scholarly journals Effect of Sperm Dna Fragmentation Index on Clinical Outcomes of Intra-Uterine Insemination Patients

2021 ◽  
Vol 14 (3) ◽  
pp. 1297-1304
Author(s):  
Shruti Chopra ◽  
Ajit Varma ◽  
Seema Jain ◽  
Sangeeta Jain ◽  
Devendra Choudhary
Keyword(s):  
Pregnancy Rate ◽  
Dna Fragmentation ◽  
Pregnancy Outcomes ◽  
Unexplained Infertility ◽  
Clinical Pregnancy ◽  
Clinical Pregnancy Rate ◽  
Female Group ◽  
Fragmentation Index ◽  
Intra Uterine Insemination ◽  
Dna Fragmentation Index

Objective: To study the effect of sperm chromatin condensation (DNA fragmentation index (DFI)) using aniline blue-eosin (AB-E) staining on pregnancy outcomes in patients facing unexplained infertility undergoing intra- uterine insemination (IUI). Our initial hypothesis states that if DNA fragmentation is high then chances of pregnancy are low/NIL hence these patients should be recommended with advanced ART procedures like IVF and ICSI. Design: Prospective study Setting: Tertiary care infertility centre Method: A total of 185 patients with age less than 40 years, non-smokers and without history of any pathogenic infection in the past 2months facing unexplained infertility i.e., males with normal semen analysis reports and females with normal ovulation and hysterosalpingography (HSG) reports were selected for the study. Patients were undergoing their first or second IUI treatment cycle between the period of June 2016 to December 2016. DNA fragmentation index (DFI) using aniline blue- eosin staining method was studied in semen samples provided on the day of IUI procedure. The patients were separated into 3 groups: low DFI (DFI<= 10%), medium DFI (DFI=11 % - 20%), and high DFI (DFI >= 21%) and clinical pregnancy outcomes of IUI were recorded. Statistical analysis was performed using Pearson correlation co-efficient, ANOVA and Shapiro Wilk Test on the above groups. Main Outcome Measures: DNA fragmentation index (DFI) (%), Clinical pregnancy rate (%) Result: The overall clinical pregnancy rate for the selected patient pool was 21.08% with an average DFI of 8.84% in the pregnant female group and 14.65% in the non-pregnant female group. Sperm DFI % and clinical outcomes in IUI treated patients were statistically significant and negatively correlated with correlation coefficient (r) of -0.1, -0.3 and -0.3 in low DFI%, medium DFI and high DFI% groups respectively. Conclusion: Our study demonstrated that DFI (%) and clinical pregnancy rate (%) are significantly and negatively correlated in patients with normal semen parameters undergoing IUI. The higher the DFI% the chances of clinical pregnancy become very low, therefore, these patients should not be recommended IUI but with advanced ART procedures like IVF and ICSI.

P–084 Microfluidic Sperm Sorting (MFSS) technique versus Physiological Intracytoplasmic Sperm Injection (PICSI) technique in high DNA fragmentation index sperm samples

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
G Kant ◽  
K D Nayar ◽  
H Sharma ◽  
S Gupta ◽  
S Mishra ◽  
...  
Keyword(s):  
Pregnancy Rate ◽  
Dna Fragmentation ◽  
Embryo Development ◽  
Intracytoplasmic Sperm Injection ◽  
Development Rate ◽  
Clinical Pregnancy ◽  
Sperm Dna Fragmentation ◽  
Fragmentation Index ◽  
Sperm Dna ◽  
Dna Fragmentation Index

Abstract Study question To evaluate the effectiveness of using Microfluidic Sperm Sorting (MFSS) technique and Physiological Intracytoplasmic Sperm Injection (PICSI) technique in patient with high DNA fragmentation index (DFI) sperm samples. Summary answer Sperm selected by microfluidic sorting are associated with significant increase in day 3 grade A embryo development rate, clinical pregnancy rate over PICSI. What is known already DNA damage is unrecognisable in living sperm prior to insemination and an increased sperm DNA fragmentation index has been associated with lower fertilization rates, impaired embryo development and reduced pregnancy rates. Standard semen processing techniques are associated with centrifugation, which may induce reactive oxygen species and DNA damage. In strategies to minimize sperm DNA fragmentation, Physiological ICSI can relatively reduce sperm DNA fragmentation by 67.9% (Parmegiani et al., 2010) while new technique Microfluidic sperm sorter technique also demonstrate sperm selection with significantly reduced DNA damage. Study design, size, duration A prospective randomised study was conducted from 1st August 2019 to 31st December 2020. Two hundred patients were randomised by computer generated list and divided into 2 groups. Group A (n = 100) , in which sperm were processed by microfluidic sperm sorter (MFSS) while in group B (n = 100), sperm were selected by Physiological Intracytoplasmic Sperm Injection (PICSI) technique and morphologically normal motile sperm were injected by Intracytoplasmic sperm injection (ICSI) technique in all mature oocytes. Participants/materials, setting, methods The study period included all normozoospermic patients with high DNA fragmentation index (&gt;25% ) while oligospermic, asthenozoospermic samples, patients with poor ovarian reserve and advanced age were excluded from the study. All A grade embryos were vitrified and transferred in frozen embryo replacement cycle. Both groups were compared on the basis of fertilisation rate, day 3 grade A embryo development rate , clinical pregnancy rate and miscarriage rate. Main results and the role of chance Cycle characteristics (female age, length of stimulation, gonadotrophin dose, number of oocytes and number of transferred embryos) were similar in both groups. Between the 2 groups, There was a significant increase observed in day 3 grade A embryo development rate (60% vs. 42%, p–0.016) and clinical pregnancy rate (62% vs. 46%, p–0.049), while no statistical significant difference observed in fertilisation rate (82% vs. 78%, p–0.80) and miscarriage rate ( 12% vs. 11%, p- 1). Limitations, reasons for caution: Larger randomised control studies are needed to strengthen these results. Wider implications of the findings: We have demonstrated that sperm sorted by microfluidic helps in selection of sperm with better DNA integrity over Physiological ICSI. Using it in routine practice can help in reducing the negative effect of reactive oxygen species and thus improve pregnancy rate and live birth rate. Trial registration number MCDH/2019/31

scholarly journals Two different timing of intra uterine insemination in patients of unexplained infertility: a randomized clinical trial

2017 ◽  
Vol 6 (3) ◽  
pp. 1071
Author(s):  
Mervat A. Elsersy
Keyword(s):  
Pregnancy Rate ◽  
Ovulation Induction ◽  
Unexplained Infertility ◽  
Clinical Pregnancy ◽  
Clinical Pregnancy Rate ◽  
Prospective Comparative Study ◽  
Group 2 ◽  
Β Hcg ◽  
Intra Uterine Insemination ◽  
Group 1

Background: Unexplained infertility is diagnosed when the basic infertility workup is found to be normal. The objective was to compare between the results of IUI performance at 24 hours or 36 hours after hCG injection in couples with unexplained infertility.Methods: A prospective comparative study was conducted on 250 patients diagnosed with unexplained infertility who were randomly allocated in two equal groups. Each patient received ovulation induction. Follicular growth scanning was performed, patients received 10.000 hCG injection when there was mature follicle equaled to or more than 18mm. Then they randomly allocated to either group 1 who underwent IUI 24 hours after hCG injection or group 2 who underwent IUI 36 hours after hCG injection.Results: The positive qualitative serum β -hCG test was higher in group 1 who received IUI  24 hours after hGC injection, 24%, while in group 2 who received IUI  36 hours after hGC injection, it was 16.8% but no statistical differences between the two studied groups  could be observed. The most important finding in this study is that the clinical pregnancy rate in group 1 was significantly higher than in group 2.Conclusions: Earlier IUI procedures increased the clinical pregnancy rate in patients with unexplained infertility during ovulation induction with gonadotropins. Correct timing of insemination is essential.

P–371 Clinical value assessment between endometrial receptivity array and immune profiling in patients with implantation failure

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Y Dong ◽  
Y Jia ◽  
Y Sha ◽  
L Diao ◽  
S Cai ◽  
...  
Keyword(s):  
Pregnancy Rate ◽  
Pregnancy Outcomes ◽  
Statistical Difference ◽  
Endometrial Receptivity ◽  
Clinical Pregnancy ◽  
Clinical Pregnancy Rate ◽  
Implantation Failure ◽  
Clinical Value ◽  
Evaluation Approaches ◽  
Immune Profiling

Abstract Study question To evaluate whether the pregnancy outcomes could be improved in implantation failure patients by endometrial receptivity array, endometrial immune profiling, or a combination of both. Summary answer There was no statistical difference between different endometrial receptivity evaluation and treatment in improving the clinical pregnancy rate. What is known already Both endometrial receptivity array and endometrial immune profiling were promised to improve the endometrial receptivity and subsequent clinical pregnancy. However, less is known about the efficiency between each other and whether the combination could further enhance their clinical value. Study design, size, duration Between November 2019 and September 2020, 143 women with a history of at least two or more consecutive implantation failure in IVF/ICSI treatment in Chengdu Xinan Gynecology Hospital were included. They were divided into three groups: ‘ERA + Immune Profiling’ (n = 70), ‘Immune Profiling’ (n = 41), and ‘ERA’ (n = 32). Participants/materials, setting, methods Inclusion criteria were age ≤ 38, with normal uterus and uterine cavity. All patients were suggested to evaluate endometrial receptivity by ERA test (Igenomix, Valencia, Spain) and endometrial immune profiling based on immunohistochemistry simultaneously, who would be free to choose each or both evaluation approaches. Personal Embryo Transfer and/or personal medical care were adopted according to evaluation results. Clinical pregnancy was confirmed by gestational sacs observed under ultrasonography. Main results and the role of chance The overall prevalence of displaced window of implantation (WOI) is 84.3%, and nearly 74.8% (83/111) patients were diagnosed as endometrial immune dysregulation. Clinical Pregnancy rate and embryonic implantation rate decreased in the ‘Immune Test’ groups, but without a statistical difference (P = 0.311, and 0.158, respectively). Multivariable logistic regression analysis showed that different endometrial receptivity evaluation and treatment was not associated the clinical pregnancy rate, suggesting the performance of different endometrial receptivity evaluation and treatment is similar in improving the clinical pregnancy rate. Neither the immune profiling (CD56, P = 0.591; FOXP3, P = 0.195; CD68, P = 0.820; CD163, P = 0.926; CD1a, P = 0.561; CD57, P = 0.221; CD8, P = 0.427; CD138 CE, P = 0.372) nor histologic endometrial dating defined by Noyes criteria (P = 0.374) were associated with ERA phases. Limitations, reasons for caution Although the selection of evaluation approaches was based on patients’ willingness, the variances of baseline characteristics and immune profiling existed in different groups. The immunological treatment efficacy based on immune profiling was not evaluated before embryo transfer. Wider implications of the findings: To our knowledge, this is the first study comparing the pregnancy outcomes after two typical endometrial receptivity evaluation approaches. The findings highlight the unsubstitutability for each assessment, indicating that both asynchronous and pathological WOI contribute to implantation failure. Trial registration number X2019004

scholarly journals Frozen Embryo Transfer in Mildly Stimulated Cycle With Letrozole Compared to Natural Cycle in Ovulatory Women: A Large Retrospective Study

2021 ◽  
Vol 12 ◽  
Author(s):  
Danjun Li ◽  
Shuzin Khor ◽  
Jialyu Huang ◽  
Qiuju Chen ◽  
Qifeng Lyu ◽  
...  
Keyword(s):  
Pregnancy Rate ◽  
Pregnancy Outcomes ◽  
Endometrial Thickness ◽  
Clinical Pregnancy ◽  
Frozen Embryo Transfer ◽  
Clinical Pregnancy Rate ◽  
Natural Cycle ◽  
Mild Stimulation ◽  
Early Miscarriage ◽  
Hcg Test

ObjectiveTo evaluate the clinical effect of mild stimulation with letrozole on pregnancy outcomes in ovulatory women undergoing frozen embryo transfer (FET) compared to natural cycle.DesignRetrospective observational study.SettingTertiary care academic medical center.PopulationA total of 6,874 infertile women with regular menstrual cycles (21-35 days) met the criteria for this study in the period from 2013 to 2020.MethodsAll patients who were prepared for and underwent FET were divided into two groups: a modified natural cycle (NC) group (n=3,958) and a letrozole cycle group (n=2,916).Main Outcome MeasuresThe primary outcome of the study was clinical pregnancy rate. Secondary outcome measures were endometrial thickness, rates of implantation, positive HCG test, live birth, early miscarriage and ectopic pregnancy.ResultsThe clinical pregnancy rate was not statistically different between the modified NC-FET group and the letrozole-FFT group before (crude OR 0.99, 95% CI 0.90-1.09, P=0.902&gt;0.05) and after propensity score matching (PSM) (crude OR 1.01, 95% CI 0.91-1.12, P=0.870&gt;0.05). After multivariable logistic regression analysis, the clinical pregnancy rate remained insignificant before (adjusted OR 1.00, 95% CI 0.91-1.10, P=0.979&gt;0.05) and after matching (adjusted OR 1.00, 95% CI 0.89-1.11, P=0.936&gt;0.05), respectively. Similarly, in the crude and adjusted analysis, the positive HCG test, implantation, live birth and early miscarriage rates were also comparable in the letrozole-FFT group and modified NC-FET group before and after matching. Furthermore, the endometrial thickness of letrozole-FFT group was similar to that of modified NC-FET group with adjusted analysis.ConclusionOur observation suggests that mild stimulation with letrozole could produce similar pregnancy outcomes in ovulatory patients who undergo FET when compared with a natural cycle.

scholarly journals Associations of Sperm mtDNA copy number, DNA fragmentation index, and reactive oxygen species with clinical outcomes in ART treatments

2021 ◽  
Author(s):  
Wei-Hui Shi ◽  
Mu-Jin Ye ◽  
Zhi-Yang Zhou ◽  
Ning-Xin Qin ◽  
Xuan-You Zhou ◽  
...  
Keyword(s):  
Reactive Oxygen Species ◽  
Clinical Outcomes ◽  
Dna Fragmentation ◽  
Pregnancy Outcomes ◽  
Copy Number ◽  
Reactive Oxygen ◽  
Sperm Parameters ◽  
Oxygen Species ◽  
Fragmentation Index ◽  
Dna Fragmentation Index

Abstract Background Except for sperm parameters (sperm concentration, motility, and morphology), sperm mitochondria DNA copy number (mtDNA-CN), DNA fragmentation index (DFI), and reactive oxygen species (ROS) content are essential characteristics for sperm function. However, the roles of these measurements in embryo development and pregnancy outcomes are still unclear. Methods Semen samples of 402 participants were collected. Sperm parameters, including sperm morphology, concentration, and motility, were analyzed by a computer-assisted sperm analysis system. MtDNA-CN, DFI, and ROS levels were measured using remained sperms through quantitative polymerase chain reaction method, sperm chromatin structure assay and Reactive Oxygen Species Assay Kit, respectively. The assisted reproductive technology (ART) treatments, including in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI), were performed in 126 couples of these participants. Results In 402 semen samples, elevated mtDNA-CN and DFI were associated with poor seminal quality. In 126 couples conducted ART, only mtDNA-CN was negatively correlated with fertilization rate in ART cases. However, it was not significant after adjusting male age, female age, seminal quality, and ART strategy. With regard to pregnancy outcomes, none of sperm mtDNA-CN, ROS and DFI was associated with clinical pregnancy rate in 79 cases transferred embryos. Conclusions Increased mtDNA-CN and DFI in sperms jointly contributed to poor seminal quality. However, none of sperm mtDNA-CN, ROS/MS and DFI were associated with clinical outcomes in ART.

Effect of granulocyte colony stimulating factor on pregnancy rate in women with unexplained infertility after intrauterine insemination: a randomized clinical trial

2020 ◽  
Author(s):  
Shahintaj Aramesh ◽  
Maryam Azizi Kutenaee ◽  
Fataneh Najafi ◽  
Parvin Ghafari ◽  
seyed abdolvahab taghavi
Keyword(s):  
Pregnancy Rate ◽  
Endometrial Thickness ◽  
Intrauterine Insemination ◽  
Intervention Group ◽  
Unexplained Infertility ◽  
Clinical Pregnancy ◽  
Clinical Pregnancy Rate ◽  
Biochemical Pregnancy ◽  
Significant Difference

Abstract Background The cause of infertility has not been found in unexplained infertile patients,, and perhaps one of the possible reasons is impairment of fetal implantation, as well as the multiple role of GCSF in improving implantation and quality of blastocyst. Therefore, the aim of this study was to investigate the role of GCSF in the pregnancy rate of patients undergoing IUI.Methods The patients with unexplained infertility were divided into two groups: one group was received GCSF in their IUI cycle and the other group had the routine IUI. Both groups were stimulated by letrozole, metformin, and monotropin during the cycle. When at least one follicle was greater than 18 mm, 5000 IU hCG intramuscularly was administered for ovulation induction and IUI was performed 34–36 hours later. In intervention group, 300 ug GCSF subcutaneously administrated in two days after IUI. Biochemical pregnancy rate was evaluated two weeks after IUI and clinical pregnancy rate was identified by the presence of a gestational sac on ultrasonography 8 weeks after IUI.Results There was no significant difference in demographic and clinical characteristics between the two groups. The chemical pregnancy rate(16.3% vs 12.2%) and the clinical pregnancy rates (16.3% vs 8.3%) were improved in patients receiving GCSF compared to controls, but these differences was not significant (P = 0.56) and (P = 0.21).Conclusion Systemic administration of a single dose of 300 µg GCSF subcutaneously two days after IUI may slightly improve clinical pregnancy rate in patients with unexplained infertility. Nevertheless, our findings do not support routine use of G-CSF in unexplained infertility women with normal endometrial thickness.

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