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 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.

Introduction:In the last decades sperm DNA quality has been recognized as one of the most important markers of male reproductive potential (Lewis and Aitken, 2005; Ozmen, 2007; Tarozzi, 2007), in contrast to standard semen parameters as sperm density, motility and morphology, which do not act as powerful discriminators between fertile and infertile men. DNA damage in the male germ line is a major contributor to infertility, miscarriage and birth defects in the offspring. In animal models, it has been unequivocally demonstrated that the genetic integrity of the male germ line plays a major role in determining the normality of embryonic development. In humans, many studies showed that sperm DNA damage is associated with impaired embryo cleavage (8), higher miscarriage rates (9) and also with a significantly increased risk of pregnancy loss after in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) (10). Specifically, above a threshold of 30% of sperms with fragmented DNA, chances for pregnancy are close to zero, either by means of natural conception or intrauterine insemination (Spano M, 2000; Bungum M, 2007). Since there is a clear relationship between sperm DNA damage and poor assisted reproduction technology (ART) outcomes, efforts should be directed in developing treatments to improve sperm DNA quality to be introduced into clinical use. The aim of this observational study was to investigate the effects of r-FSH administration on sperm DNA fragmentation of iOAT patients undergoing ICSI, comparing the DNA fragmentation index (DFI) before and after 90 days of FSH therapy.Matherial and Methods: Fifty-three iOAT men, with a median age of 33,6 ± 7,6 years, referred to our clinics because of fertility problems after at least two years of natural attempts, were selected for the study. In all patients DNA fragmentation was evaluated sperm prior to treatment with 150 IU of recombinant human FSH (GONAL-f ® , Merck Serono) three times at week for at least three months. Patients were re-evaluated after a 3-month period with semen analysis and DNA fragmentation. Sperm DNA fragmentation index (DFI) was investigated by terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate (dUTP) in situ DNA nick end labelling (TUNEL) assay. Data were analysed using the paired t-test and chi-square as appropriate. A p-value <0.05 was considered statistically significant.Results: After 3 months of r-FSH treatment, no significant differences was observed between baseline and post therapy semen sample parameters including sperm count, motility, and the percentage of normal sperm forms. IThe percentage of sperm DNA fragmentation in the total of patients dropped from 20.8 ± 9.1 to 15.1 ± 8.9 (P < 0.05) (see Tab I). Interestingly, no statistical difference was found in sperm DFI when patients showed a baseline DFI ≤15% (10.5 ± 4.2 vs 11.4 ± 4.5). We found an evident and statistically significant DFI reduction in patients with sperm baseline DFI value ≥15% (24.37 ± 9.6 vs 15.4 ± 4.6). Conclusion:Our data seems ...

Background: Although the motile sperm organelle morphology examination (MSOME) was developed merely as a selection criterion, its application as a method for classifying sperm morphology may represent an improvement in the evaluation of semen quality. The aim of this study was to determine the prognostic value of normal sperm morphology using MSOME with regard to clinical pregnancy (CP) after intrauterine insemination (IUI). Methods: A total of 156 IUI cycles that were performed in 111 couples were prospectively analysed. Each subject received 75 IU of recombinant FSH every second day from the third day of the cycle. Beginning on the 10th day of the cycle, follicular development was monitored by vaginal ultrasound. When one or two follicles measuring at least 17 mm were observed, recombinant hCG was administered, and IUI was performed 12-14 h and 36-40 h after hCG treatment. Prior to the IUI procedure, sperm samples were analysed by MSOME at 8400× magnification using an inverted microscope that was equipped with DIC/Nomarski differential interference contrast optics. A minimum of 200 motile spermatozoa per semen sample were evaluated, and the percentage of normal spermatozoa in each sample was determined. Results: Pregnancy occurred in 34 IUI cycles (CP rate per cycle: 21.8%, per patient: 30.6%). Based on the MSOME criteria, a significantly higher percentage of normal spermatozoa was found in the group of men in which the IUI cycles resulted in pregnancy (2.6+/-3.1%) compared to the group that did not achieve pregnancy (1.2+/-1.7%; P = 0.019). Logistic regression showed that the percentage of normal cells in the MSOME was a determining factor for the likelihood of clinical pregnancy (OR: 1.28; 95% CI: 1.08 to 1.51; P = 0.003). The ROC curve revealed an area under the curve of 0.63 and an optimum cut-off point of 2% of normal sperm morphology. At this cut-off threshold, using the percentage of normal sperm morphology by MSOME to predict pregnancy was 50% sensitive with a 40% positive predictive value and 79% specificity with an 85% negative predictive value. The efficacy of using the percentage of normal sperm morphology by MSOME in predicting pregnancy was 65%.

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