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

Durante a injeção intracitoplasmática de espermatozoides (ICSI) seleciona-se um espermatozoide móvel e morfologicamente normal para injeção em ovócito maduro. Evidências recentes indicam que mesmo espermatozoides aparentemente normais podem ocultar defeitos em nível molecular. O principal objetivo deste trabalho foi a descrição de um novo método capaz de selecionar espermatozoides maduros a partir de amostras não processadas em procedimento de ICSI. Em um estudo comparativo e prospectivo testou-se uma gota estendida modificada. A \"gota estendida com mecanismo contracorrente\" - GEMC foi montada em uma placa de ICSI padrão a partir de seis gotas de meio de cultivo (10 ?L). O posicionamento e união precisa das gotas deram origem a dois reservatórios e um canal, resultando em um fluxo de líquido através do canal. A adição de uma solução de PVP (polivinilpirrolidona) gerou um gradiente de viscosidade no final do circuito. Amostras seminais foram obtidas de 40 pacientes inférteis. Cada amostra seminal foi dividida em 4 alíquotas: uma alíquota para o processamento por centrifugação em gradiente de densidade (CGD), uma alíquota para a GEMC utilizando amostras não processadas, uma alíquota para a GEMC utilizando amostras processadas e uma alíquota para controle. Nos grupos GEMC uma média de 200 espermatozoides foram consecutivamente coletados, sem seleção, no reservatório de captura utilizando-se uma micropipeta de injeção como no procedimento convencional de ICSI. A morfologia espermática foi avaliada e demonstrou melhora, comparando-se com os controles, em todos os tratamentos utilizados. A imaturidade da cromatina foi avaliada utilizando-se o teste do azul de anilina. Em relação à imaturidade, 100% dos homens obtiveram melhores resultados tanto após o preparo por CGD quanto utilizando o método GEMC. Isto se refletiu em uma redução das formas imaturas de 28.65 ± 8.97% no sêmen fresco para 17.29 ± 7.72% após processamento por CGD (P < 0.01). Uma redução ainda maior nas formas imaturas foi obtida após o método GEMC quando comparado com o processamento por CGD: 0.89 ± 1.31% (P < 0.01) utilizando-se sêmen fresco e 1.05 ± 1.63% (P < 0.01) utilizando-se amostras processadas. Um novo método unindo seleção e captura de espermatozoides em um mesmo procedimento de ICSI foi descrito e testado. O método GEMC seleciona espermatozoides de forma fácil e permite o uso direto de amostras não processadas em procedimentos de ICSI. Este método seleciona espermatozoides maduros com mais eficiência do que o processamento por CGD. Novos estudos são necessários para se analisar o impacto do método nas taxas de fertilização, desenvolvimento embrionário, gravidez, implantação e abortamento / During intracytoplasmic sperm injection (ICSI) a motile spermatozoon with normal morphology is visually selected for insemination of an oocyte. Recent evidence indicates that even though the sperm appears morphologically normal, a possibility of defects at the molecular level still exists. The main objective of this work was to describe a novel approach capable of selecting mature spermatozoa from unprocessed semen sample in a one-step ICSI procedure. A modified extended drop was tested in a prospective comparative study. The \"Gota Estendida com Mecanismo Contracorrente - GEMC\" (Positive Rheotaxis Extended Drop - PRED) was assembled on a standard ICSI dish and consisted of six culture medium droplets (10 ?L). The precise merging of the drops created two reservoirs and a channel therefore the fluid flew through the channel. The addition of a PVP solution created a viscosity gradient in the final sector of the circuit. Semen samples were taken from 40 subfertile men. Each semen sample was divided into four aliquots: one aliquot for density gradient centrifugation (DGC), one aliquot for GEMC using fresh semen, one aliquot for GEMC using processed semen and one aliquot for the control. In GEMC a mean of 200 spermatozoa were collected consecutively, without selection, from the outlet reservoir with an injecting pipette as for conventional ICSI procedure. Sperm morphology was assessed and resulted in improvement compared to controls in all treatments. Chromatin immaturity was assessed using aniline blue assay. Regarding to chromatin immaturity, 100% of men had better results after DGC preparation and GEMC approach. This was reflected in a mean reduction from 28.65 ± 8.97% uncondensed chromatin in the native ejaculates to 17.29 ± 7.72% in DGC processed semen (P < 0.01). An even greater reduction was achieved after GEMC approach showing a mean of 0.89 ± 1.31% uncondensed chromatin compared to DGC processed sample (P < 0.01). A novel one-step ICSI approach joining sperm selection and recovery was developed and tested. This GEMC approach can select sperm easily and permits the direct use of native semen in ICSI. This approach can select sperm with lower chromatin immaturity than DGC method. Further studies need to access its relation to fertilization, embryo development, pregnancy, implantation and miscarriage rates

Durante a injeção intracitoplasmática de espermatozoides (ICSI) seleciona-se um espermatozoide móvel e morfologicamente normal para injeção em ovócito maduro. Evidências recentes indicam que mesmo espermatozoides aparentemente normais podem ocultar defeitos em nível molecular. O principal objetivo deste trabalho foi a descrição de um novo método capaz de selecionar espermatozoides maduros a partir de amostras não processadas em procedimento de ICSI. Em um estudo comparativo e prospectivo testou-se uma gota estendida modificada. A \"gota estendida com mecanismo contracorrente\" - GEMC foi montada em uma placa de ICSI padrão a partir de seis gotas de meio de cultivo (10 ?L). O posicionamento e união precisa das gotas deram origem a dois reservatórios e um canal, resultando em um fluxo de líquido através do canal. A adição de uma solução de PVP (polivinilpirrolidona) gerou um gradiente de viscosidade no final do circuito. Amostras seminais foram obtidas de 40 pacientes inférteis. Cada amostra seminal foi dividida em 4 alíquotas: uma alíquota para o processamento por centrifugação em gradiente de densidade (CGD), uma alíquota para a GEMC utilizando amostras não processadas, uma alíquota para a GEMC utilizando amostras processadas e uma alíquota para controle. Nos grupos GEMC uma média de 200 espermatozoides foram consecutivamente coletados, sem seleção, no reservatório de captura utilizando-se uma micropipeta de injeção como no procedimento convencional de ICSI. A morfologia espermática foi avaliada e demonstrou melhora, comparando-se com os controles, em todos os tratamentos utilizados. A imaturidade da cromatina foi avaliada utilizando-se o teste do azul de anilina. Em relação à imaturidade, 100% dos homens obtiveram melhores resultados tanto após o preparo por CGD quanto utilizando o método GEMC. Isto se refletiu em uma redução das formas imaturas de 28.65 ± 8.97% no sêmen fresco para 17.29 ± 7.72% após processamento por CGD (P < 0.01). Uma redução ainda maior nas formas imaturas foi obtida após o método GEMC quando comparado com o processamento por CGD: 0.89 ± 1.31% (P < 0.01) utilizando-se sêmen fresco e 1.05 ± 1.63% (P < 0.01) utilizando-se amostras processadas. Um novo método unindo seleção e captura de espermatozoides em um mesmo procedimento de ICSI foi descrito e testado. O método GEMC seleciona espermatozoides de forma fácil e permite o uso direto de amostras não processadas em procedimentos de ICSI. Este método seleciona espermatozoides maduros com mais eficiência do que o processamento por CGD. Novos estudos são necessários para se analisar o impacto do método nas taxas de fertilização, desenvolvimento embrionário, gravidez, implantação e abortamento / During intracytoplasmic sperm injection (ICSI) a motile spermatozoon with normal morphology is visually selected for insemination of an oocyte. Recent evidence indicates that even though the sperm appears morphologically normal, a possibility of defects at the molecular level still exists. The main objective of this work was to describe a novel approach capable of selecting mature spermatozoa from unprocessed semen sample in a one-step ICSI procedure. A modified extended drop was tested in a prospective comparative study. The \"Gota Estendida com Mecanismo Contracorrente - GEMC\" (Positive Rheotaxis Extended Drop - PRED) was assembled on a standard ICSI dish and consisted of six culture medium droplets (10 ?L). The precise merging of the drops created two reservoirs and a channel therefore the fluid flew through the channel. The addition of a PVP solution created a viscosity gradient in the final sector of the circuit. Semen samples were taken from 40 subfertile men. Each semen sample was divided into four aliquots: one aliquot for density gradient centrifugation (DGC), one aliquot for GEMC using fresh semen, one aliquot for GEMC using processed semen and one aliquot for the control. In GEMC a mean of 200 spermatozoa were collected consecutively, without selection, from the outlet reservoir with an injecting pipette as for conventional ICSI procedure. Sperm morphology was assessed and resulted in improvement compared to controls in all treatments. Chromatin immaturity was assessed using aniline blue assay. Regarding to chromatin immaturity, 100% of men had better results after DGC preparation and GEMC approach. This was reflected in a mean reduction from 28.65 ± 8.97% uncondensed chromatin in the native ejaculates to 17.29 ± 7.72% in DGC processed semen (P < 0.01). An even greater reduction was achieved after GEMC approach showing a mean of 0.89 ± 1.31% uncondensed chromatin compared to DGC processed sample (P < 0.01). A novel one-step ICSI approach joining sperm selection and recovery was developed and tested. This GEMC approach can select sperm easily and permits the direct use of native semen in ICSI. This approach can select sperm with lower chromatin immaturity than DGC method. Further studies need to access its relation to fertilization, embryo development, pregnancy, implantation and miscarriage rates

Thesis (PhD)--Stellenbosch Uni versity, 2000. / ENGLISH ABSTRACT: Intracytoplasmic sperm injection (ICSI) introduced a revolutionary way of treatment for male factor infertility. With the exception of some cases of non-obstructive azoospermia, all other male factor infertility cases have the potential to be successfully treated with ICS!. The only prerequisite seems to be the presence of a motile or viable immotile sperm cell for each oocyte. In this study we report on our own experience with the development and implementation of the ICSI method in the Reproductive Biology Unit at Tygerberg Hospita!. An analysis of 5 years of ICSI experience showed that semen parameters, sperm morphology, motility and concentration did not influence fertilization and pregnancy rates adversely. In most cases, patients who could not be treated with in vitro fertilization (IVF) and gamete intrafallopian transfer (GIFT), due to poor semen parameters or fertilization failure, were treated successfully with ICS!. Even a case of globozoospermia was treated successfully with ICS!. Testicular spermatozoa, fresh or frozen-thawed, also resulted in excellent fertilization and pregnancy rates. Cryopreservation of testicular samples facilitated the management of the infertile couple, aiding the coordination of the recovery of vital gametes from both partners and also limiting the repetition of testicular biopsies. Incubation (maturation) of testicular spermatozoa also induced an enhancement in pregnancy rates. It can be concluded that ICSI proved to be a treatment method with success similar to that of in vitro fertilization (IVF) and gamete intrafallopian transfer (GIFT), in spite of a severe male factor. The study also indicated transfer route and embryo quality (viability) to be very important factors in the success of ICS!. The tubal transfer route was shown to be a significant contributor to the pregnancy success (compared to uterine transfer) as was the transfer of embryos that showed early division to the 2-cell stage, 26 hours post injection. The transfer of early dividing embryos into the fallopian tube resulted in a pregnancy rate of almost 40%, a result similar to that of GIFT with a mild male factor. The role of the oocyte in fertilization and pregnancy success was also revealed indirectly by the introduction of ICS!. Visual observation of denuded oocytes was possible and many morphological features, normal and abnormal, can be observed. Immature oocytes can also be identified and it was shown that they could be successfully matured in vitro before injection. In this study transmission electron microscopy (TEM) was used to study abnormalities in oocyte morphology. The standard method was adapted and modified for single cell TEM. The abnormalities observed included lysosomal and non-lysosomal degeneration (yellowish or darkly coloured oocytes), degeneration and vacuole formation (vacuolated oocytes), large secondary lysosomes filled with multiple small lipid droplets - lipofuscin body (refractile body) and a fragmented oocyte. It was also possible to study at ultrastructural level, possible reasons for fertilization failure in ICS!. Different stages of oocyte activation failure, cytoplasmic immaturity, sperm cell extrusion, abnormal sperm cell decondensation, female spindle abnormalities and technique related factors were observed. TEM was also successfully implemented to elucidate the reason for infertility in a patient with a longstanding, unexplained history of infertility. TEM evaluation of two of the patient's unfertilized oocytes revealed a spindle abnormality with contributing cytoskeletal anomalies at ultrastructural level. The modified TEM technique offers a valuable tool to study this small, but important group of patients with unexplained infertility. ThisTEM study opened up a new, valuable and interesting avenue of research with both diagnostic and prognostic value for patients with unexplained infertility. ICSI is therefore a valuable method in the treatment of especially male factor infertility. It is the most advanced fertilization technique developed in the last decade in this field. Not only can almost all male factor patients be treated, but unexplained female infertility can also be exposed, studied and hopefully in future also be treated with micromanipulation methods. / AFRIKAANSE OPSOMMING: Die ontwikkeling van die mikromanipulasie tegniek "Intracytoplasmic sperm injection" (ICSI) het die behandeling van die manlike faktor in infertiliteit, revolusionêr verander. Met die uitsondering van sommige gevalle van nie-obstruktiewe asoospermia, kan potensieel alle ander manlike infertiliteits faktore suksesvol met ICSI behandel word. Die enigste voorvereiste blyk "n bewegende of "n nie-bewegende, maar bewese lewende spermsel te wees. In hierdie studie word verslag gedoen oor die ontwikkeling en toepassing van die ICSI metode in die Eenhed vir Reproduktiewe Biologie by Tygerberg Hospitaal. 'n Analise van 5 jaar se resultate na die implementering van die ICSI metode het gewys dat die semen parameters, sperm morfologie, motiliteit en konsentrasie, nie "n effek op bevrugting- en swangerskapsyfers gehad het nie. Pasiënte wat, as gevolg van ontoereikende semen parameters, nie met die klassieke metodes, in vitro bevrugting (IVB) of gameet intrafallopiusbuis terugplasing (GIFT) behandel kon word nie, kon suksesvol met ICSI behandel word. Daar was selfs "n geval van manlike infertiliteit as gevolg van globosoospermie, wat suksesvol met ICS behandel is. Die ICSI metode het dit ook moontlik gemaak om uitstekende bevrugting- en swangerskap resultate met testikulêre spermatosoa .(vars en gevries) te bereik. Die bevriesing van testisweefsel het ook bygedra tot beter hantering van sulke pasiënte. Herhaalde testisbiopsies word uitgeskakel en die koórdinasie van die verkryging van die manlike en vroulike gamete, word ook vergemaklik wanneer testisweefsel in gevriesde vorm beskikbaar is. Die studie het verder getoon dat wanneer testikulêre weefsel geïnkubeer word (om spermatosoa te laat matureer), die swangerskapsyfers verhoog was. Dit is dus duidelik dat die ICSI metode net so suksesvol soos die IVB en GIFT metodes toegepas kan word, selfs en veral in gevalle van erge manlike faktor infertiliteit. Die studie het ook verder getoon dat die plek waar embrios teruggeplaas word, asook die embriokwalitiet van teruggeplaasde embrios, belangrike bydraende faktore in die ICSI swangerskapsukses was. Embrioterugplasing in die buis van fallopius en terugplasing van embrios wat vroeë 2-sel deling, 26 uur na ICSI getoon het, is uitgewys as faktore wat ICSI swangerskap betekenisvol verbeter het. Dit was moontlik om "n swangerskapsyfer van ongeveer 40%, sootgelyk aan die van GIFT sonder "n erge manlike faktor, te bereik met die terugplasing van ten minste een vroeë deler embrio in die fallopiese buis. Die ICSI tegniek het ook indirek bygedra tot nuwe insigte met betrekking tot die rol wat die vroulike eiersel (oësief in ICSI bevrugting speel. Oósiete word gestroop van hulomringende selle vir die ICSI proses en kan dan maklik vir hul normale en abnormale morfologiese eienskappe evalueer word. Oësiete wat immatuur is kan ook so geïdentifiseer word en dit is moontlik om hulle suksesvol te matureer voor mikro-inspuiting. Transmissie-elektronmikroskopie (TEM) is in die studie gebruik om die ultrastruktuur van onbevrugde en abnormale oësiete te bestudeer. Hiervoor is "n bestaande tegniek gemodifiseer vir die hantering van "n enkele sel, in hierdie geval die oosiet. Lisasomale en nie-lisosomale degenerasie (oósiete wat geelof donker van kleur voorkom), degeneratiewe tekens en vakuole (oësiete met vakuole), groot sekondêre lisosome gevul met klein lipieddruppels ('refractile body') en 'n gefragmenteerde oosiet was van die morfologies abnormale eienskappe wat ultrastruktureel geïdentifiseer is. Moontlike faktore wat 'n rol kan speel in nie-bevrugting na ICSI kon ook op ultrastrukturele vlak met die tegniek geïdentifiseer word. Hierdie faktore het die volgende ingesluit: die onvermoë van verskillende stadiums van oosiet aktivering, sitoplasmatiese immaturiteit, uitwerping van die spermsel na die periviteliene spasie, abnormale spermsel dekondensasie, vroulike spoelvormings abnormaliteite en tegniekgekoppelde faktore. Die TEM tegniek is ook suksesvol aangewend om die infertiliteitsprobleem van 'n pasiënt wat vir etlike jare aan onverklaarbare infertiliteit gely het, te identifiseer. TEM het op die ultrastrukturele vlak gewys dat daar 'n spoel abnormaliteit in twee van haar onbevrugde oëslete was. TEM kan dus baie vrugbaar gebruik word in hierdie groep pasiënte om onverklaarbare infertiliteit, wat andersins ongeïdentifiseerd sou bly, te verklaar. Die ICSI metode is die mees revolusionêre tegniek wat die afgelope dekade vir die behandeling van veral manlike infertiliteit ontwikkel en baie suksesvol toegepas is. Die metode ook kan 'n bydraende rol speel in die hantering van onverklaarbare infertiliteit veral ten opsigte van die vroulike gameet. In die toekoms is dit moontlik dat selfs hierdie probleem met nuwe mikromanipulasietegnieke opgelos sal kan word.

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.

No description available.

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

Treatment success in IVF-ICSI is mainly limited by female age, but differences in ovarian reserve (OR; the remaining pool of oocytes and their quality) between individuals modify treatment prerequisites among women of similar age. OR may be assessed by OR tests (ORTs). The main aims of this work were to study menstrual cycle length (MCL), basal levels of circulating gonadotrophins, antral follicle count (AFC) and serum Anti-Müllerian hormone (AMH) levels and their associations with and prognostic capacities regarding IVF-ICSI outcome in large cohorts of unselected women. Age-adjusted MCL was positively and linearly associated with pregnancy rates (PRs), live-birth rates (LBRs) and ovarian response to controlled ovarian hyperstimulation. An MCL of &gt;34 days almost doubled the LBR compared with an MCL of &lt;26 days. The grouped variable ‘combined FSH and LH levels’ was superior to both individual gonadotrophin levels and the LH:FSH ratio. The highest mean PR was seen in connection with a combination of FSH &lt;6.7 U/l with LH &gt;4.9 U/l; PRs were lowest when FSH-LH levels were opposite to this (high-low) and intermediate when FSH-LH levels were low-low or high-high. Associations with LBR and ovarian response were similar as those for PR. AFCs and serum AMH levels were positively and log-linearly associated with PR, LBR and ovarian response. Success rates levelled out above AFC 30 or AMH 5 ng/ml. Treatment outcome was superior among women with polycystic ovaries. Among the studied ORTs, logAFC and logAMH concentration correlated most strongly. After multivariate testing, entering all studied ORTs, AMH and female age remained independently associated with LBR. AMH + AFC + age predicted both poor and excessive ovarian responses with high accuracy. Adjusting for age and oocyte yield, all ORTs remained significant for LBR, implying that ORTs also capture information on oocyte quality. In conclusion, measures of OR are strongly associated with PR, LBR and ovarian response in a log-linear fashion, and partly reflect oocyte quality. The OR spectrum is continuous, from small ‘oligofollicular’ ovaries (the low extreme) to polycystic ovaries (the high extreme). Among the studied ORTs, AMH together with age provide the most powerful basal estimate for IVF/ICSI outcome.

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.