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P Devroey

Publications and source records attributed to P Devroey.

At least 127 records · Page 7Linked to original sources
PubMed1997

No evidence for a decreased fertilizing potential after in-vitro fertilization using spermatozoa from polyzoospermic men.

Polyzoospermia is generally recognized as a male factor contributing to infertility and/or recurrent abortion. Although a reduced spermatozoal fertilizing capacity is assumed to be involved, so far there is no conclusive explanation for the assumed reduced reproductive performance in these patients, and data on the fertilizing capacity of spermatozoa from polyzoospermic men are lacking. The present study therefore aimed at analysing the outcome after in-vitro fertilization (IVF)-embryo transfer in polyzoospermic patients. Retrospective analysis showed that only 0.5% out of 7863 IVF cycles were performed with spermatozoa from polyzoospermic men. The outcome of these IVF cycles shows neither a reduction in spermatozoal fertilizing capacity nor an increase in pregnancy wastage in cycles in which a pregnancy was obtained. These results may suggest a normal reproductive potential in polyzoospermic patients and therefore the question may be raised whether polyzoospermia represents a real pathological entity leading to infertility.

Embryo Transfer↗
PubMed1997

Microsurgical epididymal sperm aspiration with motile trophozoite cells but no spermatozoa.

This paper reports on a patient in whom the clinical diagnosis of obstructive azoospermia was made according to clinical observations, i.e. azoospermia, normal andrological examination, normal follicle stimulating hormone and a misleading histopathological report of a testicular biopsy. Microsurgical vasoepididymostomy failed to restore fertility, and as a last resort, microsurgical sperm aspiration was performed. Although flagellated cells were observed in the epididymal aspiration, no spermatozoa were observed and wet preparation of multiple testicular biopsies failed to demonstrate any spermatozoon. This patient was diagnosed to have a non-obstructive azoospermia, resulting from maturation arrest associated with trichomonas infection at the level of the epididymis.

Adult↗
PubMed1997

Distribution of spermatogenesis in the testicles of azoospermic men: the presence or absence of spermatids in the testes of men with germinal failure.

The aim of the study was to determine whether a prior diagnostic testicle biopsy can predict success or failure of testicular sperm extraction (TESE) with intracytoplasmic sperm injection (ICSI) in patients with non-obstructive azoospermia caused by testicular failure, and what is the minimum threshold of sperm production in the testis which must be surpassed for spermatozoa to reach the ejaculate. Forty-five patients with non-obstructive azoospermia caused by testicular failure underwent diagnostic testicle biopsy prior to a planned future TESE-ICSI procedure. The diagnostic testicle biopsy was analysed quantitatively, and correlated with the quantitative findings of spermatogenesis in patients with normal spermatogenesis, as well as with the results of subsequent attempts at TESE-ICSI. Men with non-obstructive azoospermia caused by germinal failure had a mean of 0-6 mature spermatids/seminiferous tubule seen on a diagnostic testicle biopsy, compared to 17-35 mature spermatids/tubule in men with normal spermatogenesis and obstructive azoospermia. These findings were the same for all types of testicular failure whether Sertoli cell only, maturation arrest, cryptorchidism, or post-chemotherapy azoospermia. Twenty-two of 26 men with mature spermatids found in the prior testis biopsy had successful retrieval of spermatozoa for ICSI, 12 of their partners became pregnant, and are either ongoing or delivered. The study suggests that 4-6 mature spermatids/tubule must be present in the testis biopsy for any spermatozoa to reach the ejaculate. More than half of azoospermic patients with germinal failure have minute foci of spermatogenesis which are insufficient to produce spermatozoa in the ejaculate. Prior diagnostic testicle biopsy analysed quantitatively (for the presence of mature spermatids) can predict subsequent success or failure with TESE-ICSI. Incomplete testicular failure may involve a sparse multi-focal distribution of spermatogenesis throughout the entire testicle, rather than a regional distribution. Therefore, it is possible that massive testicular sampling from many different regions of the testes may not be necessary for successful TESE-ICSI.

Biopsy↗
PubMed1997

Patients with absolutely immotile spermatozoa and intracytoplasmic sperm injection.

The microinjection of completely immotile spermatozoa may impair the outcome of intracytoplasmic sperm injection (ICSI). Eleven couples underwent an initial ICSI cycle with 100% immotile freshly ejaculated spermatozoa. Two-pronuclear fertilization ensued in 18 of 145 (12.4%) successfully injected oocytes. None of these cycles resulted in a pregnancy. Nine couples underwent ICSI in subsequent cycles (n = 16). Ejaculated spermatozoa were injected in 15 cycles and testicular spermatozoa in one cycle. In 10 of the 15 cycles, motile spermatozoa were available at the time of injection. Motile testicular spermatozoa could also be injected. In the subsequent cycles, 91 of 176 (51.7%) successfully injected oocytes fertilized normally and four patients became pregnant. In the subsequent cycles where again immotile spermatozoa had to be injected no pregnancies occurred. In four subsequent cycles embryo cryopreservation was carried out. After replacement of two frozen-thawed embryos one additional pregnancy was obtained. In all, five healthy infants were born. It has been ascertained that motile spermatozoa can be detected either in repeated ejaculates or after testicular biopsy. The causes of total asthenozoospermia are variable and the problem is a sporadic rather than a permanent condition.

Adult↗
PubMed1997

The role of the number of replaced embryos on intracytoplasmic sperm injection outcome in women over the age of 40.

In order to examine if the transfer of more than three embryos has any beneficial effect on the outcome of intracytoplasmic sperm injection (ICSI) cycles in women aged > 40 years, a retrospective analysis was made of all the ICSI cycles which were performed in this age group from 1 October 1991 to 31 December 1995. A total of 525 cycles was performed in 321 patients. In 413 cycles, at least one normally fertilized embryo was available for transfer. In 271 cycles, one to three embryos were replaced while in the remaining 142 cycles at least four embryos were replaced. There was no difference in implantation rate (number of gestational sacs/number of embryos transferred), after the transfer of one to three embryos (5.2%), compared with the transfer of at least four embryos (5.1%). The pregnancy rate/embryo transfer and the clinical pregnancy rate/embryo transfer were, however, higher when at least four embryos were replaced than was the case with one to three embryos (27.5 versus 11.8%, P < 0.0001 and 20.42 versus 9.96%, P < 0.005, respectively). There were no statistically significant differences in the delivery rates, multiple pregnancy rates or spontaneous abortion rates. The pregnancy rate and the clinical pregnancy rate after ICSI in women > or = 40 years of age are related to the number of embryos replaced.

Adult↗
PubMed1997

The effect of female age and ovarian reserve on pregnancy rate in male infertility: treatment of azoospermia with sperm retrieval and intracytoplasmic sperm injection.

Factors other than spermatozoa could be the major determinant of the success of assisted reproduction treatment in cases of male infertility. Our aim was to evaluate the effect of the wife's age and ovarian reserve on assisted reproduction success rates in the most severe type of male infertility, i.e. azoospermia. A total of 249 consecutive couples suffering from male infertility caused by azoospermia underwent microsurgical epididymal sperm aspiration (MESA) or testicular sperm extraction (TESE) with intracytoplasmic sperm injection (ICSI). Of these men, 186 had irreparable obstructive azoospermia, and 63 had non-obstructive azoospermia due to testicular failure. Neither the pathology, the source, the quantity, nor the quality of spermatozoa had any effect on fertilization or pregnancy rates. Maternal age and ovarian reserve (number of eggs) had no effect on fertilization or embryo cleavage, but did dramatically affect the embryo implantation, pregnancy and delivery rates. Wives of azoospermic men who were in their 20s had a 46% live delivery rate per cycle, wives aged 30-36 years had a 34% live delivery rate per cycle, wives aged 37-39 years had a 13% live delivery rate per cycle, and wives > or = 40 years had only a 4% live delivery rate per cycle. The number of eggs retrieved also affected pregnancy and delivery rate, but to a lesser extent than age. In virtually all cases of obstructive azoospermia, and in 62% of cases with non-obstructive azoospermia caused by germinal failure, sufficient spermatozoa could be retrieved to perform ICSI, with normal fertilization and embryo cleavage. However, the pregnancy rate and the live delivery rate were dependent strictly on the age of the wife, and on her ovarian reserve. Unfortunately, exaggerated claims of high pregnancy rates can thus easily be made by manipulating, in a very simple way, selection for female factors.

Adult↗
PubMed1997

Ovulation by repeated human chorionic gonadotrophin in 'empty follicle syndrome' yields a twin clinical pregnancy.

This case illustrates the possibility of obtaining oocytes that fertilize and cleave normally after the administration of a second ovulatory dose of human chorionic gonadotrophin (HCG) in a case of 'empty follicle syndrome'. The present patient underwent ovarian stimulation with gonadotrophin-releasing hormone analogue (GnRHa)/menotropin for intracytoplasmic sperm injection (ICSI). After the failure of the first oocyte retrieval, a second dose of HCG was administered to trigger ovulation. A total of 13 oocytes was retrieved during the second procedure and 11 good quality embryos were obtained (fertilization and cleavage rates of 92 and 91% respectively). No pregnancy was achieved after the replacement of three embryos. In a subsequent cycle stimulated with clomiphene citrate, three frozen-thawed embryos were replaced and a twin pregnancy was achieved. The patient delivered two healthy babies at term.

Adult↗
PubMed1997

Ectopic pregnancy: let's cut! Strict laparoscopic approach to 194 consecutive cases and review of literature on alternatives.

From March 1989 to December 1995, 194 cases of ectopic pregnancy were diagnosed in our centre and treated following a strict laparoscopic protocol. A total of 193 cases was treated surgically and only one case was treated medically, because general anaesthesia was contraindicated. Altogether, eight laparotomies (4.1%) had to be performed; three primary and five secondary, due to uncontrollable haemorrhage (n = 3) and too large pregnancy size (n = 2). Peri- or postoperative complications were encountered in 24 cases (12.4%). Residual disease occurred in 14 cases (7.2%), all after a technically successful operative laparoscopic procedure. These cases received adjuvant therapy, either systemic administration of methotrexate or a second intervention. The overall laparoscopic cure rate was 88.1% (171/194). Conclusive follow-up data could be obtained concerning 110 cases with an active desire for pregnancy. Overall conception rate was 77.3%, with an ongoing pregnancy rate of 81.2% and a recurrency rate of 10.6%. A critical overview of the available data on non-surgical approaches is made, while the reported results are evaluated according to published data. It is concluded that at this stage a surgical approach by means of operative laparoscopy should remain the gold standard in treating ectopic pregnancies.

Adolescent↗
PubMed1997

Selective transfer of cryopreserved human embryos with further cleavage after thawing increases delivery and implantation rates.

We investigated whether further in-vitro culture of human multicellular embryos that survive cryopreservation can select the viable embryos for transfer. Embryos for cryopreservation were supernumerary multicellular embryos obtained after in-vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) treatments, with <20% of their volume filled with anucleate fragments. These had been cryopreserved using a slow-freezing and slow-thawing protocol with 1.5 M dimethylsulphoxide as the cryoprotectant. From the start of our cryopreservation programme until September 12, 1994, the thawing strategy was to thaw frozen embryos up to the exact number needed for transfer. Embryos for transfer were selected on the basis of their morphological appearance and embryo transfer to the patient was done on the day of thawing. From September 12, 1994 onwards we used a more selective thawing strategy where a cohort of up to a maximum of 12 frozen embryos per patient is thawed from which embryos of the best morphological quality, and which are furthest advanced in terms of cleavage after a 24 h in-vitro culture period in Menezo B2 medium, are selected. We took delivery rates, embryo implantation rates and birth rates into account to see if there is any difference between the following three types of transfers used: 187 transfers exclusively of embryos having continued to cleave after thawing, 107 mixed transfers of embryos with and without further cleavage and 53 transfers exclusively of embryos with no further cleavage. The overall outcome in terms of delivery rate and embryo implantation and birth rates were not different between the new and the earlier thawing policies (6.6, 5.2 and 3.6% versus 6.0, 4.1 and 2.7% respectively). Only when a distinction was made between transfers on the basis of the presence of embryos with further cleavage, did the advantage of selection on the basis of cleavage capacity become evident. Significantly higher delivery and embryo implantation and birth rates (11.2, 7.7 and 6.5% respectively) were recorded with transfers exclusively of embryos with further cleavage versus mixed transfers of embryos with and without further cleavage (1.9, 2.9 and 0.6% respectively). Fifty-three transfers exclusively of embryos with no further cleavage did not lead to any delivery. Our results demonstrate that selection of human multicellular embryos which survive cryopreservation and continue to cleave in vitro can significantly improve the delivery rate per transfer and the implantation rate per transferred embryo.

Abortion, Spontaneous↗
PubMed1997

A randomized comparison of the cryopreservation of one-cell human embryos with a slow controlled-rate cooling procedure or a rapid cooling procedure by direct plunging into liquid nitrogen.

We conducted a randomized prospective study of the cryopreservation of one-cell human embryos, comparing a slow controlled-rate freezing procedure with a rapid cooling procedure by direct plunging into liquid nitrogen. We analysed the numbers of embryos that were recovered immediately after thawing (= recovery), the number of embryos morphologically intact after thawing and subsequent dilution of the cryoprotectants (= survival), the numbers of embryos undergoing further cleavage after 24 h of in-vitro culture (= cleavage) and the implantation of transferred embryos (= children born per frozen-thawed embryo transferred). We demonstrated that the recovery of embryos was greater after slow controlled-rate freezing. Survival was greater after rapid cooling and the number of embryos undergoing further cleavage was higher after slow controlled-rate freezing. Although the birth rate was twice as high after slow controlled-rate freezing as after rapid cooling, this difference was not statistically significant. In conclusion, our results show clearly that for the freezing of one-cell human embryos, slow controlled-rate freezing is more efficient than rapid cooling. Before rapid cooling is used routinely in clinical in-vitro fertilization programmes, its safety and reproducibility must be convincingly demonstrated.

Cleavage Stage, Ovum↗
PubMed1997

Viability of partially damaged human embryos after cryopreservation.

In our centre, embryos are judged to have survived cryopreservation if at least half of the initial number of blastomeres remain intact. Therefore both fully intact and partially damaged embryos are transferred. The aim of this study was to investigate the viability of partially damaged human embryos after cryopreservation. We retrospectively analysed the implantation and in-vivo development of embryos which were either fully intact or had lost some blastomeres after cryopreservation. Oocytes were collected following stimulation with the gonadotrophin-releasing hormone (GnRH)-agonist Buserelin and human menopausal gonadotrophin. Supernumerary multicellular embryos with not more than 20% of their volume filled with anucleate fragments were frozen on day 2 or day 3 of the cycle using a slow cooling procedure with dimethylsulphoxide as the cryoprotectant. Following slow thawing, 431 fully intact embryos were transferred in 314 embryo transfer procedures and 488 partially damaged embryos were transferred in 327 such procedures. The percentage of gestational sacs with fetal heartbeat obtained after transfer of fully intact embryos was almost three times higher than that after transfer of partially damaged embryos (11.4 versus 3.5%). Forty-five children (birth rate 10% per embryo transfer) were born after transfer of fully intact embryos and 14 after transfer of embryos from which some blastomeres had been lost following cryopreservation. In conclusion, although children have been delivered after transfer of partially damaged embryos, the aim of a cryopreservation programme must be to obtain fully intact embryos after thawing.

Blastomeres↗
PubMed1997

Clinical application of preimplantation diagnosis for myotonic dystrophy.

Myotonic dystrophy (DM) or Steinert's disease is a progressive autosomal dominant disease characterized by increasing muscle weakness, myotonia, cataracts, and endocrine abnormalities such as diabetes and testicular atrophy. The gene for DM was cloned in 1992 and the mutation was shown to be an expanded trinucleotide (CTG) repeat. A polymerase chain reaction (PCR)-based assay was described soon after that would allow (prenatal) diagnosis of the disease. Based on these PCR assays, we have developed a method for carrying out single-cell PCR for DM. In preimplantation diagnosis, embryos obtained in vitro are checked for the presence or absence of a disease, after which only embryos shown to be free of the disease under consideration are returned to the mother. A single-cell assay was developed for preimplantation diagnosis in couples where one of the parents is afflicted with DM. Twenty intracytoplasmic sperm injection (ICSI) cycles were carried out in eight patients and between one and four embryos were replaced in 17 out of 20 cycles. Two of the patients became pregnant and have had prenatal diagnosis which has confirmed that they are unaffected.

Adult↗
PubMed1997

Surgical sperm retrieval for intracytoplasmic sperm injection.

The introduction of intracytoplasmic sperm injection (ICSI) provides new hope for many couples suffering from the most untreatable forms of male infertility as ICSI can also be successfully performed using epididymal or testicular spermatozoa. Testicular spermatozoa may be recovered from testicular tissue in every patient with excretory azoospermia, but also in about half of patients with secretory azoospermia. The strongest parameter to predict successful testicular sperm recovery is histopathological examination of a testicular biopsy, especially in patients with some form of germ-cell aplasia. Even in our series of Klinefelter patients, testicular sperm were recovered in eight out of 15 patients and after seven ICSI cycles combined with preimplantation diagnosis, two singletons were born. Less invasive techniques such as percutaneous fine-needle aspiration have been introduced and may yield comparable success rates in patients with normal testicular function. The high fertilization rates after testicular sperm recovery and ICSI and the favourable implantation rates may therefore render microsurgical epididymal sperm aspiration (MESA) obsolete in the future for patients with normal spermatogenesis. Besides, the use of cryopreserved testicular spermatozoa may become an alternative to repeated surgery for obtaining testicular tissue for subsequent ICSI treatment cycles.

Epididymis↗
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↗