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Effect of sperm DNA fragmentation on the clinical outcomes for in vitro fertilization and intracytoplasmic sperm injection in women with different ova
Conclusion(s): Sperm DNA fragmentation (SDF) has a greater impact on IVF and ICSI outcomes among women with ROR(reduced ovarian reserve), so SDF testing may be of particular clinical significance for these couples.
Relationship between physical occupational exposures and health on semen quality: data from the Longitudinal Investigation of Fertility and the Enviro
Conclusion(s): A negative relationship among occupational exertion, hypertension, and the number of medications with semen quality was identified. As these are potentially modifiable factors, further research should determine whether treatment or cessation may improve male fecundity.
Freeze-all policy: fresh vs. frozen-thawed embryo transfer
Conclusion(s)
The IVF outcomes were significantly better in the group using the freeze-all policy, compared with the group using fresh ET. These results suggest that even in a select group of patients that underwent fresh ET (P levels ≤:1.5 ng/mL), endometrial receptivity may have been impaired by COS, and outcomes may be improved by using the freeze-all policy.
When is clomiphene or gonadotropin intrauterine insemination futile? Results of the Fast Track and Standard Treatment Trial and the Forty and Over Tre
Conclusion(s): Women who initiated infertility treatment with FSH of 10–15 mIU/mL and E2 ≥:40 pg/mL on day 3 testing were unlikely to achieve live birth after COH-IUI treatment.
Letrozole is a promising new treatment of male infertility
A letrozole pill once a week restored fertility in obese, infertile men and led to their partners giving birth to two full-term, healthy babies, according to a new study from Canada.
Male partner's healthier lifestyle may help infertile obese female conceive
Male partners of infertile obese females may increase the odds of conceiving a child by improving their own weight and dietary habits, preliminary results from a pilot study suggest.
Key indicator for successful treatment of infertile couples
A study determines if follicle stimulating hormone and estrogen at the upper limits of normal could predict treatment success as measured in live birth rates. The essential question was: should women with higher levels of FSH and estrogen be "fast-tracked" to in vitro fertilization (IVF), bypassing the conventional treatment trajectory?
Physical labor, hypertension and multiple meds may reduce male fertility
Working in a physically demanding job, having high blood pressure, and taking multiple medications are among health risks that may undermine a man's fertility, according to a study. The study is the first to examine the relationships between workplace exertion, health, and semen quality as men are trying to conceive.
Novel Approach Helps Prevent Early Menopause in Breast Cancer Patients, Study Finds
Early menopause can be prevented and fertility may be preserved in young women with early stage breast cancer, according to a study. A major international clinical trial has found that the risk of sudden onset of menopause can be significantly reduced by adding a drug called goserelin to the chemotherapy regimen. Women who took goserelin and wanted to have children also were more likely to get pregnant and deliver a healthy baby
Phthalates potentially alter levels of a pregnancy hormone that influences sex development
Exposure to hormone-altering chemicals called phthalates - which are found in many plastics, foods and personal care products - early in pregnancy is associated with a disruption in an essential pregnancy hormone and adversely affects the masculinization of male genitals in the baby, according to new research. The findings focus on the role of the placenta in responding to these chemicals and altering levels of a key pregnancy hormone.
Key indicator for successful treatment of infertile couples
Summary
Women with an elevated FSH are unlikely to conceive using IUI/AIH but likely to conceive using IVF so why offer IUI?
Comment
No one wants to use IVF and many like the idea that more passive treatments are better. No one can argue with this since the conceptions are more natural than IVF (but still not the same as a spontaneous conception). Indeed, many criticise clinics who only offer IVF for not providing low cost options. However, there are some couples who in using IUI may be doing themselves a disservice and incorrectly believe this route is worthwhile. This study by Kaster, et. al (2015) identified an elevated FSH concentration of more than 10IU/L as a good indicator of failure using IUI even though they also were exposed to ovarian stimulation. This group had NO pregnancies after COH/IUI. Indeed, there is a good argument that offering IUI to poor prognosis clients without counselling about lack of success is poor management since it deprives the clients of valuable months to pursue IVF where the chance of pregnancy is better because their ovarian reserves are age dependent. An additional aspect is not the age to first conception but the age at last conception. By using many months with IUI, a clinic may be using up valuable months that in a few years hence when they may be trying for a second child. In IVF, few think about families, only pregnancy. But when you ask a couple, it is all about families. So any couples having treatment that offers poor prognosis should be receive counselling about the consequences of reducing the time for them to achieve a family.
Title
Relationship between physical occupational exposures and health on semen quality
Summary
This article has good and poor news for oligospermic males and their work place environment.
Comment
This study looked at work exposure activities in relation to semen quality. Any male with a poor sperm count will naturally ask what they can do about it. From this paper, advisers can suggest that shift work, night work, vibration, noise, heat, and prolonged sitting were not associated with deceased semen quality. The authors did notice a small decrease in morphology with blood pressure and as a marker of general health, the number of medications taken. One may then argue that if a male partner has high blood pressure and asthenospermia, one possible treatment option is to address the high blood pressure - although this is a clinic decision. One may also argue that as part of a general workup for IVF, weight (BMI) and blood pressure should be routine measurements. The good news is that if hypertension is a negative indicator for semen quality, then addressing this may restore any potential decrease in male based infertility. Even moving from ICSI because of asthenspermia back to IVF could be seen as a positive outcome. at the very least, adding `DO you suffer from Hypertension` on the semen sample form may not be a bad idea.
Title
Effect of sperm DNA fragmentation on IVF/CISI in women with different ovarian reserves
Summary
Not surprisingly, the level of Sperm DNA damage has differing impacts on women with diminished ovarian reserve.
Comment
There are two things of interest in this paper. First is confirmation that even in women with normal ovarian reserve, elevated sperm DNA fragmentation (SDF) is related to increased rates of miscarriage. It seems that clinics who do NOT carry out an SDF test and treatment results in miscarriage may be exposing themselves to complaint. Unfortunately, in this study, IVF and ICSI produced the same outcomes. The authors identified a SDF level of 27% as the critical cutoff point. However the main feature of the article was that the SDF level significantly influenced the rate that live birth rates were diminished in women with decreased ovarian reserve. That is, when addressing the problem of age related success rates, the degree of male related sperm damage needs to be also considered. The authors suggested this may be interpreted as an indication that poor oocyte quality may be unable to correct the sperm DNA damage. While the concept of oocyte restoration of sperm quality as been around for some time, little data actually exists to demonstrate this. This interesting article may just provide a small glimpse that oocytes can actually correct some sperm DNA fragmentation issues.
Title
Freeze-all policy: fresh vs. frozen-thawed embryo transfer
Summary
FET continues to out perform ET and raises question whether clinics can find a way to only do FET?
Comment
IN this study FET pregnancy rates (implantation clinical and ongoing) were better by about 5% to fresh ET. Most clinics would agree with this observation and one wonders whether if a clinic provides couples with this information and offers them a choice of ET or FET, how many would take it. In the past, even back as far as 1988, clinics were trying to find ways to put the best embryos back as FET transfers. Unfortunately, no-one liked the idea of doing an ET with a poor quality embryo. However, where a women has OHSS and the transfer is delayed, no-one seems to mind (probably because they are not feeling well!!). One option is to have a fee structure that includes the IVF collection and an FET cycle. If presented to couples as an option that may give them a better chance of pregnancy and if they know there is only 1-2 good embryos anyway, they may agree. The killer point against this is if the embryos fail to survive freezing or develop into blastocysts. No-one has solved this paradox but it doesn't mean clinics should strive to find a way to deliver the best rate possible.
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What is the pregnancy rate after COH/IUI for women with an FSH>10IU/l
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