OBJECTIVE:Incubation of ejaculated spermatozoa at 37 degrees C is recommended for IVF-intracytoplasmic sperm injection. Preselection of sperm cells with morphologically normal nuclei before microinjection, adapted in our laboratory, is usually a time-consuming procedure. Therefore, we aimed to verify whether incubation at 37 degrees C could affect the morphologic integrity of sperm nuclei. DESIGN:Time-kinetics studies testing fine morphology of the sperm nuclei upon prolonged in vitro incubation. SETTING:Male Fertility Laboratory at Bar-Ilan University, Ramat Gan, Israel. PATIENT(S):Forty-two males selected at random, who were referred for sperm preselection before ICSI. MAIN OUTCOME MEASURE(S):Morphologic integrity of the sperm nuclei, obtained by motile sperm organelle morphology examination. RESULT(S):After 2 hours of incubation at 37 degrees C a significant decrease occurred in the morphologic integrity of the sperm nuclei, compared with the initial state (4.7% +/- 2.8% vs. 6.8% +/- 3.5%, t = 3.2, Por=2 hours) sperm manipulations for assisted reproduction therapy should be performed at 21 degrees C rather than 37 degrees C.

BACKGROUND:To verify whether or not microinjection of sperm with a normal nuclear shape but large vacuoles affects IVF-ICSI pregnancy outcome.METHODS:A comparative study testing IVF outcome parameters of IVF-ICSI, based on morphological selection of spermatozoa with normal nuclei against those based on microinjection of sperm with a normal nuclear shape but large vacuoles. An experimental group, including 28 IVF-ICSI cycles, where only embryos obtained from microinjection of spermatozoa with a normal nuclear shape but large vacuoles were transferred, was matched with a control group, including 28 IVF-ICSI cycles, where only embryos obtained from microinjection of spermatozoa with a strictly defined morphologically normal nuclear shape and content were transferred. The main outcome was IVF-ICSI pregnancy rate.RESULTS:The experimental group exhibited a significantly lower pregnancy rate per cycle and significantly higher abortion rate per pregnancy compared to the control group (18 versus 50%, and 80 versus 7%, respectively, P=0.01).CONCLUSION:Microinjection of vacuolated sperm appears to reduce the pregnancy rate and appears to be associated with early abortion.

In previous studies, a new IVF method of intracytoplasmic morphologically selected sperm injection (IMSI) was introduced, based on motile sperm organellar morphology examination (MSOME). It was concluded that microinjection of morphologically selected sperm cells with strictly normal nucleus, defined by MSOME, improves IVF-ICSI outcome. The aim of the present study was to confirm this conclusion in new, enlarged study groups. Comparison between 80 couples, who underwent an IVF-IMSI trial, with matched couples, who underwent a standard IVF-ICSI procedure, confirmed that pregnancy rate following IVF-IMSI was significantly higher, and abortion rate significantly lower than in the routine IVF-ICSI (60.0 versus 25.0%, and 14 versus 40% respectively, P :5 0.05). Another comparison was performed between matched IMSI groups, where embryos were obtained from microinjection by spermatozoa with a morphologically normal nucleus ('best' group, n = 70) and a 'second best' group was selected, where embryos were obtained from microinjection of spermatozoa with minimal morphological impairment, since no other sperm cells were available. It was confirmed that microinjection by 'second best 'spermatozoa result in significantly lower pregnancy and delivery rates and significantly higher abortion rates than microinjection with 'best' spermatozoa (25.7 versus 58.2%, P <= 0.01; 17.1 versus 52.8%, P <= 0.01, and 33.3 versus 9.7%, P <= 0.02 respectively). The present study has strengthened previous conclusions.

Objective: (1) To evaluate the results of post swim-up sperm quality and strict criteria morphology as compared to original semen. (2) To assess the influence of sperm morphology in the insemination sample on fertilization rate. Materials and methods: Thirty-three semen samples from partners of women undergoing IVF cycles were analyzed. Treatment using ICSI was excluded. Each original semen sample and post swim-up spermatozoal population vas evaluated for percentage of motile spermatozoa, viability, and strict criteria morphology. The post swim-up results were compared with the original sperm parameters and correlated with fertilization rate, taking a cut-off point of 60%. Results: (1) Swim-up technique yields significantly higher percentage of motile, viable and morphologically normal spermatozoa than original semen. Among abnormal sperm population, percentage of spermatozoa with tail defects and cytoplasmic droplet were significantly higher in original semen as compared with post swim-up spermatozoa. (2) A tendency of higher percentage of morphologically normal spermatozoa in the insemination sample (obtained from swim-up phase) was found when fertilization rate was >60% versus fertilization rate <60%. Conclusions: (1) A high quality of spermatozoa is obtained from swim-up procedure. (2) Evaluation of spermatozoa pith normal morphology, using strict criteria, in swim-up phase, may predict the fertilization rate before IVF treatment, and may be used as a criterion for selection of patients to ICSI procedure. (C) 2004 Elsevier B.V. All rights reserved.

Objective: Pregnancies in patients with polycystic ovaries have been associated with an increase abortion rate. Although hypersecration of LH was proposed to be a cause of this pathology, the ethiology is still unclear. However, the overall frequency of chromosome anomalies among spontaneous abortions was found to be considerable high. We initiated a prospective study to obtain an insight in fertilization process in PCO as compared with non PCO patients that underwent in vitro fertilization treatment. Design: Prospective consecutive study. Materials/Methods: Sixty one PCO and 86 non PCO patients underwent 104 and 144 IVF cycles respectively, between 1.1.2000 to 31.12.2001. Same protocol of stimulation was applied to both groups. The length of ovarian stimulation, quantity of hMG used, peak E2 levels, mean number of follicles developed, oocytes retrieved, fertilization rate, percentage of triploid fertilization, cleavage rate and embryo quality were compared between the groups. Results: There were no significant differences between the groups in regard the length of stimulation, peak E2 levels, mean number of oocytes retrieved, fertilization and cleavage rate, embryo morphology and pregnancy rate. The mean dose of hMG administered in the PCO group was lower 37.1 plusminus 14.0 vs. 47.8 plusminus 19.9 ampoules, p <0.05). The incidence of polyploid fertilization was 139 out of 832 fertilized oocytes vs. 62 out of 708 in PCO and non PCO patients, accordingly (p <0.005). Conclusions: High incidence of polyploid fertilization occurred in PCO patients, possible either due to dispermic fertilization or failure of second polar body extrusion, as a consequence of more compromised oocytes retrieved. In IVF cycles, those polyploid embryos will be not transferred. However, in natural cycles, polyploid fertilization may occurred and the resulting embryos implant, possibly causing the increase in abortion rate found higher in PCO patients. Supported by: Hillel Yaffe medical center.