Thesis (MMed)--Stellenbosch University, 2105. / ENGLISH ABSTRACT: Intracytoplasmic sperm injection (ICSI), as well as other micromanipulation assisted reproductive technology methods, such as physiologic ICSI (PICSI) and intracytoplasmic morphologically selected sperm injection (IMSI), are routinely used in many fertility laboratories around the world. An integral part of these methods is the manipulation of spermatozoa in preparation of the injection into the oocyte. It is common practice to place prepared spermatozoa in a viscous holding medium to facilitate the handling, manipulation and slowdown of spermatozoon movement during the immobilization and injection processes of ICSI. The possible effect of these holding mediums on basic semen parameters, as well as the sperm deoxyribonucleic acid (DNA) and structural integrity of spermatozoa, is of importance. Hamilton Thorne IVOS® developed an automated software solution for live sperm morphology evaluation under high magnification, called IMSI StrictTM. It combines Tygerberg Strict Criteria morphological classification of human spermatozoa with motile sperm organelle morphology examination (MSOME) and provides software-based categorization. The IMSI StrictTM software was developed to aid in the IMSI spermatozoon selection process that enables objective classification of spermatozoa to remove inter-technician variation. For good optics and spermatozoon evaluation in IMSI StrictTM, spermatozoa need to be moving very slowly or be immotile, but still viable. This can be achieved by placing spermatozoa in a viscous holding medium, either polyvinylpyrrolidone (PVP) or SpermSlowTM, sometimes for a substantial time period. Before marketing the clinical use of IMSI StrictTM, the possible toxicity or deleterious effect of PVP and SpermSlowTM on spermatozoa needs to be excluded. The primary objective of this study was to evaluate the effect of PVP and SpermSlowTM on human spermatozoa after different exposure times using a viability stain, CASA motility and kinetic parameters, chromatin packaging analysis (CMA3 staining analysis) and DNA fragmentation analysis (TUNEL analysis). The secondary objective was to evaluate the effect of PVP and SpermSlowTM on human spermatozoa‟s ultrastructure with Transmission Electron Microscopy. This prospective analytical study was conducted at Drs Aevitas Fertility Clinic (Vincent Pallotti Hospital, Cape Town, South Africa) as well as the Fertility Unit at Tygerberg Hospital (Cape Town, South Africa) between July 2013 and October 2014. A total of 90 separate (no duplication) semen samples were analysed for the quantitative analysis (primary objective) and 1 sample for the descriptive analysis (secondary objective). Results showed that although PVP and SpermSlowTM treated sperm outcomes often differed significantly after typical statistical analysis, clinically these two mediums were shown to be equivalent (using a specific statistical test for equivalence) for the tested outcomes. PVP and SpermSlowTM had no detrimental effect clinically on sperm viability, motility parameters, chromatin packaging and DNA fragmentation rate. The secondary investigation indicated that SpermSlowTM might exert a disintegrating effect on various sperm membranes, and as a secondary consequence of the eventual necrotic process, alteration of chromatin and cytoskeletal components. PVP medium on the other hand did not show these disintegrating effects. This finding needs to be further investigated since only one semen sample was evaluated. Based on this study‟s results, either PVP or SpermSlowTM can be used for IMSI StrictTM purposes. However, the study did not include the technical aspects of the usage of PVP and SpermSlowTM. / AFRIKAANSE OPSOMMING: Intrasitoplasmiese sperm inspuiting (ICSI), sowel as ander mikro-manipulasie voortplantings tegnieke, soos fisiologiese ICSI (PICSI) en intrasitoplasmiese morfologies geselekteerde sperm inspuiting (IMSI), word in baie fertiliteitsklinieke regoor die wêreld gebruik. 'n Integrale deel van hierdie metodes is die manipulasie van spermatosoa ter voorbereiding van die inspuitproses. Dit is algemeen om voorbereide spermatosoa in 'n viskose medium te plaas om die hantering, manipulasie en vertraging van spermatosoön beweging tydens die immobilisasie en inspuitproses van ICSI te fasiliteer. Die effek van hierdie mediums op basiese semenparameters, sowel as die sperm deoksiribonukleïensuur (DNS) en strukturele integriteit van spermatosoa, is van belang. Hamilton Thorne IVOS® het 'n sagteware oplossing, IMSI StrictTM, vir lewende sperm morfologie evaluering onder hoë vergroting ontwikkel. Hierdie sagteware bied sagteware-gebaseerde morfologiese klassifikasie deur die Tygerberg streng kriteria morfologiese klassifikasie met beweeglike spermorganel morfologie ondersoek (MSOME) te kombineer. Die IMSI StrictTM sagteware is ontwikkel om die objektiewe klassifikasie van spermatosoa vir IMSI spermatosoön seleksie moontlik te maak. Spermatosoa moet baie stadig beweeg of immotiel, maar steeds lewensvatbaar wees om goeie optika en spermatosoön evaluering vir IMSI StrictTM te verseker. Dit sal bereik kan word deur spermatosoa in 'n viskose medium, hetsy PVP (“polyvinylpyrrolidone”) of SpermSlowTM, vir 'n aansienlike tydperk te inkubeer. Voordat IMSI StrictTM vir kliniese gebruik bemark kan word moet die moontlike toksisiteit of nadelige effek van PVP en SpermSlowTM op spermatosoa uitgesluit word. Die primêre doel van hierdie studie was om die effek van PVP en SpermSlowTM op menslike spermatosoa na verskillende inkubasie tye te evalueer deur ʼn lewensvatbaarheid kleuring toets, twee sperm DNS toetse (CMA3 en TUNEL) en rekenaar geëvalueerde sperm beweeglikheid toetse te gebruik. Die sekondêre doel was om die effek van PVP en SpermSlowTM op menslike spermatosoa se ultrastruktuur deur middel van Transmissie Elektronmikroskopie te evalueer. Hierdie studie is by Drs Aevitas Fertiliteitskliniek (Vincent Pallotti Hospitaal, Kaapstad, Suid-Afrika) sowel as die Fertiliteitseenheid by Tygerberg Hospitaal (Kaapstad, Suid-Afrika) tussen Julie 2013 en Oktober 2014 uitgevoer. 'n Totaal van 90 semenmonsters vir die kwantitatiewe analise (primêre doel) en een vir die beskrywende analise (sekondêre doel) is ontleed. Resultate het getoon dat alhoewel PVP en SpermSlowTM geïnkubeerde spermuitkomste dikwels na ʼn tipiese statistiese analise betekenisvol verskil, hierdie twee mediums vir die geëvalueerde uitkomste klinies ekwivalent (bepaal deur middel van spesifieke statistiese toetse vir ekwivalensie) is. Die mediums het ook nie klinies 'n nadelige effek op sperm lewensvatbaarheid, beweeglikheid parameters, chromatien verpakking en DNS fragmentasie koers getoon nie. Die sekondêre ondersoek het getoon dat SpermSlowTM hoofsaaklik 'n effek van disintegrasie op verskeie spermmembrane getoon het. Hierdie nekrotiese proses kan lei tot verandering van chromatien en sitoskelet komponente. PVP medium het egter nie dieselfde disintegrerende effek getoon nie. Hierdie bevinding moet egter verder ondersoek word, aangesien slegs een semenmonster geëvalueer is. Alhoewel hierdie studie nie die tegniese aspekte van die gebruik van PVP en SpermSlowTM geëvalueer het nie, kan aanbeveel word dat óf PVP óf SpermSlowTM op grond van geëvalueerde uitkomste tydens die IMSI StrictTM sperm seleksie proses gebruik word.

No description available.

No description available.

Successful fertilization depends upon the activation of metaphase II arrested oocytes by sperm-borne oocyte activating factor (SOAF). Failure of oocyte activation is considered as the cause of treatment failure in a proportion of infertile couples. SOAF induces the release of intracellular calcium in oocyte which leads to meiotic resumption and pronuclear formation. Calcium release is either in the form of single calcium transient in echinoderm and amphibian oocytes or several calcium oscillations in ascidian and mammalian oocytes. Although the SOAF attributes are established, it is not clear which sperm protein(s) play such role. Sperm postacrosomal WW binding protein (PAWP) satisfies a developmental criteria set for a candidate SOAF. This study shows that recombinant human PAWP protein or its transcript acts upstream of calcium release and fully activates the amphibian and mammalian oocytes. Interference trials provided evidence for the first time that PAWP mediates sperm-induced intracellular calcium release through a PPXY/WWI domain module in Xenopus, mouse and human oocytes. Clinical applications of PAWP were further investigated by prospective study on the sperm samples from patients undergoing intracytoplasmic sperm injection (ICSI). PAWP expression level, analyzed by flow cytometry, was correlated to ICSI success rate and embryonic development. This study also explored the developmental expression of the other SOAF candidate, PLCζ in male reproductive system and its function during fertilization. Our findings showed for the first time that PLCζ most likely binds to the sperm head surface during epididymal passage and is expressed in epididymis. We demonstrated that PLCζ is also compartmentalized early in spermiogenesis and thus could play an important role during spermiogenesis. Detailed analysis of in vitro fertilization revealed that PLCζ disappears from sperm head during acrosome reaction and is not detectable during sperm incorporation into the oocyte cytoplasm. In conclusion, this dissertation provides evidence for the essential non-redundant role of sperm PAWP in amphibian and mammalian fertilization; recommends PAWP as a biomarker for prediction of ICSI outcomes in infertile couples; and proposes that sperm PLCζ may have functions other than inducing oocyte activation during fertilization. / Thesis (Ph.D, Anatomy & Cell Biology) -- Queen's University, 2013-09-29 23:45:35.395

One in six couples wishing to start a family are infertile. The many causes of infertility include genetic defects that can be single gene, multifactorial or chromosomal (including Y deletions, karyotype abnormalities and gamete aneuploidy). This thesis is concerned with the association between infertility and increased sperm aneuploidy. Specific questions are: should males be screened for sperm aneuploidy before intracytoplasmic sperm injection (ICSI)? Is there a relationship between individual semen parameters and sperm aneuploidy for specific chromosome pairs? What is the role of genome organisation in male gametes and its association with infertility? Whether use of alternative therapy (in this case, traditional Chinese Medicine (TCM)) can be used to improve sperm disomy levels. Statistical analysis of questionnaire data revealed that infertility specialists believed there to be merit in screening sperm aneuploidy levels before ICSI. Evidence is presented for possible chromosome-specific and semen parameter specific mechanisms for sperm aneuploidy as is evidence of genome organisation that may be perturbed in infertile males. Finally, in six males studied, sperm aneuploidy levels improved significantly coincident with TCM. Closer investigation of the biological activity of individual therapeutic herbs and treatment cocktails revealed strong anti-oestrogenic and anti-oxidant properties. This suggests a possible mechanism of action of the herbs and provides the basis from which future placebo controlled clinical trials might continue. Possible criticisms of the work presented here include the unavailability of blood samples from many of the patients (thus preventing karyotype analysis) and the absence of a second control group in our studies on semen parameters. Nevertheless significant steps have been made towards establishing the need for, and the implementation of, a pre-ICSI screening test. Moreover progress has been made towards further understanding the aetiology of sperm aneuploidy and towards the implementation of a new treatment that may, ultimately, augment, or even replace ICSI.

Aujourd’hui, au moins 5 millions d’enfants à travers le monde, sont nés suite au recours de leurs parents à l’AMP. Les traitements de l’infertilité ont significativement évolué, le plus souvent cela a eu lieu en dehors des protocoles expérimentaux classiques. L’exemple le plus marquant a été l’introduction de la FIV avec micro-injection intracytoplasmique d’un spermatozoïde (ICSI). Le manque d’évaluation de la santé des enfants nés de ces techniques reste la faiblesse de cette spécialité. Nous avons mis en place un suivi longitudinal d’une cohorte mono-centrique au sein de l’hôpital Saint-Joseph (Marseille). Le recueil a été fait par la collecte des photocopies des pages du carnet de santé des enfants et de questionnaires remplis par les parents. Notre étude est une des rares études françaises présentant un suivi à long terme, pouvant aller jusqu’à 5 ans, sur une cohorte à grande échelle. L’étude de l’IMC jusqu’à l’âge de 5 ans, n’a pas révélé d’effet de la FIV, comme cela a pu être pressenti dans la littérature. D’autres investigations méritent d’être conduites. Il est important de construire un système d’information cohérent autour de la santé des enfants nés après FIV à cause de l’apparition constante des nouvelles techniques dans cette spécialité, toutes étant potentiellement responsables de risques sur la santé future de l’enfant. La faisabilité de la collecte de données couvrant à la fois l’environnement maternel, conceptionnel et les indicateurs de santé de l’enfant doit être pensée à l’échelle nationale. A cette fin le développement des méthodes de liaison entre les différents registres existants en France serait une des solutions les plus opportunes. / Today, at least 5 million children worldwide were born following the enrollment of their parents in ART program. Infertility treatments have changed significantly; most often these changes took place outside traditional experimental protocols. The most striking event was when IVF with intracytoplasmic sperm injection (ICSI) was introduced in ART practices in 1995. The lack assessment of the health of children born after this technique remains the major weak in this discipline. We established a longitudinal monocentric follow-up study in Saint-Joseph Hospital (Marseille). The data were collected by asking parents to send copies of child health records and questionnaires filled out by them. This investigation is one of the few French studies involving a long-term follow- up to 5 years, in a large scale cohort. The study of BMI up to age 5 years didn’t show the suspected epigenetic influence of IVF reported in literature. Further investigations need to be conducted. It is important to build a coherent information system around the health of children born after IVF. The feasibility of collecting a series of data covering both maternal and conceptional environment, and child health indicators should be considered at the national level through the development of connection methods between different registers developed in France.

The objective of part one of this study was to determine if the presence of porcine growth hormone (pGH) during oocycte in vitro maturation (IVM) affected subsequent embryo development. Pig cumulus-oocyte complexes (COC) (n=987) were aspirated from slaughterhouse derived ovaries and cultured in BSA-free NCSU 23 medium containing porcine follicular fluid (10% v/v), cysteine (0.1 mg/ml) and hormonal supplements (eCG and hCG, 10 IU/ml each), 10 ng/ml EGF, and with or without pGH (100 ng/ml) for 22 h. The COC were then cultured in the same medium with or without 100 ng/ml pGH, but without hormonal supplements for an additional 22 h. After the completion of maturation culture, cumulus cells were removed and oocytes were co-incubated with frozen-thawed spermatozoa for 8 h. Putative embryos were transferred to NCSU 23 containing 0.4% BSA and cultured for 144 h. Embryo development was assessed on d 6 of culture. The treatment groups were as follows: treatment 1 = control group cultured in IVM medium alone; treatment 2 = 100 ng/ml pGH present of the first 22 h of maturation culture and absent for the second 22 h of maturation culture; treatment 3 = 100 ng/ml pGH absent for the first 22 h of maturation culture, but present for the second 22 h of maturation culture; and treatment 4 = 100 ng/ml pGH present throughout the entire IVM period. Embryos were visually scored for developmental stage at 144 h following fertilization. Each oocyte in the study received a developmental score, based on a scale of 1 = uncleaved, 2 = 2-cell embryo, 3 = 4- to 8-cell embryo, 4 = 9- to 16-cell embryo, 5 = morula, and 6 = blastocyst. The addition of pGH did not affect porcine embryo development as compared to the control (1.57 ± .08, 1.67 ± .08, 1.47 ± .08, and 1.60 ± .08, respectively; P > .10). Replicates within the study differed significantly from each other (P < .01) primarily because the development in replicate 6 was greater than for all others. There was a significant treatment by replicate interaction (P < .05); pGH added during the first 22 h of IVM and pGH added during the second 22 h of IVM in replicate 6 resulted in higher development scores than for controls and continuous pGH addition. However, in replicate 2, continuous pGH resulted in the greatest development. These results suggest that pGH may exert a stimulatory effect on embryo development when present in the IVM media; however, further studies using pGH in IVM culture are necessary. The objectives of the second part of the study were to examine aspects of intracytoplasmic sperm injection (ICSI) using membrane-disrupted spermatozoa, in vitro fertilization (IVF), and sperm-mediated gene transfer in the pig. Porcine oocytes were shipped overnight in maturation media at 39°C in a portable incubator. After 22 h of maturation culture, oocytes were washed in maturation medium without gonadotropins and cultured for an additional 22 h. Cumulus cells were removed and oocytes were divided into four treatment groups: treatment 1 = ICSI using membrane-damaged spermatozoa coincubated with linear green fluorescent protein (GFP) DNA; treatment 2 = ICSI using membrane damaged spermatozoa; treatment 3 = IVF with frozen-thawed spermatozoa coincubated with linear GFP DNA prior to IVF; treatment 4 = IVF with frozen-thawed spermatozoa with no DNA coincubation. Embryos were scored for developmental stage at 144 h following fertilization. Each oocyte in the study received a developmental score, based on a scale of 1 = uncleaved, 2 = 2-cell embryo, 3 = 4-cell embryo, 4 = 5- to 8-cell embryo, 5 = 9- to 16-cell embryo, 6 = morula, and 7 = blastocyst. Although no overall difference in development score was observed following the four different treatments, a treatment difference among cleaved oocytes was observed when comparing only the two ICSI treatments (P < .05); development scores were greater in the ICSI treatment in which sperm were not coincubated with linear GFP DNA prior to injection than when the coincubation was performed (3.76 ± .21 vs. 3.13 ± .17, respectively). No differences in development score were observed in the two IVF treatments. The percentage of embryos expressing the GFP transgene on d 6 of culture following fertilization was 7.3% in the ICSI+GFP group and 0% in all other treatment groups. Thus, sperm-mediated gene transfer using ICSI in the pig has been demonstrated, although success rates were low. / Master of Science

Η ενδοκυττάρια έγχυση σπέρματος (ICSI) εισήχθη ως μέθοδος υποβοηθούμενης αναπαραγωγής (ΑRT) κυρίως για την αντιμετώπιση της ανδρικής στειρότητας. Όμως, λόγω των υψηλών ποσοστών επιτυχίας, και παρά τις αυξανόμενες ανησυχίες για τους κινδύνους από τη σημαντική ανθρώπινη παρεμβολή στο γονιδίωμα, το επιγονιδίωμα και την ανάπτυξη των παιδιών, προτιμάται ακόμα και σε περιπτώσεις όπου δεν απαιτείται ιατρικά. Από τις λίγες σήμερα συστηματικές μελέτες παιδιών από ART, καταγράφεται αυξημένο ποσοστό προδιάθεσης τους σε ασθένειες που σχετίζονται με κακό καρδιομεταβολικό πρότυπο στην ενήλικη ζωή. Στόχος της εργασίας ήταν η διερεύνηση της δυνατότητας χρήσης της μεταβολομικής ανάλυσης για τον πρώϊμο και έγκυρο προσδιορισμό σχετικών διαταραχών σε δείγματα πλάσματος προεφηβικών κοριτσιών και αγοριών από ΙCSI, που επιλέχτηκαν από ένα συστηματικά χαρακτηρισμένο σύνολο παιδιών μελέτης της Α’ Παιδιατρικής Κλινικής, Νοσοκομείου «Αγία Σοφία», Ιατρικής Σχολής, ΕΚΠΑ. ΥΛΙΚΑ ΚΑΙ ΜΕΘΟΔΟΙ: Τα μεταβολικά πρότυπα πλάσματος (α) 10 κοριτσιών από ΙCSI και 10 από φυσιολογική γονιμοποίηση (NC) και (β) 16 αγοριών από ΙCSI και 16 από NC ποσοτικοποιήθηκαν με χρωματογραφία αερίων – φασματομετρία μάζας (GC-MS). Μετά από την ταυτοποίηση κορυφών και την κατάλληλη κανονικοποίηση των προτύπων, 86 πρότυπα 70 μεταβολιτών στα κορίτσια και 92 πρότυπα 80 μεταβολιτών στα αγόρια αναλύθηκαν ξεχωριστά, και συγκριτικά με αλγορίθμους πολυπαραμετρικής στατιστικής ανάλυσης των λογισμικών TM4-MeV (v.4.9.0), και ΧLSTAT (v.2013.4.03). Οι διαφορές στο πρότυπο σύστασης του πλάσματος σε μικρού μεγέθους μεταβολίτες μεταξύ των ΙCSI και ΝC ομάδων σε κορίτσια και αγόρια και μεταξύ των δύο φύλων οπτικοποιήθηκαν σε κατάλληλα ανακατασκευασμένο από τη βιβλιογραφία και σχετικές βάσεις δεδομένων μεταβολικό δίκτυο πολλών ιστών. ΑΠΟΤΕΛΕΣΜΑΤΑ: Στα κορίτσια, ο αλγόριθμος μερικών ελαχίστων τετραγώνων-διακριτής ανάλυσης (PLS-DA) κατέδειξε σαφή διαχωρισμό των μεταβολικών πρoτύπων μεταξύ των ομάδων ΙCSI και NC. Ο διαχωρισμός αυξάνεται με το συνυπολογισμό των βιοχημικών μετρήσεων. Στα αγόρια, η PLS-DA των μεταβολικών ή και βιοχημικών προτύπων κατέδειξε επίσης διαχωρισμό, αν και μικρότερο, σε σχέση με κορίτσια. Η ανάλυση σημαντικότητας για μικροσυστοιχίες (SAM), που ενδείκνυται για την ανάλυση ομικών δεδομένων, ανέδειξε 37 από τους 70 μεταβολίτες που αναλύθηκαν στα κορίτσια με σημαντικά διαφορετική συγκέντρωση μεταξύ των ΙCSI και ΝC ομάδων, με 34 από αυτούς να αυξάνονται στην ICSI ομάδα. Οι 34 μεταβολίτες αφορούν κύρια σε σάκχαρα, αλκοόλες και οξέα σακχάρων, οργανικά οξέα και λιπίδια, που έχουν συνδεθεί με αντίσταση στην ινσουλίνη, μεταβολικό σύνδρομο, ή/και την παχυσαρκία. Η ίδια ανάλυση στα αγόρια ανέδειξε 25 από τους 80 μεταβολίτες που αναλύθηκαν με χαρακτηριστική διαφορά μεταξύ των ομάδων ICSI και NC, εκ των οποίων 9 με σημαντικά μικρότερη συγκέντρωση στην ομάδα ΙCSI. Χαρακτηριστικά αναφέρεται ότι στους 9 μεταβολίτες ανήκουν οι 4 με την πλέον διαφορετική συγκέντρωση μεταξύ των ICSI και NC ομάδων, που είναι η σορβιτόλη, και τα αρωματικά αμινοξέα τρυπτοφάνη, φαινυλαλανίνη και τυροσίνη. Συγκριτική ανάλυση του μεταβολικού προτύπου των δύο φύλων στην NC ομάδα κατέδειξε μια σαφή διαφοροποίηση, η οποία φαίνεται να αποτελεί κύρια αιτία της παρατηρούμενης φυλο-ειδικής μεταβολικής διαφοροποίησης μεταξύ των ομάδων ICSI και ΝC. ΣΥΜΠΕΡΑΣΜΑΤΑ: Η πολυπαραμετρική ανάλυση της σύστασης του πλάσματος σε μικρού μοριακού βάρους μεταβολίτες επέτρεψε τον προσδιορισμό μεταβολικών διαφορών μεταξύ των ομάδων ICSI και NC, που υποστηρίζουν την προδιάθεση των παιδιών από ICSI σε αντίσταση στην ινσουλίνη, με διακριτούς όμως μεταβολικούς και βιοχημικούς δείκτες μεταξύ των δύο φύλων. Τα ευρήματα αυτά πρέπει να επιβεβαιωθούν σε ένα ευρύτερο σύνολο παιδιών και των δύο φύλων. Καταδεικνύουν όμως την αξία της μεταβολομικής να παρέχει μία υψηλής ευκρίνειας προοπτική της μεταβολικής κατάστασης, οδηγώντας στον προσδιορισμό χαρακτηριστικών μεταβολικών προτύπων ακόμα και σε πολύπλοκες καταστάσεις φυσιολογίας. / The intracytoplasmic sperm injection (ICSI) method was introduced in artificial reproduction technology (ART) mainly to treat male infertility. However, due to its high success rates and despite the growing concerns concerning the risk that the significant human intervention associated with this method may have to the genome, epigenome and development of the offspring, the use of ICSI has gradually increased in the recent years, even when it is not medically required. Based on the few currently available systematic studies of ART conceived children, the latter are considered of higher risk for cardio-metabolic diseases as adults. The goal of the present study is to investigate whether metabolomic analysis of the blood plasma could contribute to the early and accurate determination of relevant predisposition in ICSI conceived prepubertal girls and boys, specifically selected from a systematically characterized group of children, participated in a study of the First Department of Pediatrics of the “Agia Sophia” Hospital, Medical School, University of Athens. MATERIALS AND METHODS: The blood plasma metabolic profiles of (a) 10 ICSI- and 10 naturally conceived (NC) girls and (b) 16 ICSI and 16 NC boys were acquired using gas chromatography-mass spectrometry. After peak identification and appropriate normalization, 86 profiles of 70 metabolites in girls and 92 profiles of 80 metabolites in boys were analyzed separately and comparatively using multivariate statistical analysis algorithms of TM4-MeV (v.4.9.0) and XLSTAT (v.2013.4.03) software. The differences in the plasma metabolite concentration profiles between the ICSI and NC groups in girls and boys were visualized in an inter-tissue metabolic network that was reconstructed based on relevant literature and metabolic databases. RESULTS: For the girls, the algorithm of partial least squares-discriminant analysis (PLS-DA) indicated a clear differentiation of the metabolic profiles between the ICSI and NC groups. The discrimination is more pronounced, when biochemical data are also considered. For the boys also, PLS-DA indicated separation between the metabolomic profiles of the two groups analyzed individually or in combination with the biochemical data, but not as explicit as in girls. Significance analysis for microarrays (SAM) determined 37 out of the 70 analyzed metabolites in the plasma profiles of the girls with significantly different concentration between the ICSI and the NC groups; 34 of these were of higher concentration in the ICSI group. The 34 metabolites include mainly sugars, sugar alcohols and acids, organic acids and lipids that have been associated with insulin resistance, metabolic syndrome and/or obesity. The same analysis in the plasma profiles of the boys determined 25 out of the 80 analyzed metabolites with significant difference between the ICSI and NC groups; nine of these were of significantly lower concentration in the ICSI group. It is underlined that the four most discriminatory metabolites between the ICSI and NC groups, i.e. sorbitol and the aromatic amino acids tryptophan, phenylalanine and tyrosine, are among the nine negatively significant. Comparative analysis of the metabolic profiles between the two sexes within the NC group indicated an unequivocal differentiation, which is considered to be the main cause of the observed sex-specific metabolic differences between the ICSI and NC groups. CONCLUSIONS: The multivariate statistical analysis of blood plasma metabolite profiles enabled the determination of sex-specific metabolic differences between the ICSI and NC groups; these differences support increased predisposition to insulin resistance for the ICSI offspring, with clearly different, however, metabolic and biochemical markers in the two sexes. These findings need to be confirmed in a wider group of children. They demonstrate, however, the value of metabolomics to provide a high-resolution perspective of the metabolic state, leading to the determination of characteristic metabolic profiles even in complex physiological conditions.

Des facteurs masculins sont identifiés dans près de la moitié des cas d’infertilité. À ce jour, les tests évaluant la fertilité masculine demeurent peu prédictifs de la survenue d’une grossesse. Dans le but de pallier cette lacune, nous avons mis au point deux nouveaux tests mesurant l’intégrité de l’ADN et le temps de survie des spermatozoïdes. Nous avons effectué une étude prospective portant sur 42 couples infertiles suivis en fécondation in vitro (FIV). Le spermogramme a été effectué selon les critères de l’Organisation Mondiale de la Santé (OMS) et le temps de survie des spermatozoïdes exposés à un détergent cationique a été mesuré en observant la mobilité sous microscope. L’intégrité de l’ADN des spermatozoïdes a été vérifiée par la nouvelle méthode de marquage radioenzymatique et par analyse de la structure de la chromatine (SCSA). Tous les tests ont été réalisés sur la partie des échantillons de sperme non utilisée par la clinique de fertilité. Le projet a été approuvé par le comité d’éthique du Centre Hospitalier Universitaire de Montréal (CHUM) et les patients ont préalablement signé un formulaire de consentement éclairé. L’analyse des paramètres du spermogramme et de l’intégrité de l’ADN n’a montré aucune différence statistiquement significative entre les données chez les couples avec ou sans grossesse. Cependant, le taux de grossesse biochimique était statistiquement plus élevé chez les couples dont le temps de survie des spermatozoïdes était long (>250 s) comparativement à ceux dont ce temps était court (≤250 s): 66% vs 27% respectivement (p<0,05). Les taux de grossesse clinique et d’implantation étaient aussi plus élevés, mais les différences n’atteignaient pas le seuil de signification statistique. Nos résultats confirment que le spermogramme et la mesure de la fragmentation de l’ADN des spermatozoïdes ne sont pas de bons facteurs prédictifs des résultats de la FIV. Par contre, le test de survie des spermatozoïdes serait un meilleur indicateur de la possibilité d’une grossesse en FIV. L’amélioration de sa spécificité et un plus grand nombre de sujets sont nécessaires avant de proposer son application en clinique de fertilité. / Male factors are known to be involved in almost half of the couples consulting for infertility. To date, the tests for evaluating male fertility are poor predictors of pregnancy. We developed two new tests to evaluate sperm function: a sperm survival test and a new method to measure sperm DNA integrity. This prospective study was conducted on 42 infertile couples undergoing in vitro fertilization (IVF). Assessment of sperm parameters was done according to the World Health Organization (WHO) criteria, and sperm survival upon exposure to a cationic detergent was measured by observing motility under the microscope. Sperm DNA integrity was verified by our new radioenzymatic method as well as by the sperm chromatin structure analysis (SCSA) method. All testing was performed on a remainder aliquot of the semen samples. The study was approved by the ethics committee of the Centre Hospitalier Universitaire de Montréal (CHUM), and informed consent was obtained before inclusion. Neither conventional semen analysis, nor sperm DNA fragmentation showed statistically significant difference between conception and non-conception cycles. However, the biochemical pregnancy rate was statistically higher in couples where the sperm survival time was long (>250 s) compared to short (≤250 s): 66% vs. 27% respectively, (p < 0.05). The clinical pregnancy rate and implantation rate were also higher but the differences did not reach statistical significance. Our study confirms that conventional semen analysis and the assay for sperm DNA integrity are not reliable indicators of IVF outcome. In contrast, our new sperm survival test seems to be a better predictor of the pregnancy rate after IVF. Improvement of its specificity and a larger cohort of patients are necessary before proposing its regular application in IVF clinics.

Justificativa: Falhas recorrentes de implantação (FRI) são uma fonte de grande frustração para pacientes e especialistas que, frequentemente buscam intervenções com o objetivo de atingir resultados favoráveis. A prevalência exata dessa condição é de difícil estimativa, uma vez que existem diversas definições para caracterizá-la. Diversas intervenções que visam a melhora dos resultados reprodutivos dessas pacientes já foram propostas. Entretanto, nenhuma revisão sistematizada abordou, simultaneamente, todas as potenciais estratégias para esse grupo de mulheres. Dessa forma, a eficácia e a segurança dessas intervenções não são bem definidas. Devido ao alto número de intervenções descritas para esse fim, julgamos que uma metanálise que as contemple de forma abrangente é importante para casais, especialistas e pesquisadores do assunto. Objetivos: Avaliar a eficácia e segurança das intervenções que visam a melhora do resultado reprodutivo das pacientes com FRI submetidas a um novo tratamento de reprodução assistida. Métodos de busca: As buscas por estudos randomizados e controlados, publicados e em andamento, foram realizadas nas principais bases de dados eletrônicas. Adicionalmente, as listas de referências de estudos incluídos e revisões semelhantes foram avaliadas pelos autores. A última busca eletrônica foi realizada em fevereiro de 2018. Critérios de Elegibilidade: Foram considerados elegíveis apenas os estudos verdadeiramente randomizados que comparassem quaisquer intervenções destinadas a esse grupo depacientes. No presente estudo, consideramos como FRI a história de duas ou mais falhas prévias. Extração e análise de dados: Dois autores realizaram, individualmente, a seleção de estudos, extração de dados e análise do risco de viés. Discordâncias foram resolvidas em consulta a um terceiro autor. Os pesquisadores de estudos potencialmente elegíveis foram contatados sempre que necessário para obtenção de informações adicionais. Resultados: Foram identificados 2794 registros; desses, 62 estudos foram incluídos, representando uma população de 9308 pacientes, submetidas a 26 intervenções diferentes. Informações sobre 24 intervenções e 8461 pacientes foram submetidas à análise quantitativa. Não há evidências de alta ou moderada qualidade de que alguma dessas intervenções seja realmente eficaz para a melhora dos resultados reprodutivos de pacientes com FRI. As seguintes intervenções se mostraram benéficas: assisted hatching, injúria endometrial, histeroscopia, uso de FSH urinário + recombinante para estimulação endometrial e administração intrauterina de hCG. Porém as evidências são de baixa qualidade, o que nos traz incerteza em relação aos seus reais efeitos. Todas as outras intervenções identificadas não permitiram nenhuma outra conclusão adicional, uma vez que as evidências foram avaliadas como de muito baixa qualidade ou não foram encontrados estudos randomizados que as tivessem avaliado. Conclusões: Evidências de ensaios clínicos randomizados não sustentam o uso de nenhuma intervenção para a melhora dos resultados reprodutivos de pacientes com FRI. Todos os achados foram julgados como de baixa ou muito baixa qualidade, o que nos traz incerteza quanto aos seus reais efeitos na prática clínica. Deve-se estar ciente de que o emprego de tais intervenções impõe despesas e riscos adicionais para as pacientes. Além disso, a falta de critérios universalmente aceitos para odiagnóstico de falha recorrente de implantação é uma importante limitação para o avanço do conhecimento sobre essa condição / Background: Recurrent implantation failure (RIF) is a source of deep frustration to couples and clinicians, who often look for interventions to improve the reproductive outcomes. Its exact prevalence is difficult to determine because there are several definitions used to describe the condition. Several interventions aiming to improve reproductive outcomes for such patients have been studied. However, there are no systematic reviews that focus on all potential interventions for improving reproductive outcomes in women with RIF undergoing assisted reproduction techniques. The efficacy and safety of these interventions are not clear. Because of the large number of potential interventions for this condition, it would be very difficult to be aware of the current evidence for all of them. We believe this systematic review is important for subfertile couples, clinicians and researchers. Objectives: To assess the efficacy and safety of interventions designed to improve reproductive outcomes in women with RIF undergoing ART. Search methods: We searched for randomised controlled trials (RCT) in electronic databases (Cochrane Gynaecology and Fertility Group (CGF), The Cochrane Central Register of Controlled Trials, MEDLINE Ovid, EMBASE Ovid, PsycINFO, PsycINFO Ovid, CINAHL, LILACS), trials registers (ClinicalTrials.gov, ISRCTN registry, The WHO International Clinical Trials Registry Platform, World Health Organization International Clinical Trials Registry Platform) and grey literature (OpenGrey); in addition, we handsearched the reference lists of included studies and similar reviews. We performed the last electronic search on 22 Feb 2018.Selection criteria: We considered eligible only truly randomised controlled trials comparing any intervention designed to improve outcomes in women with repeat implantation failure (RIF) compared to other intervention, placebo or no treatment. For study selection, we defined RIF as two or more previous failures Data collection and analysis: Two authors independently performed study selection, data extraction, and assessment of the risk of bias. Any disagreements were solved by consulting a third review author. Study\'s authors were contacted whenever needed to solve any queries. Results: the search retrieved 2794 records; from those, sixty-two studies were included, comprising 9308 participants, submitted to 26 different interventions. Data from 24 interventions and 8461 participants were pooled for quantitative analysis. We found no high or even moderate quality evidence that any of the tested interventions are really effective to improve reproductive outcomes of women with RIF undergoing a new IVF treatment. We observed low-quality evidence of benefit for women with RIF with the following interventions: assisted hatching, endometrial Injury, hysteroscopy, the use of human + recombinant FSH for ovarian stimulation and intrauterine hCG administration. All the other listed interventions did not allow any further conclusion: either very low-quality evidence or no evidence from RCTs. Conclusions: Evidence from RCTs does not support the use of any specific intervention for improving reproductive outcomes in women with RIF. All evidences were deemed of low to very low quality, which makes us uncertain of their real effectiveness on clinical practice. One should be aware that the employment of such interventions imposes additional expenses and risks. Additionally, the lack of universally accepted criteria for recurrent implantation failure is an important limitation for the advance of knowledge regarding this condition.More studies are needed to evaluate their real effect. Maybe even more importantly is to create universally accepted criteria for defining implantation failure; only them one will be able to test interventions for this specific group