The objective of this meta-analysis was to investigate the influence of meiotic spindle visualization in human oocytes on intracytoplasmic sperm injection (ICSI) outcomes. Search strategies included on-line surveys of databases (MEDLINE, EMBASE, Science Citation Index, Cochrane Controlled Trials Register and Ovid). The fixed effect was used for odds ratio. Ten trials fulfilled the inclusion criteria comparing in-vitro and clinical ICSI outcomes with or without visualization of meiotic spindle in fresh and in-vivo matured oocytes. According to the meta-analysis, the results showed statistically significant higher fertilization rate (P < 0.0001) when the meiotic spindle was viewed than when it was not. Moreover, the percentage of pro-nuclear-stage embryos with good morphology (P = 0.003), cleavage rate (P < 0.0001), percentage of day-3 top-quality embryos (P = 0.003) and percentage of embryos that reached the blastocyst stage (P < 0.0001) were statistically significantly better among embryos derived from oocytes in which meiotic spindle was viewed compared with those in which meiotic spindle was not observed. However, these differences were not observed in the clinical pregnancy or implantation rates. This observation has clinical relevance mainly in countries where there is a legal limit on the number of oocytes to be fertilized. However, additional controlled trials are needed to further confirm these results.
The endometrial pattern and thickness were analysed by ultrasonography in 139 cycles stimulated for in-vitro fertilization (IVF) on the day of administration of human chorionic gonadotrophin (HCG). A semi-programmed schedule based on the pill + clomiphene citrate + human menopausal gonadotrophin (HMG) was used in all cycles. On the day of HCG administration, endometrial pattern and thickness were assessed with an Ultramark 4 (ATL) ultrasound equipped with a 5 MHz vaginal probe. Endometrial pattern I (a 'triple-line' multilayer) was observed in a total of 105 cycles (76%), and pattern II (fully homogeneous and hyperechogenic in relation to myometrial tissue) in 34 (24%). The incidence of clinical pregnancy did not differ (P = 0.52) between the groups with endometrial patterns I (23.8%) and II (29.4%). Endometrial thickness on the day of HCG administration in the group with pattern I (8.4 +/- 1.9 mm) was similar (P = 0.96) to that observed in the group with pattern II (8.4 +/- 2.0 mm). In addition, the endometrial thickness of the patients who became pregnant (8.0 +/- 1.7 mm) did not differ (P = 0.15) from that of women who did not achieve pregnancy (8.6 +/- 2.0 mm). The conclusion from the present data is that ultrasonographic analysis of endometrial thickness and refringency on the day of HCG administration had no predictive value for conception in IVF cycles.
The present study was carried out to investigate the predictive value of the sperm survival test (SST) with respect to the fertilization of oocytes in culture. In general, our laboratory uses a total of 50,000-150,000 motile spermatozoa to inseminate each oocyte. The remaining material is evaluated for motility before and after 24 h of incubation at 37 degrees C in a 5% CO2 atmosphere. A total of 250 oocytes from 50 cases (mean +/- SD, 5.0 +/- 2.4 oocytes per retrieval) were inseminated and the final rate of cleaved embryos obtained was 52.5%. The SST (%) was considered normal when the ratio (final density of progressing spermatozoa after 24 h x 100/initial density of progressing spermatozoa) was 50% or more. Any other result was considered abnormal. Cases presenting one or more cleaved embryos (n = 40) were separated from those in which no embryo formation occurred (n = 10) and the results were compared in terms of the respective sperm survival rates over a period of 24 h: normal SST (one or more cleaved embryos, 37; none, five), abnormal SST (one or more cleaved embryos, three; none, five). The specificity of the SST was 0.92 and sensitivity 0.50, the predictive value of the abnormal test was 0.62 and the predictive value of the normal test 0.88. The efficacy of the test was estimated at 0.71, which was better than the conventional parameters of sperm analysis. A receiver-operating characteristics curve for SST confirmed that the test can be useful for the prediction of fertilizability of oocytes in the laboratory.
The present study was carried out to present a new ultrasound parameter used in stimulated cycles and called the ovarian synchrony factor (OSF), which reflects the response of the total follicular cohort. It is calculated from the formula: OSF = (total no. of follicles > or = 16 mm)/(total no. of follicles > or = 10 mm). OSF was determined on the day of human chorionic gonadotrophin (HCG) administration (indicated when at least one follicle was > or = 16 mm) by measuring the widest follicular diameters with an ATL ultrasound apparatus model Ultramark 4, with a 5.0 MHz vaginal transducer, in a total of 221 cycles stimulated for non-invasive assisted reproduction techniques (i.e. no oocyte retrieval). A new ultrasound examination was performed 56-60 h after HCG administration to determine the possible presence of follicular rupture indicated by the disappearance of the follicular image and/or a > 5 mm decrease in the widest follicular diameter. The mean OSF in the group of patients with rupture of at least one follicle (195 cycles) was mean +/- SD, 0.57 +/- 0.25, as opposed to a mean +/- SD of 0.39 +/- 0.25 for the group without follicular rupture (26 cycles). The Mann-Whitney test showed that the OSF of the group with follicular rupture was significantly higher than that detected in the group without follicular rupture (P < 0.01). This information suggests that ovarian stimulation protocols should produce a synchronous follicular response (an OSF as close as possible to 1), i.e. that the follicular lots developing in both ovaries should not vary widely in size. This follicular homogeneity should facilitate the follicular rupture process.
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