double and as AAB and ABB in triple embryo transfer, the pregnancy rates were 36.8 (14/38) and 39.9% (59/148) respectively (not significant). There was no difference in the miscarriage rate between double and triple embryo transfers; 16.7 and 18.1% respectively. The multiple pregnancy rate was 14.3% for double embryo transfers and 32.4% for triple embryo transfers (P < 0.001). This study demonstrates that if there is at least one good quality embryo available for transfer, then double instead of triple embryo transfer will not yield a significantly lower pregnancy rate. The influence of the number of embryos transferred on the pregnancy rate became significant when only poor quality embryos were transferred.(ABSTRACT TRUNCATED AT 250 WORDS)
To evaluate the possible effect of pentoxifylline on the acrosome reaction (AR) and its correlation with in-vitro fertilization (IVF), sperm samples obtained from 51 patients who underwent IVF treatment were studied. Acrosome reactions were evaluated as spontaneous, pentoxifylline-treated and calcium ionophore (A23187) induced, before and after treatment. The correlation of AR with fertilization in vitro in spermatozoa pre-treated with pentoxifylline was sought. In cases with failure or very low fertilization rate (< or = 10%) in their previous trials, spermatozoa after swim-up were treated before insemination. Spontaneous acrosome loss remained low even after treatment (mean +/- SD: 8.18 +/- 1.74%). Response to A23187 was enhanced significantly (P < 0.001) by pre-treatment with pentoxifylline in 33 control cases (group A) in which fertilization in vitro was previously successful without this treatment. Patients with at least two episodes of failed fertilization were divided into two groups. In 11 cases (group B), the IVF rate was improved significantly (P < 0.001) by the treatment. This was not observed in seven cases (group C) in which the treatment induced no increase in IVF rate. We achieved nine (27.3%) pregnancies in group A and five (45.4%) pregnancies in group B. This study demonstrated that pentoxifylline enhanced A23187 induced the acrosome reaction and this effect was correlated with improvement in IVF rate.
Preventing the occurrence of high-rank multiple pregnancies without reducing the pregnancy rate remains a high priority of in-vitro fertilization and embryo transfer programmes. Our previous study demonstrated that, if there is at least one embryo with a good morphological grade, then the transfer of two (a double embryo transfer) instead of three embryos does not result in a lower pregnancy rate, and that the influence of the number of embryos transferred becomes significant only when poor-quality embryos are transferred. This result allowed us to employ the simple policy of systematically selecting double embryo transfer cycles without affecting the pregnancy rate. Since January 1994, when patients < 37 years of age had more than two embryos available for transfer, only two instead of three embryos were transferred if at least one of the embryos demonstrated a good morphological grade. After a 1 year application of this policy, of the 147 cycles (group A) that fulfilled the above criteria, two embryos were transferred in 92 cycles, while three embryos were transferred in the other 55 cycles. The results of these cycles were compared to those of the control 144 cycles (group B) in which three embryos were transferred, prior to the application of this policy. The on-going pregnancy rates and the incidence of multiple and triplet pregnancies were 24% and 28%, 22% and 23%, and 2% and 9% in groups A and B respectively. The rates were not significantly different. In conclusion, although our prospective trial demonstrated a tendency of decreasing pregnancy rate and an invariable incidence of multiple pregnancies, the very low occurrence of triplets during this period indicated that this policy provided a practical compromise between achieving a high pregnancy rate and an acceptable incidence of triplet pregnancies.
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