Introduction. Introduction. Assisted reproduction using donor sperm bank IUI IVF ICSI. Andrology Laboratory IVI Madrid. Dr.
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1 Assisted reproduction using donor sperm bank Dr. Alberto Pacheco Andrology Laboratory IVI Madrid Introduction Registration Screening Cryopreservation Recruitment Storage IUI IVF ICSI Página 2 Introduction Mean pregnancy rate: 21,27% Andersen AM, 9 Página 3
2 Introduction Which factors could influence pregnancy rates? Página 4 ART RESULTS MALE FACTORS LABORATORY FACTORS FEMALE FACTORS Donor selection Sperm proccesing Female/cycle factors Página IVI experience (1998-9) Retrospective study of treatments using donor sperm bank in all the IVI centers DONOR IUI DONOR IVF Number of treatments Number of patients Mean number of cycles Mean Age Página 6
3 Overall success rates IUI Number of patients 3137 Number of treatments 7122 Mean number of cycles 2,27 Pregnancy rate per cycle 26,8 % Delivery rate per cycle,4 % Multiple pregnancy rate 12,9 % Miscarriage rate 23,9 % Ectopic pregnancy rate,2 % IVF Number of patients 3771 Number of treatments 14 Mean number of cycles 1,36 Pregnancy rate per cycle 1, % Delivery rate per cycle 49,6 % Multiple pregnancy rate 28,3 % Miscarriage rate 29 % Ectopic pregnancy rate 1, % Página 7 Cumulative s The cumulative live birth rate gives information about the chances of achieving a live birth after a given number of cycles. Donor IUI Donor IVF Página 8 MALE FACTORS Página 9
4 Male factor Strict donor selection ensures the all the donor fresh semen samples are normozoospermic But freezing/thawing techniques and other procedures affect post thaw seminal characteristics Do new seminal characteristics have impact on pregnancy rates? Are they present in all the semen Banks? Página Donor sperm selection criteria SEMINAL CHARACTERISTICS REQUIRED FOR DONOR SELECTION Volume: > 2 ml % Motile spermatozoa: > % A+B Concentration: > 7 mill/ml Total motile sperm: > 8 mill Recovery of motile sperm after thawing: > mill And similar freezing/thawing protocol similar semen processing protocol Página 11 Use of different Semen Bank in IUI = p <, (%) Página 12
5 LABORATORY FACTORS Página 13 Effect of sperm freezing/thawing process Different laboratory factors can influence pregnancy rates: Freezing/Thawing process Sperm selection procedures (gradient, swim up) Sperm characteristics after capacitation Página 14 Donor sperm characteristics N = 168 IUI cycles in 132 couples with NOA Pregnancy rate: 18.4%, after 2, IUI cycles on average Significant differences in Amplitude of lateral head displacement (ALH) between pregnant and nonpregnant cycles Fréour T et al. () Página 1
6 Donor IUI: Total motile sperm = p <, < 2 Mill 2-4 Mill 4-6 Mill 6-8 Mill > 8 Mill Low total number of motile spermatozoa influence pregnancy rates Página 16 FEMALE FACTORS Age of the patient Indication Antral follicles Days of stimulation Estradiol levels on HCG-day Página 17 IUI: Age effect In recent years, the development of postponing pregnancy due to social, economical and cultural factors is leading to an increase in treatments for age-related subfertility < yo - 34 yo 3-37 yo yo > 4 yo Página 18
7 6 IUI: Age effect 3 % < yo - 34 yo 3-37 yo 38-4 yo > 4 yo Miscarriage rate Miscarriage rate is dramatically increased in older patients. Página 19 IUI: Age effect Cumulative Live birth rate Age group Maternal age have a profound impact on live birth rates. Página Página 21
8 IVF: Effect of age < yo - 34 yo 3-37 yo yo > 4 yo Página 22 DONOR IVF CYCLES DONOR OOCYTES + DONOR SPERM OWN OOCYTES + DONOR SPERM cycles 1.62 cycles The analysis of these different treatments could give information about the real semen and oocyte effects Página 23 Cumulative Own oocytes 162 cycles,4 % PR 4, % LbR Donor oocytes 2119 cycles 71,3 % PR 7,1 % LbR Página 24
9 Age of patient < yo - 34 yo 3-37 yo yo > 4 yo (%) Donated Own < yo - 34 yo 3-37 yo yo > 4 yo Donated Own Página 2 Donated vs Own oocytes: Effect of age Donor oocytes Own oocytes Age group Age group Oocyte quality have a profound impact on live birth rates. Página 26 IUI: Effect of indication = p <, Single parent Lesbian couple Male factor 36, 8 33,6 32, 8 Página 27
10 IVF: Effect of indication 6 4 (%) 41. yo! 39.8 yo! 36.6 yo! Single Parent Lesbian couple Male factor = p <, Donated Own Indication, by itself, is not an influence factor for pregnancy rates Página 28 IUI: Effect of age and indication Página 29 IUI: Antral follicles = p <, yo! 3. yo! 33.3 yo! 33.7 yo! < > 18 Página
11 IVF: Antral follicles = p <, yo! 36.6 yo! 34. yo! 34.9 yo! < >1 Página 31 IUI: Effect of stimulation protocol = p <, 2 Age effect?? Nat. cycle C.C. Gonad. Stimulation protocol is an influence factor for pregnancy rates Página 32 IUI: Effect of cycle characteristics = p <, DAYS OF STIMULATION ESTRADIOL LEVELS AT HCG-DAY < > < > 73 Página 33
12 IVF: Effect of cycle characteristics = p <, 6 DAYS OF STIMULATION ESTRADIOL LEVELS AT HCG-DAY < >22 < >248 Página 34 Conclusions To obtain good results in treatments with semen bank, your perfect team is: Total number of motile sperm inseminated > 2 mill Maternal age < 37 yo Adequate ovarian reserve Stimulation protocol with FSH Página 3 IVI collaborations IVI Madrid IVI Valencia Dr. Nicolás Garrido IVI Bilbao Dra. Carmen Anarte IVI Sevilla Dra. Cristina González IVI Lisboa Dr. Susana Alves IVI Murcia Dr. Juan Carlos Martínez IVI Vigo IVI Barcelona Dra. Dina Pabón Dr. David Amorós IVI Alicante Dra. Elena Sellés IVI Almería Dra. Inmaculada Campos Página 36
13 Thank you!! IVI Madrid Avenida del Talgo, Madrid Tel Página 37
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Family Practice, 2014, Vol. 31, No. 3, 290 297 doi:10.1093/fampra/cmu003 Advance Access publication 3 March 2014 Prospective study of a Swedish infertile cohort 2005 08: population characteristics, treatments
Consent for In Vitro Fertilization (IVF), Intracytoplasmic Sperm Injection (ICSI), and Embryo Cryopreservation/Disposition
Consent for In Vitro Fertilization (IVF), Intracytoplasmic Sperm Injection (ICSI), and Embryo Cryopreservation/Disposition Patient Name (please print) Patient DOB (MM/DD/YYYY) Patient eivf number Partner