No abstract

The purpose of this study was to examine the effects of pentoxifylline used before and after semen cryopreservation-thawing on sperm motility and membrane integrity. Twenty-four semen samples were split into four equal aliquots. Aliquots were incubated at 37 degrees C for 30 min, followed by cryopreservation with TEST-yolk freezing medium using slow programmable freezing protocol. After 2 weeks the sperm samples were thawed, washed twice in Quinn's Sperm Washing Medium (modified HTF with 5.0 mg/mL Human Albumin) and incubated at 37 degrees C for 30 min. Aliquots were treated by adding 3 mmol/L pentoxifylline to: (1) fresh sperm samples during incubation period prior to cryopreservation, (2) sperm samples as a supplement to the cryoprotectant prior to cryopreservation, and (3) thawed sperm samples during incubation period. One aliquot received no treatment (control group). The addition of 3 mmol/L pentoxifylline to fresh semen during incubation period prior to cryopreservation significantly decreased progressive and total motility compared with controls. However, the addition of 3 mmol/L pentoxifylline to cryopreserved semen after thawing significantly increased progressive and total motility compared with controls. After post-thaw, no differences in motion characteristics between sperm samples treated by adding 3 mmol/L pentoxifylline as a supplement to the cryoprotectant and control groups were observed. Post-thaw hypoosmotic swelling (HOS) test scores did not improve with the addition of pentoxifylline compared with the control group. It is concluded that pentoxifylline enhanced post-thaw motility of cryopreserved human spermatozoa when added after thawing. No improvement was found by freezing sperm with pentoxifylline.

No abstract

STUDY QUESTION How did coronavirus disease 2019 (COVID-19) impact on medically assisted reproduction (MAR) services in Europe during the COVID-19 pandemic (March to May 2020)? SUMMARY ANSWER MAR services, and hence treatments for infertile couples, were stopped in most European countries for a mean of 7 weeks. WHAT IS KNOWN ALREADY With the outbreak of COVID-19 in Europe, non-urgent medical care was reduced by local authorities to preserve health resources and maintain social distancing. Furthermore, ESHRE and other societies recommended to postpone ART pregnancies as of 14 March 2020. STUDY DESIGN, SIZE, DURATION A structured questionnaire was distributed in April among the ESHRE Committee of National Representatives, followed by further information collection through email. PARTICIPANTS/MATERIALS, SETTING, METHODS The information was collected through the questionnaire and afterwards summarised and aligned with data from the European Centre for Disease Control on the number of COVID-19 cases per country. MAIN RESULTS AND THE ROLE OF CHANCE By aligning the data for each country with respective epidemiological data, we show a large variation in the time and the phase in the epidemic in the curve when MAR/ART treatments were suspended and restarted. Similarly, the duration of interruption varied. Fertility preservation treatments and patient supportive care for patients remained available during the pandemic. LARGE SCALE DATA N/A LIMITATIONS, REASONS FOR CAUTION Data collection was prone to misinterpretation of the questions and replies, and required further follow-up to check the accuracy. Some representatives reported that they, themselves, were not always aware of the situation throughout the country or reported difficulties with providing single generalised replies, for instance when there were regional differences within their country. WIDER IMPLICATIONS OF THE FINDINGS The current article provides a basis for further research of the different strategies developed in response to the COVID-19 crisis. Such conclusions will be invaluable for health authorities and healthcare professionals with respect to future similar situations. STUDY FUNDING/COMPETING INTEREST(S) There was no funding for the study, apart from technical support from ESHRE. The authors had no COI to disclose.

The aim of this review is to analyze the efficacy of different dopamine agonists in the prevention of ovarian hyperstimulation syndrome (OHSS). Cabergoline, quinagolide and bromocriptine are the most common dopamine agonists used. There are wide clinical variations among the trials in the starting time (from the day of human chorionic gonadotrophin (hCG) to the day following oocyte retrieval); the duration of the treatment (4-21 days), the dose of cabergoline (0.5 mg or 0.25 mg orally) and in the regimens used. At present, the best known effective regimen is 0.5 mg of cabergoline for 8 days or rectal bromocriptine at a daily dose of 2.5 mg for 16 days. Dopamine agonists have shown significant evidences of their efficacy in the prevention of moderate and early-onset OHSS (9.41%), compared with a placebo (21.45%), which cannot be confirmed for the treatment of late OHSS. It would be advisable to start with the treatment on the day of hCG injection or preferably a few hours earlier. The use of dopamine agonists should be indicated in patients at high risk of OHSS, as well as in patients with a history of previous OHSS even without evident signs of the syndrome.

SummaryOur objective was to assess the effect of benchtop incubators with low oxygen concentrations on the clinical and embryological parameters of our patients. We conducted a prospective, randomized, opened controlled trial on infertile patients in stimulated cycles. In total, 738 infertile patients were assessed for eligibility and, after final exclusions, 230 patients were allocated either to a 5% O2 group (benchtop incubator) or a 20% O2 group (classic incubator). Finally, 198 patients in the 5% O2 group and 195 in the 20% O2 group were analysed. The outcomes measured were fertilization rate, clinical pregnancy rate, and live birth rate. The primary outcome – live birth rate per all transfers – did not show any improvement in the 5% oxygen group over the 20% oxygen group (25.3% versus 22.6%, P=0.531), but the number of day 5 blastocysts was significantly higher (P=0.009). Fertilization rate did not show any beneficial effect of reduced oxygen (5%) (73.4%±22.4% versus 74.6%±24.0%, P=0.606) per all transfers but there was statistically significant difference in the day 5 SET subgroup (85.3±15.1 versus 75.1±17.5; P=0.004). Clinical pregnancy rate showed results in favour of the 5% oxygen group for all subgroups (day 3: 23.7% versus 21.1%, P=0.701; day 5 SET: 35.0% versus 30.6%. P=0.569) but showed statistical significance only in the day 5 SET subgroup (51.1% versus 29.8%; P=0.038). Culturing of embryos in benchtop incubators under low oxygen produced more blastocysts and therefore was a better alternative for embryo selection, which resulted in higher pregnancy rates. To achieve higher live birth rates, embryo quality is not the only factor.

Ana li za građe sper mi ja pre ma kri te ri ji ma SZO i strik tnim kri te ri ji ma: us po red ba dvi ju me to da i unu tar la bo ra to rij ska va ri ja bil no st Spe rm mor pho lo gy as ses sme nt ac cor di ng to WHO and stri ct cri te ria: met hod com pa ri son and in tra-la bo ra to ry va ria bi li ty An drea Čipak 1 , Pat rik Sta nić 1 , Ko ralj ka Đurić 2 , Ti ha na Ser dar 3 , Er ne st Suc ha nek 41 Klini ka za žen ske bo les ti i po ro de, Kli nički bol nički cen tar "Zag reb", Zag reb 1 Uni ver si ty De par tme nt of Ob stet ri cs and Gyne co lo gy, Zag reb Uni ver si ty Hos pi tal Cen ter, Zag reb, Croa tia 2 Me di cin sko bio ke mij ski la bo ra to rij, Po lik li ni ka "Sun ce", Zag reb 2 Me di cal Bioc he mis try La bo ra to ry, Sun ce Po lycli nic, Zag reb, Croa tia 3 Kli nički za vod za la bo ra to rij sku di jag nos ti ku, Kli nička bol ni ca Dub ra va, Zag reb 3 De par tme nt of La bo ra to ry Me di ci ne, Dub ra va Uni ver si ty Hos pi tal, Zag reb, Croa tia 4 Fer ti li ty Cli nic, Tawam Hos pi tal, Joh ns Hop ki ns Me di ci ne, Al Ain, Abu Dha bi, U.A.E. 4 Fer ti li ty Cli nic, Tawam Hos pi tal, Joh ns Hop ki ns Me di ci ne, Al Ain, Abu Dha bi, U.A.E. SažetakUvod: Ana li za građe sper mi ja je dan je od naj važni jih ko ra ka u proc je ni muškog par tne ra kod nep lod nih pa ro va. Međutim, značaj ne međula bo ra to rij ske i unu tar la bo ra to rij ske va ri ja ci je mo gu uz ro ko va ti po teškoće u tu mačenju rezu ltata, pog rešne di jag no ze te mo gu do ves ti do za bu na. Sto ga je neop hod no ove va ri ja ci je sves ti na naj ma nju mo guću mje ru ka ko bi se uk lo ni le pos lje dične greške i osi gu ra la međula bo ra to rij ska i unu tar la bo ra to rij ska po nov lji vo st. Ma te ri ja li i me to de: Uzor ci sjeme na do bi ve ni su od 49 uzas top nih muškara ca ko ji su do la zi li u an dro loški la bo ra to rij ra di proc je ne plod nos ti. Us po re di li smo dva kri te ri ja za ana li zu građe sper mi ja: 1) raz maz sje me na prip rem ljen po moću bo je Giem sa ko ji smo ana li zi ra li pre ma kri te ri ji ma Svjet ske zdravstve ne or ga ni za ci je (SZO) i 2) raz maz sje me na prip rem ljen bo jom Sper mac ko ji smo ana li zi ra li pre ma strik tnim kri te ri ji ma. Ta kođer smo pro ve li i unu tarla bo ra to rij sku us po red bu ana li ze građe sper mi ja. Re zul ta ti: Di jag nos ti ci ra nje te ra to zoos per mije pre ma kri te ri ji ma SZO i prema strik tnim kri te ri ji ma bi lo je po du dar no kod 45 od 49 is pi ta ni ka. Mje ra suklad nos ti među pro mat ra nji ma bi la je slična i kod kri te ri ja SZO i kod strik tnih kri te ri ja (ka pa = 0,700 za SZO kri te rij; ka pa = 0,715 za strik tni kriterij). Zak ljučci: Ana li ze građe sper mi ja pre ma kri te ri ji ma SZO i strik tnim kri te ri jima po du da ra ju se u pos tav lja nju di jag no ze te ra to zoos per mi je i može se postići dob ra ra zi na suk lad nos ti među pro mat račima na kon od go va ra jućeg os posob lja va nja, pažlji vog pregle da raz ma za i poštiva nja kla si fi ka cij skih sus ta va. Ključne ri ječi: sper ...

The purpose of this review is to analyse the sources and effects of follicular progesterone elevations during ovarian stimulation, with the underlying mechanisms and preventive strategies on the in vitro fertilisation pregnancy outcome. In the early follicular phase, a flare-up effect of gonadotrophin releasing hormone (GnRH) agonists and incomplete luteolysis in GnRH antagonist regimens can result in significant elevations of progesterone. In the late follicular phase, progesterone elevations in GnRH analogue cycles are the result of the ovarian stimulation itself, driven by high follicle stimulating hormone dosage, estradiol levels, the number of follicles and oocytes. It seems that progesterone elevations (> or = 1.5 ng/mL or 4.77 nmol/L) have a detrimental effect on the outcome of pregnancy, accelerating the endometrial maturation. The most appropriate choice to avoid the negative effects of follicular progesterone elevations is to cancel fresh embryo transfer and to transfer frozen-thawed embryos in natural cycles. To prevent follicular phase elevations it might be preferable to use milder stimulation protocols, earlier trigger of ovulation in high responders and single-blastocyst transfer on day 5. The optimal GnRH analogue protocols during the entire stimulation period appear to be the long agonist as well as "long" and long GnRH antagonist regimens.