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Background: There is considerable uncertainty as to the significance of a high sperm DNA fragmentation index (DFI) for achieving a successful pregnancy.Methods: The sperm DFI of 124 patients undergoing 192 IVF cycles and of 96 patients undergoing 155 ICSI cycles was determined using the sperm chromatin structure assay on neat sperm.Results: The rate of continuing pregnancies in ICSI cycles (but not in IVF cycles) showed significant negative correlation (r = -0.184, P = 0.022) with the DFI value. A threshold value of DFI which showed a significant difference (P = 0.005) in rate of continuing pregnancies between higher and lower DFI levels was found for ICSI cycles to be > or = 19%, but no such threshold was found for IVF cycles. However, if the threshold of > or = 30% was used for IVF cycles there was a non-significant lowering of the rates of continuing pregnancy and implantation at the higher DFI levels. DFI level had no effect on fertilization rate or on the percentage of embryos having more than 4 cells at Day 3 after fertilization. A high DFI level had a marked significant effect (P = 0.001) on implantation rate in ICSI cycles but not in IVF cycles. A significant positive correlation (r = 0.268, P = 0.001) between DFI and sperm midpiece defects was also noted in the ICSI patients.Conclusions: These observations may help to resolve the issues about how, and to what extent, sperm DNA damage impacts upon the success of IVF and ICSI procedures. [ABSTRACT FROM AUTHOR]

To examine the influence of cytoplasmic morphology on the success rate of intracytoplasmic sperm injection (ICSI), the morphology of 837 metaphase II oocytes was assessed after cumulus stripping. The main abnormalities detected were excessive granularity, cytoplasmic inclusions such as vacuoles, smooth endoplasmic reticulum clustering and refractile bodies. Microinjection was performed in 538 oocytes with normal cytoplasm, 142 out of 161 with excessive granularity and 112 out of 138 with cytoplasmic inclusions. Very poor oocytes were not injected. No difference was found in fertilization rate. The embryos achieved cleaved normally and a similar number of good quality embryos among the three groups was noted. The outcome of transfer of embryos derived solely from normal oocytes (group A: 72 patients, 183 embryos) was compared with those from oocytes with cytoplasmic abnormalities (group B: 34 patients, 85 embryos). In group A, 17 clinical pregnancies (24% per patient, implantation rate 10%) were established. In group B, only one clinical pregnancy (3% per patient, implantation rate 1%) was established, from the transfer of embryos derived from oocytes with homogeneous granularity of the cytoplasm. No pregnancy resulted following the transfer of embryos from eggs with cytoplasmic inclusions. The difference was statistically significant. The outcome of ICSI is dependent on the quality of the oocytes retrieved. Normal fertilization and early embryo development were achieved in oocytes with abnormal cytoplasm morphology, but the resulting embryos failed to demonstrate the same implantation potential as those derived from oocytes with normal cytoplasm. [ABSTRACT FROM PUBLISHER]

A prospective randomized study was designed to compare gamete intra-Fallopian transfer (GIFT) and in-vitro fertilization (IVF) and embryo transfer in the treatment of couples who have failed to conceive after at least three cycles of ovarian stimulation and intrauterine insemination (IUI). A total of 69 couples with primary unexplained infertility of at least 2 years' duration plus at least three failed cycles of ovarian stimulation and IUI were randomly allocated to either GIFT or IVF/embryo transfer. The clinical pregnancy rate was 34% after GIFT treatment and 50% after IVF/embryo transfer. This difference was not statistically significant. The twin rate in the IVF/embryo transfer group was higher than in the GIFT group (53 versus 17%, P = 0.005). We conclude that patients with unexplained infertility and failed ovarian stimulation and IUI can still achieve encouraging pregnancy rates with IVF/embryo transfer or GIFT. Since IVF/embryo transfer is the least invasive of the two procedures and may yield diagnostic information, we would favour this therapy; however, the number of embryos transferred should be reduced to two to reduce the risk of twin pregnancy. [ABSTRACT FROM AUTHOR]

A prospective randomized study was designed to compare gamete intra-Fallopian transfer (GIFT) and in-vitro fertilization (IVF) and embryo transfer in the treatment of couples who have failed to conceive after at least three cycles of ovarian stimulation and intrauterine insemination (IUI). A total of 69 couples with primary unexplained infertility of at least 2 years' duration plus at least three failed cycles of ovarian stimulation and IUI were randomly allocated to either GIFT or IVF/embryo transfer. The clinical pregnancy rate was 34% after GIFT treatment and 50% after IVF/embryo transfer. This difference was not statistically significant. The twin rate in the IVF/embryo transfer group was higher than in the GIFT group (53 versus 17%, = 0.005). We conclude that patients with unexplained infertility and failed ovarian stimulation and IUI can still achieve encouraging pregnancy rates with IVF/embryo transfer or GIFT. Since IVF/embryo transfer is the least invasive of the two procedures and may yield diagnostic information, we would favour this therapy; however, the number of embryos transferred should be reduced to two to reduce the risk of twin pregnancy. [ABSTRACT FROM PUBLISHER]

To determine whether preliminary assessment of ovarian reserve by simultaneous evaluation of basal follicle-stimulating hormone (FSH) and oestradiol response to gonadotrophin releasing hormone (GnRH) analogue (F-G-test) can be used to tailor individually the drug regimen for ovarian stimulation, the in-vitro fertilization (IVF) results of 238 patients were retrospectively analysed. Sixty-two women with abnormal response to the test (ΔE2 <180 pmol/l and/or FSH >9.5 mIU/ml) had commenced buserelin nasal spray in the mid-luteal phase and discontinued it on cycle day 1. Ovarian stimulation was started on cycle day 3 with 375 IU/day of gonadotrophin. Fifty-three patients completed the treatment cycle (group A). A total of 176 women with normal response to the test (ΔE2 >180 pmol/l and FSH <9.5 mIU/ml) had continued the GnRH analogue throughout the stimulation cycle and a starting dose of 225 IU/day of gonadotrophin was used from cycle day 3. A total of 158 patients completed the treatment cycle (group B). Group A had significantly higher age (34.9 ± 4.2 versus 33.2 ± 4.2) (P < 0.05) and basal FSH (9.2 ± 3.8 versus 7.0 ± 2.2) (P < 0.05) and required a higher total dose of gonadotrophin. The numbers of oocytes retrieved and embryos transferred were significantly lower. However, fertilization, clinical pregnancies, and implantation rates were similar in both groups. It was concluded that simultaneous evaluation of basal FSH and oestradiol response to GnRH analogue can be useful in identifying subcategories of women with reduced ovarian reserve who may benefit from reduced GnRH analogue administration and a higher starting dose of gonadotrophin. [ABSTRACT FROM PUBLISHER]

The association between X chromosome deletions and premature ovarian failure is well established. Previous anecdotal reports however, have not documented the prevalence of X deletions in women with premature ovarian failure. We therefore performed cytogenetic analyses on 79 women with primary or secondary amenorrhoea to assess the utility of screening for a genetic marker for familial premature ovarian failure. A normal karyotype was found in 77 women. One woman with primary amenorrhoea had an XY karyotype and a woman with secondary amenorrhoea had a deletion at Xq 26.1. This second case had a family history of premature ovarian failure, and her mother who underwent premature ovarian failure at 28 years shared this deletion. The early diagnosis of familial X deletions causing premature ovarian failure allowed for the prediction of impending menopause and the implementation of manoeuvres to advance conception. Although cytogenetic aberrations are rare in secondary amenorrhoea, the ability to predict premature ovarian failure can be vital. [ABSTRACT FROM AUTHOR]

We report a case of a 42 year old female patient with hypergonadotrophic hypogonadism requiring oocyte donation. Spontaneous ovulation occurred during a hormonal replacement treatment cycle and three embryos were transferred 7 days after documented ovulation. This resulted in a viable twin pregnancy. The twins were genetically distinct from the mother. To the best of our knowledge this is the first reported case of a successful transfer of embryos on day 7 of the luteal phase leading to a viable pregnancy in an oocyte donation programme. [ABSTRACT FROM AUTHOR]

Cryopreserved spermatozoa from men having treatment for lymphoma or testicular tumour have been reported to function sub-optimally. We report on three successful pregnancies following gamete intra-Fallopian transfer (GIFT) using such cryopreserved sperm samples. In one case, ovum donation was required since the woman had premature ovarian failure. [ABSTRACT FROM AUTHOR]

: BACKGROUND Preimplantation genetic screening (PGS) is used to determine the chromosome status of human embryos from patients with advanced maternal age (AMA), recurrent miscarriage (RM) or repeated implantation failure (RIF). : METHODS Embryos from 47 such couples were investigated for chromosomes 13, 15, 16, 18, 21 and 22 using fluorescence in situ hybridization with two rounds of hybridization. The investigation included parental lymphocyte work-up, the screening of blastomeres on day 3 and full follow-up on day 5/6 of untransferred embryos. : RESULTS The outcome of 60 PGS cycles is described, in which 523 embryos were biopsied; 91% gave results, of which 18% were diploid for all the chromosomes tested and 82% were abnormal. The pregnancy rate per cycle that reached the biopsy stage was 27%, and 30% per embryo transfer. Satisfactory follow-up was obtained from 353 embryos; all those diagnosed as abnormal were confirmed as such, although two false-positives were detected in relation to specific chromosome abnormalities. Meiotic errors were identified in 16% of embryos. Between the RM, AMA and RIF groups, there was a significant difference in the distribution of embryos that were uniformly abnormal and of those with meiotic errors; with an almost 3-fold increase in meiotic errors in the first two groups compared with the RIF group. : CONCLUSIONS This complete investigation has identified significant differences between referral groups concerning the origin of aneuploidy in their embryos. [ABSTRACT FROM AUTHOR]