Showing papers by "A. Van Steirteghem published in 1994"
TL;DR: The morphological nuclear changes in 14 patients' oocytes were studied by means of light microscopic observation at 2, 4, 6, 8, 16, 18 and at 20 h after intracytoplasmic single sperm injection (ICSI).
Abstract: Knowledge of the timing of the stages of fertilization in humans is still limited because the time of gamete fusion is not known when pre-ovulatory or in-vitro matured cumulus-enclosed oocytes are inseminated. We therefore studied the morphological nuclear changes in 14 patients' oocytes by means of light microscopic observation at 2, 4, 6, 8, 16, 18 and at 20 h after intracytoplasmic single sperm injection (ICSI). A total of 144 metaphase II oocytes were injected with the spermatozoa of the patients' partners. Out of the 134 oocytes that survived the injection, 93 displayed two pronuclei in the course of the observation period (69%). Out of the 93 normally fertilized oocytes, 21 extruded the second polar body at 2 h after micro-injection (23%) and 63 oocytes at 4 h (68%). Pronuclei appeared as early as 6 h after ICSI in 16 normally fertilized oocytes (17%). At 8 h, 75 (80%) oocytes had two visible pronuclei, at 16 h 92 (99%), at 18 h 76 (82%) and at 20 h 63 (68%). In 24 oocytes (26%) the appearance of pronuclei was asynchronous, while the disappearance of the pronuclei was always synchronous, except in one oocyte. Nine of the 134 successfully injected oocytes showed three equal-sized pronuclei (6.7%). Four of the nine multi-pronucleated oocytes did not extrude the second polar body at all, while the time sequence of appearance of pronuclei was similar to that of the normally fertilized oocytes.(ABSTRACT TRUNCATED AT 250 WORDS)
185 citations
TL;DR: Women who become pregnant after oocyte donation and especially those with ovarian failure should be considered as high-risk obstetric patients.
Abstract: A total of 199 patients participated in the oocyte donation programme in 336 replacement cycles in whom 69 clinical pregnancies were achieved, of which 53 reached term and delivery. Data concerning the evolution and outcome of pregnancies were retrieved in 52 cases, which involved 39 women with ovarian failure and 18 with functional ovaries. The most frequent complications of pregnancy were uterine bleeding in the first trimester in 18 cases (34.6%), hypertension in 17 (32.7%) and intra-uterine growth retardation (IUGR: 11.5%). These complications were more prominent in twin pregnancies. The Caesarean section rate was 63.5% and a high percentage of elective sections (54.5%) was observed. Of singleton pregnancies, 54.6% had a birth weight of > 3000 g at full term (> 37 weeks), while 62.5% of twins weighed between 2000 and 3000 g. One intra-uterine death occurred, so that the perinatal mortality was 1.7% and one newborn was operated on for stenosis of the pulmonary artery, while the incidence of premature labour was low (1.9%). A comparison of complications between pregnancies associated with ovarian failure and with functional ovaries revealed a higher frequency of bleeding in the first trimester (38.2% and 27.8% respectively) and of hypertension (38.2% and 22.2% respectively) in those with ovarian failure, although the differences were not statistically significant. In conclusion, women who become pregnant after oocyte donation and especially those with ovarian failure should be considered as high-risk obstetric patients.
126 citations
TL;DR: The incidence of major malformations was not different from the incidence in the general population, and no cytogenetic aberrations were observed in 43 children tested.
Abstract: In 163 couples referred for assisted fertilization, pregnancy was established by subzonal insemination (SUZI), intracytoplasmic sperm injection (ICSI) or a combination of both techniques. These couples agreed to participate in a prospective study that included a prenatal diagnosis and clinical follow-up of the children. No cytogenetic aberrations were observed in 43 children tested. In 23 pregnancies occurring after SUZI, 15 women gave birth to 21 children. After replacement of combined SUZI and ICSI embryos, 10 pregnancies resulted in 8 deliveries with 10 children. Transfer of ICSI embryos led to 130 pregnancies ending in 20 deliveries with 24 children, with many others still ongoing successfully. In total, 55 children have been examined: 29 boys and 26 girls. One child from a singleton pregnancy presented multiple congenital malformations; one twin child presented a quadriparesis. In this observational study on a limited number of children, the incidence of major malformations was not different from the incidence in the general population.
86 citations
TL;DR: Endometrial parameters confirm the need for luteal support in GnRH agonist/HMG stimulated cycles, and all endometrial features were consistent with an impaired progesterone bioavailability.
Abstract: In human cycles stimulated for ovulation with gonadotrophin-releasing hormone (GnRH) agonists and human menopausal gonadotrophin (HMG), a luteal phase defect has been described. To evaluate the influence on the endometrium, endometrial development in GnRH agonist/HMG stimulated cycles was assessed in cycles with and without luteal phase supplementation. Endometrial histological maturation, ultrastructure and oestrogen receptor (ER) and progesterone receptor (PR) status were analysed in the mid-luteal phase. Serum concentrations of oestradiol and progesterone were measured daily from days 1-5 of the luteal phase. Supplementation of the luteal phase was achieved with either human chorionic gonadotrophin or natural progesterone, administered intramuscularly or intravaginally. In non-supplemented cycles all endometrial features were consistent with an impaired progesterone bioavailability. After supplementation of the luteal phase, fewer signs of luteal phase deficiency were visible, especially with the intravaginal route of progesterone administration. We concluded that the endometrial parameters confirm the need for luteal support in GnRH agonist/HMG stimulated cycles.
68 citations
TL;DR: There was no difference in the morphological characteristics of the embryos cultured in the different media, although the rate of development was different, and effects on the pregnancy and implantation rates of both media were analysed.
Abstract: In order to optimize the in-vitro fertilization (IVF) procedure and to avoid the batch-to-batch fluctuations of in-house culture medium, we investigated the use of a commercially available medium. In our human IVF programme, a controlled comparison was performed from July 1991 to February 1992 between in-house Earle's medium and commercially available Menezo B2 medium. The major difference between the two tested media is the additional presence of amino acids and water-soluble vitamins in Menezo B2 and the different origins of the proteins source, i.e. bovine serum albumin (BSA) in Menezo B2 and human serum albumin (HSA) in Earle's medium. In the first, auto-controlled study, sibling oocytes cultured in Menezo B2 showed a significantly higher fertilization rate than those cultured in Earle's medium: 58.1 +/- 37.2% and 52.1 +/- 36.9% respectively. After further culture of the fertilized oocytes, there was no difference in the morphological characteristics of the embryos cultured in the different media, although the rate of development was different. In Menezo B2 medium, a higher proportion of the embryos had reached at least the 4-cell stage at transfer. In the second, randomized study, effects on the pregnancy and implantation rates of both media were analysed. In the group of oocytes cultured in B2, more excellent or good-quality embryos were available for transfer at a more advanced stage of development. No significant difference in pregnancy rate was observed: 39.1% per transfer in Earle's medium versus 40.5% per transfer in Menezo B2.(ABSTRACT TRUNCATED AT 250 WORDS)
31 citations
TL;DR: The results of 600 consecutive treatment cycles of subzonal insemination (SUZI) and intracytoplasmic sperm injection (ICSI) are described in couples with failed fertilization after standard IVF or insufficient spermatozoa in the ejaculate for IVF to indicate an increase in congenital malformations.
Abstract: The results of 600 consecutive treatment cycles of subzonal insemination (SUZI) and intracytoplasmic sperm injection (ICSI) are described in couples with failed fertilization after standard IVF or insufficient spermatozoa in the ejaculate for IVF. More oocytes were damaged by ICSI (16.3%) than by SUZI (8.5%) and the normal fertilization rate was substantially higher after ICSI (49.1% v. 16.6%). Subsequent development of two-pronuclear oocytes in vitro was 80% after SUZI and 73.9% after ICSI. Significantly more triple embryo replacements were carried out after ICSI than after SUZI. Embryo transfers were possible in 421 of the 600 cycles. There were 63 pregnancies after ICSI (215 transfers) and 23 after SUZI (156 transfers); 10 additional pregnancies were achieved after 50 transfers of a mixture of SUZI and ICSI embryos. The results of fetal karyotypes and follow-up of the children do not indicate an increase in congenital malformations.
21 citations
TL;DR: It has been the experience of all centres for reproductive medicine that a certain number of couples with male-factor infertility cannot be helped by standard IVF treatment, so that patients may have no embryos to transfer.
Abstract: For more than a decade in vitro fertilization (IVF) has been successful in the treatment of couples with long-standing infertility due to various aetiologies such as tubal disease, male-factor infertility, unexplained infertility and endometriosis. The usual fertilization rate in IVF for nonmale infertility cases is 60–70% of the inseminated cumulus-oocyte complexes and in andrological infertility it is only 20–30%. The lower the number of normally fertilized oocytes, the less chance there is of available embryos, so that patients may have no embryos to transfer. It has been the experience of all centres for reproductive medicine, including our own, that a certain number of couples with male-factor infertility cannot be helped by standard IVF treatment. After insemination with progressively motile spermatozoa the number of two-pronuclear oocytes was either zero or less than 5%. Furthermore, a sizeable number of couples cannot be accepted for IVF if the number of progressively motile spermatozoa in the ejaculate is below a certain threshold number such as 500 000. In the past five years, assisted fertilization procedures have been developed to circumvent the barriers that prevent sperm access to the ooplasma, namely the zona pellucida and the ooplasmic membrane. Pregnancies and births have been reported after partial zona dissection (PZD) and subzonal insemination (SUZI). The success rate of PZD and SUZI has remained moderate: the normal fertilization rate (two-pronuclear oocytes) has never exceeded 20–25% of the micromanipulated oocytes; only two-thirds of the patients have had embryo transfers of, usually, a low number of embryos, resulting in a reduced pregnancy and take-home baby rate.
10 citations
4 citations
TL;DR: Although pentoxifylline is known to enhance motility in-vitro and to promote induced acrosomal loss, its indiscriminate use failed to improve IVF performance in patients with anti-sperm antibodies.
3 citations