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Biomedical subjects

H Tournaye

Publications and source records attributed to H Tournaye.

At least 109 records · Page 6Linked to original sources
PubMed1995

Ongoing pregnancies and birth after intracytoplasmic sperm injection with frozen-thawed epididymal spermatozoa.

In seven patients who did not become pregnant following microsurgical epididymal sperm aspiration (MESA) and intracytoplasmic sperm injection (ICSI), a subsequent ICSI was performed using previously cryopreserved super-numerary epididymal spermatozoa without re-operating on the husband. During the original MESA procedure a mean sperm concentration of 12.3 x 10(6)/ml was achieved. The supernumerary spermatozoa were cryopreserved for later use. After thawing frozen epididymal spermatozoa a mean concentration of 1.9 x 10(6) spermatozoa/ml was obtained in straws containing a total volume of sperm suspension of 250 microliters. From 68 intact oocytes injected with frozen-thawed epididymal spermatozoa, a two pronuclear fertilization rate of 45% and a cleavage rate of 82% were obtained. A total of 17 embryos were replaced in the seven patients, resulting in two ongoing singleton pregnancies and one twin delivery. Six embryos were cryopreserved. In conclusion, it would appear mandatory to cryopreserve supernumerary spermatozoa during a MESA in order to avoid subsequent further scrotal surgery.

Adult↗
PubMed1995

The result of intracytoplasmic sperm injection is not related to any of the three basic sperm parameters.

High success rates have been reported for the use of intracytoplasmic sperm injection (ICSI) in alleviating essentially andrological infertility. However, neither the relationship between any of the sperm parameters and the result of ICSI nor the minimal sperm requirements for ICSI have been investigated so far. In this paper, our objective was therefore to study the relationship between three basic sperm parameters (total sperm count, sperm motility and morphology) and the outcome of ICSI by retrospective analyses of fertilization, embryo development and pregnancy rates in 966 micro-injection cycles, performed with ejaculated semen. The results showed that there was no important influence from either the type or the extent of sperm impairment on the outcome of ICSI. Even in the most extreme cases of male-factor infertility, where cryptozoospermia or total astheno- or total teratozoospermia was diagnosed in the initial semen sample, high fertilization and pregnancy rates were obtained by ICSI. Only one condition had a strongly negative influence on the result of ICSI: where an immotile (presumably dead) spermatozoon was injected into the oocyte. Thus the only ultimate criterion for successful ICSI is the presence of at least one living spermatozoon per oocyte in the pellet of the treated semen sample used for micro-injection.

Cytoplasm↗
PubMed1995

The use of epididymal and testicular spermatozoa for intracytoplasmic sperm injection: the genetic implications for male infertility.

The results and rationale of using testicular and epididymal spermatozoa with intracytoplasmic sperm injection (ICSI) for severe cases of male infertility are reviewed. A total of 72 consecutive microsurgical epididymal sperm aspiration (MESA) cases were performed for congenital absence of the vas (CAV) and for irreparable obstructive azoospermia. ICSI was used to obtain normal embryos for transfer and fertilization in 90% of the cases. The overall fertilization rate was 46% with a normal cleavage rate of 68%. The pregnancy and delivery rates per transfer were 58 and 37% respectively. The delivery rate per cycle was 33%. In many cases, no epididymal spermatozoa were available and so testicular sperm extraction (TESE) was used for sperm retrieval. The transfer rate was lower with TESE (84 versus 96%) and the spermatozoa could not be frozen and saved for use in future cycles. However, there was little difference in pregnancy rates using epidiymal or testicular spermatozoa. The results were not affected by whether the obstruction was caused by CAV or failed vasoepididymostomy. Both fresh and frozen spermatozoa gave similar results; the only significant factor appeared to be the age of the female. Because of the consistently good results obtained using epididymal sperm with ICSI when compared with conventional IVF, and the similarly good results with testicular tissue spermatozoa, ICSI is mandatory for all future MESA patients. All CAV patients and their partners should be offered genetic screening for cystic fibrosis; hence pre-implantation embryo diagnosis should be available in any full service MESA programme. It is now clear that even with non-obstructive azoospermia, e.g. Sertoli-cell only, or maturation arrest, there are usually some small foci of spermatogenesis which allow TESE with ICSI to be carried out. This means that even in men with azoospermia due to absence of spermatogenesis or to a block in meiosis, there are usually a few spermatozoa available in the testes that are adequate for successful ICSI. Finally, it is likely that some forms of severe male factor infertility are genetically transmitted and although ICSI offspring have been shown to be completely normal, it is possible that the sons of these infertile couples will also require ICSI when they grow up and wish to have a family.

Adult↗
PubMed1995

Analysis of 76 total fertilization failure cycles out of 2732 intracytoplasmic sperm injection cycles.

From October 1992 to December 1994, 2732 cycles of treatment by intracytoplasmic sperm injection (ICSI) were carried out in couples mainly with severe male-factor infertility. The overall fertilization rate in these 2732 cycles was 71% of intact oocytes. However, in 76 (72 couples) of these cycles, none of the injected oocytes became fertilized, so the total fertilization failure rate was 3% (76/2732 cycles). Details of these 76 cycles were analysed. The results show that total fertilization failure after ICSI may be explained by different factors related to (i) semen characteristics (only immotile or round-headed spermatozoa for ICSI) or (ii) the oocytes (number, abnormal morphology, damage after ICSI). Of 26 couples, 22 achieved fertilization in their subsequent ICSI cycles. In conclusion, total fertilization failure after ICSI for the treatment of severe male-factor infertility was mainly caused by the poor viability of the spermatozoa used for injection; it was also associated with a low number and poor quality of oocytes. Repeated ICSI treatment may be useful or necessary in couples with total fertilization failure.

Adult↗
PubMed1995

Indications for and results of intracytoplasmic sperm injection (ICSI).

In this report the indications for, and the results of, 1275 consecutive ICSI cycles carried out between October 1991 and December 1993 are described. Failure of fertilization in at least one previous IVF cycle, semen parameters below the threshold for standard IVF treatment and successful MESA or TESE procedure performed in patients with obstructive or non-obstructive azoospermia, respectively, were the indications in these ICSI cycles. In 1194 cycles, ejaculated spermatozoa were used, whereas 59 and 17 cycles were performed with epididymal and testicular spermatozoa, respectively. The normal fertilization rate was significantly higher with ejaculated spermatozoa than with epididymal or testicular spermatozoa, but no differences were observed with regard to embryo quality, the percentages of transfer after ICSI and the clinical pregnancy rates in the three groups of patients.

Embryo Transfer↗
PubMed1994

The effect of pentoxifylline on in-vitro fertilization in the presence of anti-sperm antibodies.

In cases of severe immunological male-factor infertility, impairment of spermatozoal motility and of acrosome reaction resulting in reduced fertilization capacity have been described by several authors. The present study investigated the use of pentoxifylline in enhancing in-vitro fertilization (IVF) in the presence of anti-sperm antibodies. Thirty-seven IVF cycles were conducted in 28 different couples suffering from immunological male-factor infertility with at least 50% antibody-coated spermatozoa. Sibling oocytes were inseminated at random with spermatozoa incubated with or without 3.6 mM pentoxifylline after selection by a Percoll gradient. No difference in motility of the final sperm preparations was observed prior to insemination. Fertilization rate, cleavage rate and embryo quality were similar in both treatment and control groups. Nine out of ten pregnancies were achieved after the replacement of embryos both from the treatment and control group. Although pentoxifylline is known to enhance motility in-vitro and to promote induced acrosomal loss, its indiscriminate use failed to improve IVF performance in patients with anti-sperm antibodies. Further research may be necessary in order to elucidate whether a given subpopulation of these patients may benefit from a selective application of pentoxifylline.

Adult↗
PubMed1994

Microsurgical epididymal sperm aspiration and intracytoplasmic sperm injection: a new effective approach to infertility as a result of congenital bilateral absence of the vas deferens.

OBJECTIVE: To present and assess the efficacy of a new approach for the treatment of infertility due to congenital bilateral absence of the vas deferens. DESIGN: A retrospective study of consecutive trials. SETTING: Centre for Reproductive Medicine, which is a tertiary referral institution. PATIENTS: Twelve couples suffering from infertility because of congenital bilateral absence of the vas deferens. INTERVENTIONS: A microsurgical epididymal sperm aspiration procedure was performed in the husbands, followed by intracytoplasmic sperm injection of oocytes recovered from the wives. Cleaving embryos were transferred to the uterine cavity 48 hours after the intracytoplasmic sperm injection procedure. MAIN OUTCOME MEASURES: Sperm parameters after microsurgical epididymal sperm aspiration, fertilization, cleavage, and pregnancy rates. RESULTS: In all 14 microsurgical epididymal sperm aspiration procedures, sperm was retrieved. Notwithstanding the poor quality of this epididymal sperm, a fertilization rate of 58% was achieved after intracytoplasmic sperm injection. On 10 occasions, embryos were transferred and five patients became pregnant, i.e., an overall pregnancy rate of 35.7% per started trial and 50.0% per transfer. Another two patients became pregnant after replacement of frozen-thawed embryos, which increases the pregnancy rate to 50.0% per microsurgical epididymal sperm aspiration procedure. Early pregnancy wastage was 57%, limiting the ongoing pregnancy rate to 21.4% per microsurgical epididymal sperm aspiration procedure. CONCLUSION: This study shows the combined microsurgical epididymal sperm aspiration-intracytoplasmic sperm injection procedure to be highly efficient in achieving fertilization in vitro, even after recovery of grossly impaired epididymal sperm.

Adult↗
PubMed1994

In vitro fertilization in couples with previous fertilization failure using sperm incubated with pentoxifylline and 2-deoxyadenosine.

OBJECTIVE: To evaluate whether incubation of spermatozoa with both pentoxifylline and 2-deoxyadenosine would improve fertilization rates in couples with previous IVF failure. DESIGN: Autocontrolled design in which sibling oocytes were inseminated at random in vitro with spermatozoa treated or not treated by pentoxifylline and 2-deoxyadenosine. MEAN OUTCOME MEASURES: Oocyte quality, sperm motility, fertilization in vitro, and embryo quality. RESULTS: Sperm motility was found optimized by metabolic stimulation using pentoxifylline and 2-deoxyadenosine. The mean fertilization rate per patient was 33.1% in the treatment group compared with 37.0% in the control group. The mean cleavage rate per patient was 79.6% for treatment versus 68.7% for control embryos. No differences in embryo quality were noted. CONCLUSION: The results of this study demonstrate that an indiscriminate use of pentoxifylline and 2-deoxyadenosine is not beneficial to fertilization in couples with previous IVF failure. Further prospective research may be needed to assess the benefit of pentoxifylline and 2-deoxyadenosine in patients selected by preliminary functional in vitro tests.

Adult↗
PubMed1994

Mouse in vitro fertilization using sperm treated with pentoxifylline and 2-deoxyadenosine.

If sperm were treated by both pentoxifylline and 2-deoxyadenosine before insemination of postovulatory mouse oocytes, two-cell embryo formation was found to be reduced even if both agents were eluted from the sperm before insemination. If these agents were not washed out before insemination, an adverse effect on early embryonic development was noted, that is, the numbers of two-cell embryos reaching the blastocyst stage and the numbers of blastocysts able to form the egg cylinder were found to be reduced. However, egg-cylinder formation was also found to be reduced when both compounds were washed out before insemination.

Animals↗
PubMed1994

Intracytoplasmic sperm injection.

Intracytoplasmic sperm injection (ICSI) is a promising assisted fertilization technique that may benefit women who have not become pregnant by in-vitro fertilization. ICSI and subzonal insemination (SUZI) were used to treat couples who failed fertilization after standard IVF or who could not be accepted for IVF because too few motile spermatozoa were present in the ejaculate. This paper describes the outcome of 750 consecutive cycles of SUZI and ICSI. Different aspects of these novel assisted fertilization procedures are described: patient management, ovarian stimulation, semen evaluation and treatment, oocyte collection and preparation, SUZI and ICSI techniques, assessment of fertilization and embryo cleavage, outcome of embryo transfers and the evolution of the pregnancies.

Embryo Transfer↗
PubMed1994

The effect of pentoxifylline on mouse in-vitro fertilization and early embryonic development.

This study was designed to assess the effect of pentoxifylline (PTX) on fertilization and early embryonic development in the mouse. Oocytes from superovulated B6CBA female mice were inseminated in vitro with spermatozoa from B6CBA males incubated with PTX according to different protocols, i.e. (i) 3.6 and 7.2 mM PTX washed out prior to insemination, (ii) 3.6 and 7.2 mM PTX diluted six times in the insemination medium and (iii) PTX present at 3.6 and 7.2 mM in the insemination medium. After insemination and washing, fertilization was assessed by the presence of 2-cell stage embryos. These were further cultured up to the blastocyst or egg-cylinder stage to assess embryonic development. Parthenogenetic activation was evaluated by exposing post-ovulatory oocytes to 3.6 and 7.2 mM PTX. If spermatozoa were washed free from PTX before insemination, no effect on either fertilization or subsequent development was found. If PTX was not washed out, fertilization was reduced significantly, yet development of fertilized oocytes was unaffected. If insemination was performed in the presence of PTX both fertilization and development were impaired. Parthenogenetic activation was not increased by PTX exposure. We conclude that if used in in-vitro fertilization, exposure of oocytes and/or zygotes to PTX has to be avoided by washing out the compound thoroughly to prevent adverse effects on early embryonic development.

Animals↗
PubMed1994

Incubation of spermatozoa from asthenozoospermic semen samples with pentoxifylline and 2-deoxyadenosine: variability in hyperactivation and acrosome reaction rates.

We examined hyperactivation and acrosomal loss in asthenozoospermic patients with a history of failed in-vitro fertilization (IVF). After selection by a Percoll gradient, spermatozoa were incubated with 3.6 mM pentoxifylline (PTX), 3.0 mM 2-deoxyadenosine (2-DXA) or both. Hyperactivation and ionophore A-23187-induced acrosome reaction were assessed immediately after sperm treatment and again after 180 min. In all groups studied, the mean hyperactivation rates were found to be low. No significant differences were noted between assessments immediately after treatment and 180 min later, except after treatment with both PTX and 2-DXA. The mean hyperactivation rates were found not to improve as a result of either PTX or 2-DXA, while the combination of both PTX and 2-DXA revealed a significant enhancement of total hyperactivation. When individual hyperactivation rates between control and treated sperm samples were compared, large differences in response were observed. Some sperm samples showed a marked increase in hyperactivation with one treatment, while another treatment led to a decrease. Acrosome reaction rates assessed immediately after ionophore A-23187 stimulation were found not to be significantly different from those assessed 180 min later. No significant effect could be demonstrated for either treatment, although, here too, marked interindividual variations were noted. It was concluded that an unselective use of PTX, 2-DXA or both compounds together, may restore sperm function in certain of these patients, and perhaps improve fertilization in vitro, but in others it may produce no change or may even be detrimental to sperm function.

Acrosome↗
PubMed1994

Auto-controlled study on in-vitro fertilization performance with 'antibody-free' spermatozoa selected by immunobead adsorption from semen of patients with anti-sperm antibodies.

Selection of antibody-free spermatozoa by immunobead adsorption was performed as a preliminary test in order to check probable recovery before introducing the procedure in an in-vitro fertilization (IVF) trial. On this basis, only nine out of 21 couples could be allocated to the study on IVF, which was designed to compare fertilization rates obtained with the immuno-selected spermatozoa fraction versus the control swim-up fraction. The study comprised eight properly controlled IVF procedures with sibling oocytes. Despite the high severity of antibody-binding in the fresh semen [mean of 91% for immunoglobulin (Ig) G, 77% for IgA], selection of antibody-free spermatozoa was successful in seven out of eight cases (mean of 15% for IgG, 20% for IgA). Nevertheless, mean fertilization rate on a per patient basis was not different after using one of the two sperm preparation procedures. Four patients had similar fertilization rates with the two sperm fractions, while for three patients fertilization was achieved only with the immuno-depleted fraction. In terms of embryo quality, similar results between the two groups were obtained. Two pregnancies were obtained, one was obtained with swim-up-prepared spermatozoa alone; the second, a twin pregnancy, originated from both the swim-up and immuno-depleted sperm populations. From this study, it can be concluded that the technique of immunobead adsorption itself seems attractive for the selection of antibody-free spermatozoa, but can be applied only to a limited population of patients (< 50%) suffering from immunological male infertility. Furthermore, in cases where immunodepletion seemed successful, no consistent benefit was observed in terms of IVF performance.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Intracytoplasmic sperm injection does not require special treatment of the spermatozoa.

In order to assess whether specific treatment of spermatozoa is required prior to intracytoplasmic sperm injection (ICSI), three methods of sperm preparation were compared in this study. These three methods were (A) incubation of spermatozoa with pentoxifylline (PTX) and 2-deoxyadenosine (DOA), (B) electroporation followed by incubation in medium with PTX, and (C) no further treatment with the Percoll gradient. Controlled comparisons were carried out between method A and method B in 21 patients, and between method A and method C in 32 patients. There was no difference in the rates of fertilization and embryo cleavage when ICSI was done with spermatozoa treated by procedures A, B or C. Furthermore, the sperm selection procedure prior to ICSI was done in two different media: T6 medium containing 1.78 mM CaCl2.2H2O and a final washing step after the Percoll gradient in T6 medium containing 5.0 mM CaCl2.2H2O, and Earle's medium containing 1.78 mM CaCl2.2H2O. The results of ICSI on sibling oocytes from 12 patients revealed no difference in the fertilization and embryo cleavage rates between the two different media used during the sperm selection procedures. In conclusion, it appears that high fertilization and pregnancy rates can be obtained in couples with severe male-factor infertility by ICSI and that no special treatment of the spermatozoa prior to ICSI is required.

Colloids↗
PubMed1994

Pentoxifylline in idiopathic male-factor infertility: a review of its therapeutic efficacy after oral administration.

Since the use of pentoxifylline has received much recent attention for its role in the treatment of male-factor infertility by in-vitro fertilization, there is now an increasing interest in its oral use. Therefore, results reported in the literature on the treatment of idiopathic male-factor infertility by oral administration of pentoxifylline were summarized and reviewed. None of the reports presented a valid rationale for the systematic use of pentoxifylline and the reported results were found to be conflicting. Because of poor study design or low statistical power, the published data did not support a beneficial role of the systemic use of pentoxifylline in idiopathic male-factor infertility. Prospective, double blind trials dealing with fecundity as the major outcome measure may provide the information needed.

Administration, Oral↗
PubMed1994

An indiscriminate use of pentoxifylline does not improve in-vitro fertilization in poor fertilizers.

In order to enhance fertilization in vitro, pentoxifylline (PTX) was used in couples showing low fertilization rates in previous in-vitro fertilization (IVF) attempts for the treatment of male-factor infertility. Sibling oocytes were inseminated at random with spermatozoa prepared with or without PTX. After selection by Percoll gradient, sperm samples were divided into two equal aliquots. One aliquot was incubated in Earle's medium containing approximately 3.6 mM PTX (treatment group), the other aliquot was incubated with PTX-free Earle's medium (control group). After 30 min, both suspensions were washed twice. Sperm parameters after preparation did not differ between treatment and control samples, and nor did the mean fertilization rates, which were 49.3 and 42.6% respectively. Cleavage characteristics and morphological quality of the embryos were not significantly different between the treatment and control groups. The results of this study demonstrate that indiscriminate use of PTX in an IVF programme increases neither fertilization rate nor embryo transfer rate in poor fertilizers. More prospective research is needed to evaluate the role of PTX in IVF in couples selected according to the effect of the compound on sperm function, e.g. hyperactivation and acrosome reaction.

Adult↗