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Abstract Background In freeze–thawed embryo transfer (FET) cycles, hormone replacement treatment (HRT) is crucial for implantation and pregnancy maintenance. HRT typically continues until the 10th week of pregnancy owing to a luteoplacental shift, although a definitive HRT regimen remains undetermined. We present the case of a woman who underwent FET during an HRT cycle and ceased HRT after a negative pregnancy test at 3 weeks and 5 days, who went on to deliver a healthy baby. Case presentation A 30-year-old Japanese woman with primary infertility was scheduled for FET. Estrogen supplementation was initiated as part of the HRT cycle for endometrial preparation. After achieving an endometrial thickness of 8 mm, progesterone supplementation was commenced, and the transfer of a 4BB blastocyst occurred 5 days after initiating progesterone treatment. At a gestational age of 3 weeks and 5 days, her serum human chorionic gonadotropin (hCG) level was only 8.3 mIU/mL, leading to discontinuation of HRT due to the absence of pregnancy. However, at 6 weeks and 1 day, her serum hCG levels significantly rose to 9359 mIU/mL, prompting the resumption of HRT. Ultrasonography confirmed the presence of a gestational sac and cardiac activity in the uterus, and HRT was continued until the 10th week. Ultimately, she delivered a healthy female neonate vaginally, weighing 2601 g at 40 weeks and 6 days. Conclusions Progesterone supplementation is customary in FET with HRT cycles, although it has raised the possibility that there is demonstrating the potential for an ongoing pregnancy and resulting in a healthy baby under no progesterone replacement prior to the luteoplacental shift in this case. The duration and dosage of progesterone in luteal support for FET with HRT warrant further investigation.

Background and Aims: Little information is available for investigating the effect of the direction of sperm injected into the cytoplasm on clinical results for human oocytes following intracytoplasmic sperm injection (ICSI). This study aimed to examine the impact of the direction of sperm (head-first or tail-first) injected into the cytoplasm on fertilization and embryo development for high-elasticity or low-elasticity human oocytes following the Piezo-ICSI. Methods: We retrospectively investigated 2717 high-elasticity oocytes and 907 low-elasticity oocytes between May 2016 and December 2022. Of 2717 high-elasticity oocytes, 1148 were injected sperm head-first, and 1569 were injected sperm tail-first into the cytoplasm by Piezo-ICSI. Of 907 low-elasticity oocytes, 480 were injected head-first, and 427 were injected sperm tail-first into the cytoplasm. The membrane of high-elasticity oocytes was robust and was ruptured artificially by the piezo-pulse. The membrane of low-elasticity oocytes was weak and spontaneously ruptured without the piezo-pulse. The rates of degeneration, fertilization (2PN), 0PN, 1PN, [Formula: see text]3PN, abnormal cleavage, and good-quality day-3 embryos were evaluated in both groups. Results: Table 1 shows the effect of sperm direction on fertilization and embryo development for high-elasticity oocytes. The fertilization rate of tail-first group was significantly higher than the head-first group. The 0PN rate of tail-first group was significantly lower than the head-first group. The good quality Day-3 embryo rate of tail-first group was significantly higher than the head-first group. Table 2 shows the effect of sperm direction on fertilization and embryo development for low-elasticity oocytes. The fertilization rate of the tail-first group was significantly higher than the head-first group. However, no significant difference was observed in other comparable items. Conclusions: Tail-first sperm injection significantly improved the fertilization rates more than the head-first sperm injection regardless of the elasticity of the oocyte membrane following Piezo-ICSI.

Background: The objective of this study was to investigate accurately the effect of the meiotic spindle imaging of human oocytes on their fertilization and embryo development by using the Piezo-ICSI. Methods: We retrospectively assessed 529 oocytes with the first polar body retrieved from 124 infertile couples (147 cycles) who attended our clinic between May 2016 and December 2018. Of these, 489 oocytes (92.4%) with visible meiotic spindle comprised the Spindle (+) group and 40 oocytes (7.6%) not observed meiotic spindle comprised the Spindle (−) group. The meiotic spindle was imaged using polarized light microscopy. The rates of fertilization, high-quality day-3 embryo, day-5 blastocyst, and high-quality day-5 blastocyst were evaluated in both groups. Results: The fertilization rates of Spindle (+) and Spindle (−) were 92.0% (450/489) and 70.0% (28/40), respectively; high-quality day-3 embryo rates were 62.9% (283/450) and 35.7% (10/28); day-5 blastocyst rates were 53.7% (205/382) and 32.1% (9/28); high-quality day-5 blastocyst rates were 29.8% (114/382) and 3.6% (1/28). Fertilization, high-quality day-3 embryo, day-5 blastocyst, and high-quality day-5 blastocyst rates were significantly higher in the Spindle (+) group than in the Spindle (−) group. Conclusion: Spindle imaging (i.e., oocytes with a visible meiotic spindle or with not observed meiotic spindle) influences the outcome of Piezo-ICSI in human oocytes, including fertilization and embryo development. To our knowledge, this study is the first to evaluate the effect of meiotic spindle imaging on fertilization or embryo development among oocytes after Piezo-ICSI. The meiotic spindle imaging could be the indicator for the quality management of medical doctors and embryologists.

Purpose: Male infertility is partially caused by an inappropriate lifestyle and comorbidities. In this study, we analyzed the prevalence of these factors and the effects of lifestyle modifications as part of male preconception care. Methods: Four hundred and two male partners of couples seeking conception with abnormal parameters upon the first semen analysis were enrolled. They were advised to modify their inappropriate lifestyle as male preconception care. Afterward, their general and male reproductive health was examined. Semen quality was compared before and after the promotion. Results: Smoking, chronic alcohol use, and genital heat stress were found in 22.6%, 47.0%, and 75.1% of patients, respectively. Palpable varicoceles, hypogonadism, obesity (body mass index ≧30 kg/m2), hypertension, zinc deficiency, hyperlipidemia, liver dysfunction, and diabetes mellitus were found in 25.9%, 17.0%, 7.0%, 14.9%, 16.2%, 37.0%, 26.9% and 3.4% of the participants, respectively; 98.8% of the patients had at least one factor. After the promotion, semen parameters and sperm DNA fragmentation were improved significantly. Improvement was found in those with palpable varicocele or hypogonadism but not in those with night work shift, abstinence (>3 days), erectile dysfunction, hypertension, obesity, zinc deficiency, or diabetes mellitus. Conclusions: Comorbidities and inappropriate lifestyle choices were common among men with infertility. The promotion of lifestyle modifications as part of male preconception care could improve semen quality without urologic intervention.