新鮮胚胎植入未懷孕, 下一周期即可準備冷凍胚胎植入, 不須多休息1個月再植 入

Fertil Steril. 2016 Jan 21. pii: S0015-0282(16)00006-6. doi: 10.1016/j.fertnstert.2015.12.140. [Epub ahead of print]

To delay or not to delay a frozen embryo transfer after a failed fresh embryo transfer attempt?

Santos-Ribeiro S1, Siffain J2, Polyzos NP3, van de Vijver A2, van Landuyt L2, Stoop D2, Tournaye H2, Blockeel C2.

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Abstract

OBJECTIVE:

To evaluate if increasing the interval between a failed fresh embryo transfer and a subsequent frozen embryo transfer (FET) cycle has any effect on clinical pregnancy rates (CPRs).

DESIGN:

Retrospective cohort study.

SETTING:

University-based tertiary referral center.

PATIENT(S):

Women who underwent at least one FET after ovarian stimulation for in vitro fertilization (IVF) and a failed fresh embryo transfer attempt from January 2010 to November 2014. We divided our sample according to the "timing" of the first FET (TF-FET), defined by the interval between oocyte retrieval and the FET cycle start date. The start of the FET was classified as either immediate (≤22 days after oocyte retrieval) or delayed (>22 days after oocyte retrieval).

INTERVENTION(S):

None.

MAIN OUTCOME MEASURE(S):

CPR after the first FET.

RESULT(S):

A total of 1,183 FET cycles (performed in 1,087 women) were included in our study. No significant differences were found between the immediate and delayed FET groups regarding age, number of oocytes retrieved, number of good-quality embryos produced, embryo developmental stage at FET, and number of frozen embryos transferred. Most importantly, the CPRs of the first FET did not differ significantly according to the TF-FET (32.5% after immediate FET vs. 31.7% after delayed FET), even after adjusting for potential confounding with the use of multivariable logistic regression.

CONCLUSION(S):

FETs performed immediately after fresh IVF cycles had CPRs similar to those postponed to a later time. Therefore, deferring FETs may unnecessarily prolong time to pregnancy.

胚胎切片TEcell 5個細胞即足夠
品質較差之囊胚期胚胎(B 或C級)施行胚胎切片TEcell較多(>6個細胞)，雖不影響其囊胚存活率卻可能會影響其著床率

Fertil Steril. 2016 Jan 25. pii: S0015-0282(16)00046-7. doi: 10.1016/j.fertnstert.2016.01.011. [Epub ahead of print]

The number of biopsied trophectoderm cells is likely to affect the implantation potential of blastocysts with poor trophectoderm quality.

Zhang S1, Luo K2, Cheng D1, Tan Y2, Lu C2, He H3, Gu Y2, Lu G4, Gong F2, Lin G5.

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Abstract

OBJECTIVE:

To evaluate whether the developmental potential of the blastocyst is affected by the number of trophectoderm (TE) cells biopsied in preimplantation genetic diagnosis (PGD) cycles.

DESIGN:

Retrospective study.

SETTING:

University-affiliated center.

PATIENT(S):

Women underwent PGD cycles of blastocyst biopsy and fluorescence in situ hybridization analysis.

INTERVENTION(S):

Not applicable.

MAIN OUTCOME MEASURE(S):

Biopsied TE cell number of blastocysts, survival, and implantation rates.

RESULT(S):

The biopsied TE cell number was affected by the TE quality and experience of different embryologists. The diagnostic efficiency increased when from one to five cells were biopsied (86.7%, 91.7%%, 96.0%, 96.8%, to 98.7%) and was maximized when more than six cells were biopsied. To compare the clinical efficiencies, blastocysts were divided into four groups according to biopsied TE cell number: 1-5, 6-10, 11-15, and 16-41. For the blastocysts with grade A TE score, no significant difference was observed in the survival and implantation rates among the four groups. For the blastocysts with grades B and C TE scores, the survival rates showed no significant differences among the four groups, but a significant decreasing trend in implantation rates was observed with increasing biopsied TE cell number.

Aspirin可能會提高懷孕早期絨毛膜下血腫之機率

Fertil Steril. 2016 Jan 25. pii: S0015-0282(16)00044-3. doi: 10.1016/j.fertnstert.2016.01.009. [Epub ahead of print]

Subchorionic hematomas are increased in early pregnancy in women taking low-dose aspirin.

Truong A1, Sayago MM2, Kutteh WH3, Ke RW4.

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Abstract

OBJECTIVE:

To determine the frequency of subchorionic hematomas (SCH) in first-trimester ultrasound examinations of patients with infertility and recurrent pregnancy loss (RPL) and in patients from a general obstetric population. To determine if the method of assisted reproduction utilized or the use of anticoagulants, such as heparin and aspirin (ASA), influenced frequency of SCH.

DESIGN:

Prospective, cohort study.

SETTING:

Fertility clinic and general obstetrics clinic.

PATIENT(S):

Five hundred and thirty-three women who were pregnant in the first-trimester.

INTERVENTIONS:

Not applicable.

MAIN OUTCOME MEASURE(S):

Frequencies of subchorionic hematomas in women based on diagnosis, use of anticoagulants, and fertility treatment.

RESULT(S):

SCH were identified in 129/321 (40.2%) in the study group compared to 23/212 (10.9%) in the control group. Fertility diagnosis and the use of heparin did not appear to affect the frequency of SCH in the first trimester; however, SCH occurred at an almost four-fold increase in patients taking ASA compared to those not taking ASA, regardless of fertility diagnosis or method of fertility treatment.

CONCLUSION(S):

The use of ASA may be associated with an increased risk of developing a SCH during the first trimester. The increased frequencies of SCH in pregnancies of patients attending a fertility clinic compared to women from a general obstetrical practice was highly correlated with the use of ASA.

植入胚胎之細胞數會影響植入後12天偵測HCG之濃度
細胞數越多, HCG濃度越高
取出卵子數越多(>20), HCG濃度越低???

Hum Reprod. 2015 Dec;30(12):2758-63. doi: 10.1093/humrep/dev269. Epub 2015 Oct 27.

Maternal hCG concentrations in early IVF pregnancies: associations with number of cells in the Day 2 embryo and oocytes retrieved.

Tanbo TG1, Eskild A2.

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Abstract

STUDY QUESTION:

Do number of cells in the transferred cleavage stage embryo and number of oocytes retrieved for IVF influence maternal hCG concentrations in early pregnancies?

SUMMARY ANSWER:

Compared with transfer of a 2-cell embryo, transfer of a 4-cell embryo results in higher hCG concentrations on Day 12 after transfer, and more than 20 oocytes retrieved were associated with low hCG concentrations.

WHAT IS KNOWN ALREADY:

Maternal hCG concentration in very early pregnancy varies considerably among women, but is likely to be an indicator of time since implantation of the embryo into the endometrium, in addition to number and function of trophoblast cells.

STUDY DESIGN, SIZE, DURATION:

We followed 1047 pregnancies after IVF/ICSI from oocyte retrieval until Day 12 after embryo transfer. Women were recruited in Norway during the years 2005-2013.

PARTICIPANTS/MATERIALS, SETTING, METHODS:

Successful pregnancies after transfer of one single embryo that had been cultured for 2 days were included. Maternal hCG was quantified on Day 12 after embryo transfer by chemiluminescence immunoassay, which measures intact hCG and the free β-hCG chain. Information on a successful pregnancy, defined as birth after >16 weeks, was obtained by linkage to the Medical Birth Registry of Norway.

MAIN RESULTS AND THE ROLE OF CHANCE:

Transfer of a 4-cell embryo resulted in higher maternal hCG concentrations compared with transfer of a 2-cell embryo (134.8 versus 87.8 IU/l, P < 0.05). A high number of oocytes retrieved (>20) was associated with low hCG concentrations (P < 0.05).

卵細胞Ca離子穩定攸關卵子受孕之過程
卵細胞細胞膜上之K+離子ATP閥可控制Ca離子之進出進而影響Ca離子穩定
Pinacidil and glibenclamide可控制K+離子ATP閥，進而維持卵子細胞內Ca離子穩定

Hum Reprod. 2016 Feb;31(2):287-97. doi: 10.1093/humrep/dev300. Epub 2015 Dec 18.

A spontaneous increase in intracellular Ca2+ in metaphase II human oocytes in vitro can be prevented by drugs targeting ATP-sensitive K+ channels.

Fernandes G1, Dasai N1, Kozlova N1, Mojadadi A2, Gall M3, Drew E3, Barratt E3, Madamidola OA4, Brown SG5, Milne AM1, Martins da Silva SJ6, Whalley KM3,Barratt CL6, Jovanović A7.

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Abstract

STUDY QUESTION:

Could drugs targeting ATP-sensitive K(+) (KATP) channels prevent any spontaneous increase in intracellular Ca(2+) that may occur in human metaphase II (MII) oocytes under in vitro conditions?

SUMMARY ANSWER:

Pinacidil, a KATP channel opener, and glibenclamide, a KATP channel blocker, prevent a spontaneous increase in intracellular Ca(2+) in human MII oocytes.

WHAT IS KNOWN ALREADY:

The quality of the oocyte and maintenance of this quality during in vitro processing in the assisted reproductive technology (ART) laboratory is of critical importance to successful embryo development and a healthy live birth. Maintenance of Ca(2+) homeostasis is crucial for cell wellbeing and increased intracellular Ca(2+) levels is a well-established indicator of cell stress.

STUDY DESIGN, SIZE, DURATION:

Supernumerary human oocytes (n = 102) collected during IVF/ICSI treatment that failed to fertilize were used from October 2013 to July 2015. All experiments were performed on mature (MII) oocytes. Dynamics of intracellular Ca(2+) levels were monitored in oocytes in the following experimental groups: (i) Control, (ii) Dimethyl sulfoxide (DMSO; used to dissolve pinacidil, glibenclamide and 2,4-Dinitrophenol (DNP)), (iii) Pinacidil, (iv) Glibenclamide, (v) DNP: an inhibitor of oxidative phosphorylation, (vi) Pinacidil and DNP and (vii) Glibenclamide and DNP.

PARTICIPANTS/MATERIALS/SETTINGS/METHODS:

Oocytes were collected under sedation as part of routine treatment at an assisted conception unit from healthy women (mean ± SD) age 34.1 ± 0.6 years, n = 41. Those surplus to clinical use were donated for research. Oocytes were loaded with Fluo-3 Ca(2+)-sensitive dye, and monitored by laser confocal microscopy for 2 h at 10 min intervals. Time between oocyte collection and start of Ca(2+) monitoring was 80.4 ± 2.1 h.

MAIN RESULTS AND THE ROLE OF CHANCE:

Intracellular levels of Ca(2+) increased under in vitro conditions with no deliberate challenge, as shown by Fluo-3 fluorescence increasing from 61.0 ± 11.8 AU (AU = arbitrary units; n = 23) to 91.8 ± 14.0 AU (n = 19; P < 0.001) after 2 h of monitoring. Pinacidil (100 µM) inhibited this increase in Ca(2+) (85.3 ± 12.3 AU at the beginning of the experiment, 81.7 ± 11.0 AU at the end of the experiment; n = 13; P = 0.616). Glibenclamide (100 µM) also inhibited the increase in Ca(2+) (74.7 ± 10.6 AU at the beginning and 71.8 ± 10.9 AU at the end of the experiment; n = 13; P = 0.851. DNP (100 mM) induced an increase in intracellular Ca(2+) that was inhibited by glibenclamide (100 µM; n = 9) but not by pinacidil (100 µM; n = 5).

約15%精液內有HPV病毒
2%為高危險HPV病毒
但HPV病毒與精液品質無關

Hum Reprod. 2016 Feb;31(2):280-6. doi: 10.1093/humrep/dev317. Epub 2016 Jan 2.

Presence of human papillomavirus in semen in relation to semen quality.

Luttmer R1, Dijkstra MG2, Snijders PJ1, Hompes PG2, Pronk DT1, Hubeek I3, Berkhof J4, Heideman DA1, Meijer CJ5.

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Abstract

STUDY QUESTION:

Is the presence of human papillomavirus (HPV) in semen associated with impairment of semen quality?

SUMMARY ANSWER:

In a large cohort of males seeking fertility evaluation, no associations were observed between seminal HPV presence and semen parameters.

WHAT IS KNOWN ALREADY:

HPV is commonly detected in semen samples. Whether the presence of HPV is related to impairment of semen quality, remains unclear.

STUDY DESIGN, SIZE, DURATION:

This cross-sectional study included a cohort of 430 males.

PARTICIPANTS/MATERIALS, SETTING, METHODS:

Male partners in couples seeking fertility evaluation provided one semen sample per person. Semen samples were tested for HPV-DNA using GP5+/6+-PCR. Sperm concentration was counted and motility was assessed in a Makler counting chamber at a magnification of ×200. The presence of antisperm antibodies was assessed by a mixed agglutination reaction (MAR)-test.

MAIN RESULTS AND THE ROLE OF CHANCE:

Overall HPV was detected in 14.9% (64/430) of semen samples, including 2.1% (9/430) that contained both high-risk (hr) HPV and low-risk (lr) HPV types, 8.8% (38/430) with exclusively hrHPV types and 4.0% (17/430) with exclusively lrHPV types. The presence of HPV in semen was not associated with the age of the participants, seminal pH, semen volume, total sperm count, sperm concentration, progressive motility or the presence of antisperm antibodies.

原始濾泡取出之時間點, 濾泡期或黃體期並無明顯差異
傳統月經來才可誘導排卵可能並非鐵律

Hum Reprod. 2016 Jan 11. pii: dev325. [Epub ahead of print]

Similar in vitro maturation rates of oocytes retrieved during the follicular or luteal phase offer flexible options for urgent fertility preservation in breast cancer patients.

Grynberg M1, Poulain M2, le Parco S3, Sifer C4, Fanchin R5, Frydman N2.

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Abstract

STUDY QUESTION:

Are in vitro maturation (IVM) rates of cumulus-oocyte complexes (COCs), retrieved from breast cancer patients seeking urgent fertility preservation (FP) before neoadjuvant chemotherapy, different between those recovered in the follicular or in the luteal phase of the cycle?

SUMMARY ANSWER:

The present investigation reveals no major difference in the number of COCs recovered or their IVM rates whatever the phase of the cycle at which egg retrieval is performed, suggesting that IVM is a promising tool for breast cancer patients seeking urgent oocyte cryopreservation.

WHAT IS KNOWN ALREADY:

FP now represents a standard of care for young cancer patients having to undergo gonadotoxic treatment. Mature oocyte cryopreservation after IVM of COCs has been proposed for urgent FP, especially in women, who have no time to undergo ovarian stimulation, or when it is contraindicated.

STUDY DESIGN, SIZE, DURATION:

From January 2011 to December 2014, we prospectively studied 248 breast cancer patients awaiting neoadjuvant chemotherapy, aged 18-40 years, candidates for oocyte vitrification following IVM, either at the follicular or the luteal phase of the cycle.

PARTICIPANTS/MATERIALS, SETTING, METHODS:

Serum anti-Müllerian hormone and progesterone levels and antral follicle count (AFC) were measured prior to oocyte retrieval. Patients were sorted into two groups according to the phase of the cycle during which eggs were harvested (Follicular phase group, n = 127 and Luteal phase group, n = 121). Number of COCs recovered, maturation rates after 48 h of culture and total number of oocytes cryopreserved were assessed. Moreover, the oocyte retrieval rate (ORR) was calculated by the number of COCs recovered ×100/AFC.

MAIN RESULTS AND THE ROLE OF CHANCE:

In the Follicular and the Luteal phase groups, women were comparable in terms of age, BMI and markers of follicular ovarian status. There was no significant difference in the number of COCs recovered (mean ± SEM), 9.3 ± 0.7 versus 11.1 ± 0.8, and ORR (median (range)) 43.1 (1-100) versus 47.8 (7.7-100)%. Moreover, maturation rates after 48 h of culture (median (range)) were comparable in the follicular and luteal phase groups, 66.7 (20-100) versus 64.5 (0-100)%. Finally, the total number of oocytes cryopreserved (mean ± SEM) was similar in both groups (6.2 ± 0.4 versus 6.8 ± 0.5).

76%胚胎植入後1小時內會緩慢朝向子宮頂移動
胚胎最後位置在距子宮頂1.5cm內可達較佳懷孕率

Hum Reprod. 2016 Jan 11. pii: dev343. [Epub ahead of print]

Assessment of the embryo flash position and migration with 3D ultrasound within 60 min of embryo transfer.

Saravelos SH1, Wong AW1, Chan CP1, Kong GW1, Cheung LP1, Chung CH1, Chung JP1, Li TC2.

Author information

Abstract

STUDY QUESTION:

Does the air bubble (embryo flash) position and migration as visualized with 3D ultrasound (US) within 60 min of embryo transfer correlate with clinical outcome following fresh ART transfer cycles?

SUMMARY ANSWER:

The location of the embryo flash and the direction of its movement at 60 min, but not at 1 or 5 min after transfer, are associated with clinical pregnancy.

WHAT IS KNOWN ALREADY:

Studies assessing the relation between the pregnancy rate and the position of the catheter tip and/or the position of the air bubbles following embryo transfer show conflicting results to date.

STUDY DESIGN, SIZE AND DURATION:

This was a prospective cohort study including 277 infertile women undergoing ART between July 2011 and August 2013.

PARTICIPANTS/MATERIALS, SETTING AND METHODS:

Good prognosis patients undergoing fresh ART cycles within a single tertiary University unit were assessed by 3D US at 1, 5 and 60 min after embryo transfer. The distance of the embryo flash from the fundus was measured at these time points, along with the direction of the embryo flash movement within 60 min of transfer.

MAIN RESULTS AND THE ROLE OF CHANCE:

Within 60 min of embryo transfer, 76.4% (198/259) of the embryo flashes migrated towards the fundus, 12.4% (32/259) migrated towards the cervix and 11.2% (29/259) remained static. There was no significant association between the embryo position or movement and the pregnancy rate at 1 and 5 min. At 60 min, however, the pregnancy and implantation rates among subjects with embryo flashes located <15 mm from the fundus was significantly higher than those with embryo flashes located >15 mm from the fundus (46.5 and 32.8% versus 25.8 and 18.2%, respectively; P < 0.05). The pregnancy and implantation rates when the embryo flash was seen moving towards the cervix (25.0 and 15.0%) was significantly lower (P < 0.05 and P < 0.01, respectively) compared with those remaining static (55.2 and 37.7%) or moving towards the fundus (45.5 and 32.8%).

ICSI後卵細胞內Ca濃度會上升
若Ca濃度無上升, 與ICSI後卵無法受孕分裂有關
ICSI溶液添加recombinant phospholipase Czeta (PLCζ)可提高Ca濃度進而提高卵受孕率

Mol Hum Reprod. 2015 Oct;21(10):783-91. doi: 10.1093/molehr/gav042. Epub 2015 Jul 17.

Rescue of failed oocyte activation after ICSI in a mouse model of male factor infertility by recombinant phospholipase Cζ.

Sanusi R1, Yu Y2, Nomikos M1, Lai FA1, Swann K3.

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Abstract

Artificial oocyte activation to overcome failed fertilization after intracytoplasmic sperm injection (ICSI) in human oocytes typically employs Ca(2+) ionophores to produce a single cytosolic Ca(2+) increase. In contrast, recombinant phospholipase Czeta (PLCζ) causes Ca(2+) oscillations indistinguishable from those occurring during fertilization, but remains untested for its efficacy in a scenario of ICSI fertilization failure. Here, we compare PLCζ with other activation stimuli in a mouse model of failed oocyte activation after ICSI, in which heat-treated sperm are injected into mouse oocytes. We show that increasing periods of 56 °C exposure of sperm produces a progressive loss of Ca(2+) oscillations after ICSI. The decrease in Ca(2+) oscillations produces a reduction in oocyte activation and embryo development to the blastocyst stage. We treated such oocytes that failed to activate after ICSI either with Ca(2+) ionophore, or with Sr(2+) media which causes Ca(2+) oscillations, or we injected them with recombinant human PLCζ. All these treatments rescued oocyte activation, although Sr(2+) and PLCζ gave the highest rates of development to blastocyst. When recombinant PLCζ was given to oocytes previously injected with control sperm, they developed normally to the blastocyst stage at rates similar to that after control ICSI. The data suggest that recombinant human PLCζ protein is an efficient means of rescuing oocyte activation after ICSI failure and that it can be effectively used even if the sperm already contains endogenous Ca(2+) releasing activity.

低劑量hCG(125iu/d)可用於黃體期補充賀爾蒙

可取代傳統黃體素補充賀爾蒙

hCG可明顯提高P4濃度(compare to controls)

Hum Reprod. 2015 Oct;30(10):2387-95. doi: 10.1093/humrep/dev184. Epub 2015 Jul 23.

Daily low-dose hCG stimulation during the luteal phase combined with GnRHa triggered IVF cycles without exogenous progesterone: a proof of concept trial.

Andersen CY1, Elbaek HO2, Alsbjerg B3, Laursen RJ2, Povlsen BB2, Thomsen L3, Humaidan P3.

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Abstract

STUDY QUESTION:

Can the luteal phase support be improved in terms of efficacy, hormonal profiles and convenience as compared with today's standard care?

SUMMARY ANSWER:

Daily low-dose rhCG supplementation in GnRHa triggered IVF cycles can replace the traditional used luteal phase support with exogenous progesterone.

WHAT IS KNOWN ALREADY:

A bolus of hCG for final maturation of follicles in connection with COS may induce the risk of OHSS and the luteal phase progesterone levels rise very abruptly in the early luteal phase.

STUDY DESIGN, SIZE, DURATION:

This is a proof-of-concept study conducted as a three arm RCT with a total of 93 patients. First patient enrolled in January 2012 and the study finished in January 2014.

PARTICIPANTS/MATERIALS, SETTING, METHODS:

Normal responder women undergoing IVF/ICSI treatment in a university hospital. One arm served as control, where women followed a standard antagonist protocol. Two study arms were included both having 125 IU hCG daily for luteal phase support without exogenous progesterone after using a GnRHa trigger for ovulation induction. In both study arms exogenous FSH was stopped on stimulation day 6 and replaced by exogenous hCG that was initiated on either stimulation day 2 or day 6. Blood samples were obtained on the day of ovulation induction, on the day of oocyte pickup (OPU) and day OPU + 7.

MAIN RESULTS AND THE ROLE OF CHANCE:

The mean serum levels of hCG did not exceeded the normal physiological range of LH activity in any samples. Mid-luteal progesterone levels were significantly higher in the two study groups receiving daily low-dose hCG for luteal phase support as compared with the control group (control group: 177 ± 27 nmol/l; study group 1: 334 ± 42 nmol/l; study group 2: 277 ± 27 nmol/l; (mean ± SEM). No differences in reproductive outcome were seen between groups.

捐卵者使用排卵藥於誘導排卵達施打破卵針
可防止LH
減少排卵針劑量
減少GnRHantagonist使用
不影響懷孕率

J Hum Reprod Sci. 2015 Jul-Sep;8(3):142-5. doi: 10.4103/0974-1208.165151.

Clomiphene based ovarian stimulation in a commercial donor program.

Gupta S1, Satwik R1, Majumdar A1, Mittal S1, Tiwari N1.

Author information

Abstract

OBJECTIVE:

This study was conducted to compare an extended clomiphene-based ovarian stimulation regimen with the conventional antagonist protocol in donor-recipient cycles.

MATERIALS AND METHODS:

A total of 170 (N) donors were stimulated between January 2013 and December 2013. Conventional antagonist protocol (group I) was employed in (n1 = 31) cycles, and clomiphene was used in (n2 = 139) donor cycles (group II). 50 mg clomiphene was given simultaneously with gonadotropins from day 2 of the cycle until the day of trigger. The analysis was performed retrospectively for oocytes retrieved, fertilization rates, cycle cancelation, blastocyst formation, and pregnancy rates. The dosages, cost, and terminal E2 (estradiol) were also compared between the two groups.

RESULTS:

The donor age groups were comparable in both the groups. There were no unsuccessful egg retrievals with clomiphene. The pregnancy rate (positive beta human chorionic gonadotropin) was significantly higher in the clomiphene group (odds ratio: 2.453; P = 0.02). Similarly, fertilization rate was significantly higher in the clomiphene group (59.5/50.5, P = 0.04). Eggs retrieved were similar in both groups, but the terminal E2 was significantly higher in the clomiphene group (P = 0.001). Average gonadotropin used was also significantly lower in clomiphene group (P < 0.001).

CONCLUSION:

Clomiphene can effectively prevent luteinizing hormone surge and limit the dose of gonadotropins thus bringing down the costs and its negative impact on the endometrium and oocyte quality.

男性高齡並不明顯影響IVF懷孕率及活產率

Hum Reprod. 2014 Oct 10;29(10):2114-22. doi: 10.1093/humrep/deu189. Epub 2014 Jul 28.

Paternal age and assisted reproductive outcomes in ICSI donor oocytes: is there an effect of older fathers?

Beguería R1, García D2, Obradors A1, Poisot F1, Vassena R3, Vernaeve V4.

Author information

Abstract

STUDY QUESTION:

Does paternal age affect semen quality and reproductive outcomes in oocyte donor cycles with ICSI?

SUMMARY ANSWER:

Paternal age is associated with a decrease in sperm quality, however it does not affect either pregnancy or live birth rates in reproductive treatments when the oocytes come from donors <36 years old and ICSI is used.

WHAT IS KNOWN ALREADY:

The weight of evidence suggest that paternal age is associated with decreasing sperm quality, but uncertainty remains as to whether reproductive outcomes are affected. Although developed to treat severe sperm factor infertility, ICSI is gaining popularity and is often used even in the presence of mild male factor infertility.

STUDY DESIGN, SIZE, DURATION:

A retrospective cohort study spanning the period between February 2007 and June 2010. A total of 4887 oocyte donation cycles were included.

PARTICIPANTS/MATERIALS, SETTING, METHODS:

Fertilization was carried out by ICSI in all cycles included, and the semen sample used was from the male partner in all cases. The association of male age with semen parameters (volume, concentration, percentage of motile spermatozoa) was analyzed by multiple analysis of covariance. The association of male age with reproductive outcomes (biochemical pregnancy, miscarriage, ongoing pregnancy and live birth rate) was modeled by logistic regression, where the following covariates were introduced: donor age, recipient age, semen state (fresh versus frozen) and number of transferred embryos (3 and 2 versus 1).

MAIN RESULTS AND THE ROLE OF CHANCE:

We identified a significant relationship between paternal age and all sperm parameters analyzed: for every 5 years of age, sperm volume decreases by 0.22 ml (P < 0.001), concentration increases by 3.1 million sperm/ml (P = 0.003) and percentage motile spermatozoa decreases by 1.2% (P < 0.001). No differences were found in reproductive outcomes (biochemical pregnancy, miscarriage, clinical pregnancy, ongoing pregnancy and live birth) among different male age groups.

男性捐精者年齡對IVF影響不大
男性高齡無明顯影響IVF流產率

Hum Reprod. 2016 Jan 12. pii: dev331. [Epub ahead of print]

Does age of the sperm donor influence live birth outcome in assisted reproduction?

Ghuman NK1, Mair E2, Pearce K3, Choudhary M4.

Author information

Abstract

STUDY QUESTION:

Does age of the sperm donor have an effect on reproductive outcomes (live birth rate and miscarriage occurrence) of donor insemination or in vitro fertilization treatment using donated sperm?

SUMMARY ANSWER:

Live birth and miscarriage occurrence in assisted reproduction treatment using donor sperms was not found to be affected by the age of sperm donors up to 45 years old.

WHAT IS ALREADY KNOWN:

Literature on the effect of sperm donor age on outcome of medically assisted reproduction is scarce. Most researchers agree that semen parameters deteriorate with increasing paternal age. However, there is no substantial evidence to suggest that this deterioration adversely affects the reproductive outcomes in couples undergoing medically assisted reproduction.

STUDY DESIGN, SIZE, DURATION:

This retrospective cohort study analysed 46 078 first donor insemination treatments and fresh in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) cycles using donated sperm from 1991 to 2012.

PARTICIPANTS/ DURATION/METHODS:

The first fresh donor insemination and IVF/ICSI treatment cycles (46 078 treatment cycles) using donated sperm from the long-term anonymized data registry from 1991 to 2012 of the HFEA, the UK regulator, were analysed by the binary logistic modelling technique for association between sperm donor age and reproductive outcomes (live birth occurrence and miscarriage occurrence). The statistical package SPSS (version 21) was used for analysis and results were considered to be statistically significant if the P-value was <0.05.

MAIN RESULTS AND THE ROLE OF CHANCE:

Of 46 078 women, 84.6% (N = 38 974) underwent donor insemination treatment and the remainder, 15.4% (N = 7104), had IVF/ICSI treatment with donor sperm. The live birth occurrence decreased with increasing female age in both treatment groups; In the donor insemination treatment group, it was 11.1% in 18-34 year old women, 8.3% in 35-37 year old women and 4.7% in 38-50 year old women. The corresponding figures in the IVF/ICSI treatment group were 28.9, 22.0 and 12.9% respectively. In each of these subgroups, no evidence of declining likelihood of live birth with increasing sperm donor age was found (P > 0.05). The miscarriage occurrence (i.e. number of miscarriages per 100 women commencing treatment) was 1.3% in 18-34 year old women, 1.9% in 35-37 year old women and 1.9% in 38-50 year old women undergoing donor insemination treatment. In the sperm donation IVF/ICSI treatment group, these figures were 5.7, 8.4 and 6.8% respectively. The results were not suggestive of any unfavourable effect of advancing sperm donor age on the odds of miscarriage occurrence (P > 0.05).