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patients ask questions help fully understand various treatment options<A href="http://www.tcartonline.com/"> <IMG src="http://www.tcartonline.com/images/prd.gif" border="0" alt="in vitro maturation infertility research resources in vitro fertilization ivf reproductive technology"> </A> realize treatment comes lot stress anxiety referral support services available upon request<A href="http://www.tcartonline.com/"> <IMG src="http://www.tcartonline.com/images/prd.gif" border="0" alt="infertility treatments programs pregnancy baby ultrasound sperm in vitro fertilization ivf reproductive technology"> </A> If you require further information wish appointment call toronto centre advanced reproductive technology <A href="http://www.tcartonline.com/"> <IMG src="http://www.tcartonline.com/images/prd.gif" border="0" alt="egg oocyte cryopreservation embryo zygote estrogen progesterone follicles obstetrics gynecology in vitro fertilization ivf reproductive technology"> </A> Office hours monday friday a<A href="http://www.tcartonline.com/"> <IMG src="http://www.tcartonline.com/images/prd.gif" border="0" alt="gynecology male infertility female infertility profasi lupron puregon sperm injection toronto centre for advance reproductive technology in vitro fertilization ivf"> </A>m<A href="http://www.tcartonline.com/"> <IMG src="http://www.tcartonline.com/images/prd.gif" border="0" alt="fertility clinics; treatments for infertile couples (tcart). In vitro fertilization ivf reproductive technology"> </A> p<A href="http://www.tcartonline.com/"> <IMG src="http://www.tcartonline.com/images/prd.gif" border="0" alt="infertility and fertility issues. Trying to get pregnant or to conceive? Our clinic can help. The toronto centre for advanced reproductive technology."> </A>m<A href="http://www.tcartonline.com/"> <IMG src="http://www.tcartonline.com/images/prd.gif" border="0" alt="barren in vitro fertilization ivf reproductive technology"> </A> close affiliation Toronto Centre Advanced Reproductive Technology TCART Toronto provides services based latest research technology science reproductive medicine constantly evolving business Programs Treatment Services TCART clinic offers range treatment programs based extensive University research success following index lists services available Index In vitro fertilization IVF In vitro maturation IVM Intracytoplasmic sperm injection ICSI Epididymal sperm aspiration Known Ovum donor Gestational carrier Embryo cryopreservation Therapeutic donor insemination TDI TCART pleased comprehensive information direct associated costs reproductive services years experience researched documented costs including comparisons alternatives plan ahead best possible position decide entering program time continuing treatment exploring options Stop Source back philosophy individuals families help right available information order informed decisions care Leading Clinic TCART recognized top research based clinics North America leading facility Canada reflected in success TCART Services Outstanding Value TCART programs cost comparable services value added program American patients note significant difference in US Canadian currency value savings approximately equal buying power Fee Schedule March Fee Country Administrative Services Clinic Registration deducted cycle cost Consultation per patient now per couple Needle supplies initial cost per patient Restriction consultation hr Satellite Review Country monitoring registration TCART chart copy Insurance Letter ART Services IVF Natural IVF Blastocyst Transfer Assisted Hatching ICSI IVF Known Donor ICSI Known Donor IVF Gestational Carrier FET Gestational Carrier IVM ICSI & Gestational Carrier Mesa Pesa Tesa Sperm Wash Swim Partner's sperm donor sperm per insemination Cyst Aspiration TCART patient FET FET Blastocyst ICSI conversion TGH OHIP ICSI conversion TGH In Vitro Fertilization IVF Freezing Services Sperm Freezing Yearly Sperm Storage Fee Embryo Freezing Includes year storage Yearly Embryo Storage Fee Mesa Pesa Tesa Sperm Freezing Services Sonohysterogram contrast non OHIP Karotyping Patient Karotyping Couple Yearly Storage Fee NOTE include cost medication treatment required Fee schedule effective July Prices subject change notice Some above costs covered OHIP Ontario residents confirmed referring physician GST added applicable Courier charges sending materials charged directly patient Financial advice loan assistance available qualifying couples through Bank Montreal Drugs Treatment Medications TCART programs latest most effective drug treatments listed in following index Index Birth Control Pill Marvelon Micronor Profasi Pregnyl Lupron Suprefact Gonal F Puregon Progesterone luteal support additional information visit www serono canada Insurance Canadian Patients Some costs listed in TCART fee schedule covered Ontario Health Insurance Plan OHIP Ontario residents confirmed referring physician Note payment plan see infertility treatment available through Bank Montreal US Patients mandatory insurance coverage Massachusetts Rhode Island Illinois states operate independently each mandated cover in vitro fertilization IVF depend insurance company amount coverage available Financing accept Visa American Express Mastercard Interac Bank Montreal TCART Why loan available People going through fertility treatment experience different types stress Financial stress most difficult stresses couple manage attempt child hope developing loan specifically fertility treatment alleviate stress available health loan available clients TCART seeking financing fertility treatment medication costs loan available loan currently exclusive TCART clients undergoing treatment in Canada Each application assessed individually Bank Montreal funds available loan currently available standard unsecured loan in intervals unsecured line credit Cdn Higher amounts available upon request through Bank Montreal details loan loan amounts in excess prime plus Standard Loan loan revolving Line Credit Bank Montreal's Base Line Credit plus maximum term months available Standard Loan Line Credit How get loan Contact TCART through mail phone fax if more information Copyright Toronto Centre Advanced Reproductive Technology Email info@tcartonline October Powered By Webxoom Resources Glossary Assisted hatching Artificial thinning creating opening in zona pellucida Corpus luteum special gland forms surface ovary site ovulation produces progesterone second half cycle necessary prepare uterine lining implantation fertilized egg Cryopreservation Freezing living cells embryos sperm eggs Cytoplasm granular portion in centre each egg Embryo term describe early stages cell division Endometriosis presence endometrial tissue the normal uterine lining in abnormal locations fallopian tubes ovaries peritoneal cavity causing pelvic pain painful menstruation infertility Endometrium mucus membrane lining uterus Epididymis coiled tubular structure in male receives sperm testes sperm stored nourished matured period months conducted vas deferens Estrogen primary female hormone produced mainly ovaries puberty menopause Fallopian tubes Tubes lead uterus in finger projections fimbriae ovaries Fertilization place in fallopian tubes Follicle structure in ovary nurtures ripening egg egg released fallopian tube Follicle stimulation hormone FSH Hormone released pituitary gland stimulates growth ovarian follicles in women sperm production in men indicator egg production GnRH hormone released hypothalamus signals pituitary gland release gonadotropins LH FSH Gonads glands produce reproductive organs ovaries in female testes in male Gametes term refer human eggs sperm Gonadotropins class hormones role in regulation female male reproduction Gonadotropins include follicle stimulation hormone FSH luetenizing hormone LH human chorionic gonadotropin hCG FSH LH secreted pituitary gland In female stimulate growth maturation ovarian follicles trigger ovulation in male stimulate production sperm spermatogenesis HCG hormone secreted placenta pregnancy support endometrium uterine lining Human menopausal gonadotropins HMG term designate FSH LH extracted urine post menopausal women prepared in treatment infertility Hypothalamus region brain above pituitary controls hormone production release gland Implantation embedding fertilized ovum in lining uterus In vitro fertilization IVF Assisted reproduction technique involving stimulation ovulation obtain oocytes eggs drugs gonadotropins Eggs removed using ultrasound guided needle immediately mixed partner's sperm donor sperm enable cell division fertilized eggs placed in protected environment embryos obtained subsequently replaced patient's uterus implant In vitro maturation IVM Immature oocytes eggs retrieved ovary matured in vitro in laboratory oocytes eggs mature IVF ICSI performed Intracytoplasmic sperm injection ICSI technique using microinjection inject sperm cytoplasm egg Laparoscopy direct visualization reproductive organs fibre optic scope inserted through abdominal incision Laparoscopy part basic infertility investigation tubal damage endometriosis suspected Luetenizing hormone LH hormone released pituitary gland triggers release egg mature ovarian follicle In male LH stimulates production testosterone testes Testosterone important sperm development spermatogenesis Oocyte Human egg Ovaries female sex glands reproductive function releasing eggs hormone function producing estrogen progesterone Ovulation induction OI Drug therapy stimulate growth release eggs ovaries treat underlying ovulatory problem augment ovulatory process Ovum egg cell produced in ovaries each month Pituitary gland gland located base brain hypothalamus controls almost every endocrine gland in body controls human growth development reproduction Progesterone hormone produced released corpus luteum ovary second half ovulatory cycle necessary preparation lining uterus implantation fertilized egg produced placenta pregnancy Scrotum sac skin thin muscle holds testes found penis Semen sperm seminal secretions ejaculated orgasm Spermatogenesis production sperm Testes male sex glands reproductive function producing sperm cells hormone function producing testosterone Varicocele varicose vein around vas deferens in testes cause male infertility Vas deferens thick walled tubular structure running each testis ejaculatory duct structures carry sperm epididymis Zona pellucida Membrane surrounding cleaved embryo Cytochemical Analysis Spindle Chromosome Relationships in Human Oocytes Matured In Vitro Intracytoplasmic Sperm Injection Treatment Infertility Due Acrosomal Enzyme Deficiency Hypo osmotic Swelling Test Selection Viable Sperm Intracytoplasmic Sperm Injection in Men Complete Asthenozoospermia Modified Embryo Cryopreservation Method Gives Good Survival ICSI Embryos Utility Human Sperm Activation Assay in Determining Sperm Sample Efficacy Fertilization in ICSI Pregnancy Attempts Assisted Reproductive Technologies Severe Male Factor Infertility Effect Half Dose GNRH Suppression Oocyte Yield in Women American Society Reproductive Medicine Fact Sheet Side Effects Gonadotropins Cytochemical Analysis Spindle Chromosome Relationships in Human Oocytes Matures In Vitro Maria Teresa Zenzes Ryszard Bielecki Jim P Leibo Robert F Dept Obs Gyn U Toronto Toronto Center Advanced Reproductive Technology Dept Biomedical Sciences U Guelph Ontario Canada Objective determine status meiotic spindles metaphase II chromosomes in cytochemical preparations oocytes mature in vitro women in IVF therapy Design Prospective study patients in private clinic setting Oocytes in V stage showed hr in culture in second polar body analyzed meiotic spindle quality spindle alignment MII chromosomes Materials Methods Twenty women ages years mean participated signed consent Women hyperstimulated GnRH agonist hMG later oocytes aspirated Cumulus cells removed hyaluronidase Oocytes remained in culture in modified HTF medium visualization second polar body for Oocytes fixed in formaldehyde treated polyclonal antibody tubulin FITC conjugated secondary antibody DAPI localize chromosomes Results total thirty oocytes required hr culture require hr proportion oocytes chromosomes misaligned plane metaphase plate difference in proportion oocytes misaligned chromosomes found between hr hr stages culture Conclusions Chromosome behavior directly linked meiotic spindle kinetics Spindle assembly in second meiotic division altered in structure resulting in displacement chromosomes spindle plane lead oocytes chromosomal aneuploidies high proportion abnormal oocytes displayed chromosomes due selected population women infertility relative high mean proportion oocytes misaligned chromosomes found in study similar reported cytogenetic data oocytes chromosomal aneuploidies Supported MRC Canada Intracytoplasmic Sperm Infection Treatment Infertility Due Acrosomal Enzyme Deficiency Mayada Abdul Aziz James Sc R T Robert F Objective determine absence fertilization in IVF associated acrosomal enzyme defect hyaluronidase deficiency results simple mechanical block sperm penetration more serious sperm abnormality Design Nonrandomized prospective study Setting Toronto Center Advanced Reproductive Technology tertiary referral center infertility associated University Toronto Patients hundred twenty couples undergo intracytoplasmic sperm injection ICSI selected Thirty studied couples failed fertilize in prior IVF cycles Interventions Hyaluronidase activity measured in semen samples provided ICSI using zymogenic assay Intracytoplasmic sperm injection performed in couples using standard techniques Results Forty semen samples poor absent semen hyaluronidase activity samples resulted in successful fertilization ICSI in study average fertilization per oocyte in couples in male partner low semen hyaluronidase activity in male normal hyaluronidase activity per cycle pregnancy per cycle in cycles poor normal semen hyaluronidase activity respectively Unlike routine IVF statistical correlation found between semen hyaluronidase activity fertilization in ICSI Conclusion results indicate semen hyaluronidase deficiency associated simple mechanical block fertilization In addition measurement semen hyaluronidase activity provide reliable means selecting couples benefit ICSI Fertil Steril Words Hyaluronidase sperm ICSI male factor infertility process fertilization acrosomal enzymes facilitate penetration sperm through oocyte's vestments Hyaluronidase acrosomal enzyme considered important in process fertilization through participation in dissolution extracellular matrix cumulus oophorus containing hyaluronic acid possibility low acrosomal enzyme activity cause reduced fertilizing capability sperm suggested shown previously semen hyaluronidase activity correlates sperm concentration motility percentage normal forms demonstrated semen samples low absent hyaluronidase activity failed fertilize in routine IVF hypothesized failure samples fertilize in IVF related inability sperm penetrate through oocyte's vestments development intracytoplasmic sperm injection ICSI direct injection sperm oocyte's cytoplasm bypasses zona pellucida oocyte membrane thus overcoming need acrosomal enzymes objective study determine intracytoplasmic injection sperm semen samples low absent hyaluronidase activity results in fertilization cleavage similar sperm samples apparently normal hyaluronidase activity If results confirm relationship acrosomal enzyme deficiency simple mechanical block fertilization MATERIALS METHODS Patients hundred twenty couples undergo ICSI selected study indications ICSI severe oligoasthenospermia motile sperm recovered sperm wash swim previous failure fertilize in vitro Forty men low semen hyaluronidease activity defined ring diameter in zymogenic assay described previously men demonstrated failure fertilize in prior IVF cycles representing previous IVF fertilization failures diagnosed severe male factor infertility based semen analysis swim assessments remaining couples studied underwent ICSI similar indications previous failure fertilize in IVF low motility sperm apparently normal semen hyaluronidase activity Semen Hyaluronidase Activity Hyaluronidase activity measured using method described previously In method petri dishes place mixture agar hyaluronic acid bacterial sodium hyaluronate Lifecore Biomedical Chaska MN cut in center each dish Semen treated Nonidet P Sigma Chemical Co St Louis MO mL mixture placed incubating dishes degrees reaction stopped hyaluronidase activity detected presence clear rings hydrolyzed substrate surrounding ring diameters measured in millimeters subtracting represented diameter ring size determined ring size considered represent deficient hyaluronidase activity Controlled Ovarian Stimulation Oocyte Retrieval ICSI Controlled ovarian hyperstimulation consisted long protocol using daily SC GnRH agonist GnRH mg leuprolide acetate Lupron Abbott Pharmaceutical Company Ltd Pointe Claire Quebec Canada starting in midluteal phase subsequent menses described previously If serum concentration pg mL pmol cycle dose GnRH reduced half hMG Pergonal Serono Mississauga Ontario Humegon Organon Toronto Ontario highly purified human FSH Fertinorm Serono administered daily standard protocol began ampules hMG FSH in women years ampules in women years Vaginal ultrasound US follicular measurement performed starting th gonadotropin administration Blood samples measurement serum concentration drawn serially Human chronic gonadotropin IU Profasi Serono administered mean diameter more follicles measured level approximated pg mL pmol per mature follicle Transvaginal US guided oocyte retrieval performed hCG administration Oocyte sperm preparation sperm injection carried using method Van Steirteghem method described previously Statistics fertilization calculated percentage injected oocytes pronuclei injection number embryos suitable transfer in each couple calculated group t test x test compare patient parameters oocyte fertilization Spearman rank correlation determine relationship between semen hyaluronidase activity fertilization in ICSI RESULTS total number oocytes in studied cycles average oocytes per patient total number oocytes in couples male partners having poor semen hyaluronidase activity average oocytes per couple ranging total oocyte number in group good semen hyaluronidase activity average oocytes per couple ranging significant Table comparison between oocyte number female serum levels in groups Table Cycle Characteristics Groups Poor Good Semen Hyaluronidase Activity Hyaluronidase activity Total oocyte number Average oocytes per couple Average female partner y Average serum estrogen level hCG mIU mL Poor ring size Good ring size Total significant differences found between groups in parameters Conversion factor SI unit hCG results couples included in study successful fertilization in ICSI resulting in overall mean fertilization per couple average fertilization per oocyte Table average fertilization in patients poor semen hyaluronidase activity compared good enzyme activity correlation found between semen hyaluronidase activity fertilization in ICSI in group Similarly pregnancy similar in groups Table DISCUSSION crucial role sperm quality in human reproduction established highlighted introduction assisted reproductive technologies whereby capability spermatozoa fertilize oocyte assessed directly In vitro fertilization programs report reduced fertilization pregnancy insemination performed subnormal spermatozoa development ICSI male factor infertility important able identify patients low probability successful fertilization in routine IVF In previous study defined severe male factor infertility recovery motile sperm semen preparation sperm wash swim based mean in vitro oocyte fertilization in patients basis cut value motile sperm recovery now suggest ICSI line therapy infertile couples severe male factor infertility in center shown in recent report men poor semen hyaluronidase activity unlikely fertilize in routine IVF regardless sperm count motility measurement semen hyaluronidase activity provides presumptive information acrosomal function fertilizing capability sperm study designed compare fertilization ICSI between sperm men semen hyaluronidase deficiency men apparently normal enzyme activity Based previous work globozoospermia appears fertilizing potential sperm absent acrosome diminished even ICSI performed cycles ICSI round headed sperm injected eggs embryos formed in cycles fertilization per oocyte injected per cycle results suggest acrosomal defect in globozoospermia part problem possible abnormalities round headed sperm account low fertilization cleavage mechanical block fertilization overcome ICSI More ICSI cycles globozoospermic men required confirm preliminary observations In contrast results study difference in fertilization in ICSI between patients good semen hyaluronidase activity suggesting normal acrosomal function compared deficient semen hyaluronidase activity presumably poor acrosomal function fertilization per oocyte injected men good poor semen hyaluronidase activity respectively per cycle in groups respectively pregnancy per cycle respectively data suggest sperm men deficient absent semen hyaluronidase activity otherwise normal appropriate ICSI In conclusion results acrosomal enzyme deficiency indicated poor semen hyaluronidase activity overcome ICSI Fertilization pregnancy in couples male partner poor semen hyaluronidase activity appear similar ICSI compared couples normal semen hyaluronidase activity study supports previous conclusion measurement semen hyaluronidase activity provides useful information selection couples benefit ICSI rather routine IVF Table Comparison Fertilization in ICSI per Couple per Oocyte Pregnancy Between Groups Poor Good Semen Hyaluronidase Activity Hyaluronidase activity cases Average fertilization per couple in ICSI Average fertilization per oocyte in ICSI Pregnancy Poor Good Total Values in parentheses ring sizes Talbot P Sperm penetration through oocyte investments in mammals Am Anat Yanagimachi R Mammalian fertilization In Knobil Neill JD editors physiology reproduction Raven Press McRorie RA Williams WL Biochemistry mammalian fertilization Ann Rev Biochem SchiU W Topfer Petersen Heissler sperm acrosome functional clinical aspects Hum Reprod T T Massahiko measurement hvaluronidase activity in human spermatozoa substrate slide assay clinical application Fertil Steril Abdul Aziz NJ Bhavnani BR RF Hyaluronidase activity in human semen correlation fertilization in vitro Fertil Steiil Van Steirteghem AC Z Smitz High fertilization implantation intracytoplasmic sperm injection Hum Reprod Van Steirteghem AC Janssenswillen Tournaye Higher success bv intracytoplasmic sperm injection subzonal insemination Report second series consecutive treatment cycles Hum Reprod Z Tournaye Devroey P Van Steirteghem AC Intracytoplasmic sperm injection require special treatment spermatozoa Hum Reprod Greenblatt EM RF Type stimulation protocol affects oocyte maturity fertilization cleavage intracytoplasmic sperm injection Fertil Steril Mahadevan Trouson AO influence seminal characteristics success human in vitro fertilization Fertil Steril Battin Vargyas JM Sato F Brown RP correlation between in vitro fertilization human oocytes semen profile Fertii Steril Ben Chetrit Senoz Greenblatt EM RF In vitro fertilization outcome in presence severe male factor infertility Fertil Steril Z Tournave Devroey P Van Steirteghem AC Successful fertilization establishment pregnancies intracytoplasmic sperm injection in patients globozoospermia Hum Reprod Hypo osmotic Swelling Test Selection Viable Sperm Intracytoplasmic Sperm Injection in Men Complete Asthenozoospermia Robert James T T Lisa Cowan T P Mara Lucato Sc Keith Jarvi Division Reproductive Sciences Department Obstetrics Gynecology University Toronto Toronto Centre Advanced Reproductive Technology Toronto Ontario Canada Objective determine ability hypo osmotic swelling test select viable sperm nonmotile sperm samples intracytoplasmic sperm injection ICSI Design Nonrandomized sequential comparative study Patients Thirteen couples enrolled in ICSI program cycles in sperm preparations motility obtained cycles cryopreserved epididymal sperm complete asthenozoospermia Interventions In cycles semen samples through Percoll gradient sperm selected randomly ICSI In another cycles sperm placed in hypo osmotic solution fructose sodium citrate sperm curled tails taken microinjection needle rinsed ICSI Main Outcome Measures Fertilization per oocyte injected determined presence pronuclei retrieval embryo cleavage per oocyte injected retrieval Results random sperm injection fertilization cleavage respectively In contrast injection sperm selected using hypo osmotic swelling test fertilization cleavage significantly greater respectively pregnancies in cycles hypo osmotic swelling test selected sperm including frozen epididymal sperm Fertil Steril Words Hypo osmotic swelling test asthenozoospermia intracytoplasmic sperm injection sperm viability advent IVF techniques using micromanipulation complete asthenozoospermia meant almost certain infertility Now techniques micromanipulation particularly using intracytoplasmic sperm injection ICSI fertilizations pregnancies reported using completely immotile sperm major technical problem arisen immotile sperm micromanipulation differentiating between live dead sperm In experience sperm viable in samples complete asthenozoospermia standard techniques vital dye exclusion assess integrity sperm membrane inference sperm viability result in death sperm nondamaging methods identify live sperm ICSI procedure hypo osmotic swelling test developed investigate ability sperm membrane transport fluid Sperm incubated in hypo osmolar medium sperm functional membrane undergo swelling cytoplasmic space sperm tail fibers curl changes visualized easily under light microscopy sperm damaged chemically inactive plasma membranes cytoplasmic swelling tails remain uncurled sperm positive hypo osmolar swelling test appear viable investigated possibility could hypo osmotic swelling test identify viable sperm in population completely immotile sperm resulting sperm ICSI MATERIALS METHODS Oocyte Retrieval Multiple follicular stimulation cycle monitoring oocyte retrieval performed using standard protocols women stimulated using long GnRH agonist protocol mg SC leuprolide acetate LA Lupron Abbott Pharmaceuticals Oakville Ontario Canada starting in midluteal phase subsequent cycle If serum pg ml pmol LA dose cut in half HMG Pergonal Serono Canada Mississauga Ontario Canada Humegon Organon Canada Toronto Ontario Canada started dose ampules daily Human chorionic gonadotropin IU IM Profasi Serono given least follicles cm in diameter visualized levels approximately pg mL pmol per mature follicle Oocyte retrieval performed ultrasound guided transvaginal aspiration under local anesthetic hCG administration Follicular fluid aspirated heparinized HEPES buffered human tubal fluid HTF Irvine Scientific Santa Ana CA oocyte cumulus complex identified in HTF supplemented v v human serum albumin HSA solution USP Canadian Red Cross Society Toronto Ontario Canada equilibrated degrees in N Oocyte complexes incubated in organ culture dishes Falcon Products Befford MA approximately hour denuding Cumulus Corona Cell Removal Oocyte cumulus corona cell complexes placed in HEPES buffered modified HTF HSA medium supplemented IU mL hyaluronidase Type VII bovine testes Sigma Chemical Company St Louis MO seconds oocytes removed placed modified HTF HSA mechanical denuding resulting stripped oocytes in equilibrated HTF HSA maturity quality oocytes assessed injection described previously Sperm Preparation each cycle raw semen specimen assessed sperm concentration motility morphology sperm sample in equilibrated HTF HSA minutes x resulting pellet resuspended in mL medium suspension placed onto Percoll gradient Perwash Immucor Canada Toronto Ontario Canada centrifuged x minutes pellet gradient retrieved resuspended in mL medium centrifuged again minutes resulting pellet resuspended in mL HTF HSA mixed gently counting final assessment In samples found motility sperm selected randomly normal morphology intracytoplasmic injection Supravital staining sperm in samples performed using Eosin Y stain described previously introducing hypo osmotic swelling test test select sperm injection next specimens motility cycles performed course months sperm injections performed authors months ICSI experience Fertilization cleavage stable time period differences seen between groups unlikely result improved ICSI technique Hypo osmotic Swelling Test Incubation possible approximately sperm placed in culture dish containing hypo osmotic solution fructose sodium citrate in sterile water incubated degrees approximately hour percentage reactive curled tails nonreactive straight tails sperm assessed counting approximately cells uL aliquot placed in microinjection dish under equilibrated mineral oil Intracytoplasmic Sperm Injection Procedure curled tailed sperm identified aspirated microinjection pipette moved drop uL under oil modified HTF HSA rinsed times moved again drop uL polyvinylpyrrolidone PVP wt vol in modified HTF HSA rinsed repeatedly tail almost straightened sperm injected cytoplasm oocyte described previously nonhypo osmotic swelling tested sperm placed uL modified HTF HSA uL aliquot sperm mixture mixed uL drop PVP sperm injection In groups metaphase II oocytes obtained time retrieval injected prior experience injection in vitro matured oocytes poor awaiting further research in area continuing immature oocytes Fertilization assessed presence distinct pronuclei approximately retrieval Cleavage assessed retrieval transfer maximum embryos if available performed hours postretrieval cumulative embryo score calculated each patient modifying protocol described Steer Briefly number blastomeres in each embryo multiplied embryo score transposed give best embryos worst embryos scores each embryo transferred summed give cumulative embryo score Luteal support using mg natural P suppositories twice daily intravaginally started in women Statistical Analysis Descriptive data compared groups using group t test Sperm count morphology found distributed normally Mann Whitney Rank Sum test analyze data Fertilization cleavage in groups compared X test Yates' correction continuity RESULTS couples diagnosis male factor infertility complete sperm immotility semen preparation treated ICSI initiation hypo osmotic swelling test couples another couples complete asthenospermia treated introduction hypo osmotic swelling test identification sperm intact membranes In couples female partner normal evidence pathology associated infertility semen sperm parameters male partners couples shown in Table Sperm concentrations significantly different between groups percent sperm normal morphology lower P in group undergoing sperm selection hypo osmotic swelling test men motile sperm Percoll gradient centrifugation introducing hypo osmotic swelling test samples stained Eosin Y dye completion ICSI procedure sperm excluded stain indicating structurally intact sperm membrane mean percentage reactive presumably viable sperrn in samples tested hypo osmotic swelling test mean serum concentrations hCG percentage mature oocytes collected did differ in couples introduction hypo osmotic swelling test Table mean fertilization hypo osmotic swelling test hypo osmotic swelling test select sperm injection X P mean cleavage hypo osmotic swelling test hypo osmotic swelling test X P embryo quality in groups assessed method Veeck shown in Table Grade embryos usually selected transfer represented embryos in group hypo osmotic swelling test embryos in group hypo osmotic swelling test non significant Embryo transfer routinely performed ICSI embryos transferred in women in hypo osmotic swelling test group in women in hypo osmotic swelling test group Delayed at occurred in patients in group hypo osmotic swelling test slow embryo development in patient in group hypo osmotic swelling test patient convenience Table mean cumulative embryo score Table hypo osmotic swelling test group hypo osmotic swelling test group P pregnancies occurred in cycles treated ICSI hypo osmotic swelling test sperm selection whereas pregnancies occurred in couples treated ICSI sperm selection pregnancies occurred in couples frozen epididymal sperm motility thawing Patient delivered healthy twin boys whereas patients spontaneous abortions weeks gestation respectively Fetal heart activity observed ultrasound in cases weeks gestation Table Male Factor Parameters Hypo osmotic Swelling Test Sperm parameters Patient Epidymal Sperm Frozen Concentration Morphology Motility Supravital staining hypo osmotic swelling test ml normal ve hypo osmotic swelling test Values means SEM include standard error mean SEM Morphology different between groups P Table Intracytoplasmic Sperm Injection Parameters Outcome Hypo osmotic Swelling Test Outcome Patients Oocytes injected Pro nuclear zygotes cell embryos Atretic Cumu lative embryo score Pregnant y pg mL hypo osmotic swelling test Mean total hypo osmotic swelling test Mean total Conversion factor SI unit In cases more embryos available embryos transferred indicates embryos transferred Values means SEM percentages in parentheses Significantly different P Table Embryo Quality Grade Hypo osmotic Swelling Test Hypo osmotic Swelling Test Groups Embryo quality hypo osmotic swelling test hypo osmotic swelling test Grade Grade Grade Grade Grade Grade Grade best quality Grade worst Values in parentheses percentages DISCUSSION concept using hypo osmotic swelling test selecting viable immotile sperm in ICSI procedure proposed Bocken Vankelecom abstract investigators sperm thus selected injection unfertilized oocytes resulting fertilization cleavage respectively appears test abandoned poor results In study injected metaphase II oocytes in stripping cumulus corona cells results demonstrate possible hypo osmotic swelling test select sperm ICSI samples motility fertilization cleavage respectively similar results same time period in couples motile sperm In contrast random selection sperm injection completely asthenospermic samples resulted in significantly poorer fertilization cleavage cleaved embryos produced percentage high quality embryos similar in each group higher fertilization in group sperm selection hypo osmotic swelling test embryos available transfer in women whereas women in group treated introduction hypo osmotic swelling test embryos transfer result cumulative embryo score significantly higher in group in sperm selected using hypo osmotic swelling test In preliminary study couples conceived ICSI using hypo osmotic swelling test selected sperm pregnancies resulted in delivery healthy twin boys Unfortunately pregnancies lost spontaneous abortions weeks gestation fetal heart activity observed in cases suggest sperm damaged hypo osmotic swelling test procedure based similar percentage high quality embryos in groups occurrence pregnancy hypo osmotic swelling test hypo osmotic swelling test extremely simple perform curled tails sperm intact membranes easy identify sperm aspirated individually hypo osmotic solution resume normal size shape placed in usual culture medium injection Approximately sperm identified having intact membranes hypo osmotic swelling test similar percentage identified viable using Eosin Y staining extremely likely hypo osmotic swelling test able identify viable sperm believe results extremely promising provide simple method select immotile viable sperm ICSI Jeyendran RS Van der Ven HH Perez Pelaez BG LJD Development assay assess functional integrity human sperm membrane relationship semen characteristics Reprod Fertil Greenblatt EM RF Type stimulation protocol affects oocyte maturity fertilization cleavage intracytoplasmic sperm injection Fertil Steril Eliasson R Treichl Supravital staining human spermatozoa Fertil Steril Van Steirteghem AC Z Smitz ai High fertilization implantation intracytoplasmic sperm injection Hum Reprod Steer CV Mills CL Tan SL Campbell Edwards RG cumulative embryo score predictive embryo scoring technique select optimal number embryos transfer in in vitro fertilization embryo transfer program Hum Reprod Veeck Atlas human oocyte early conceptus Vol Baltimore Williams Wilkins Modified Embryo Cryopreservation Method Gives Good Survival ICSI Embryos Lucato Cowan Visram R F Toronto Centre Advanced Reproductive Technology Toronto Ontario Introduction others disappointing results embryo survival pregnancy using standard IVF cryopreservation method embryos derived ICSI program hypothesized breach in zona oolemma possibly allowing sucrose normally extracellular cryopreservative cell resulting in toxic effect In addition possible exposure oocyte hyaluronidase manipulation ICSI procedure causing zona hardening resulting in impaired implantation Objective decrease concentration sucrose in cryopreservation solution in reducing amount sucrose seeping cell reduce possible zona hardening in culture replacing protein source synthetic serum substitute SSS Design Non randomized sequential study Patients Group ICSI patient couples embryos cryopreserved using following cryoprotectant solution PROH sucrose HSA Group ICSI patient couples embryos cryopreserved using following modified protocol PROH sucrose SSS Results Legend CES Cumulative Embryo score BC blastomeres cryopreserved BS blastomeres surviving ova inj MII ova injected mean SEM NS significant Utility Human Sperm Activation Assay in Determining Sperm Sample Efficacy Fertilization in ISCI Pregnancy Attempts Brown Maeker R F Department Human Biology Chemistry Genetics University Texas Medical Brnach Galveston TX Diagnostic System Laboratories Inc Webster TX Toronto Centre Advanced Reproductive Technology Canada Department Ob Gyn University Toronto Canada In previous studies sperm samples unexplained infertility patients sperm normal in standard semen analysis analyzed in human sperm activation assay HSSA Brown Yale Biol Med Fertil Steril Sixteen inexplicably infertile males produced sperm responded abnormally in HSAA Portions samples in ART attempts pregnancy IUI IVF GIFT resulted in pergnancies extended studies using HSAA analyze sperm samples males unexplained infertility male factor infertility abnormal morphology see Brown Abstrat meeting samples in ICSI attempts pregnancy Permeabilized human sperm incubated in Xenopus laevis frog egg extract containing tritiated thymidine sperm decondensed chromatin synthesized DNA hour in vitro assay determined patient assays performed in parallel assay using control sperm fertile male abnormal response control decondensation DNA synthesis samples responded abnormally in HSAA ICSI fertilization cleavage respectively abnormal HSAA responders unsuccessful ICSI attempts pregnancy Seventeen samples responded normally in HSAA ICSI fertilization cleavage respectively criterion determining pregnancy success pregnancy traverse trimester spontaneous abortion pregnancy normal HSAA responders being determined In study significant different in fertilization observed vs Data previous studies indicate HSAA utility in determining sperm sample efficacy fertilization in ART attempts pregnancy Assisted Reproductive Technologies Severe Male Factor Infertility P Incze Jarvi R Buckspan Toronto Ontario Canada Azoospermia secondary proximal epididymal obstruction retetestis due maturation arrest benefit Assisted Reproductive Technologies former undergo testicular sperm aspiration TESA combined intracytoplasmic sperm injection ICSI latter round spermatids isolated testicular biopsy Using micromanipulator round spermatid nucleus extracted haploid cell injected oocyte ROSNI men proximal epididymal obstruction underwent TESA ICSI men maturation arrest underwent testicular biopsy found round spermatids in ROSNI procedure men achieved fertilization minimum zygotes being transferred transvaginally uterus spouse zygote transfer occurred cell blastocyst stage clinical pregnancy occurred patient proximal epididymal obstruction Effect Half Dose GNRH Suppression Oocyte Yield in Women Authors Ward RN Parker RNC study determine reducing amount pituitary suppression in women years older effectively increase oocyte yield down regulation regimen reduce amount GNRH agonist administered mg mg diluting half half sterile O followed regular routine down regulation calls beginning gonadotropin stimulation estradiol levels equal pmol study prospective non randomized cohort cycles previously undergone cycle using full dose suppression agonist identified prior poor responders following parameters number ampoules gonadtropin number oocytes retrieved number embryos hCG time hCG cycles initiated half dose suppression mean mean number ampoules gonadotropins mean number oocytes collected mean number embryos compared identical parameters in cycles full dose suppression results indicated difference in above parameters study demonstrates half dose suppression significantly alter number oocytes available retrieval in group American Society Reproductive Medicine Fact Sheet Side Effects Gonadotropins types gonadotropins alone in combination ovulation induction include hMG human Menopausal Gonadotropin Pergonal® Humegon hFSH Human Follicle stimulating Hormone Metrodin® hCG human Chorionic Gonadotropin Profasi® APL® Pregnyl® drugs careful monitoring required minimize risk side effects discussed Ovarian Hyperstimulation OHSS Occurring in percent cycles chance OHSS increased in women polycystic ovarian syndrome in conception cycles sever result in blood clots kidney damage ovarian twisting torsion chest abdominal fluid collections In severe cases hospitalization required monitoring condition transient lasting week Occasionally drawing fluid chest abdominal cavity best prevention give hCG induce ovulation overly vigorous stimulation cycle Multiple Gestation percent pregnancies resulting gonadotropins multiple in contrast percent in general population most pregnancies twins significant percentage triplets higher High order multiple gestation pregnancy associated increased risk pregnancy loss premature delivery pregnancy induced hypertension hemorrhage significant maternal complications Ectopic Tubal Pregnancies ectopic pregnancies occur percent time in gonadotropin cycles slightly increased percent treated medicine surgery Combined tubal intrauterine pregnancies heterotropic pregnancies occasionally occur hMG need treated surgery Birth Defects birth defects gonadotropin cycles higher in general population percent Furthermore children developmentally different peers Adnexal Torsion Ovarian Twisting percent time stimulated ovary twist itself cutting blood supply Surgery required untwist even remove Gonadotropins Ovarian Cancer risk ovarian cancer seems in part related number times woman ovulates Infertility increases risk birth control pill decreases Controversial data exists associate ovulation stimulation drugs gonadotropins risk future ovarian cancer research underway help clarify issue careful gonadotropins reasonable especially considering pregnancy breast feeding reduce cancer risk Treatments Drugs Glossary Psychological Counseling TCART Payment Necessary Blood Work Treatments IVF in vitro fertilization In vitro fertilization involves removing eggs ovaries fertilizing in laboratory replacing embryos uterus implant mature qualifies IVF IVF originally designed help women blocked absent fallopian tubes Today IVF proven successful couples unexplained infertility ovulation disorders endometriosis male factor problems IVM in vitro maturation retrieval immature oocytes Human egg ovary matured in vitro in laboratory mature IVF performed considered IVM treatment In general women infertility polycystic ovaries PCO polycystic ovarian syndrome PCOS under years considered candidates IVM treatment women repeatedly produce poor quality embryos demonstrate poor responders ovarian stimulation conventional IVF considered IVM treatment depending individual agreement ICSI intracytoplasmic sperm injection ICSI acronym describe Intracytoplasmic Sperm Injection injection single sperm directly cytoplasm oocyte ICSI intracytoplasmic sperm injection safe comprehensive information button gestational carrier Gestational carrier procedure taking oocyte sperm gametes biological parents fertilizing in vitro implanting fertilized embryo uterus woman carrier she able carry pregnancy term embryo cryopreservation Embryo cryopreservation method preserve embryos cooling storing low temperatures thawed future transferred uterus in unstimulated cycle candidate epididymal sperm aspiration Occasionally men sperm in ejaculate sperm removed epididymis directly testicle procedures microsurgical epididymal sperm aspiration testicular sperm aspiration sperm intracytoplasmic sperm injection ICSI in IVF cycle produce pregnancy TDI therapeutic donor insemination Therapeutic donor insemination TDI referred treatment infertile couples male factor problem anonymous donor sperm fertility problems TDI possible option couples azoospermia absence sperm oligospermia sperm male carry genetic disorder could pass his offspring Treatments Drugs Glossary Psychological Counseling TCART Payment Necessary Blood Work Drugs Profasi Pregnyl Profasi Pregnyl Human Chorionic Gonadotropin HCG natural hormone produced placenta purified urine pregnant women action HCG virtually identical pituitary LH triggers ovulation side effects Profasi Pregnyl following adverse reactions associated administration HCG headache irritability restlessness fatigue breast tenderness nausea Profasi Pregnyl affect developing fetus increased risk abnormality reported in general population Lupron Suprefact Lupron Suprefact acts pituitary gland medication causes suppression ovarian response unless ovary stimulated drugs Puregon Gonal F side effects Lupron Suprefact following adverse reactions associated administration Lupron Suprefact joint pain headache hot flashes bruising tenderness around injection site Lupron Suprefact affect developing fetus In comparison general population increased risk abnormality Gonal F Prurgon medications made highly purified human Follicle Stimulating Hormone prepared recombinant DNA technology non urinary products contains FSH LH component side effects Gonal F Prurgon Some women experience abdominal discomfort headache weight gain irritability breast tenderness most serious side effect ovarian hyperstimulation Hyperstimulation occurs follicles develop in response Gonal F Prurgon stimulation causes sudden enlargement ovary abdomen become distended fluid Hyperstimulation usually mild moderate severe hyperstimulation occurs in patients Treatment consists bed rest careful monitoring fluid levels Gonal F Prurgon affect developing fetus increased risk abnormality reported in general population Treatments Drugs Glossary Psychological Counseling TCART Payment Necessary Blood Work Glossary Alpha fetoprotein AFP plasma protein produced fetal liver yolk sac parts body Amniotic fluid AFP in prenatal diagnosis neural tube anomaly Amnion innermost membrane enclosing developing foetus fluid in foetus bathed Assisted hatching Artificial thinning creating opening in zona pellucida Corpus luteum special gland forms surface ovary site ovulation produces progesterone second half cycle necessary prepare uterine lining implantation fertilized egg Cryopreservation Freezing living cells embryos sperm eggs Cytoplasm granular portion in centre each egg Embryo term describe early stages cell division Endometriosis presence endometrial tissue the normal uterine lining in abnormal locations fallopian tubes ovaries peritoneal cavity causing pelvic pain painful menstruation infertility Endometrium mucus membrane lining uterus Epididymis coiled tubular structure in male receives sperm testes sperm stored nourished matured period months conducted vas deferens Estrogen primary female hormone produced mainly ovaries puberty menopause Fallopian tubes Tubes lead uterus in finger projections fimbriae ovaries Fertilization place in fallopian tubes Follicle structure in ovary nurtures ripening egg egg released fallopian tube Follicle stimulation hormone FSH Hormone released pituitary gland stimulates growth ovarian follicles in women sperm production in men indicator egg production GnRH hormone released hypothalamus signals pituitary gland release gonadotropins LH FSH Gonads glands produce reproductive organs ovaries in female testes in male Gametes term refer human eggs sperm Gonadotropins class hormones role in regulation female male reproduction Gonadotropins include follicle stimulation hormone FSH luetenizing hormone LH human chorionic gonadotropin hCG FSH LH secreted pituitary gland In female stimulate growth maturation ovarian follicles trigger ovulation in male stimulate production sperm spermatogenesis HCG hormone secreted placenta pregnancy support endometrium uterine lining Human menopausal gonadotropins HMG term designate FSH LH extracted urine post menopausal women prepared in treatment infertility Hypothalamus region brain above pituitary controls hormone production release gland Implantation embedding fertilized ovum in lining uterus In vitro fertilization IVF Assisted reproduction technique involving stimulation ovulation obtain oocytes eggs drugs gonadotropins Eggs removed using ultrasound guided needle immediately mixed partner's sperm donor sperm enable cell division fertilized eggs placed in protected environment embryos obtained subsequently replaced patient's uterus implant In vitro maturation IVM Immature oocytes eggs retrieved ovary matured in vitro in laboratory oocytes eggs mature mature IVF ICSI performed Intracytoplasmic sperm injection ICSI technique using microinjection inject sperm cytoplasm egg Laparoscopy direct visualization reproductive organs fibre optic scope inserted through abdominal incision Laparoscopy part basic infertility investigation tubal damage endometriosis suspected Luetenizing hormone LH hormone released pituitary gland triggers release egg mature ovarian follicle In male LH stimulates production testosterone testes Testosterone important sperm development spermatogenesis Oocyte Human egg Ovaries female sex glands reproductive function releasing eggs hormone function producing estrogen progesterone Ovulation induction OI Drug therapy stimulate growth release eggs ovaries treat underlying ovulatory problem augment ovulatory process Ovum egg cell produced in ovaries each month Pituitary gland gland located base brain hypothalamus controls almost every endocrine gland in body controls human growth development reproduction Progesterone hormone produced released corpus luteum ovary second half ovulatory cycle necessary preparation lining uterus implantation fertilized egg produced placenta pregnancy Scrotum sac skin thin muscle holds testes found Semen sperm seminal secretions ejaculated orgasm Spermatogenesis production sperm Testes male sex glands reproductive function producing sperm cells hormone function producing testosterone Varicocele varicose vein around vas deferens in testes cause male infertility Vas deferens thick walled tubular structure running each testis ejaculatory duct structures carry sperm epididymis Vas deferens thick walled tubular structure running 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