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Background: Repeated implantation failure (RIF) refers to the condition where high quality embryos are unable tosuccessfully implant after multiple cycles of in vitro fertilization (IVF) treatment. The aim of this study is to investigatethe impact of intrauterine granulocyte colony-stimulating factor (G-CSF) and platelet-rich plasma (PRP) onpregnancy rate in patients with RIF.Materials and Methods: The present randomised clinical trial study was conducted at the IVF Centre of MehrMedical Institute in Rasht, Iran, from 2020 to 2022. The research consisted of 200 individuals who had experiencedmultiple failed cycles. These patients were randomised into two groups: intrauterine infusion of 1 ml of G-CSF andintrauterine infusion of 1 ml autologous PRP at least 48 hours before embryo transfer (ET). The groups were comparedin terms of implantation rate, and chemical, clinical, and ongoing pregnancy.Results: The implantation rate was significantly higher in patients who received PRP (P=0.016). Chemical pregnancy inthe PRP group was significantly higher than G-CSF group (P=0.003). Both clinical pregnancy and ongoing pregnancyrates were significantly higher in the PRP group (P=0.001) compared to the G-CSF group (P=0.02).Conclusion: The utilisation of PRP via intrauterine infusion is considerably more successful than G-CSF in enhancingpregnancy and live birth rates among patients with RIF.

To explore whether intracytoplasmic sperm injection (ICSI) would increase the malformation risk in fetuses and live births compared with conventional in vitro fertilization (IVF). Retrospective cohort study. Data were collected from couples who underwent conventional IVF or ICSI from January 2009 to December 2019 at the Center for Reproductive Medicine of Peking University Third Hospital in the People's Republic of China. A total of 46,167 conventional IVF fresh transfer cycles and 33,247 ICSI fresh transfer cycles were included. Intracytoplasmic sperm injection and conventional IVF. The primary outcomes were congenital abnormalities in live births. The secondary outcomes included the pregnancy outcomes, the malformations among the miscarriages, specific types of malformations in live births, birth weight, and sex. The rates of congenital malformations in conventional IVF and ICSI were 5.44‰ and 5.78‰, respectively. There was no statistically significant difference between the two groups, as indicated by the adjusted odds ratio of 1.098 (95% confidence interval 0.787, 1.532). The rates of specific malformations were comparable between ICSI and IVF. Additionally, no discernible disparities were noted in pregnancy outcomes, the malformations among the miscarriages,birth weight between the two groups. Our study suggested the safety of ICSI and provided novel evidence by comparing pregnancy outcomes and congenital malformations in offspring between patients undergoing conventional IVF and ICSI. [ABSTRACT FROM AUTHOR]

Background: Hyaluronan (HA) sperm selection, utilizing the affinity of mature sperm for HA, has emerged as a technique to enhance the selection of sperm for intracytoplasmic sperm injection (ICSI). However, conflicting evidence exists regarding the impact of HA-ICSI on clinical outcomes including fertilization, embryo utilization, and pregnancy rates. The study aimed to compare clinical outcomes including fertilization, utilization, and pregnancy rates between paired ICSI and HA-ICSI cycles within patients, particularly for male factor and low utilization subgroups. Methods: A retrospective study from 3,988 ICSI treatment cycles was conducted between January 2018 and March 2022. A HA-ICSI cycle was paired with the preceding ICSI cycle from the same patient. Fertilization, utilization, and clinical pregnancy rates were compared based on infertility diagnosis and utilization rate (UR) from the initial ICSI cycle. Results: There were no differences in fertilization, utilization, embryo quality, euploidy, or pregnancy rates between ICSI and HA-ICSI in all paired cycles. However, for patients with male factor infertility UR increased from 25.0% to 38.5% in their HA-ICSI cycle ([Formula: see text]). There was no difference observed for female factor infertility patients. HA-ICSI use was of particular benefit for male factor infertility patients with low ([Formula: see text]) embryo utilization in their initial ICSI cycle, evident by an increased utilization from 14.3% to 25.0% in their HA cycle ([Formula: see text]). Conclusions: This is the first study to focus on the impact of HA-ICSI on embryo utilization, particularly in patients with male factor infertility. The efficacy of HA-ICSI as a sperm selection tool appears to be limited to improving UR in patients with male factor infertility, particularly those with low utilization in a previous ICSI cycle, with no significant effect on fertilization or pregnancy rates. Conclusion: HA-ICSI may be useful for sperm selection at the time of ICSI for a select subgroup of patients. Male factor infertility patients, who have previously undertaken an ICSI cycle with less than 40% utilization, should be considered as candidates for treatment.

Objective To explore the correlation between seminal plasma oxidative stress and reproductive hormone levels with teratospermia and ICSI outcome. Methods A total of 206 male infertility patients from the reproductive medicine center of our hospital from August 2021 to December 2022 were selected as the research objects. They were grouped according to the fifth edition of the World Health Organization’s Handbook on Human Semen Testing and Processing Laboratories, of which 120 patients with percentage of normal sperm morphology ＜ 4% were included in the teratospermia group. 86 cases with percentage of normal sperm morphology ≥4% were included in the normal group. The levels of seminal plasma oxidative stress (reactive oxygen species (ROS), superoxide dismutase (SOD)) and reproductive hormones (follicle-stimulating hormone (FSH), luteinizing hormone (LH), testosterone (T)) were detected in both groups. The influencing factors of teratospermia were analyzed. The ICSI rates of patients with different spermatozoa oxidative stress and reproductive hormone levels were compared in the teratospermia group. The correlation between the severity of teratozoospermia and seminal oxidative stress and reproductive hormone levels was analyzed. Results The proportions of advanced age, higher body mass index, smoking, drinking, varicocele and diabetes in the teratospermia group were higher than those in the control group, while sperm activity rate and forward movement sperm rate were lower than those in the control group (P＜0.05). Levels of ROS, FSH and LH in spermatozoa group were higher than those in the control group, while the levels of SOD and T in the spermatozoa group were lower than those in the control group (P＜0.05). Smoking, varicocele and ROS were independent risk factors for teratospermia, while SOD and T were independent protective factors for teratospermia (P＜ 0.05). In the teratospermia group, the fertilization rate was decreased with the increase of ROS level, and it was increased with the increase of seminal plasma SOD and T level (P＜0.05); Spearman’s correlation analysis showed a positive correlation between the severity of teratospermia and the level of seminal plasma ROS (r=0.832, P＜0.001). Furthermore, a negative correlation was observed between the severity of teratospermia and the level of SOD (r=-0.825, P＜0.001). However, there was little correlation between the severity of teratospermia and the level of T (r=0.206, P=0.024). Conclusion Oxidative stress and abnormal expression of reproductive hormones are closely related to the occurrence of teratospermia and affect the outcome of ICSI. [ABSTRACT FROM AUTHOR]

Objective: To explore the impact of poly-pronucleus (PN) incidence on the embryonic development and pregnancy outcome after intracytoplasmic sperm injection (ICSI). Methods: This is a retrospective cohort study, analyzing the clinical data of patients after ICSI between January 2016 and December 2021. The objects of study were divided into three groups according to the proportion of poly-PN: the control group (the proportion of poly-PN=0%, n=333), the low-frequency poly-PN group (0%＜the proportion of poly-PN＜20%, n=80) and the high -frequency poly -PN group (the proportion of poly -PN ≥20%, n =31). The embryonic development and pregnancy outcomes were compared among the groups, respectively. Results: The numbers of oocytes retrieved and available embryos on day 3 (D3) were higher in the low-frequency poly-PN group than those in the control group, but the rates of normal fertilization and high -scoring blastocyst formation were lower than those in the control group (all P＜0.017). Compared with the control group and the low-frequency poly-PN group, the high-frequency poly-PN group had lower rate of normal fertilization rate, lower number of available embryos on D3 (all P＜0.017), and low rate of biochemical pregnancy and high miscarriage rate (but P＞0.017). Multifactorial Logistic analysis showed that patients in the high-frequency poly-PN group had significantly lower biochemical pregnancy rate and live birth rate when compared with the control group (aOR=0.402, 95%CI: 0.186-0.870, aP=0.021; aOR=0.247, 95%CI: 0.068-0.901, aP=0.034). Conclusions: In the ICSI cycles, the incidence of poly-PN may reflect oocyte quality, and the incidence of poly -PN ≥20% may predict the poor embryo development, lower biochemical pregnancy rate and lower live birth rate. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to compare the efficacy of physiological intracytoplasmic sperm injection (PICSI) and intracytoplasmic sperm injection (ICSI) in terms of the fertilization rate and embryo quality using sibling oocyte cycles. Methods: This prospective, cross-sectional study collected data from 76 couples who underwent their first cycle at the Hue Center for Reproductive Endocrinology and Infertility, Vietnam, between May 2019 and November 2021. The inclusion criteria were cycles with at least eight oocytes and a sperm concentration of 5×106/mL. Sperm parameters, sperm DNA fragmentation (SDF), fertilization, and the quality of cleavage-stage embryos on day 2 and blastocysts on day 5 were examined. Results: From 76 ICSI cycles, 1,196 metaphase II (MII) oocytes were retrieved, half of which were randomly allocated to either the PICSI (n=592) or ICSI (n=604) treatment group. The results showed no significant difference between the two groups in terms of fertilization (72.80% vs. 75.33%, p=0.32), day 2 cleavage rate (95.13% vs. 96.04%, p=0.51), blastulation rate (52.68% vs. 57.89%), and high-quality blastocyst rate (26.10% vs. 31.13%, p=0.13). However, in cases where SDF was low, 59 cycles consisting of 913 MII oocytes produced a considerably higher blastulation rate with PICSI than with ICSI (50.49% vs. 35.65%, p=0.00). There were no significant differences between the pregnancy outcomes of the PICSI and ICSI embryo groups following embryo transfer. Conclusion: Using variable sperm quality provided no benefit for PICSI versus ICSI in terms of embryo outcomes. When SDF is low, PICSI appears to be able to produce more blastocysts. [ABSTRACT FROM AUTHOR]

Study questionDoes parental fertility, measured by time to pregnancy (TTP), or use of medically assisted reproduction (MAR) affect pubertal development in the offspring?Summary answerNeither TTP nor type of MAR treatment had clinically relevant implications for mean age at achieving individual pubertal milestones or overall timing of puberty in boys and girls.What is known alreadyParental TTP and MAR have been associated with impaired semen quality in adult sons. Timing of puberty reflects earlier signals of reproductive health, but it remains unclear whether parental fertility or MAR affects pubertal development, especially in the growing generation of children conceived by IVF or ICSI.Study design, size, durationIn this study, 15 819 children born by mothers in the Danish National Birth Cohort from 2000 to 2003 participated in a nationwide puberty cohort (participation rate = 70%). Parental TTP and use of MAR were reported by mothers in early pregnancy and children's pubertal development data was self-recorded in web-based questionnaires from 11 years of age and 6 monthly throughout puberty (2012-2018).Participants/materials, setting, methodsPubertal development in children (of planned pregnancies, n = 13 285) born by untreated subfecund (TTP: 6-12 months) (n =2038), untreated severely subfeund (TTP: >12 months) (n = 1242), treated subfecund (n = 230) and treated severely subfecund (n = 1234) parents were compared to children born to more fertile parents (TTP: ≤5 months). We estimated mean monthly differences in mean age at achieving individual pubertal milestones (i.e. age at menarche, voice break, first ejaculation and Tanner stages 2, 3, 4 and 5 for breast or genital development and pubic hair growth) and a combined indicator of timing of puberty. Further, we compared mean age at achieving the individual pubertal milestones in children born by use of IVF or ICSI (n = 480) with children born by controlled ovarian stimulation or ovulation induction with or without intrauterine insemination (n = 902).Main results and the role of chanceWe found tendencies towards slightly later mean age at male pubertal timing and slightly earlier mean age at female pubertal timing among children born by untreated subfecund, treated subfecund, untreated severely subfecund and treated severely subfecund parents. There were no specific patterns with increasing TTP, use of MAR nor type of MAR treatment, and the magnitude of the mean differences for individual milestones and overall timing of puberty were small, i.e. 0.9 months (95% CI: -1.0; 2.8) for first ejaculation and -0.5 months (95% CI: -2.0; 1.0) months for age at menarche in boys and girls, respectively, born by treated severely subfecund parents when compared with children born by more fertile parents.Limitations, reasons for cautionNon-differential misclassification of the self-reported information on parental TTP and pubertal development in the offspring may serve as an alternative explanation of the findings, possibly biasing the estimates towards the null. The information on pubertal development was collected from around 11 years of age and onwards.Wider implications of the findingsThis study adds to the growing body of literature suggesting only limited harmful effects of parental subfecundity and MAR on offspring's long-term growth and development.Study funding/competing interest(s)This work was supported by the Danish Council for Independent Research [DFF 4183-00152]; and the Faculty of Health at Aarhus University. The authors have no financial relationships or competing interests to disclose.

PurposeThis study investigated the relationship between the vitamin D [25(OH)D] level in individual follicles and oocyte developmental competence.MethodsA prospective cohort study in a private infertility center. Infertile women (N = 198) scheduled for intracytoplasmic sperm injection (ICSI) and a single embryo transfer (SET) provided serum samples and 322 follicular fluid (FF) specimens, each from a single follicle on the day of oocyte retrieval.ResultsFFs corresponding to successfully fertilized oocytes (following ICSI) contained significantly lower 25(OH)D level compared with those that were not fertilized (28.4 vs. 34.0 ng/ml, P = 0.001). Top quality embryos on the third day after fertilization, when compared to other available embryos, developed from oocytes collected from follicles containing significantly lower 25(OH)D levels (24.56 vs. 29.59 ng/ml, P = 0.007). Positive hCG, clinical pregnancy, and live birth rates were achieved from embryos derived from oocytes that grew in FF with significantly lower 25(OH)D levels than in follicles not associated with subsequent pregnancy. The concentration of 25(OH)D in FF in women with negative hCG was 32.23 ± 20.21 ng/ml, positive hCG 23.62 ± 6.09 ng/ml, clinical pregnancy 23.13 ± 6.09 ng/ml, and live birth 23.45 ± 6.11 ng/ml (P

Study questionCan the histone deacetylase inhibitor Scriptaid improve the efficiency of the development of round spermatid injection (ROSI)-fertilized embryos in a mouse model?Summary answerTreatment of ROSI mouse zygotes with Scriptaid increased the expression levels of several development-related genes at the blastocyst stage, resulting in more efficient in vitro development of the blastocyst and an increased birth rate of ROSI-derived embryos.What is known alreadyThe full-term development of embryos derived through ROSI is significantly lower than that following ICSI in humans and other species.Study design, size, durationOocytes, spermatozoa and round spermatids were collected from BDF1 (C57BL/6 × DBA/2) mice. For in vitro development experiments, mouse ROSI-derived zygotes were treated with Scriptaid at different concentrations (0, 125, 250, 500 and 1000 nM) and for different exposure times (0, 6, 10, 16 or 24 h). Next, blastocysts of the optimal Scriptaid-treated group and the non-treated ROSI group were separately transferred into surrogate ICR mice to compare in vivo development with the ICSI group (control). Each experiment was repeated at least three times.Participants/materials, setting, methodsMetaphase II (MII) oocytes, spermatozoa and round spermatids were obtained from sexually mature BDF1 female or male mice. The developmental potential of embryos among the three groups (the ICSI, ROSI and optimal Scriptaid-treated ROSI groups) was assessed based on the rates of obtaining zygotes, two-cell stage embryos, four-cell stage embryos, blastocysts and full-term offspring. In addition, the expression levels of development-related genes (Oct4, Nanog, Klf4 and Sox2) were analysed using real-time PCR, and the methylation states of imprinted genes (H19 and Snrpn) in these three groups were detected using methylation-specific PCR (MS-PCR) sequencing following bisulfite treatment.Main results and the role of chanceThe in vitro experiments revealed that treating ROSI-derived zygotes with 250 nM Scriptaid for 10 h significantly improved the blastocyst formation rate (59%) compared with the non-treated group (38%) and further increased the birth rates of ROSI-derived embryos from 21% to 40% in vivo. Moreover, in ROSI-derived embryos, the expression of the Oct4, Nanog and Sox2 genes at the blastocyst stage was decreased, but the optimal Scriptaid treatment restored expression to a level similar to their ICSI counterparts. In addition, Scriptaid treatment moderately repaired the abnormal DNA methylation pattern in the imprinting control regions (ICRs) of H19 and Snrpn.Large scale dataN/A LIMITATIONS, REASONS FOR CAUTION: Because of the ethics regarding the use of human gametes for ROSI studies, the mouse model was used as an approach to explore the effects of Scriptaid on the developmental potential of ROSI-derived embryos. However, to determine whether these findings can be applied to humans, further investigation will be required.Wider implications of the findingsScriptaid treatment provides a new means of improving the efficiency and safety of clinical human ROSI.Study funding/competing interestsThe study was financially supported through grants from the National Key Research Program of China (No. 2016YFC1304800); the National Natural Science Foundation of China (Nos: 81170756, 81571486); the Natural Science Foundation of Shanghai (Nos: 15140901700, 15ZR1424900) and the Programme for Professor of Special Appointment (Eastern Scholar) at Shanghai Institutions of Higher Learning. There are no conflicts of interest to declare.

ObjectiveTo evaluate the effectiveness of semen washing in human immunodeficiency virus (HIV)-discordant couples in which the male partner is infected.DesignSystematic review and meta-analysis.SettingNot applicable.Patient(s)Forty single-arm open-label studies among HIV-discordant couples that underwent intrauterine insemination (IUI) or in vitro fertilization (IVF) with or without intracytoplasmic sperm injection (ICSI) using washed semen.Intervention(s)Semen washing followed by IUI, IVF, or IVF/ICSI.Main outcome measure(s)Primary outcomeHIV transmission to HIV-uninfected women; secondary outcomes: HIV transmission to newborns and proportion of couples achieving a clinical pregnancy.Result(s)No HIV transmission occurred in 11,585 cycles of assisted reproduction with the use of washed semen among 3,994 women. Among the subset of HIV-infected men without plasma viral suppression at the time of semen washing, no HIV seroconversions occurred among 1,023 women after 2,863 cycles of assisted reproduction with the use of washed semen. Studies that measured HIV transmission to infants reported no cases of vertical transmission. Overall, 56.3% of couples (2,357/4,184) achieved a clinical pregnancy with the use of washed semen.Conclusion(s)Semen washing appears to significantly reduce the risk of transmission in HIV-discordant couples desiring children, regardless of viral suppression in the male partner. There are no randomized controlled studies or studies from low-income countries, especially those with a large burden of HIV. Continued development of lower-cost semen washing and assisted reproduction technologies is needed. Integration of semen washing into HIV prevention interventions could help to further reduce the spread of HIV.

Background: Repeated implantation failure (RIF) refers to the condition where high quality embryos are unable to successfully implant after multiple cycles of in vitro fertilization (IVF) treatment. The aim of this study is to investigate the impact of intrauterine granulocyte colony-stimulating factor (G-CSF) and platelet-rich plasma (PRP) on pregnancy rate in patients with RIF., Materials and Methods: The present randomised clinical trial study was conducted at the IVF Centre of Mehr Medical Institute in Rasht, Iran, from 2020 to 2022. The research consisted of 200 individuals who had experienced multiple failed cycles. These patients were randomised into two groups: intrauterine infusion of 1 ml of G-CSF and intrauterine infusion of 1 ml autologous PRP at least 48 hours before embryo transfer (ET). The groups were compared in terms of implantation rate, and chemical, clinical, and ongoing pregnancy., Results: The implantation rate was significantly higher in patients who received PRP (P=0.016). Chemical pregnancy in the PRP group was significantly higher than G-CSF group (P=0.003). Both clinical pregnancy and ongoing pregnancy rates were significantly higher in the PRP group (P=0.001) compared to the G-CSF group (P=0.02)., Conclusion: The utilisation of PRP via intrauterine infusion is considerably more successful than G-CSF in enhancing pregnancy and live birth rates among patients with RIF.

BackgroundThe number of children conceived using assisted reproductive technologies (ART) has reached >5 million worldwide and continues to increase. Although the great majority of ART children are healthy, many reports suggest a forthcoming risk of metabolic complications, which is further supported by the Developmental Origins of Health and Disease hypothesis of suboptimal embryo/fetal conditions predisposing adult cardiometabolic pathologies. Accumulating evidence suggests that fetal and placental growth kinetics are important features predicting post-natal health, but the relationship between ART and intrauterine growth has not been systematically reviewed.MethodsRelevant studies describing fetoplacental intrauterine phenotypes of concepti generated by in vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI) and somatic cell nuclear transfer (SCNT) in the mouse, bovine and human were comprehensively researched using PubMed and Google Scholar. Intrauterine growth plots were created from tabular formatted data available in selected reports.ResultsART pregnancies display minor but noticeable alterations in fetal and placental growth curves across mammalian species. In all species, there is evidence of fetal growth restriction in the earlier stages of pregnancy, followed by significant increases in placental size and accelerated fetal growth toward the end of gestation. However, there is a species-specific effect of ART on birthweights, that additionally vary in a culture condition-, strain-, and/or stage at transfer-specific manner. We discuss the potential mechanisms that underlie these changes, and how they are affected by specific components of ART procedures.ConclusionsART may promote measurable alterations to intrauterine growth trajectory and placental function. Key findings include evidence that birthweight is not a reliable marker of fetal stress, and that increases in embryo manipulation result in more deviant fetal growth curves. Because growth kinetics in early life are particularly relevant to adult metabolic physiology, we advise more rigorous assessment of fetal growth and placental function in human ART pregnancies, as well as continued follow-up of ART offspring throughout post-natal life. Finally, strategies to minimize embryo manipulations should be adopted whenever possible.

ItalyPurpose: The relationship between male systemic inflammation and fertility seems intriguing, but no data about its impact on the assisted reproductive technology outcomes has been reported. Here, we aimed to evaluate the prognostic role of male systemic inflammatory parameters in intracytoplasmic sperm injection (ICSI) outcomes prediction, in couples undergoing an ovum donation program.Materials and Methods: From January 2016 to December 2017, one hundred-ten couples were considered for this cross-sectional study. Neutrophil-to-lymphocyte ratio (NLR), monocyte-to-eosinophil ratio (MER), platelet-to-lymphocyte ratio (PLR), seminal parameters, fertilization rate (FR), cleavage rate (CR), pregnancy rate (PR) were evaluated. Male patients were divided into Group A with FR ≤70%, Group B with FR >70%.Results: Overall, FR was 74.5%, CR 90.9%, PR 41.8%. Group A included 43 patients, Group B 67 men. Group A showed a median NLR of 1.55, PLR of 106.09, MER of 2.33. Group B reported a median NLR of 1.64, PLR 109.0, MER 2.76. We found no statistically differences between two groups with respect to NLR, PLR, MER (p=0.90, p=0.70, p=0.96, respectively). The age-adjusted linear regression analysis demonstrated only a relationship between NLR and sperm motility count (r=-0.02; p

Aim: Recurrent implantation failure is an important issue in Assisted reproduction and despite various treatments that have been described before, there is no agreement on which is the best option. This study was directed to assess the efficacy of autologous platelet-rich plasma (PRP) on pregnancy rate in recurrent implantation failure. Between 2016 and 2019, a total of 98 women who unsuccessful to be pregnant after three or more high-quality embryo transfers undergoing frozen-thawed embryo transfer with or without an intrauterine infusion of platelet-rich plasma. Thus, 0.5 ml of platelet-rich plasma at 4–6 times higher concentration than peripheral blood infused intrauterine 48 h before embryo transfer. A control group underwent standard protocol. There were no significant differences between the two groups in terms of age, body mass index and duration and cause of infertility and total transferred embryos and kind of treatment protocol, but secondary infertility and endometrial thickness 96 h before embryo transfer, was more in the intervention group. The clinical pregnancy (48.3% versus 23.26; p =.001) and ongoing pregnancy (46.7% versus 11.7%; p =.001) and implantation rate (58.3% versus 25%; p =.001) was more significant in the intervention group rather than controls. In conclusion, intrauterine infusion of platelet-rich plasma 48 h before freeze-thawed embryo transfer may have more effectiveness in in vitro fertilization (IVF) outcomes in recurrent implantation failure. [ABSTRACT FROM AUTHOR]

Background: Multiple pregnancies occur more frequently in assisted reproductive technology (ART) compared to normal conception (NC). It is known that the risk of congenital malformations in a multiple pregnancy are higher than single pregnancy. The aim of this study is to compare congenital malformations in singleton infants conceived by ART to singleton infants conceived naturally. Materials and Methods: In this historical cohort study, we performed a historical cohort study of major congenital malformations (MCM) in 820 singleton births from January 2012 to December 2014. The data for this analysis were derived from Tehran’s ART linked data file. The risk of congenital malformations was compared in 164 ART infants and 656 NC infants. We performed multiple logistic regression analyses for the independent association of ART on each outcome. Results: We found 40 infants with MCM 29 (4.4%) NC infants and 14 (8.3%) ART infants. In comparison with NC infants, ART infants had a significant 2-fold increased risk of MCM (P=0.046). After adjusting individually for maternal age, infant gender, prior stillbirth, mother’s history of spontaneous abortion, and type of delivery, we did not find any difference in risk. In this study the majority (95.1%) of all infants were normal but 4.9% of infants had at least one MCM. We found a difference in risk of MCMs between in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI). We excluded the possible role of genotype and other unknown factors in causing more malformations in ART infants. Conclusion: This study reported a higher risk of MCMs in ART singleton infants than in NC singleton infants. Congenital heart disease, developmental dysplasia of the hip (DDH), and urogenital malformations were the most reported major malformations in singleton ART infants according to organ and system classification.

Introduction: In different studies worldwide, gender ratios derived from ICSI (Assisted reproductive techniques) have been reported differently. Objective: Evaluation of neonatal gender in ICSI women referred to Mehr Infertility Research Center of Rasht. Materials and Methods: In this descriptive-analytical study, the cases of infertile women referred to Mehr Infertility Research Center in Rasht for ICSI were examined to determine the sex ratio of the neonates. Data were analyzed using SPSS 21 and descriptive and an alytical (Chi-square and independent t) tests. Results:The results showed that 52% of single-born neonates, 60% of multiple pregnancies (single sex) and 52.5% of multiple pregnancy (two sexes) were male. Conclusion:The ratio of male in single and multiple pregnancies in ICSI was higher than female. [ABSTRACT FROM AUTHOR]

ObjectiveTo determine whether center to center discrepancies in the ability to locate sperm in infertile testes with abnormal histology stems in part from inconsistencies in pathologists' readings of testis biopsies.DesignProspective cohort study.SettingAcademic male infertility practice.Patient(s)Consecutive series of azoospermic men referred with testis biopsy slides between 1998 and 2003.Intervention(s)Testis biopsy histologies on azoospermic patients referred for infertility care were re-reviewed by a single pathologist blinded to the original reading. Subsequent infertility care was guided by the findings from the second histologic reading.Main outcome measure(s)Agreement between the outside and in-house review of testis biopsy readings was assessed with the kappa statistic. Pregnancy outcomes that resulted from clinical decisions informed by the second histologic readings were also assessed.Result(s)Among 113 histologic specimens, re-review was complicated by fixation artifacts in 18 cases (16%) and insufficient biopsy sample size in 13 cases (12%). The kappa score for interobserver agreement in readings was 0.43 (95% CI 0.32-0.054). Mixed histology patterns in particular were underappreciated by outside pathologists (13% of cases on original reading, 36% of cases on review). In 27% of all cases, the differences in biopsy readings had a significant impact on clinical management.Conclusion(s)A correlation between independent testis histology readings in azoospermic men demonstrates frequent inconsistencies. These differences contribute to inaccurate phenotyping of male infertility and can significantly impact the direction of infertility care. These findings highlight the need for a standardized approach to testis histologic review.

Purpose: The relationship between male systemic inflammation and fertility seems intriguing, but no data about its impact on the assisted reproductive technology outcomes has been reported. Here, we aimed to evaluate the prognostic role of male systemic inflammatory parameters in intracytoplasmic sperm injection (ICSI) outcomes prediction, in couples undergoing an ovum donation program. Materials and Methods: From January 2016 to December 2017, one hundred-ten couples were considered for this crosssectional study. Neutrophil-to-lymphocyte ratio (NLR), monocyte-to-eosinophil ratio (MER), platelet-to-lymphocyte ratio (PLR), seminal parameters, fertilization rate (FR), cleavage rate (CR), pregnancy rate (PR) were evaluated. Male patients were divided into Group A with FR ≤70%, Group B with FR >70%. Results: Overall, FR was 74.5%, CR 90.9%, PR 41.8%. Group A included 43 patients, Group B 67 men. Group A showed a median NLR of 1.55, PLR of 106.09, MER of 2.33. Group B reported a median NLR of 1.64, PLR 109.0, MER 2.76. We found no statistically differences between two groups with respect to NLR, PLR, MER (p=0.90, p=0.70, p=0.96, respectively). The age-adjusted linear regression analysis demonstrated only a relationship between NLR and sperm motility count (r=-0.02; p<0.05). Using the univariate logistic regression analysis, we found no significant associations. Conclusions: We did not find any relationship between ICSI outcomes and male inflammation parameters. [ABSTRACT FROM AUTHOR]

Study Question: Is the presence or absence of certain vaginal bacteria associated with failure or success to become pregnant after an in vitro fertilization (IVF) or IVF with intracytoplasmic sperm injection (IVF-ICSI) treatment?Summary Answer: Microbiome profiling with the use of interspace profiling (IS-pro) technique enables stratification of the chance of becoming pregnant prior to the start of an IVF or IVF-ICSI treatment.What Is Known Already: Live-birth rates for an IVF or IVF-ICSI treatment vary between 25 and 35% per cycle and it is difficult to predict who will or will not get pregnant after embryo transfer (ET). Recently, it was suggested that the composition of the vaginal microbiota prior to treatment might predict pregnancy outcome. Analysis of the vaginal microbiome prior to treatment might, therefore, offer an opportunity to improve the success rate of IVF or IVF-ICSI.Study Design, Size, Duration: In a prospective cohort study, 303 women (age, 20-42 years) undergoing IVF or IVF-ICSI treatment in the Netherlands were included between June 2015 and March 2016.Participants/materials, Setting, Methods: Study subjects provided a vaginal sample before the start of the IVF or IVF-ICSI procedure. The vaginal microbiota composition was determined using the IS-pro technique. IS-pro is a eubacterial technique based on the detection and categorization of the length of the 16S-23S rRNA gene interspace region. Microbiome profiles were assigned to community state types based on the dominant bacterial species. The predictive accuracy of the microbiome profiles for IVF and IVF-ICSI outcome of fresh ET was evaluated by a combined prediction model based on a small number of bacterial species. From this cohort, a model was built to predict outcome of fertility treatment. This model was externally validated in a cohort of 50 women who were undergoing IVF or IVF-ICSI treatment between March 2018 and May 2018 in the Dutch division of the MVZ VivaNeo Kinderwunschzentrum Düsseldorf, Germany.Main Results and the Role Of Chance: In total, the vaginal microbiota of 192 women who underwent a fresh ET could be analysed. Women with a low percentage of Lactobacillus in their vaginal sample were less likely to have a successful embryo implantation. The prediction model identified a subgroup of women (17.7%, n = 34) who had a low chance to become pregnant following fresh ET. This failure was correctly predicted in 32 out of 34 women based on the vaginal microbiota composition, resulting in a predictive accuracy of 94% (sensitivity, 26%; specificity, 97%). Additionally, the degree of dominance of Lactobacillus crispatus was an important factor in predicting pregnancy. Women who had a favourable profile as well as <60% L. crispatus had a high chance of pregnancy: more than half of these women (50 out of 95) became pregnant. In the external validation cohort, none of the women who had a negative prediction (low chance of pregnancy) became pregnant.Limitations, Reasons For Caution: Because our study uses a well-defined study population, the results will be limited to the IVF or IVF-ICSI population. Whether these results can be extrapolated to the general population trying to achieve pregnancy without ART cannot be determined from these data.Wider Implications Of the Findings: Our results indicate that vaginal microbiome profiling using the IS-pro technique enables stratification of the chance of becoming pregnant prior to the start of an IVF or IVF-ICSI treatment. Knowledge of their vaginal microbiota may enable couples to make a more balanced decision regarding timing and continuation of their IVF or IVF-ICSI treatment cycles.Study Funding/competing Interest(s): This study was financed by NGI Pre-Seed 2014-2016, RedMedTech Discovery Fund 2014-2017, STW Valorisation grant 1 2014-2015, STW Take-off early phase trajectory 2015-2016 and Eurostars VALBIOME grant (reference number: 8884). The employer of W.J.S.S.C. has in collaboration with ARTPred acquired a MIND subsidy to cover part of the costs of this collaboration project. The following grants are received but not used to finance this study: grants from Innovatie Prestatie Contract, MIT Haalbaarheid, other from Dutch R&D tax credit WBSO, RedMedTech Discovery Fund, (J.D.d.J.). Grants from Ferring (J.S.E.L., K.F., C.B.L. and J.M.J.S.S.), Merck Serono (K.F. and C.B.L.), Dutch Heart Foundation (J.S.E.L.), Metagenics Inc. (J.S.E.L.), GoodLife (K.F.), Guerbet (C.B.L.). R.K. is employed by ARTPred B.V. during her PhD at Erasmus Medical Centre (MC). S.A.M. has a 100% University appointment. I.S.P.H.M.S., S.A.M. and A.E.B. are co-owners of IS-Diagnostics Ltd. J.D.d.J. is co-owner of ARTPred B.V., from which he reports personal fees. P.H.M.S. reports non-financial support from ARTPred B.V. P.H.M.S., J.D.d.J. and A.E.B. have obtained patents `Microbial population analysis' (9506109) and `Microbial population analysis' (20170159108), both licenced to ARTPred B.V. J.D.d.J. and A.E.B. report patent applications `Method and kit for predicting the outcome of an assisted reproductive technology procedure' (392EPP0) and patent `Method and kit for altering the outcome of an assisted reproductive technology procedure' by ARTPred. W.J.S.S.C. received personal consultancy and educational fees from Goodlife Fertility B.V. J.S.E.L. reports personal consultancy fees from ARTPred B.V., Titus Health B.V., Danone, Euroscreen and Roche during the conduct of the study. J.S.E.L. and N.G.M.B. are co-applicants on an Erasmus MC patent (New method and kit for prediction success of in vitro fertilization) licenced to ARTPred B.V. F.J.M.B. reports personal fees from Advisory Board Ferring, Advisory Board Merck Serono, Advisory Board Gedeon Richter and personal fees from Educational activities for Ferring, outside the submitted work. K.F. reports personal fees from Ferring (commercial sponsor) and personal fees from GoodLife (commercial sponsor). C.B.L. received speakers' fee from Ferring. J.M.J.S.S. reports personal fees and other from Merck Serono and personal fees from Ferring, unrelated to the submitted paper. The other authors declare that they have no competing interests.Trial Registration Number: ISRCTN83157250. Registered 17 August 2018. Retrospectively registered. [ABSTRACT FROM AUTHOR]

Objective: To explore the relationship between the embryodynamic parameters using time-lapse system and the pregnancy outcomes, so as to establish a model of the optimal embryo selection. Methods: A total of 137 cycles with the time-lapse system (IVF/ICSI-ET cycle) were retrospectively analyzed from December 2016 to December 2017. The clinical data including basic information and pregnancy outcomes were collected. The morphokinetic parameters using the time -lapse system (t2、t3、t4、t5、t6、t7、t8、cc2、s2、cc3、s3) were compared between the implanted embryos and the unimplanted embryos. Based on those parameters related with embryo implantation, a multivariate classification model was developed. This model was then primarily verified. Results: ① Totally 171 embryos had one or more early abnormal division event, in which 16 were considered to be implantable, and then transplanted. There were 4 embryos implantated succesfully. ② There were no significant differences in all of 11 morphokinetic parameters between the implanted embryos and the unimplanted embryos (P>0.05).③Thet6(OR=1.462,95%CI:1.093-1.954, P=0.010)and t7 (OR=0.803,95%a:0.653-0.989, P=0.039) could be the best predictors of implantation. A classification model was developed with these two parameters combined with the exclusion standard of abnormal division event. The implantation rate was declined as the embryonic grade dropped. The area under the receiver operating characteristic curve (AUC) was 0.649 (95% CI: 0.528-0.770). Conclusions: Two of morphokinetic parameters (t6, t7) could be closely related to the implantation potential. We tried to develop an embryo selecting model with these two parameters combined with exclusion standard of abnormal division events. It is true that this model should be furtherly validated in our centers. [ABSTRACT FROM AUTHOR]

Objective: To investigate the application of intracytoplasmic sperm injection (ICSI) combined with immature oocyte in vitro maturation (IVM) in those ageing women with poor ovarian response(POR) who underwent different ovarian stimulation. Methods: A total of 81 cycles of ICSI were evaluated retrospectively from January 2016 to September 2018 at the First Affiliated Hospital of Zhengzhou University. The inclusion criteria were age 多 35 years, the number of oocytes 矣3, and the oocytes immature. These cycles were grouped according to the protocols of ovulation stimulation: the micro-stimulation group (n=37) and the antagonist group (n=44). The basal levels of reproductive hormones and the pregnancy outcome were compared between the two gruops. Results: There were no significant differences in age, infertility years, basal levels of hormones (including AMH) and basal antral follicles between the two groups (P>0.05). The amount of Gn in the antagonist group was significantly higher than that in the micro-stimulation group (P<0.05). There were no significant differences in the in vitro culture maturation rate, 2PN rate, cleavage rate, embryonic rate and excellent embryo rate between the two groups (P<0.05). Meanwhile, there were no significant differences in the implantation rate and the clinical pregnancy rate (P> 0.05). Conclusions: The ICSI combined with IVM in ageing women with POR is beneficial to improve the oocyte maturation rate and embryo utilization, and to increase the pregnancy chance. The micro-stimulation protocol is a cost-effective option for those women with POR. [ABSTRACT FROM AUTHOR]

Objective：To evaluate the effect of GnRHa ultra long protocol on clinical outcomes of IVF/ ICSI-ET in patients with different stages of endometriosis. Methods：PubMed, EMBASE, Web of Science, Cochrane Library, CNKI, Wanfang Data, VIP database, CBM and Google Scholar were searched to identify those studies involving human subjects published before August 1st, 2018. Those clinical trials that compared the effects of the GnRHa ultra long protocol and the GnRHa long protocol on clinical outcomes of IVF/ICSI-ET in patients with endometriosis were included. The meta-analysis was performed by two investigators. Results：Nine studies were included in the meta-analysis. Comparing with the GnRHa long protocol, the GnRHa ultral long protocol in those endometriosis patients at stage Ⅰ-Ⅱ had significantly higher Gn doses (SMD=0.36, 95%CI：0.01-0.70) and higher implantation rate (RR=1.19, 95%CI: 1.04-1.37), and lower number of oocytes retrieved (SMD=-0.26, 95%CI: -0.48- -0.04), although there were no significant differences in basal FSH, Gn days and clinical pregnancy rate (all P＞0.05). In those endometriosis patients at stage Ⅲ-Ⅳ, the GnRHa ultra long protocol had significantly higher clinical pregnancy rate (RR=1.38, 95%CI: 1.06 -1.80) when compared with the GnRHa long protocol, although there were no significantly differences in basal FSH, Gn doses, Gn days, the number of oocytes retrieved and implantation rate (all P＞0.05). Conclusions：For those endometriosis patients at stage Ⅰ-Ⅱ, the GnRHa ultra long protocol could not improve the pregnancy rate, but cost more Gn and retrieve fewer oocytes. For those endometriosis patients at stage Ⅲ-Ⅳ, the GnRHa ultra long protocol could significantly improve the pregnancy rate. [ABSTRACT FROM AUTHOR]

Objective：To investigate the correlation between serum vitamin D and the pregnancy outcome of in-vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) in women with polycystic ovary syndrome (PCOS). Methods: A total of 286 infertility women with PCOS underwent IVF/ICSI from November 2016 to June 2018 were included，including 114 women received fresh embryo transfer (ET). According to the level of 25-hydroxyvitamin D(25OHD), those patients were divided into three groups: vitamin D deficiency group (≤10 ng/mL), insufficiency group (10-30 ng/mL) and sufficiency group (≥30 ng/mL).The pregnancy rate of IVF/ICSI was analyzed. Furthermore, the patients with fresh ET were further divided into two groups: clinical pregnancy group and non -pregnancy group. After adjusting for baselines of luteinizing hormone (LH), testosterone and endometrial thickness on the ET day, logistic regression analysis on the vitamin D level and clinical pregnancy outcome of IVF/ICSI -ET was performed. Results: (1)There were significant differences in BMI, baseline testosterone, the ratio of baseline LH/ FSH among three groups (P＜0.05). There were no significant differences in the indicators of ovulation induction (P＞0.05). (2)In those fresh ET patients, there were significant differences in BMI, the rate of fertilization and the rate of embryo implantation among three subgroups (P＜0.05). (3) The baselines of LH and testosterone in the pregnancy group were lower than those in the non-pregnancy group (P＜0.05), while the endometrial thickness on the ET day and the rate of fertilization in the pregnancy group were significantly higher than those in the nonpregnancy group (P＜0.05). After adjusting for age, baseline LH, baseline testosterone, the endometrial thickness on the ET day and the ratio of baseline LH/FSH, the logistic regression analysis showed that the pregnancy rates in the vitamin D insufficiency group and the sufficiency group were significantly higher than this rate in the vitamin D deficiency group （aOR=5.559，95%CI：1.463-21.124，P=0.012；aOR=11.192，95%CI：1.674 -74.822，P =0.013）. Conclusions: The level of serum vitamin D≥10 ng/mL is a protective factor of IVF/ICSI-ET in women with PCOS. [ABSTRACT FROM AUTHOR]

Objective：To investigate the high-accuracy predictive factors of ovarian response to ovulation induction. Methods：The basic information, medication and outcome of 5 859 IVF/ICSI cycles were respectively analyzed in our center from June 2014 to December 2016. The Logistic regression model was developed to predict the ovarian response. There were a total of 517 cycles in the low-response group, 1 281 cycles in the high - response group and 4 061 cycles in the normal-response group. The clinical data of 1 143 cycles in 2017 were used to test the diagnostic value of those factors. Results：The differences in the age, AFC, basal hormone levels, medication and clinical outcomes were significant among the three groups (P＜0.001). The level of serum AMH was the important predictor of ovarian response, with the cut-off values of 2.76 ng/mL for high ovarian response and 1.50 ng/mL for low ovarian response. AMH if combining with age could predict high ovarian response, while AMH combining with AFC also predict low ovarian response. Conclusions：The level of serum AMH was a good predictor of ovarian response before Gn initiation. AMH if combining with AFC and age was of great significance in obtaining an appropriate number of oocytes, ensuring a good pregnancy outcome and preventing ovarian hyperstimulation syndrome. [ABSTRACT FROM AUTHOR]

Objective：To evaluate whether the index of sperm DNA fragmentation index (DFI) can be used as a parameter of male fertility. Methods：A total of 460 infertile men were enrolled in the observation group, and 107 fertile men in the control group. Semen parameters were calculated by the computer assisted semen analysis system (CASA). Sperm DNA fragmentation index (DFI) was detected by the sperm chromatin structure assay (SCSA). The results of routine semen analysis were divided into the normal, oligospermia, asthenospermia and oligoasthenospermia subgroups. Objects were also grouped into 3 subgroups according to the age, ＜30 years, 30-39 years, and over 40 years. Specially, those objects were further divided into three subgroups according to DFI, ≤15, 15 -30 and ≥30. DFI was compared between the control group and the observation group. The correlations between sperm DFI and age, IVF/ICSI embryonic development and reproductive outcome were successively analyzed. Results：There were significant differences in the proportions of normal, oligospermia, asthenospermia and oligoasthenospermia between the observation group and the control group (22.17% vs. 60.96%, 13.26% vs. 34.59%, 52.62% vs. 1.75% and 11.95% vs. 2.70%, all P＜0.05). In the observation group, the proportion of sperm DFI ≤15% was decreased while the proportion of DFI ≥30% increased (both P＜0.05). The level of sperm DFI was increased with age (P＜0.05). The early abortion rates of those IVF or ICSI embryos derived from sperms with DFI≥30 were significantly increased (31% and 25%, P＜0.05). However, there were no significant differences in the fertilization rate, cleavage rate, biochemical pregnancy rate, clinical pregnancy rate, implantation rate among those subgroups (all P＞0.05). Conclusions： The sperm DFI in infertile men is at a higher level, and increased with age. The early abortion rate of IVF or ICSI embryos will be increased when sperm DFI≥30, suggesting that sperm DFI is a practical reference for the evaluation of the potential fertility in those infertile men. [ABSTRACT FROM AUTHOR]

Objective: To assess the pregnancy outcomes of intracytoplasmic sperm injection (ICSI) in a sample of Saudi men with obstructive (OA) and nonobstructive (NOA) azoospermia. Methods: A retrospective cohort study was undertaken between August 2004 and December 2012. The study was conducted in the Reproductive Endocrinology and Infertility unit at the department of Obstetrics and Gynecology, King Abdul-Aziz Medical City and King Fahd National Guard Hospital. A total of 136 ICSI cycles (6 in OA group and 130 in NOA group) with thawed-frozen spermatozoa was included in the study. Data on demographic and clinical characteristics of couples were collected such as age, number of cycles, clinical pregnancy, fertilization, and implantation. Results: 43.4% of the cycles performed had the first ICSI attempt, and 72.8% had primary infertility. Male gender was the most common cause of infertility (96.3%). It was noted that the pregnancy rate was 10.8% in the NOA group, while none (0.0%) of the OA group had a positive pregnancy. Of 14 pregnancies in the NOA group, 8 (57.1%) had successful live birth. Primary infertility was more common in NOA than in OA (74.6% vs. 33.3%), conversely secondary infertility was less common in NOA than in OA (66.7% vs. 25.4%, P value = 0.047). The fertilization rate was not different between the two groups. Conclusions: This is the first hospital-based examinations of ICSI outcomes in Saudi Arabia. The study failed to present statistical evidence that the ICSI outcomes, including fertilization rate and clinical pregnancy, differ between the two types of azoospermia in the Saudi population.

Background To compare the pregnancy outcomes after two embryos versus three embryos transfers (ETs) in women undergoing in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) cycles. Materials and Methods This retrospective study was performed on three hundred eighty seven women with primary infertility and with at least one fresh embryo in good quality in order to transfer at each IVF/ICSI cycle, from September 2006 to June 2010. Patients were categorized into two groups according to the number of ET as follows: ET2 and ET3 groups, indicating two and three embryos were respectively transferred. Pregnancy outcomes were compared between ET2 and ET3 groups. Chi square and student t tests were used for data analysis. Results Clinical pregnancy and live birth rates were similar between two groups. The rates of multiple pregnancies were 27 and 45.2% in ET2 and ET3 groups, respectively. The rate of multiple pregnancies in young women was significantly increased when triple instead of double embryos were transferred. Logistic regression analysis indicated two significant prognostic variables for live birth that included number and quality of transferred embryos; it means that the chance of live birth following ICSI treatment increased 3.2-fold when the embryo with top quality (grade A) was transferred, but the number of ET had an inverse relationship with live birth rate; it means that probability of live birth in women with transfer of two embryos was three times greater than those who had three ET. Conclusion Due to the difficulty of implementation of the elective single-ET technique in some infertility centers in the world, we suggest transfer of double instead of triple embryos when at least one good quality embryo is available for transfer in women aged 39 years or younger. However, to reduce the rate of multiple pregnancies, it is recommended to consider the elective single ET strategy.

Abstract: A wide variety of assisted reproductive techniques (ARTs) are available to aid in managing aspects of equine reproduction. Embryo recovery and transfer can be used to obtain more than one foal per mare per year, and to obtain foals from mares that cannot carry a foal to term. Oocyte recovery and either transfer to the oviduct of an inseminated recipient mare (oocyte transfer), or intracytoplasmic sperm injection (ICSI) and embryo culture can be used to obtain foals from mares with some types of subfertility, such as problems of the tubular tract. ICSI can be used to obtain foals when sperm number or quality is low. Because of its ease of use for the mare owner and efficiency, oocyte recovery and ICSI is being used in some cases for management of normally fertile mares and stallions. Oocytes can be recovered from live mares by the referring veterinarian, and shipped overnight to a laboratory for ICSI, without any decrease in oocyte or embryo viability. In case of unexpected death of a mare, ovaries or oocytes can be transported to the ICSI laboratory for production of embryos. Embryos produced both in vitro and in vivo can be biopsied to determine their genetic makeup before they are transferred. Equine embryos can be vitrified successfully; collapse of the blastocoele cavity allows efficient vitrification of expanded blastocysts. In contrast, cryopreservation of unfertilized equine oocytes still has low success. Genetics of valuable animals can be preserved via nuclear transfer (cloning) and several commercial companies offer this service clinically. [ABSTRACT FROM AUTHOR]

Objective：To explore the relationship between chromosomal polymorphism of the infertile couples and the outcomes of IVF/ICSI -ET. Methods: The chromosome karyotype analysis of 1 318 infertile couples received IVF/ICSI-ET was performed in our center from September 2015 to November 2016. The couples with either male or female chromosome polymorphism were enrolled as the study group，while the couples with normal chromosome karyotypes were served as the control group. The outcomes of IVF/ICSI-ET of two groups were compared. Results: The occurrence of miscarriage history in the study group was significantly higher than that in the control group (24.64% vs. 15.65%, P=0.007). The rate of high-grade blastocysts in the male polymorphic couple was significantly lower than that in the woman′s chromosomal polymorphism (18.11% vs. 29.03%, P=0.016) or the control group (18.11% vs. 23.81% , P =0.017). Conclusions: The infertile couples with chromosomal polymorphism have higher rate of previous miscarriage history, and the embryos from male chromosomal polymorphism might have relatively low development potential. However, their outcomes of IVF/ICSI -ET are similar to those with normal chromosome karyotypes. [ABSTRACT FROM AUTHOR]

Oocyte activation deficiency (OAD) refers to the failure of the evoking calcium oscillations which orchestrates a series of key events, such as the resumption of meiosis, extrusion of polar body, exocytosis of cortical granules and the formation of pronuclei after the spermatozoon is engulfed by the oocyte cytoplasm. These events are essential for the following embryogenesis. Both the defect of sperm and oocyte may cause OAD. Assisted oocyte activation (AOA) and the recombinant protein recombinant human phospholipases C zeta (rhPLCζ) injected into oocyte can significantly improve the fertilization outcome of OAD oocyte undergoing intracytoplasmic sperm injection (ICSI). In this paper, the causes and countermeasures of OAD were discussed. [ABSTRACT FROM AUTHOR]

Background: Multiple pregnancies occur more frequently in assisted reproductive technology (ART) compared to normal conception (NC). It is known that the risk of congenital malformations in a multiple pregnancy are higher than single pregnancy. The aim of this study is to compare congenital malformations in singleton infants conceived by ART to singleton infants conceived naturally. Materials and Methods: In this historical cohort study, we performed a historical cohort study of major congenital malformations (MCM) in 820 singleton births from January 2012 to December 2014. The data for this analysis were derived from Tehran's ART linked data file. The risk of congenital malformations was compared in 164 ART infants and 656 NC infants. We performed multiple logistic regression analyses for the independent association of ART on each outcome. Results: We found 40 infants with MCM 29 (4.4%) NC infants and 14 (8.3%) ART infants. In comparison with NC infants, ART infants had a significant 2-fold increased risk of MCM (P=0.046). After adjusting individually for maternal age, infant gender, prior stillbirth, mother's history of spontaneous abortion, and type of delivery, we did not find any difference in risk. In this study the majority (95.1%) of all infants were normal but 4.9% of infants had at least one MCM. We found a difference in risk of MCMs between in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI). We excluded the possible role of genotype and other unknown factors in causing more malformations in ART infants. Conclusion: This study reported a higher risk of MCMs in ART singleton infants than in NC singleton infants. Congenital heart disease, developmental dysplasia of the hip (DDH), and urogenital malformations were the most reported major malformations in singleton ART infants according to organ and system classification. [ABSTRACT FROM AUTHOR]

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.

BACKGROUND: There is no consensual definition of diminished ovarian reserve and the best therapeutic strategy has not yet been demonstrated. METHODS: We performed a retrospective study to evaluate outcomes following a first in-vitro fertilization/intra-cytoplasmic sperm injection (IVF/ICSI) cycle in young women with diminished ovarian reserve. Women with tubal factor, endometriosis or previous stimulation cycle were excluded. We defined diminished ovarian reserve as women ≤38 years with an AMH ≤1.1 ng/mL or antral follicular count ≤7. RESULTS: Among 59 IVF/ICSI cycles (40% IVF/60% ICS1), the pregnancy rate was 17% (10/59) and live birth rate 8.5% (5/59). Miscarriage rate was 50%. Baseline characteristics and IVF outcomes of the pregnant and not pregnant women were compared. No differences in age, antral follicular count, AMH, protocol used or number of harvested oocytes were found between the groups. A higher gonadotropin starting dose in the pregnancy group (397.5±87 IU vs. 314.8± 103 IU; P=0.02) and a trend to a higher total dose received (4720± 1349 IU vs. 387U1367 IU; P=0.07) were noted. CONCLUSIONS: The present study confirms that women with diminished ovarian reserve have low live birth rates after a first IVF-ICSI cycle and that a higher gonadotropin starting dose might be associated with better outcomes. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this retrospective cohort study was to establish a ratio of the progesterone level to the number of follicles (having diameter larger than 12 mm) on ovulation trigger day [human chorionic gonadotropin (hCG)-day] and to demonstrate if this ratio is associated with pregnancy outcome in gonadotropin releasing hormone (GnRH) antagonist/intracytoplasmic sperm injection cycles with high hCG-day serum progesterone value (≥1.5 ng/mL). Material and Methods: Among 2.111 GnRH antagonist cycles which were conducted at İzmir Tepecik Education and Research Hospital, Gynecology and Obstetrics Clinic, In Vitro Fertilization Center between March 2010-July 2015, 203 cycles matching inclusion criteria and with serum progesterone levels ≥1.5 ng/mL on hCG day were included in the analysis. Following controlled ovarian stimulation, serum progesterone levels and the follicle diameters were measured on hCG-day. In addition, the basal demographic and hormonal data, the embryo development data after oocyte pick-up process, and the pregnancy results were included in the analysis. Results: In this study, the receiver operating characteristics area under curve value, cut-off value, sensitivity and specificity were found to be 0.617, 0.307, 0.97 and 0.24 for progesterone/follicle ratio (P/F ratio), respectively (p=0.023). In addition, it was also found in our study that while the total follicle stimulating hormone amount used and hCG day progesterone level in patients, who have P/F ratio value ≤0.307 was significantly lower (p<0.01, p<0.001); whereas hCG-day ≥12 mm and ≥17 mm follicle number, hCG-day endometrial thickness, hCGday estradiol level, total and metaphase II oocyte number were significantly higher in patients with P/F ratio ≤0.307. Moreover, chemical, clinical, ongoing pregnancy and live birth rates were significantly higher in patients with P/F ratio ≤0.307. Conclusions: As a conclusion, in patients with hCG-day serum progesterone levels ≥1.5 ng/mL, progesterone/follicle ratio is a useful parameter in predicting live birth rate in patients undergoing fresh embryo transfer and antagonist IVF cycle. [ABSTRACT FROM AUTHOR]

Objective: To identify genitourinary malformations among children conceived by assisted reproductive techniques in a population of pregnant women seen at a tertiary hospital in the city of Sao Paulo, Brazil. Methods: A descriptive and retrospective study with data collected from 238 pregnant women who underwent assisted reproduction techniques, including the classic in vitro fertilization and intracytoplasmic sperm injection, and gave birth to 322 children at the Hospital Israelita Albert Einstein. Rresults: The mean maternal age for classic in vitro fertilization was 34 years and for intracytoplasmic sperm injection was 34.8 years. There was an increase in malformed children with older maternal age, but with no statistical significance. Thirty-four malformed newborns were found (10.6%) and 10 (29.4% of malformed children) presented genitourinary malformations. Cconclusions: Several genitourinary malformations were found in children following techniques of human assisted reproduction and there was a tendency to malformation in children as maternal age increased.

OBJETIVO: avaliar a eficácia da fertilização in vitro (FIV) com injeção intracitoplasmática de espermatozóide (ICSI) em ciclo natural (CN). MÉTODOS: estudo clínico retrospectivo que avaliou 70 ciclos de tratamento em 60 casais que se submeteram ao tratamento de FIV com auxílio da técnica de ICSI em CN em clínica privada de 1999 a 2003. Foi realizada monitorização ultra-sonográfica diária ou em dias alternados, e dosagem de LH urinário a partir de 16 mm de diâmetro folicular. Programada captação oocitária quando o folículo atingiu 18 mm de diâmetro e 36 horas após a administração de gonadotrofina coriônica humana (hCG - 5000UI) quando o teste de LH era negativo. A transferência embrionária foi realizada 48 a 52 horas depois do ICSI. RESULTADOS: foram realizados 70 ciclos de ICSI em 60 pacientes com as seguintes indicações: fator masculino (47,1%), fator tubo-peritoneal (37,1%), fatores associados (8,7%) e infertilidade sem causa aparente (7,1%). Do total de 70 ciclos, 18 foram cancelados (25,7% de taxa cancelamento). Das 52 pacientes que se submeteram à punção ovariana, oócitos maduros foram encontrados em 77% das vezes (40 ciclos). A taxa de fertilização foi de 70% e as taxas de transferência embrionária por punção e por oócito maduro foram de 52 e 67,5%, respectivamente. As taxas de gestação por ciclo iniciado, ciclo puncionado e transferência embrionária foram 11,4, 15,4 e 29,6%, respectivamente. Das oito gestações, sete foram diagnosticadas em pacientes com idade inferior a 37 anos. A única gestação conseguida em pacientes com idade entre 37 e 43 anos evoluiu para abortamento. CONCLUSÕES: ICSI em ciclos naturais parece ser uma opção satisfatória de tratamento, com custos e índice de complicações (gestação múltipla e síndrome de hiperestímulo ovariano) reduzidos. Os resultados são melhores em pacientes mais jovens, com idade inferior a 37 anos.PURPOSE: to evaluate the efficacy of in vitro fertilization (IVF) with intracytoplasmic sperm injection (ICSI) in natural cycle (NC). METHODS: retrospective clinical trial that evaluated 70 treatment cycles in 60 couples that were submitted to IVF treatment with ICSI in NC performed in private clinic from 1999 until 2003. It was performed daily ultrasound monitorization or on alternate days, and urinary LH dosage when the follicle reached 16 mm of diameter. It was scheduled egg retrieval when the follicle reached 18 mm of diameter and 36 hours after hCG administration when the LH test was negative. Embryo transfer was performed 48 to 52 hours after ICSI. RESULTS: 70 ICSI cycles in 60 patients were performed and the indications of treatment included: male factor (47.1%), tubal factor (37.1%), associated factors (8.7%), unknown infertility (7.1%). Out of 70 cycles, 18 cycles were cancelled (25.7% of cancellation rate). Out of 52 patients that were submitted to ovarian punction to oocyte retrieval we found mature oocytes in 77% of the cases (40 cycles), in four cases we collected immature oocytes and in eight cases we could not found it. We had 70% of fertilization rate and only one fertilized oocyte did not achieve the cleavage stage. So, the transfers rate per punction and per mature oocyte was 52% and 67.5%, respectively. We had 11.4% of pregnancy rate per cycle, 15.4% per punction and 29.6% per embryo transfer. CONCLUSIONS: FIV/ICSI in NC seem to be a satisfactory option of treatment, with low costs and complications (multiple gestation and Ovarian Hyperstimulation Syndrome), mainly in poor responder patients and in poor populations.

Study Question: Can an externally validated model, based on biological variables, be developed to predict successful sperm retrieval with testicular sperm extraction (TESE) in men with non-obstructive azoospermia (NOA) using a large nationwide cohort?Summary Answer: Our prediction model including six variables was able to make a good distinction between men with a good chance and men with a poor chance of obtaining spermatozoa with TESE.What Is Known Already: Using ICSI in combination with TESE even men suffering from NOA are able to father their own biological child. Only in approximately half of the patients with NOA can testicular sperm be retrieved successfully. The few models that have been developed to predict the chance of obtaining spermatozoa with TESE were based on small datasets and none of them have been validated externally.Study Design, Size, Duration: We performed a retrospective nationwide cohort study. Data from 1371 TESE procedures were collected between June 2007 and June 2015 in the two fertility centres.Participants/materials, Setting, Methods: All men with NOA undergoing their first TESE procedure as part of a fertility treatment were included. The primary end-point was the presence of one or more spermatozoa (regardless of their motility) in the testicular biopsies.We constructed a model for the prediction of successful sperm retrieval, using univariable and multivariable binary logistic regression analysis and the dataset from one centre. This model was then validated using the dataset from the other centre. The area under the receiver-operating characteristic curve (AUC) was calculated and model calibration was assessed.Main Results and the Role Of Chance: There were 599 (43.7%) successful sperm retrievals after a first TESE procedure. The prediction model, built after multivariable logistic regression analysis, demonstrated that higher male age, higher levels of serum testosterone and lower levels of FSH and LH were predictive for successful sperm retrieval. Diagnosis of idiopathic NOA and the presence of an azoospermia factor c gene deletion were predictive for unsuccessful sperm retrieval. The AUC was 0.69 (95% confidence interval (CI): 0.66-0.72). The difference between the mean observed chance and the mean predicted chance was <2.0% in all groups, indicating good calibration. In validation, the model had moderate discriminative capacity (AUC 0.65, 95% CI: 0.62-0.72) and moderate calibration: the predicted probability never differed by more than 9.2% of the mean observed probability.Limitations, Reasons For Caution: The percentage of men with Klinefelter syndrome among men diagnosed with NOA is expected to be higher than in our study population, which is a potential selection bias. The ability of the sperm retrieved to fertilize an oocyte and produce a live birth was not tested.Wider Implications Of the Findings: This model can help in clinical decision-making in men with NOA by reliably predicting the chance of obtaining spermatozoa with TESE.Study Funding/competing Interest: This study was partly supported by an unconditional grant from Merck Serono (to D.D.M.B. and K.F.) and by the Department of Obstetrics and Gynaecology of Radboud University Medical Center, Nijmegen, The Netherlands, the Department of Obstetrics and Gynaecology, Jeroen Bosch Hospital, Den Bosch, The Netherlands, and the Department of Obstetrics and Gynaecology, Academic Medical Center, Amsterdam, The Netherlands. Merck Serono had no influence in concept, design nor elaboration of this study.Trial Registration Number: Not applicable. [ABSTRACT FROM AUTHOR]

OBJETIVO: avaliar a incidência e tipos de malformações congênitas maiores (MCM) em crianças concebidas por injeção intracitoplasmática de espermatozóides (ICSI) e nascidas vivas. MÉTODOS: um total de 680 crianças nasceram vivas de 511 casais submetidos à ICSI no período de janeiro de 1999 a dezembro de 2002. A coleta de dados das crianças foi procedida por meio de questionário padronizado e exame clínico. Dos 511 casais, 366 foram contatados para amostragem de 371 gestações. Das 680 crianças nascidas vivas, 520 foram avaliadas, 250 delas (48,1%) por meio de questionário e 270 (51,9%) por questionário e exame físico. Duzentas e cinqüenta crianças foram de gestação única e 270 de gestação múltipla. Na análise das malformações congênitas foi empregada a 10ª Revisão da Classificação Internacional de Doenças. Nesse estudo foram analisadas apenas as MCM. A incidência de MCM foi comparada à da população geral obtida pelo Estudo Colaborativo Latino-Americano de Malformações Congênitas. A análise estatística foi feita usando o teste do chi2 (nível de significância p0,05), que teve 2,6% de incidência de MCM. As malformações mais freqüentes foram as de origem cardíaca (quatro isoladas e duas associadas), correspondendo a 40% do total. Os outros tipos de MCM foram: renal (três), defeito de fechamento do tubo neural (dois), defeito do crânio (um), lábio leporino (um), genital (um), síndrome de Down (associada à cardiopatia) (dois) e músculo-esquelética (um). Seis MCM ocorreram em crianças provenientes de gestações únicas e nove de gestações múltiplas. CONCLUSÃO: as crianças concebidas por ICSI e nascidas vivas apresentaram incidência de malformações congênitas maiores (2,9%) próximo ao esperado para a população geral (2,6%). Entretanto, para estabelecer com precisão os riscos de MCM é necessária continuidade na avaliação das crianças concebidas por ICSI.PURPOSE: to evaluate the incidence and types of major congenital malformations (MCM) in liveborn children conceived by intracytoplasmic sperm injection (ICSI). METHODS: a total of 680 liveborn children resulted from 511 couples submitted to ICSI from January, 1999 to December, 2002. Data collection of the children was performed through standardized questionnaire and clinical examination. Of the 511 couples, 366 had been contacted for a sampling of 371 gestations. Of the 680 liveborn, 520 had been evaluated, 250 of them (48.1%) through questionnaire and 270 (51.9%) through questionnaire and physical examination. Two hundred and fifty children were from singleton pregnancies and 270 from multiple pregnancies. Malformations were classified according to the 10th revision of the International Statistical Classification of Diseases and Related Health. Only MCM were analyzed in this study. The incidence of MCM was compared with that of the general population obtained by the Latin American Collaborative Study of Congenital Malformations. The statistical analysis was performed by the c² test (level of significance p0.05), which showed 2.6% incidence of MCM. The most frequent malformations were of cardiac origin (four isolated and two associated), corresponding to 40% of the total. The other types of MCM were: renal (three), neural tube (two), skull (one), cleft lip (one), genital (one), Down syndrome (associated with cardiac malformations) (two), and musculoskeletal (one). Six MCM occurred in children from singleton pregnancies and nine in children from multiple pregnancies. CONCLUSION: the liveborn children conceived by ICSI presented incidence of major congenital malformations (2.9%) near to the expected for the general population (2.6%). However, to establish the risks of MCM with precision it is necessary to continue the evaluation of the children conceived by ICSI.

OBJECTIVE: Histological testicular pattern has a predictive role in the possibility of finding spermatozoa for ICSI in cases of non-obstructive azoospermia because some individuals could show residual spermatogenic sites in the testis. The aim of this study was to evaluate the sperm retrieval rate in each of the histopathological groups (hypospermatogenesis-Hypo, spermatogenic maturation arrest-MA, Sertoli cell only-SCO and testicular hyalinization) in patients assisted in our clinic. MATERIALS AND METHODS: Retrospective study from March 1997 to October 2002. We analyzed 14 patients with mean age of 34.3 ± 0.7, with non-obstructive azoospermia. All patients were submitted to previous diagnostic biopsy (Bx) elsewhere and came to our institution for treatment. After an average of 12 months (8 - 20), they were submitted to a new Bx procedure to retrieve sperm. RESULTS: Previous diagnostic Bx showed the following histopathological results: 5 patients with MA, 4 with Hypo and 5 SCO. In the following Bx (for sperm retrieval) spermatozoa was found in 33% of the procedures in patients with MA, 50% in patients with Hypo and 40% of the procedures in patients with SCO. CONCLUSION: Previous diagnostic Bx can help in patient counseling concerning the result of sperm retrieval.

Background: To compare the pregnancy outcomes after two embryos versus three embryos transfers (ETs) in women undergoing in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) cycles. Materials and Methods: This retrospective study was performed on three hundred eighty seven women with primary infertility and with at least one fresh embryo in good quality in order to transfer at each IVF/ICSI cycle, from September 2006 to June 2010. Patients were categorized into two groups according to the number of ET as follows: ET2 and ET3 groups, indicating two and three embryos were respectively transferred. Pregnancy outcomes were compared between ET2 and ET3 groups. Chi square and student t tests were used for data analysis. Results: Clinical pregnancy and live birth rates were similar between two groups. The rates of multiple pregnancies were 27 and 45.2% in ET2 and ET3 groups, respectively. The rate of multiple pregnancies in young women was significantly increased when triple instead of double embryos were transferred. Logistic regression analysis indicated two significant prognostic variables for live birth that included number and quality of transferred embryos; it means that the chance of live birth following ICSI treatment increased 3.2-fold when the embryo with top quality (grade A) was transferred, but the number of ET had an inverse relationship with live birth rate; it means that probability of live birth in women with transfer of two embryos was three times greater than those who had three ET. Conclusion: Due to the difficulty of implementation of the elective single-ET technique in some infertility centers in the world, we suggest transfer of double instead of triple embryos when at least one good quality embryo is available for transfer in women aged 39 years or younger. However, to reduce the rate of multiple pregnancies, it is recommended to consider the elective single ET strategy. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the pregnancy outcomes of those patients with balanced reciprocal translocations after conventional in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI), and to provide valuable reference for genetic counseling and assisted reproductive technology (ART) treatment. Methods: Forty- one patients with balanced reciprocal translocation (the study group) and 751 couples with normal karyotypes (the control group) were included. Clinical pregnancy outcomes were compared between the two groups. Results: In the study group, 24 patients were treated with IVF, while other patients treated with ICSI. Additionally, 28 patients were diagnosed as primary infertility, and 11 patients had a history of adverse pregnancy or childbearing. There were not significant differences in the maternal age, number of retrieved oocytes, number of M II oocytes, number of transferred embryo, clinical pregnancy rate, late abortion rate, ectopic pregnancy rate, fetal malformation rate, stillbirth rate, live birth rate, live birth rate per ovum pick-up (OPU) cycle between the two groups (P>0.05). However, there was significant differences in the embryo implantation rate and early miscarriage rate (P<0.05). Nineteen patients in the study group delivered a total of 22 babies in 27 pregnancy cycles. Conclusions: Those balanced reciprocal translocation carrier could achieve an ideal pregnancy outcome when treated with conventional IVF/ICSI and prenatal diagnosis which is an economical and effective treatment for those patients. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effect of the collected oocytes by controlled ovarian stimulation (COS, long GnRHa protocol) on the clinical outcomes of intracytoplasmic sperm injection (ICSI). Methods: All couples (1 042 cycles) who underwent ICSI because of male factor were involved in this retrospective study, from January 2007 to June 2013 in our center. Those cycles were divided into 4 groups according to the number of collected oocytes: G1 as ≤4 oocytes(90 cycles), G2 as 5-10(368 cycles), G3 as 11-20 oocytes(449 cycles) and G4 as ≥21 oocytes (135 cycles). Results: In the ICSI treatment cycle, the mean age in G1 was highest among 4 groups (P<0.01), while 57.8% women were aged <35. The total fertilization failure(TFF) rate in G1, the ovarian hyperstimulation syndrome (OHSS) rate in G4 and the rates of cancelled transfer cycles in G1 and G4 were significantly higher than those in G2 and G3 (P<0.01). The rate of clinical pregnancy in G1 was the lowest in 4 groups (31.3%, P<0.05). The rate of clinical pregnancy, the implant rate and the live birth rate in G3 were the highest in 4 groups (P<0.05). Conclusions: In the ICSI treatment cycle, the number of collected oocytes lower than 4 has negative effect on fertilization; the collected oocytes between 11 to 20 have good clinical outcomes. [ABSTRACT FROM AUTHOR]

The motile sperm organelle morphology examination (MSOME), a morphological analysis of isolated motile spermatozoa in real-time at more than 6 000 times magnification, can help embryologist to select those sperms with normal morphology for intracytoplasmic sperm injection (ICSI). MOSME is a very special method to identify sperm head vacuoles. What are sperm vacuoles? Whether may sperm vacuoles influence the outcome of ART? This article reviewed those characteristics of sperm vacuoles as follows: (1)Vacuoles were commonly found in sperm head; (2)Vacuoles were distributed more frequently in the anteromedian region of sperm head; (3)There were different types of vacuoles; (4)The origin of sperm vacuoles was still unsure; (4)There were correlation in a certain extent between sperm vacuoles and routine semen parameters. It was found, although unasserted, that sperm vacuoles were positively correlated with abnormal chromatin condensation, DNA fragmentation rate, and aneuploid rate; (6)Spern vacuoles could lead to the lowed fertilization rate, the lowed rate of high-qualified embryo, and the lowed rate of clinical pregnancy specially. [ABSTRACT FROM AUTHOR]