Pregnancy outcome after in vitro fertilisation at the Pretoria unit

This retrospective study was conducted to ascertain the success rate of a university-based in vitro fertilisation (IVF) programme. Over a 4-year period a total of881 patients was aspirated with an 81,8% embryo transfer (ET) rate. This resulted in 150 biochemical pregnancies (20,8% per ET), and 92 births that produced 100 babies were recorded (12,8% per ET). Multiple pregnancies accounted for 8,7% of births and 6,5% of the 100 babies presented with minor congenital abnormalities. Delivery took place by caesarean section in 46% of cases. Birth mass of babies ranged from 1,06 to 4 kg with a mean of 2,944 ± 0,629 kg. Mean gestational age was 260 ± 18,2 days. Twenty-three percent of babies born were pretenn, 13,8% of these were twins and presented with a low birth mass. It was concluded that the conception rate of patients did not differ with regard to the number of IVF attempts but that those who conceived during the first two attempts had a significantly better chance (P < 0,05) of carrying to tenn

Effect of metformin therapy and dietary supplements on semen parameters in hyperinsulinaemic males

Previous reports indicated that hyperinsulinaemic men may exhibit a higher percentage of poorly compacted DNA in their spermatozoa and less success in an IVF programme (Andrologia, 45, 2003, 18; Andrologia, 2014, doi: 10.1111/ and.12227). The aim of this study was to investigate the effect of metformin (Glucophage ) and antioxidant treatment (StaminoGro ) on the semen parameters of hyperinsulinaemic men. Nineteen hyperinsulinaemic male patients were treated for 3 months with metformin alone (Group A), and fifteen patients used metformin in combination with the nutritional supplement (Group B). Combined data of the two groups (pre- and post-treatment) differ significantly regarding sperm morphology (P = 0.0003) and CMA3 (P < 0.0001) values. The improvement in sperm morphology after treatment was similar for the two respective groups (P < 0.05). The morphological normal sperm forms increased from the mean percentage of 3.9 to 5.5% and from 4.2 to 5.5% for Group A and B respectively. Where a combination of metformin and the supplement were used (Group B), the combination treatment proved to be superior in obtaining enhanced chromatin packaging quality although not statistically significant (P = 0.5929) when compared with the metformin (Group A) group. The chromatin packaging quality in Group B improved with 10% while the improvement in Group A was approximately 8.3%. Therefore, infertile hyperinsulinaemic men can benefit from metformin treatment and should be advised on the use of nutritional supplements with antioxidant properties.http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1439-02722016-11-30hb2016Clinical Epidemiolog

Clinical importance of a micro-assay for the evaluation of sperm acrosome reaction using homologous zona pellucida

This study aimed to develop an acrosome reaction assay using microvolumes of solubilized human zonae pellucidae among 35 couples attending an in vitro fertilization programme. The sperm morphology of the men was classified as g-pattern (5-14% normal forms) and/or normal pattern (&gt;14% normal forms). All the couples had a history of repeated poor or failed in vitro fertilization rates from previous attempts. A zona-induced acrosome reaction test was performed using homologous 0.25 zona pellucida μl-1 incubated with spermatozoa to induce the acrosome reaction. Acrosome reactions were measured with FITC-PSA staining, and expressed as the difference between zona-induced and spontaneous acrosome reaction spermatozoa. The results indicated that microvolumes of solubilized human zona pellucida could successfully be used to determine the acrosome reaction status of spermatozoa. The results were compared with in vitro fertilization rates of metaphase II oocytes, and analysed with the receiver operating characteristics curve. Receiver operating characteristics analyses divided the patients into two groups: i.e. zona-induced acrosome reaction &lt;15% and &gt;15%. The sensitivity and specificity for zona-induced acrosome reaction results versus fertilization were 93% and 100%, respectively. The correlation coefficient between zona-induced acrosome reaction and in vitro fertilization was r=0.94 (P&lt;0.0001). Zona-induced acrosome reaction data can be used as an indictor for fertilization failure, thus helping clinicians to refine the therapeutic approach for infertile couples prior to the onset of the treatment.Revie

Clinical importance of zona pellucida-induced acrosome reaction and its predictive value for IVF

The study aimed to establish zona pellucida induced acrosome reaction response (ZIAR) among 35 couples with normal and G-pattern sperm morphology and repeated poor fertilization results during assisted reproduction treatment. ZIAR tests were performed using 0.25 zona pellucida/μl co-incubated with spermatozoa for 60 min. Acrosome reactions were measured with FITC-PSA staining, and expressed as the difference between stimulated and unstimulated (spontaneous) sperm populations. Results were compared with IVF rates of metaphase II oocytes. Interactive dot diagrams divided the patients into two groups, i.e. ZIAR 15%, with mean fertilization rates of 49 and 79% respectively. The sensitivity and specificity for ZIAR results versus fertilization were 93 and 100% respectively. The area under the curve was 99% and the 95% confidence interval did not include 0.5 which implies that the ZIAR test is able to predict fertilization failure among IVF patients. In conclusion, the ZIAR test has diagnostic potential since it can assist the clinician to identify couples that will benefit from intracytoplasmic sperm injection therapy.Articl

Sperm chromatin packaging as an indicator of in-vitro fertilization rates

The development of a sequential diagnostic schedule for patients consulting for infertility disturbances would be an ideal method of approach for clinicians in the absence of an aetiological or pathophysiological diagnosis. Since sperm morphology recorded by strict criteria has often been correlated with fertilization failure, the present study aimed to evaluate the relationship between normal morphology as well as in-vitro fertilization (IVF) rates, with chromatin staining among fertile and subfertile men. Two semen smears were prepared from each specimen obtained from 72 men to record normal morphology and chromatin packaging as recorded by chromomycin A3 (CMA3) staining. Following the semen analyses, the 72 men were divided into the two morphological groups, namely &lt;4% and &gt;4% normal forms. Significantly different percentages of CMA3 staining (mean ± SE) were recorded between the two morphological groups, namely 65.9% ± 3.5 and 44.5% ± 1.7 (P ± 0.001). A highly negative significant correlation existed between percentage of normal morphology as recorded by strict criteria and CMA3 staining. A highly significant and positive correlation was recorded for normal morphology and IVF rates (r ± 0.45, P ± 0.0001). A significant negative correlation (r ± -0.51, P ± 0.0001) existed between CMA3 values and IVF rates. The discriminating power of nuclear maturity, as recorded by CMA3 staining, to identify abnormal morphology values and poor IVF rates was calculated with receiver operator characteristic (ROC) analyses. The areas under the ROC curves were 0.86 for sperm morphology and 0.74 for IVF rates. The calculated threshold values for CMA3 staining to distinguish between morphology groups were 48 and 50% for IVF. Chromatin packaging assessment is a valuable addition to the sequential diagnostic programme in an assisted reproductive arena.Articl

Defective sperm decondensation: A cause for fertilization failure

The study aimed to evaluate the role of chromatin packaging (CMA3 staining), sperm morphology during sperm-zona binding, sperm decondensation and the presence of polar bodies in oocytes that failed in vitro fertilization (IVF). The percentage CMA3 staining categorized the data into three groups, &lt;44%, n=10; ≥44-59%, n=10; and ≥60%, n=29. Morphology groups were ≤4% (n=11); &gt;4-14% (n=19); and &gt;14% (n=19). One hundred and seventy-two oocytes that failed IVF were evaluated for sperm-zona binding, ooplasma penetration and sperm decondensation. Odds ratio analyses indicated that being in the ≥60% CMA3 staining group resulted in a 15.6 fold increase in the risk of decondensation failure, relative to CMA3 staining of &lt;44%. For morphology, there was a 2.17 fold decrease in the risk of fertilization failure in the morphology group with &gt;4-14% normal cells, while it increased 2.45 fold for the morphology group with ≤4% normal cells. Using CMA3 fluorescence to discriminate, 51% of the oocytes in the group with elevated CMA3 fluorescence had no sperm in the ooplasma compared to 32% and 16% penetration failure in the CMA3 staining groups ≥44-59% and &lt;44%, respectively. Sperm chromatin packaging quality and sperm morphology assessments are useful clinical indicators of human fertilization failure. Immunofluorescence techniques could be used to provide a clear diagnosis of failed fertilization.Articl

The ASOS Surgical Risk Calculator: development and validation of a tool for identifying African surgical patients at risk of severe postoperative complications

Background: The African Surgical Outcomes Study (ASOS) showed that surgical patients in Africa have a mortality twice the global average. Existing risk assessment tools are not valid for use in this population because the pattern of risk for poor outcomes differs from high-income countries. The objective of this study was to derive and validate a simple, preoperative risk stratification tool to identify African surgical patients at risk for in-hospital postoperative mortality and severe complications. Methods: ASOS was a 7-day prospective cohort study of adult patients undergoing surgery in Africa. The ASOS Surgical Risk Calculator was constructed with a multivariable logistic regression model for the outcome of in-hospital mortality and severe postoperative complications. The following preoperative risk factors were entered into the model; age, sex, smoking status, ASA physical status, preoperative chronic comorbid conditions, indication for surgery, urgency, severity, and type of surgery. Results: The model was derived from 8799 patients from 168 African hospitals. The composite outcome of severe postoperative complications and death occurred in 423/8799 (4.8%) patients. The ASOS Surgical Risk Calculator includes the following risk factors: age, ASA physical status, indication for surgery, urgency, severity, and type of surgery. The model showed good discrimination with an area under the receiver operating characteristic curve of 0.805 and good calibration with c-statistic corrected for optimism of 0.784. Conclusions: This simple preoperative risk calculator could be used to identify high-risk surgical patients in African hospitals and facilitate increased postoperative surveillance. © 2018 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.Medical Research Council of South Africa gran