Tehran University Medical Journal

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Background: With introduction of intracytoplasmic sperm injection with testicular sperm extraction or precutaneouse epididymal sperm aspiration, effective treatment was provided for azoospermic men. The aim of present study was to compare clinical outcome following intracytoplasmic sperm injection using extracted testicular/epididymal sperm or ejaculated severe oligoasthenoteratozoospermic sperm. Methods: After retrospective evaluation of more than four hundred medical records of patients undergoing intracytoplasmic sperm injection Mehr medical institute (between 2011-2012), 45 cycles with severe eligoasthenoteratozoospermia and 34 cycles with azoospermia were included. Patients were treated with gonadotropin releasing hormone agonist. The clinical characteristics and intracytoplasmic sperm injection outcome such as the rate of fertilization, implantation and clinical pregnancy were compared between the two groups. Results were presented as mean±standard deviation and number (percent). Differences between variables were analyzed using student's t test and the chi-square test was used to examine differences between categorical variables. P value less than 0.05 were considered as statistically significant. Results: Mean of female age (29±4.9 vs. 30.2±5.8), body mass index (26.9±5.3 vs. 26.9±3.8), estradiol level on human chorionic gonadotropin administration day (1375.6±843.9 vs. 1181.8±673.1), total number of retrieved oocytes (9.7±5.3 vs. 9.2±5.9) and metaphase II oocytes (7.7±5.1 vs. 7.5±5.4) were similar between the two groups. Of 436 and 313 retrieved oocytes, respectively 232 and 163 oocytes were ferti-lized in oligoasthenoteratozoospermic and azoospermic groups (53.2% vs. 52.1%, P=0.214). There were not statistical differences between groups in number of trans-ferred top quality embryos (1.5±1.2 vs. 1±1.2, P=0.09), implantation rate (22.7% vs. 16.9%, P=0.238) and clinical pregnancy rate (21 (47.7%) vs. 11 (35.4%), P=0.199). Conclusion: Intracytoplasmic sperm injection with precutaneouse epididymal sperm aspiration and testicular sperm extraction are effective methods to treat azoospermic men and its clinical outcome were comparable to ejaculated sever oligoasthenoterato-zoospermic cycles. It can be concluded that the influence of sperm quality and origin on intracytoplasmic sperm injection outcome are the same.

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Background: Last decades, we have observed major improvements in treating infertility by using microinjection. However, reduction in abortion or increase in fertility has not been significant. It seems use of corticosteroids improves clinical outcomes during assisted reproductive technology (ART) techniques. Therefore, this study tried to show how corticosteroids therapy improves the results of intracytoplasmic sperm injection (ICSI). Methods: This semi clinical trial study without control group was included infertile women with more than one year’s infertility and were candidate to ICSI which were referred to Kosar Infertility Center, Urmia University of Medical Sciences from April 2011 to September 2013. Patients received prednisolone which was started 20 mg/day from one day before embryo transfer to 7 days, then for 2 days more 1 tablet and stopped. Pregnancy outcomes were chemical and clinical pregnancy, ectopic pregnancy, multiple pregnancy and rate of abortion before 20 weeks. Beta human chorionic gonadotropin (HCG) test was performed. Patients with positive pregnancy test were followed by sonography in 6, 12 weeks and 20 weeks of pregnancy. Results: One hundred and eighty one patients entered to the study. The mean± SD of age and fertility duration were 30.42± 6.07 and 7.69± 5.54 years. The mean± SD of transferred embryo was 4.60± 1.10 and embryo grading was 138 (44.7%) grade A, 124 (40.1%) grade B, 47 (15.2%) grade C, respectively. There were no significant difference between fresh/frozen embryo transfer in pregnancy outcomes (P> 0.05 in all of outcomes comparison). The incidence rate of biochemical pregnancy was 48.1% (87), clinical pregnancy rate with appearance of fetal heart was 44.2% (80), incidence rate of abortion before appearance of fetal heart (6 weeks) in women with intra-uterine pregnancy was 5.9% (5), incidence rate of abortion before 20 weeks was 12.9% (11). Incidence rate of ectopic pregnancy was 2.3% (2) and rate of multiple pregnancies was 32.5% (26). Conclusion: Our study suggests that the infertile patients who receive prednisolone in ICSI cycle, had improved pregnancy outcomes. Additional confirmatory studies are needed.

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Background: Receptivity of endometrium has a critical role in the establishment of pregnancy after embryo transfer in the treatment process of infertile couples. As the glycoprotein CA-125 is a product of human endometrium and is measurable in the peripheral circulation, it is investigated whether it might serve as an indicator of endometrial receptivity and predictor of pregnancy following Intracytoplasmic sperm injection (ICSI).

Methods: In an observational diagnostic study, over a twelve-month period (from August 2013 to July 2014), all couples with male-factor infertility who attended to infertility clinic of Moheb Yas Hospital, Tehran and were candidate of performing ICSI, were invited to participate in the study. Based on the inclusion criteria of study, 64 women were eligible to take part in the study. They were assessed for serum CA-125 levels on the day of human chorionic gonadotropin (HCG) administration and also on the day of oocyte retrieval. After ICSI, the possibility of pregnancy was assessed by measuring serum concentration of &beta-HCG on 14 days after embryo transfer and also by visualizing the gestational sac by trans-vaginal ultrasound examination on four to five weeks after transfer. The pregnancy rate was compared between those with normal and high CA-125 levels.

Results: Among the subjects, 15 patients (23.4%) had high CA-125 levels, and totally 19 patients (29.7%) experienced pregnancy. Among those with normal and high CA-125 levels, 16 patients (32.7%) and 3 subjects (20%) experienced pregnancy, respectively, that showed no statistically significant difference according to Chi-square test (P=0.348). Also, according to the Fisher’s exact test, there was no correlation between CA-125 levels and the rate of pregnancy on the basis of body mass index (BMI).

Conclusion: Totally, according to the obtained results in current study, it may be concluded that serum CA-125 levels has no prognostic value in prediction of the outcomes of ICSI among infertile couples with male-factor infertility.