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Biomedical subjects

P Devroey

Publications and source records attributed to P Devroey.

At least 199 records · Page 11Linked to original sources
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

Assisted fertilization by subzonal insemination and intracytoplasmic sperm injection.

The results of 600 consecutive treatment cycles of subzonal insemination (SUZI) and intracytoplasmic sperm injection (ICSI) are described in couples with failed fertilization after standard IVF or insufficient spermatozoa in the ejaculate for IVF. More oocytes were damaged by ICSI (16.3%) than by SUZI (8.5%) and the normal fertilization rate was substantially higher after ICSI (49.1% v. 16.6%). Subsequent development of two-pronuclear oocytes in vitro was 80% after SUZI and 73.9% after ICSI. Significantly more triple embryo replacements were carried out after ICSI than after SUZI. Embryo transfers were possible in 421 of the 600 cycles. There were 63 pregnancies after ICSI (215 transfers) and 23 after SUZI (156 transfers); 10 additional pregnancies were achieved after 50 transfers of a mixture of SUZI and ICSI embryos. The results of fetal karyotypes and follow-up of the children do not indicate an increase in congenital malformations.

Adult↗
PubMed1994

Human endometrial maturation is markedly improved after luteal supplementation of gonadotrophin-releasing hormone analogue/human menopausal gonadotrophin stimulated cycles.

In human cycles stimulated for ovulation with gonadotrophin-releasing hormone (GnRH) agonists and human menopausal gonadotrophin (HMG), a luteal phase defect has been described. To evaluate the influence on the endometrium, endometrial development in GnRH agonist/HMG stimulated cycles was assessed in cycles with and without luteal phase supplementation. Endometrial histological maturation, ultrastructure and oestrogen receptor (ER) and progesterone receptor (PR) status were analysed in the mid-luteal phase. Serum concentrations of oestradiol and progesterone were measured daily from days 1-5 of the luteal phase. Supplementation of the luteal phase was achieved with either human chorionic gonadotrophin or natural progesterone, administered intramuscularly or intravaginally. In non-supplemented cycles all endometrial features were consistent with an impaired progesterone bioavailability. After supplementation of the luteal phase, fewer signs of luteal phase deficiency were visible, especially with the intravaginal route of progesterone administration. We concluded that the endometrial parameters confirm the need for luteal support in GnRH agonist/HMG stimulated cycles.

Adult↗
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

Controlled comparison of Earle's balanced salt solution with Ménézo B2 medium for human in-vitro fertilization performance.

In order to optimize the in-vitro fertilization (IVF) procedure and to avoid the batch-to-batch fluctuations of in-house culture medium, we investigated the use of a commercially available medium. In our human IVF programme, a controlled comparison was performed from July 1991 to February 1992 between in-house Earle's medium and commercially available Ménézo B2 medium. The major difference between the two tested media is the additional presence of amino acids and water-soluble vitamins in Ménézo B2 and the different origins of the proteins source, i.e. bovine serum albumin (BSA) in Ménézo B2 and human serum albumin (HSA) in Earle's medium. In the first, auto-controlled study, sibling oocytes cultured in Ménézo B2 showed a significantly higher fertilization rate than those cultured in Earle's medium: 58.1 +/- 37.2% and 52.1 +/- 36.9% respectively. After further culture of the fertilized oocytes, there was no difference in the morphological characteristics of the embryos cultured in the different media, although the rate of development was different. In Ménézo B2 medium, a higher proportion of the embryos had reached at least the 4-cell stage at transfer. In the second, randomized study, effects on the pregnancy and implantation rates of both media were analysed. In the group of oocytes cultured in B2, more excellent or good-quality embryos were available for transfer at a more advanced stage of development. No significant difference in pregnancy rate was observed: 39.1% per transfer in Earle's medium versus 40.5% per transfer in Ménézo B2.(ABSTRACT TRUNCATED AT 250 WORDS)

Amino Acids↗
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

The evolution and outcome of pregnancies from oocyte donation.

A total of 199 patients participated in the oocyte donation programme in 336 replacement cycles in whom 69 clinical pregnancies were achieved, of which 53 reached term and delivery. Data concerning the evolution and outcome of pregnancies were retrieved in 52 cases, which involved 39 women with ovarian failure and 18 with functional ovaries. The most frequent complications of pregnancy were uterine bleeding in the first trimester in 18 cases (34.6%), hypertension in 17 (32.7%) and intra-uterine growth retardation (IUGR: 11.5%). These complications were more prominent in twin pregnancies. The Caesarean section rate was 63.5% and a high percentage of elective sections (54.5%) was observed. Of singleton pregnancies, 54.6% had a birth weight of > 3000 g at full term (> 37 weeks), while 62.5% of twins weighed between 2000 and 3000 g. One intra-uterine death occurred, so that the perinatal mortality was 1.7% and one newborn was operated on for stenosis of the pulmonary artery, while the incidence of premature labour was low (1.9%). A comparison of complications between pregnancies associated with ovarian failure and with functional ovaries revealed a higher frequency of bleeding in the first trimester (38.2% and 27.8% respectively) and of hypertension (38.2% and 22.2% respectively) in those with ovarian failure, although the differences were not statistically significant. In conclusion, women who become pregnant after oocyte donation and especially those with ovarian failure should be considered as high-risk obstetric patients.

Adult↗
PubMed1994

Bilateral salpingectomy does not compromise ovarian stimulation in an in-vitro fertilization/embryo transfer programme.

The question whether salpingectomy has a negative influence on ovarian function and the outcome of pregnancy in an in-vitro fertilization (IVF) and embryo transfer treatment programme is not yet answered. We performed a retrospective case-control study to investigate the possible negative effect of salpingectomy on ovarian response to human menopausal gonadotrophins (HMG) during IVF and embryo transfer. The study group was composed of 26 patients with bilateral salpingectomy. In 67 cycles we analysed different parameters of ovulation such as the number of days of ovarian stimulation, numbers of ampoules of HMG, pre-ovulatory oestradiol concentrations and the numbers of oocytes retrieved. These parameters were compared to a control group of 134 cycles in 134 women with healthy Fallopian tubes. No differences were found. Implantation ratio, pregnancy rate and outcome were the same in both groups. We conclude that bilateral salpingectomy had no detrimental effect on ovarian performance during IVF and embryo transfer treatment nor on the outcome.

Adult↗
PubMed1994

Amplification of X- and Y-chromosome-specific regions from single human blastomeres by polymerase chain reaction for sexing of preimplantation embryos.

We describe a polymerase chain reaction (PCR) assay for the simultaneous detection of X and Y chromosomes in human blastomeres. In a first round of PCR, both X- and Y-specific fragments are amplified with primers which are common to both chromosomes and are derived from the X-linked steroid sulphatase gene and the Y-linked pseudogene. In a second round of PCR, fragments specific to each chromosome are generated: both an X and a Y fragment in male embryos and, due to the absence of a Y chromosome, only an X fragment in females. The efficiency and accuracy of this assay are high; it generates no false positive amplification signals and allows sexing in approximately 6 h after embryo biopsy. We therefore believe that it is suitable for gender determination by preimplantation diagnosis for couples at risk for X-linked genetic diseases.

Base Sequence↗
PubMed1994

Clinical outcome of a pilot efficacy study on recombinant human follicle-stimulating hormone (Org 32489) combined with various gonadotrophin-releasing hormone agonist regimens.

In total, 50 couples participated in a pilot study evaluating the efficacy of various regimens of gonadotrophin-releasing hormone agonist (GnRHa) in association with recombinant human follicle-stimulating hormone (recFSH) in women undergoing in-vitro fertilization (IVF) and embryo transfer. The women were treated with recFSH alone (group I), or with recFSH in conjunction with pituitary desensitization using a buserelin intranasal spray, 4 x 150 micrograms per day, in a short protocol (group II) or in a long protocol (group III), or using triptorelin in a long protocol, giving a single dose of 3.75 mg i.m. (group IV) or daily s.c. injections of 200 micrograms (group V). In all women, treatment with recFSH resulted in multiple follicular growth and rises of serum inhibin and oestradiol. The latter indicates that the amount of remaining luteinizing hormone (LH) was sufficient to support FSH-induced oestrogen biosynthesis. On the day of human chorionic gonadotrophin (HCG) administration, endogenous LH was most profoundly suppressed in subjects treated with triptorelin. The median number of ampoules and treatment days required in the various treatment groups varied from 21 to 36 ampoules and from 7 to 14 days, respectively. The median number of oocytes per group ranged from 9 to 11 and all cumulus-corona-oocyte complexes, with the exception of two, were classified as mature. The median fertilization and cleavage rates ranged between the treatment groups from 40 to 73% and from 73 to 100%, respectively. Fertilization failure of retrieved oocytes occurred in six couples with andrological or unexplained infertility. One patient had no transfer because of insufficient embryo quality.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
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↗
PubMed1994

Conventional in-vitro fertilization versus intracytoplasmic sperm injection for patients requiring microsurgical sperm aspiration.

Intracytoplasmic sperm injection (ICSI) has been successful in cases of extreme oligoasthenozoospermia in achieving pregnancies via in-vitro fertilization (IVF) with the lowest imaginable sperm counts. In azoospermia caused by congenital bilateral absence of the vas deferens (CBAVD), it has been shown that epididymal spermatozoa can be retrieved in large numbers, but fertilization rates using conventional IVF are low. Furthermore, no fertilization has ever been possible using testicular spermatozoa with conventional IVF. In the most extreme case of absence of the epididymis, spermatozoa can only be retrieved from macerated testicular biopsy specimens. In such cases, all that can be seen are free-floating Sertoli cells with many spermatids attached, and only occasional spermatozoa per high power field which have only the barest, occasional, slightly twitching motion. The objective of the present study was to determine whether ICSI could achieve better results than conventional IVF with microsurgical aspiration of spermatozoa (MESA). ICSI (using epididymal or testicular spermatozoa) from men with CBAVD or irreparable obstructive azoospermia, achieved good fertilization and normal embryos in 82% of cases, compared to 19% with conventional IVF. There was an overall fertilization rate of 45%, with 85% progressing to normally cleaving embryos using ICSI, compared to 6.9% using conventional IVF. The pregnancy rate with ICSI/MESA was 47% per stimulated cycle (normal delivery rate was 30%), compared to 4.5% with conventional IVF. These results were achieved in patients who had consistently failed to fertilize in previous cycles with MESA and conventional IVF.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗