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Ebner T.,Landes Frauen und Kinderklinik | Montag M.,University of Bonn | Montag M.,Ilabcomm GmbH | Van Der Ven K.,University of Bonn | And 16 more authors.
Reproductive BioMedicine Online | Year: 2015

Artificial oocyte activation has been proposed as a suitable means to overcome the problem of failed or impaired fertilization after intracytoplasmic sperm injection (ICSI). In a multicentre setting artificial oocyte activation was applied to 101 patients who were diagnosed with fertilization abnormalities (e.g. less than 50% fertilized oocytes) in a previous conventional ICSI cycle. Female gametes were activated for 15 min immediately after ICSI using a ready-to-use Ca2+-ionophore solution (A23187). Fertilization, pregnancy and live birth rates were compared with the preceding cycle without activation. The fertilization rate of 48% in the study cycles was significantly higher compared with the 25% in the control cycles (P < 0.001). Further splitting of the historical control group into failed (0%), low (1-30%) and moderate fertilization rate (31-50%) showed that all groups significantly benefitted (P < 0.001) in the ionophore cycle. Fewer patients had their embryo transfer cancelled compared with their previous treatments (1/101 versus 15/101). In total, 99% of the patients had an improved outcome with A23187 application resulting in a 28% live birth rate (35 babies). These data suggest that artificial oocyte activation using a ready-to-use compound is an efficient method. © 2014 Reproductive Healthcare Ltd. All rights reserved.


Ebner T.,Landes Frauen und Kinderklinik | Oppelt P.,Johannes Kepler University | Wober M.,Kinderwunschzentrum Goldenes Kreuz | Staples P.,Medical University of Graz | And 6 more authors.
Human Reproduction | Year: 2015

STUDY QUESTION Does calcium ionophore treatment (A23187, calcimycin) improve embryo development and outcome in patients with a history of developmental problems/arrest? SUMMARY ANSWER Application of A23187 leads to increased rates of cleavage to 2-cell stage, blastocyst formation and clinical pregnancy/live birth. WHAT IS KNOWN ALREADY Studies on lower animals indicate that changes in intracellular free calcium trigger and regulate the events of cell division. In humans, calcium fluctuations were detected with a peak shortly before cell division. Interestingly, these calcium oscillations disappeared in arrested embryos. Mitotic division blocked with a Ca2+ chelator could be restored by means of ionophores in an animal model. STUDY DESIGN, SIZE, DURATION This prospective, multicenter (five Austrian centers), uncontrolled intervention study (duration 1 year) includes 57 patients who provided informed consent. PARTICIPANTS/MATERIALS, SETTING, METHODS Inclusion criteria were complete embryo developmental arrest in a previous cycle (no transfer), complete developmental delay (no morula/blastocyst on Day 5), or reduced blastocyst formation on Day 5 (≤15%). Severe male factor patients and patients with <30% fertilization rate after ICSI were excluded because these would be routine indications for ionophore usage. The total of the 57 immediately preceding cycles in the same patients constituted the control cycles/control group. In the treatment cycles, all metaphase II-oocytes were exposed to a commercially available ready-to-use ionophore for 15 min immediately after ICSI. After a three-step washing procedure, in vitro culture was performed as in the control cycles, up to blastocyst stage when achievable. MAIN RESULTS AND THE ROLE OF CHANCE Fertilization rate did not differ (75.4 versus 73.2%); however, further cleavage to 2-cell stage was significantly higher (P < 0.001) in the ionophore group (98.5%) when compared with the control cycles (91.9%). In addition, significantly more (P < 0.05) blastocysts formed on Day 5 in the study compared with the control group (47.6 versus 5.5%, respectively) and this was associated with a significant increase (P < 0.01) in the rates of implantation (44.4 versus 12.5%), clinical pregnancy (45.1 versus 12.8%) and live birth (45.1 versus 12.8%). All babies born at the time of writing (22/28) were healthy. LIMITATIONS, REASONS FOR CAUTION The frequency of patients showing embryo developmental problems was expected to be low; therefore, a multicenter approach was chosen in order to increase sample size. In one-third of the cycles, the clinician or patient requested a change of stimulation protocol; however, this did not influence the developmental rate of embryos. WIDER IMPLICATIONS OF THE FINDINGS This is the first evidence that developmental incompetence of embryos is an additional indication for ionophore treatment. The present approach is exclusively for overcoming cleavage arrest. STUDY FUNDING/COMPETING INTEREST(S) No funding received. T.E. reports fees from Gynemed, outside the submitted work. All co-Authors have no interest to declare. © 2014 © The Author 2014. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved.


Ebner T.,Landes Frauen und Kinderklinik | Koster M.,University of Bonn | Shebl O.,Landes Frauen und Kinderklinik | Moser M.,Landes Frauen und Kinderklinik | And 4 more authors.
Fertility and Sterility | Year: 2012

Objective: To analyze whether a ready-to-use calcium ionophore improves outcomes, from fertilization to live birth, in patients with severe male factor infertility. Design: Artificial oocyte activation offered to applicable patients over a 20-month period. Setting: Specialized in vitro fertilization (IVF) centers in Austria and Germany. Patient(s): Twenty-nine azoospermic and 37 cryptozoospermic men. Intervention(s): Mature oocytes treated with a ready-to-use Ca2+-ionophore (GM508 Cult-Active) immediately after intracytoplasmic sperm injection (ICSI). Main Outcome Measure(s): Rates of fertilization, implantation, clinical pregnancy, and live birth. Result(s): Patients had had 88 previous cycles without artificial activation that resulted in a fertilization rate of 34.7%, 79 transfers (89.8%), and 5 pregnancies, which all spontaneously aborted except one. After artificial oocyte activation, the fertilization rate was 56.9%. In terms of fertilization rate, both azoospermic (64.4%) and cryptozoospermic (48.4%) men statistically significantly benefited from use of the ionophore. In 73 transfer cycles, positive β-human chorionic gonadotropin levels were observed in 34 cases (46.6%) and 29 cycles (39.7%) that ended with a clinical pregnancy. The corresponding implantation rate was 33.3%. Four spontaneous abortions occurred (11.8%), and 32 healthy children were born. Conclusion(s): This is the first prospective multicenter study on artificial oocyte activation in severe male factor infertility. Present data indicate that a ready-to-use calcium ionophore can yield high fertilization and pregnancy rates for this particular subgroup. In addition to fertilization failure after ICSI, severe male factor infertility is an additional area for application of artificial oocyte activation. © 2012 by American Society for Reproductive Medicine.


Ebner T.,Landes Frauen und Kinderklinik | Filicori M.,GynePro Medical Centers | Tews G.,Landes Frauen und Kinderklinik | Parmegiani L.,GynePro Medical Centers
Andrologia | Year: 2012

Intracytoplasmic sperm injection (ICSI) can be considered the most 'revolutionary' in vitro insemination technique because it has efficiently allowed the treatment of male factor infertility. Although ICSI has been successfully and safely applied worldwide for almost 20 years, currently, we have no real knowledge regarding the hypothetical long-term side effects on ICSI adults, given the increased likelihood of spermatozoa with defective nuclear content fertilising the oocytes. The aim of this review article is to investigate the most recent advances of performing ICSI in the safest possible manner, thus, minimising the theoretical hazards of this procedure. To allow for substantiated recommendation which male gametes to choose for physiological ICSI an updated search was performed in Medline and Embase, from 1996 to June 2011. Recent technical advances allow operators to more or less simulate physiological conditions in the laboratory, reducing potential damage to the gametes. It seems possible to prevent fertilisation by DNA-damaged and chromosomal-unbalanced spermatozoa by selecting ICSI sperm by motility and/or maturation markers such as hyaluronic acid or other zona pellucida receptors. Furthermore, novel non-invasive imaging techniques can be valid tools for helping in the morphological selection of ICSI spermatozoa. © 2011 Blackwell Verlag GmbH.


Seiringer M.,Landes Frauen und Kinderklinik | Maurer M.,Landes Frauen und Kinderklinik | Shebl O.,Landes Frauen und Kinderklinik | Dreier K.,Private Kinderwunsch Clinic | And 5 more authors.
Reproductive BioMedicine Online | Year: 2013

Since most current techniques analysing spermatozoa will inevitably exclude these gametes from further use, attempts have been made to enrich semen samples with physiological spermatozoa with good prognosis using special sperm-processing methods. A particular sperm-selection chamber, called the Zech-selector, was found to be effective in completely eliminating spermatozoa with DNA strand breaks. The aim of this study was to further analyse the subgroup of spermatozoa accumulated using the Zech-selector. In detail, the potential of the chamber to select for proper sperm morphology, DNA status and chromatin condensation was tested. Two samples, native and processed semen, of 53 patients were analysed for sperm morphology (×1000, ×6300), DNA packaging (fragmentation, chromatin condensation) and chromosomal status (X, Y, 18). Migration time (the time needed for proper sperm accumulation) was significantly correlated to fast progressive motility (P = 0.002). The present sperm-processing method was highly successful with respect to all parameters analysed (P < 0.001). In particular, spermatozoa showing numeric (17.4% of patients without aneuploidy) or structural chromosomal abnormalities (90% of patients without strand-breaks) were separated most effectively. To summarize, further evidence is provided that separating spermatozoa without exposure to centrifugation stress results in a population of highly physiological spermatozoa.


PubMed | University of Graz, Medical University of Graz and Landes Frauen und Kinderklinik
Type: Journal Article | Journal: Journal of assisted reproduction and genetics | Year: 2016

Prolonged in vitro culture is thought to affect pre- and postnatal development of the embryo. This prospective study was set up to determine whether quality/size of inner cell mass (ICM) (from which the fetus ultimately develops) and trophectoderm (TE) (from which the placenta ultimately develops) is reflected in birth and placental weight, healthy live-birth rate, and gender after fresh and frozen single blastocyst transfer.In 225 patients, qualitative scoring of blastocysts was done according to the criteria expansion, ICM, and TE appearance. In parallel, all three parameters were quantified semi-automatically.TE quality and cell number were the only parameters that predicted treatment outcome. In detail, pregnancies that continued on to a live birth could be distinguished from those pregnancies that aborted on the basis of TE grade and cell number. Male blastocysts had a 2.53 higher chance of showing TE of quality A compared to female ones. There was no correlation between the appearance of both cell lineages and birth or placental weight, respectively.The presented correlation of TE with outcome indicates that TE scoring could replace ICM scoring in terms of priority. This would automatically require a rethinking process in terms of blastocyst selection and cryopreservation strategy.


Ebner T.,Landes Frauen und Kinderklinik | Shebl O.,Landes Frauen und Kinderklinik | Mayer R.B.,Landes Frauen und Kinderklinik | Moser M.,Landes Frauen und Kinderklinik | And 2 more authors.
Fertility and Sterility | Year: 2014

Objective To analyze whether the use of ready-to-use theophylline is a feasible option in a case of retrograde ejaculation and absolute asthenozoospermia. Design Case report. Setting In vitro fertilization unit of a public hospital. Patient(s) Thirty-one-year-old nulliparous woman, and 39-year-old male with retrograde ejaculation and absolute asthenozoospermia. Intervention(s) Retrieval of postejaculatory urine, restoration of motility using a methylxanthine, intracytoplasmic sperm injection, single-embryo transfer. Main Outcome Measure(s) Sperm motility, fertilization, embryo quality, live birth. Result(s) Successful fertilization and a single-embryo transfer resulted in a healthy live birth. Conclusion(s) Theophylline turned out to be a safe, efficient agent for stimulating immotile spermatozoa in patients with retrograde ejaculation. © 2014 American Society for Reproductive Medicine, Published by Elsevier Inc.


Ebner T.,IVF Unit | Maurer M.,Landes Frauen und Kinderklinik | Shebl O.,IVF Unit | Moser M.,IVF Unit | And 3 more authors.
Reproductive BioMedicine Online | Year: 2012

Normally, day-2 embryos show a crosswise arrangement of four cells with three blastomeres lying side by side. Cleavage anomalies include embryos that are characterized by a particular planar constellation of four blastomeres with presumed incomplete cleavage. Since little is known on the developmental fate of such conceptuses, within a 10-month period all consecutive patients were screened for day-2 planar embryos. A total of 64/2070 embryos with suboptimal blastomere configuration were detected (3.1%). In conventional IVF, planar embryos were significantly less frequent (0.7%) as compared with intracytoplasmic sperm injection (2.8%; P < 0.05) and cases of testicular sperm extraction (5.4%; P < 0.01). Interestingly, embryos with a cleavage anomaly showed better morphology both on day 2 (P < 0.005) and day 3 (P < 0.001). In contrast, blastocyst formation (P < 0.001) and blastocyst quality (P = NS) was higher in tetrahedral embryos. There was a significant increase in implantation rate if tetrahedral embryos could be transferred compared with when planar embryos had to be transferred (P < 0.01). It may be postulated that, in planar embryos, the mitotic spindle might have been affected, e.g. sperm centrosome composition or function, which in turn might have led to the observed cleavage anomaly. Normally, day-2 embryos show a crosswise arrangement of four cells with three blastomeres lying side by side. Cleavage anomalies include more planar embryos that are characterized by a particular flat constellation of four blastomeres with presumed premature cleavage (like a tetrafoliate clover). Since little is known on the developmental fate of such embryos within a 10-month study period, all consecutive patients were screened for the presence of day-2 planar embryos (study group). A total of 64 (out of 2070) embryos with abnormal blastomere configuration were detected (3.1%). Interestingly, in conventional IVF (0.7%), the presence of planar embryos was significantly less frequent as compared with intracytoplasmic sperm injection (2.8%; P < 0.05) and cases of testicular biopsy (5.4%; P < 0.01). Embryos from the study group showed better morphology both on day 2 (P < 0.005) and day 3 (P < 0.001). In contrast, blastocyst formation (survival to day 5 of preimplantation development) was higher in the normally cleaved control group (P < 0.001) and so was blastocyst quality; however, the latter parameter did not reach level of significance. This was also reflected in a significantly higher implantation rate in the control group (P < 0.01). Based on present data, it may be postulated that, in planar embryos, the mitotic spindle (which involves the sperm centrosome) might have been affected, which in turn might have led to an incomplete cleavage. © 2012, Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.


Mayer R.B.,Landes Frauen und Kinderklinik | Ebner T.,Landes Frauen und Kinderklinik | Shebl O.,Landes Frauen und Kinderklinik | Tews G.,Landes Frauen und Kinderklinik
Journal of the Turkish German Gynecology Association | Year: 2012

We present a case with a severe injection error: a 25- year old woman with secondary infertility caused by a male factor was enrolled in our IVF/ICSI-ET program. Stimulation was performed in a long- protocol and ovarian stimulation, using rFSH follitropin beta, starting on the third day of the menstrual cycle. The rFSH dose per day was 900 IU-0 IU-0 IU-0 IU. Due to normal ovarian response and follicle growth, stimulation was continued and there was no detriment in oocyte quality and no symptoms of OHSS. Following blastocyte transfer cesarean section was unpreventable at 37+5 weeks of gestation due to an impacted transverse lie. Different stimulation protocols are needed for appropriate treatment of various patients provided that the administration of treatment was done correctly. In the case of injection errors, continuing stimulation protocol seems to be achievable in certain cases considering hormone levels and the process of follicle growth. © 2011 by the Turkish-German Gynecological Education and Research Foundation.


Tews G.,Landes Frauen und Kinderklinik | Shebl O.,Landes Frauen und Kinderklinik | Moser M.,Landes Frauen und Kinderklinik | Ebner T.,Landes Frauen und Kinderklinik
Fertility and Sterility | Year: 2012

Objective: To analyze whether the use of blastocyst intrafallopian transfer is a feasible option in a case of repeated difficult ET. Design: Case report. Setting: Public hospital. Patient(s): Forty-year old nulliparous patient. Intervention(s): Transfer of two vitrified/warmed blastocysts into the right tube by means of laparoscopy. Main Outcome Measure(s): Successful ET, clinical pregnancy. Result(s): Successful ET procedure resulting in positive ß-hCG and clinical pregnancy. Conclusion(s): In cases of repeated difficult ETs (regardless of whether the patient shows cervical adhesions or any type of genital malformations), blastocyst intrafallopian transfer can be a successful alternative approach. © 2012 American Society for Reproductive Medicine, Published by Elsevier Inc.

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