Human reproduction
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Review Meta Analysis
The impact of assisted hatching on live birth rates and outcomes of assisted conception: a systematic review.
During the past decade in the UK, only one in six cycles of assisted conception has resulted successfully in a live birth. Assisted hatching (AH) has been proposed to improve outcome. This systematic review of randomized controlled trials addresses primary outcomes of live birth, clinical pregnancy and embryo implantation. ⋯ AH probably enhances clinical pregnancy, especially in women with previous failure of assisted conception treatment and in older women; however, trials were of poor quality and so may be biased. Better quality trials reporting live birth are required to confirm any positive effects on the 'take-home-baby rate'.
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Our research has focused on promoting the development of compromised embryos by transferring presumably normal ooplasm, including mitochondria, to oocytes during intracytoplasmic insemination. Because of the enigma of mitochondrial heteroplasmy, the mixing of populations of oocyte cytoplasm has provoked considerable debate. We are currently investigating oocyte mitochondrial (mt) DNA mutations and the effects of ooplasmic transplantation on mitochondrial inheritance and mitochondrial functionality. ⋯ By examining the donor and recipient blood samples it is possible to distinguish differences in their mtDNA fingerprint. A small proportion of donor mitochondrial DNA was detected in samples with the following frequencies: embryos (six out of 13), amniocytes (one out of four), placenta (two out of four), and fetal cord blood (two out of four). Ooplasmic transfer can thus result in sustained mtDNA heteroplasmy representing both the donor and recipient.
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Review Comparative Study
Subzonal insemination, partial zona dissection or intracytoplasmic sperm injection? An easy decision?
This review aims to analyse and compare the results to date of subzonal insemination (SUZI), partial zona dissection (PZD) and intracytoplasmic sperm injection (ICSI) to evaluate critically whether it is now possible to replace SUZI and PZD by ICSI. It appears that ICSI is a much more efficient assisted reproduction technique than SUZI and PZD for resolving cases of severe male infertility and/or repeated failure of conventional in-vitro fertilization (IVF). For ICSI compared with SUZI and PZD, fertilization (49.4, 17.7 and 16.8% respectively), percentage of patients reaching embryo transfer (91.0, 55.1 and 23.3% respectively), percentage of transfers performed with two or three embryos (83.3% ICSI and 39.3% SUZI), pregnancy rate per embryo replacement (28.2, 18.7 and 16.5% respectively) and pregnancy rate per oocyte retrieval (24.8, 10.3 and 3.8% respectively) are all improved. In addition, cases of severely impaired semen characteristics, which were condemned to infertility for life with conventional IVF, SUZI or PZD, can now be treated and resolved efficiently with ICSI.