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Biomedical subjects

P Devroey

Publications and source records attributed to P Devroey.

At least 19 recordsLinked to original sources
PubMed1996

Pregnancy and birth after intracytoplasmic sperm injection of in vitro matured germinal-vesicle stage oocytes: case report.

OBJECTIVE: To report a normal pregnancy and the delivery of a healthy child after the combination of in vitro maturation of germinal-vesicle stage oocytes and intracytoplasmic sperm injection (ICSI) in a patient. SETTING: Procedures were performed in a tertiary IVF center coupled with an institutional research environment. MAIN OUTCOME MEASURES: Maturation rate of immature oocytes after in vitro maturation and intactness, fertilization, and developmental rates of oocytes after microinjection. RESULTS: Nine of 14 germinal-vesicle stage oocytes matured to the metaphase II stage after 30 hours of in vitro culture (64%). Seven of eight injected and intact oocytes fertilized normally (78%) and five of them cleaved with < 20% fragmentation (71%). Four embryos were transferred and a singleton pregnancy was obtained that ended in the delivery of a healthy child. CONCLUSION: In vitro maturation of immature oocytes together with ICSI can result in normal fertilization, embryo development, pregnancy, and the delivery of healthy child.

Adult↗
PubMed1996

Seminoma discovered in two males undergoing successful testicular sperm extraction for intracytoplasmic sperm injection.

OBJECTIVE: To describe two cases with testicular seminoma incidentally discovered at the time of successful testicular sperm extraction for intracytoplasmic sperm injection (ICSI)> DESIGN: Report of two cases. SETTING: Tertiary care academic center. PATIENTS: Two males with nonobstructive azoospermia with history of cryptorchidism. INTERVENTION: Testicular biopsy combined with ICSI; orchiectomy with radiotherapy. RESULTS: From two couples and in three different cycles, 17 of 55 (31%) metaphase II oocytes fertilized after microinjection. Eleven of these fertilized oocytes cleaved normally and all 11 were replaced. One twin pregnancy was established and was delivered successfully later. In both cases, a seminoma was discovered at the time of testicular biopsy. CONCLUSIONS: At the time of testicular biopsy for ICSI, a specimen for histopathology must be sent to exclude the presence of seminoma in males with nonobstructive azoospermia with a history of cryptorchidism. The effectiveness of testicular sperm extraction in combination with ICSI also has been demonstrated even against the background of testicular tumor.

Biopsy↗
PubMed1996

Normal pregnancies resulting from testicular sperm extraction and intracytoplasmic sperm injection for azoospermia due to maturation arrest.

OBJECTIVE: To see whether testicular sperm extraction could be used to perform intracytoplasmic sperm injection (ICSI) for men with nonobstructive azoospermia caused by maturation arrest. DESIGN: Uncontrolled prospective trial of an attempt to find occasional elongated spermatids or spermatozoa in testes of azoospermic patients with maturation arrest and to use these haploid cells for ICSI. SETTING: European university-based center for reproductive medicine and private American community hospital. PATIENTS: Thirty-eight azoospermic males without obstruction and with biopsy-documented maturation arrest, seven of whom elected, with their wives, to undergo scrotal exploration and testicular sperm extraction with ICSI in an attempt to become pregnant. INTERVENTIONS: Histologic evaluation of spermatid development in 38 patients with azoospermic maturation arrest. Testicular sperm extraction with ICSI in seven random volunteers from this group. MAIN OUTCOME MEASURES: Presence or absence of mature spermatids in the testis biopsy specimen of patients with azoospermic maturation arrest. Fertilization, cleavage, and pregnancy after testicular sperm extraction and ICSI in patients with azoospermic maturation arrest. RESULTS: All seven patients with azoospermic maturation arrest had occasional sperm found with testicular sperm extraction. Five had sufficient numbers (between 6 and 30) for ICSI, and those five had ETs. In four, the partners became pregnant. In all 38 patients examined, the maturation defect was in meiosis rather than in spermiogenesis. CONCLUSION: Nonobstructive azoospermia caused by maturation arrest may be treated with testicular sperm extraction with ICSI apparently as successfully as Sertoli cell only.

Cellular Senescence↗
PubMed1996

Premature luteinization in in vitro fertilization cycles using gonadotropin-releasing hormone agonist (GnRH-a) and recombinant follicle-stimulating hormone (FSH) and GnRH-a and urinary FSH.

OBJECTIVE: To determine if premature luteinization can occur in GnRH agonist (GnRH-a) and FSH (recombinant FSH and human urinary FSH) IVF cycles and whether premature luteinization affects IVF and clinical outcome. DESIGN: Retrospective evaluation of 171 IVF-ET cycles. The cycles were divided into two groups according to the P level on the day of hCG: group I (serum P </= 0.9 ng/mL [conversion factor to SI unit, 3.180]) and group II (serum P >/= 1.1 ng/mL). MAIN OUTCOME MEASURES: Comparison of cycles characteristics and of cumulative exposure of follicular serum E2, FSH, LH, and P as well as of IVF and clinical outcome were made between the study groups. RESULTS: Twenty-three of the 171 cycles (13.4%) demonstrated premature luteinization. The age of the patients, the E2, and LH exposure were similar between the groups. The number of the ampules of gonadotropins (recombinant FSH and urinary FSH) used and the area under FSH and P curve were higher in cycles with premature luteinization. The area under the FSH curve correlated with the area under the P curve. Similar IVF and clinical outcomes were observed in cycles with and without premature luteinization. CONCLUSION: The greater FSH exposure and its correlation with the P exposure suggest that one of the possible factors inducing premature luteinization is the increased FSH-induced LH receptivity in granulosa cells. No adverse effects of premature luteinization on the IVF and clinical outcome were observed.

Adult↗
PubMed1996

The use of testicular sperm for intracytoplasmic sperm injection in patients with necrozoospermia.

OBJECTIVE: To investigate whether intracytoplasmic sperm injection (ICSI) using testicular spermatozoa from necrozoospermic patients results in acceptable fertilization and transfer rates. DESIGN: Retrospective clinical study. SETTING: Tertiary referral center. PATIENTS: Five patients presenting consistently with 100% dead spermatozoa in their ejaculates. INTERVENTIONS: In seven treatment cycles, an open testicular biopsy was performed to increase the chances for retrieving viable spermatozoa which were used for ICSI. MAIN OUTCOME MEASURES: Sperm recovery, fertilization, and transfer rates. RESULTS: Testicular sperm were recovered in all treatment cycles and fertilization occurred in six of seven cycles. Overall normal fertilization and transfer rates were 67% and 71%, respectively. One live birth was obtained after five ETs. CONCLUSION: We recommend testicular sperm recovery for ICSI in patients who invariably or occasionally present with absolute necrozoospermia.

Adult↗
PubMed1996

Correlation between testicular histology and outcome after intracytoplasmic sperm injection using testicular spermatozoa.

A comprehensive study is presented of a series of 124 infertile men undergoing testicular sperm retrieval for intracytoplasmic sperm injection (ICSI). In this study we correlated the histological changes observed in the testicular tissue with the results of the wet preparation and the outcome after ICSI using testicular spermatozoa. In all patients with normal spermatogenesis and hypospermatogenesis spermatozoa were recovered from the wet preparation. The sperm recovery rate as 84% in patients with incomplete germ-cell-aplasia and maturation arrest, while in patients with complete germ-cell aplasia or maturation arrest this figure was 76%. In these patients more specimens were sampled and fewer spermatozoa were recovered. Since no spermatozoa were recovered in only 10 patients, ICSI with testicular sperm was performed in the remaining 114 couples (91.9%). The normal fertilization rate was 57. 8%. The fertilization rate was significantly lower in couples among whom the husband showed germ-cell aplasia and maturation arrest. Overall, 55.2% of normally fertilized oocytes developed into embryos showing <=50% of anucleate fragments. There were no major differences between the different histological categories in terms of embryonic development in vitro. The overall pregnancy rates per testicular sperm extraction (TESE) procedure, per ICSI procedure and per transfer were respectively 36.3, 39.5 and 43.7%. The overall implantation rate per embryo (sacs/embryos replaced) was 20.3%. A lower implantation rate was observed in couples among whom the husband had maturation arrest (not statistically significant). The above data show that testicular biopsies may have an important therapeutic role in the management of infertility in azoospermic patients.

Adult↗
PubMed1996

Outcome of intracytoplasmic sperm injection with testicular spermatozoa in obstructive and non-obstructive azoospermia.

From 1 August 1993 until 30 September 1994, 69 couples suffering from azoospermia underwent testicular sperm extraction and intracytoplasmic sperm injection. In 50 couples with obstructive azoospermia a total of 631 metaphase-II oocytes were injected after testicular sperm extraction yielding a 2-PN fertilization rate of 57%. In female patients <40 years of age an ongoing pregnancy rate per transfer of 42% (14/33) was obtained. So far, eight healthy babies have been born, including two singletons and three twin gestations. In 19 couples with non-obstructive azoospermia a total of 264 metaphase-II oocytes were injected after testicular sperm extraction, yielding a 2-PN fertilization rate of 58%. An ongoing pregnancy rate per transfer of 31% (5/16) was established. So far, six healthy babies have been born including one singleton, one twin and one triplet gestation.

Adult↗
PubMed1996

Female age predicts embryonic implantation after ICSI: a case-controlled study.

From 1 October 1991 until 31 December 1993, 1270 cycles for intracytoplasmic sperm injection were performed. Of these, 71 (5.6%) were carried out in women >/=40 years of age. The semen characteristics in couples >/=40 years of age or <40 years were similar. The mean male age for the older group of women was 47.1 years (range 34-67) versus 35 years (25-71) for the younger group of women (P < 0.001). The mean female age was 41.9 years (range 40-47) and 31.8 years (range 23-39). The numbers of cumulus-oocyte complexes and metaphase-II oocytes were significantly lower in women >/=40 years of age (P < 0.001). The mean numbers of replaced embryos were respectively 2.3 (133/59) in women >/=40 years of age and 2.5 (160/63) in women <40 years of age. The delivery rate per retrieval and per transfer was significantly lower in women >/=40 years of age (P < 0.05). The delivery rates per retrieval and per transfer were respectively 7% (5/71) and 8.5% (5/59) in the older group of women versus 22.5% (16/71) and 25.4% (16/63) in the younger group. Female age is the predictive factor for embryonic implantation.

Adult↗
PubMed1996

Subtle progesterone rise after the administration of the gonadotrophin-releasing hormone antagonist cetrorelix in intracytoplasmic sperm injection cycles.

In the present study, subtle serum progesterone rise (>= 1.1 ng/ml) during the late follicular phase is reported, for the first time to our knowledge, in patients using a potent gonadotrophin-releasing hormone (GnRH) antagonist, Cetrorelix, in combination with human menopausal gonadotrophin (HMG) for ovarian stimulation prior to intracytoplasmic sperm injection (ICSI). In five out of 24 patients (20%) serum progesterone levels were >/= 1.1 ng/ml. The cycle characteristics of the patients were similar in both groups. No premature endogenous luteinizing hormone (LH) surge occurred and the serum LH concentrations were constantly low during the follicular phase. The 17-beta oestradiol and follicle stimulating hormone (FSH) exposure were higher in cycles with premature luteinization. The greater oestradiol and FSH exposure confirm that one of the possible factors inducing subtle serum progesterone rise is the increased oestradiol and FSH-induced LH receptivity in granulosa cells.

Adult↗
PubMed1996

Prospective follow-up study of 423 children born after intracytoplasmic sperm injection.

In order to evaluate the safety of the intracytoplasmic sperm injection (ICSI) procedure, a prospective follow-up study of 423 children born after ICSI was carried out. The aim of this study was to compile data on karyotypes, congenital malformations, growth parameters and developmental milestones. Before starting the infertility treatment, couples were asked to participate in a follow-up study including genetic counselling and prenatal diagnosis. The follow-up study of the child was based on a visit to the paediatrician-geneticist at birth or at 2 months of age, at 1 year and at 2 years of age when a physical examination for major and minor malformations and a psychomotoric evaluation were done. Between April 1991 and September 1994, 320 pregnancies obtained after ICSI led to the birth of 423 children (222 singletons, 186 twins and 15 triplets). Prenatal diagnosis determined a total of 293 karyotypes, one of which was abnormal (0.3%), and four were benign familial structural aberrations, all inherited from the paternal side. A total of 14 (3.3%) major malformations were observed, defined as those causing functional impairment or requiring surgical correlation. Neurological or developmental problems at the age of 2 months were found in 14 children, four of whom were multiples. Compared to most registers of children born after assisted reproduction and to registers of malformations in the general population, the figure of 3.3% major malformations is within the expected range. Before drawing any firm conclusion, further careful evaluations of the available data are necessary.

Adult↗
PubMed1995

Endoscopic surgery in gynecologic practice.

In recent decades, the operative approach for several gynecologic diseases has changed from laparotomy to laparoscopy. New techniques and indications are continuously being developed. Laparoscopy offers a lot of advantages for the patient, but still a lot of additional data are required to determine the exact indications. Operative laparoscopy requires not only skill and experience, but also specialized equipment and paramedical staff. The most important topics for the gynecologist will be reviewed in this article.

Female↗
PubMed1995

Amplification of exon 11 of the gene for the alpha-chain of beta-N-acetylhexosaminidase in single human blastomeres.

OBJECTIVE: To evaluate the possibility of using polymerase chain reaction (PCR) technology for preimplantation diagnosis for Tay-Sachs disease. DESIGN: Polymerase chain reaction on single human blastomeres. SETTING: Bad quality embryos from IVF analyzed in an academic research genetics lab. INTERVENTIONS: Patients underwent standard IVF procedures as infertility treatment. RESULTS: Amplification was seen in 89.5% of the blastomeres; only one blank was contaminated. CONCLUSION: The technique of PCR on single blastomeres is ready to be used in clinical preimplantation diagnosis for Tay-Sachs disease.

Base Sequence↗
PubMed1995

Using ejaculated, fresh, and frozen-thawed epididymal and testicular spermatozoa gives rise to comparable results after intracytoplasmic sperm injection.

OBJECTIVE: To describe the preparation of fresh or frozen-thawed epididymal and testicular sperm for intracytoplasmic single sperm injection and to compare the fertilization, embryo quality, and pregnancy rates (PRs) obtained after using these spermatozoa to the results when freshly ejaculated sperm was used for microinjection. DESIGN: Retrospective analysis of 1,034 consecutive microinjection cycles. Ejaculated (965 cycles), fresh epididymal (43 cycles), frozen-thawed epididymal (9 cycles), and testicular sperm (17 cycles) was used for intracytoplasmic sperm injection. SETTING: Procedures were performed in a tertiary IVF center coupled with an institutional research environment. MAIN OUTCOME MEASURES: Semen density and motility were judged by the World Health Organization criteria and sperm morphology was evaluated by the Tygerberg's strict criteria. After microinjection, oocyte intactness, fertilization, embryo cleavage, transfer, and PRs were evaluated and compared. RESULTS: The median values of total sperm count, total motility and normal morphology were 17.85 x 10(6), 37%, 8% for freshly ejaculated sperm; 46.20 x 10(6), 12%, 9% for fresh epididymal sperm; 0.15 x 10(6), 0%, 0% for frozen-thawed epididymal sperm; and 0.54 x 10(6), 0% for testicular sperm (morphology was not determined). The percentage of intact oocytes after microinjection ranged from 84% to 90%. Normal fertilization rates were high when fresh or frozen-thawed epididymal and testicular spermatozoa were used for the injection (56%, 56%, 48%, respectively) but were significantly lower than for ejaculated sperm (70%). There was a higher proportion of transferable embryos obtained after ejaculated sperm injection than after testicular sperm injection. Forty percent, 58%, 33%, and 46% of cycles had positive serum hCG using ejaculated, fresh, or frozen-thawed epididymal and testicular sperm. Initial pregnancy loss occurred in 26.3% of the conception cycles. CONCLUSION: Intracytoplasmic sperm injection can provide high normal fertilization, cleavage, and PRs when fresh or frozen-thawed epididymal and testicular spermatozoa are used, but normal fertilization rates are significantly lower than after microinjection with ejaculated sperm.

Adult↗
PubMed1995

Fertilizing capacity of epididymal and testicular sperm using intracytoplasmic sperm injection (ICSI).

For men with uncorrectable obstructive azoospermia, their only hope of fathering a child is microsurgical epididymal sperm aspiration (MESA) combined with in vitro fertilization (IVF). In 1988, proximal epididymal sperm were demonstrated to have better motility than senescent sperm in the distal epididymis, and it was thought that retrieval of motile sperm from the proximal epididymis would yield reliable fertilization and pregnancy rates after conventional IVF. However, the results to date have been poor, and although a minority of patients achieved good fertilization rates with IVF, the vast majority (81%) had consistently poor or no fertilization and the pregnancy rate averaged only 9%. Recently, intracytoplasmic sperm injection (ICSI) has been successfully used to achieve fertilization and pregnancies for patients with extreme oligoasthenozoospermia. ICSI has therefore been applied to cases of obstructive azoospermia and, in this report, 67 MESA-IVF cases are compared with 72 MESA-ICSI cases. The principle that motile sperm from the proximal segments of the epididymis should be used for ICSI was followed, although in the most severe cases in which there was an absence of the epididymis (or absence of sperm in the epididymis), testicular sperm were obtained from macerated testicular biopsies. These sperm only exhibited a weak, twitching motion. In 72 consecutive MESA cases, ICSI resulted in fertilization and normal embryos for transfer in 90% of the cases, with an overall fertilization rate of 46%, a cleavage rate of 68%, and ongoing or delivered pregnancy rates of 46% per transfer and 42% per cycle. The pregnancy and take-home baby rates increased from 9% and 4.5% with IVF to 53% and 42% with ICSI. There were no differences between the results for fresh epididymal, frozen epididymal or testicular sperm, and the number of eggs collected did not affect the outcome. The results were also unaffected by the aetiology of the obstruction such as congenital absence of the vas deferens or failed vasoepididymostomy. The only significant factor which affected the pregnancy rate was female age. It is concluded that although complex mechanisms involving epididymal transport may be beneficial for conventional fertilization of human oocytes (in vivo or in vitro), none of these mechanisms are required for fertilization after ICSI. Given the excellent results with epididymal and testicular sperm, ICSI is obligatory for all future MESA patients. Finally, the use of ICSI with testicular sperm from men with non-obstructive azoospermia is also discussed.

Cytoplasm↗
PubMed1995

High fertilization and pregnancy rate after intracytoplasmic sperm injection with spermatozoa obtained from testicle biopsy.

In cases requiring microsurgical epididymal sperm aspiration (MESA) for congenital absence of the vas deferens (CAVD) or irreparable obstructive azoospermia, often no spermatozoa can be retrieved from the epididymis, or there may even be no epididymis present. We wished to see whether testicular biopsy with testicular sperm extraction (TESE) in such cases could yield spermatozoa that would result in successful fertilization and pregnancy (despite the absence of epididymal spermatozoa) using intracytoplasmic sperm injection (ICSI). In the same setting during the same 2-week period, 28 patients with CAVD or irreparable obstruction were treated; 16 consecutive fresh MESA-ICSI cycles and 12 cycles which required testicular biopsy with testicular sperm extraction (TESE-ICSI) were performed. Normal two-pronuclear fertilization rates were similar in both groups: 45% for epididymal spermatozoa and 46% for testicular biopsy-extracted spermatozoa. Cleavage rates were also similar (68% for epididymal and 65% for testicular spermatozoa). The ongoing pregnancy rates in this series were 50 and 43% respectively. We conclude that epididymal spermatozoa and testicular spermatozoa yield similar fertilization, cleavage and ongoing pregnancy rates using ICSI. When epididymal spermatozoa cannot be retrieved, a testicular biopsy can be performed and the few barely motile spermatozoa thus obtained can be used for ICSI. It appears that all cases of obstructive azoospermia can now be successfully treated.

Biopsy↗
PubMed1995

Pregnancy and birth after high serum progesterone concentrations during the follicular phase in an in-vitro fertilization cycle with gonadotrophin-releasing hormone agonist suppression.

This case illustrates the possibility of achieving a pregnancy and birth when elevated progesterone concentrations (> 4 ng/ml) are present during the follicular phase (from 6 days before human chorionic gonadotrophin injection) of a gonadotrophin-releasing hormone agonist/menotrophin cycle for in-vitro fertilization (IVF). The present patient underwent three IVF/embryo transfer cycles in which progesterone concentrations were repeatedly increased from the midfollicular phase onwards. A pregnancy was achieved after the first IVF attempt but ended in a miscarriage in the 19th week of gestation. During the second IVF attempt an endometrial biopsy taken on the day of oocyte retrieval revealed an endometrial advancement of 2 days. A successful pregnancy and birth was again achieved after the third IVF attempt although progesterone concentrations were considerably increased from 6 days before the ovulatory stimulus.

Adult↗
PubMed1995

Pregnancies after testicular sperm extraction and intracytoplasmic sperm injection in non-obstructive azoospermia.

In this study (May 1 until August 31, 1994) a total of 15 azoospermic patients suffering from testicular failure were treated with a combination of testicular sperm extraction (TESE) and intracytoplasmic sperm injection (ICSI). Spermatozoa were available for ICSI in 13 of the patients. Out of 182 metaphase II injected oocytes, two-pronuclear fertilization was observed in 87 (47.80%); 57 embryos (65.51%) were obtained for either transfer or cryopreservation. Three ongoing pregnancies out of 12 replacements (25%) were established, including one singleton, one twin and one triplet gestation. The ongoing implantation rate was 18% (six fetal hearts out of 32 embryos replaced).

Adult↗