Minilaparoscopy-assisted natural orifice surgery.

Background And Objectives: New technology has allowed us to perform major abdominal and pelvic surgeries with increasingly smaller instruments. The ultimate goal is surgery with no visible scars. Until current technical limitations are overcome, minilaparoscopy-assisted natural orifice surgery (MANOS) provides a solution.

Does ICSI require acrosomal disruption? An ultrastructural study.

Background: Aggressive immobilization of sperm prior to ICSI significantly improves fertilization rates, but the mechanism of this effect is not yet clear. This study was performed in order to assess the characteristics of mechanically immobilized human sperm by transmission electron microscope (TEM).

Methods: Sperm obtained from ejaculated semen samples from three different donors were immobilized in a standard manner for ICSI.

Culdolaparoscopic oophorectomy with vaginal hysterectomy: an optional minimal-access surgical technique.

Background And Purpose: Oophorectomy during vaginal hysterectomy may be difficult or impossible when the ovaries lie high in the pelvis or when adhesions are present. A new technique of culdolaparoscopic oophorectomy during vaginal hysterectomy is described.

Patients And Methods: After the uterus is removed, a 12-mm cannula is introduced into the culde-sac, and a pneumoperitoneum is created.

Chromosome analysis of epididymal and testicular sperm in azoospermic patients undergoing ICSI.

Background: Although ICSI provides a way of treating azoospermic men, concern has been raised about the potential risk for transmission of genetic abnormalities to the offspring. We quantified the incidence of chromosomal abnormalities in epididymal and testicular sperm retrieved from azoospermic patients undergoing ICSI.

Methods: Individual testicular sperm were collected from testicular biopsies with an ICSI pipette, and epididymal sperm were retrieved by microsurgical epididymal sperm aspiration.

Operative culdolaparoscopy: a new approach combining operative culdoscopy and minilaparoscopy.

The tendency is to use small cannulas for operative laparoscopy; however, working with these cannulas may have technical limitations. We developed a technique for performing appendectomy combining culdoscopy and minilaparoscopy. It uses 3- or 5-mm abdominal cannulas, and the large 10- or 12-mm cannula is inserted into the posterior vaginal fornix under laparoscopic surveillance.

A comparison of human spermatozoa immunolabeling features using xenogenic reagents for centrosomal proteins.

The centrosome is an organelle essential to proper chromosomal migration and normal cell growth. In the human, the centrosome is comprised of two centrioles and the pericentriolar cytosol; its control of embryo cleavage processes derives from its role as a locus for spindle organisation. At fertilisation, it is the human sperm centrosome that is responsible for ordering these processes, as the oocyte appears not to contain working centrosomal structures.

Laparoscopic leash: a simple technique to prevent specimen loss during operative laparoscopy.

Background: Surgical specimens can be lost in the peritoneal cavity during operative laparoscopy. Although specimens left might cause no complications, peritonitis and adhesion formation have been reported, requiring subsequent laparoscopy or laparotomy. We report a simple technique to prevent loss of surgical specimens during laparoscopy.

Sperm integrity is critical for normal mitotic division and early embryonic development.

The human zygote relies on the paternal gamete to provide the centrosome component essential for the first mitotic division. It is not known whether normal centrosome function requires an intact spermatozoon, or whether donation of an isolated paternal centrosome component can result in normal zygotes and embryos. To explore this possibility, mature human oocytes were microinjected with either intact or dissected spermatozoa.

Incidence of sperm aneuploidy in relation to semen characteristics and assisted reproductive outcome.

Objective: To evaluate the incidence of sperm aneuploidy in men screened for infertility and identify any eventual relation with assisted reproductive outcome.

Design: Controlled prospective study.

Setting: University hospital-based IVF program.

The role of structural integrity of the fertilising spermatozoon in early human embryogenesis.

While the fertilising spermatozoon supplies the active centre directing the human zygote's first mitotic division, the relative contributions of the sperm head and tail (as well as the importance of the sperm's general structural integrity) to subsequent developmental processes remain incompletely studied. The sperm nucleus contains paternal chromatin necessary for restoration of a diploid genome, but the functional role of the sperm tail (either attached or dissected) in early human embryonic growth is not known. In this investigation using oocytes donated by in vitro fertilisation patients, human oocytes were injected with isolated sperm heads (n = 73), isolated sperm flagella (n = 11) or both (dissected sperm heads + free sperm tails, n = 26).

Human glucosamine-6-phosphate isomerase, a homologue of hamster oscillin, does not appear to be involved in Ca2+ release in mammalian oocytes.

Injections of cytosolic preparations from mammalian sperm into oocytes have been shown to trigger calcium [Ca2+]i oscillations and initiate activation of development. Recently, a protein isolated from hamster sperm has been suggested to be involved in the generation of these oscillations and it was named "oscillin." The human homologue of hamster oscillin is glucosamine 6-phosphate isomerase (GPI, EC no.

H-Y antigen expression patterns in human X- and Y-chromosome-bearing spermatozoa.

Problem: Restricted expression of H-Y antigen on Y-chromosome-bearing sperm has been reported in some species, although such preferential expression for H-Y antigen in human sperm has yet to be described. In this study, an immunomagnetic approach was used to characterize antigen expression patterns as a function of sex-chromosome content.

Method Of Study: Human sperm was treated with monoclonal immunoglobulin (Ig) M antibodies directed against H-Y antigen.

Effect of parental age on fertilization and pregnancy characteristics in couples treated by intracytoplasmic sperm injection.

The purpose of this study was to investigate any influence of maternal and/or paternal age on gamete characteristics and pregnancy outcomes in intracytoplasmic sperm injection (ICSI) cycles. In all, 821 consecutive ICSI cases were analysed retrospectively. While a significant linear decline in semen volume was detected, no significant differences in the concentration, motility or morphology of the spermatozoa were found with paternal ageing.

Human sperm cytosolic factor triggers Ca2+ oscillations and overcomes activation failure of mammalian oocytes.

Among the possible mechanisms of oocyte activation after sperm penetration, it appears most likely that a protein released by the spermatozoon elicits a calcium elevation in the ooplasm. To further test this idea, cytosolic factors obtained from human spermatozoa by two different methods, freezing-thawing and sonication, were injected into mouse oocytes following which intracellular calcium release was measured. Of a total of 42 mouse oocytes, a pattern of calcium oscillations was observed in nine out of 16 oocytes injected with sonicated fraction, in all of eight oocytes with the frozen-thawed fraction and in none of 18 control oocytes.

The human sperm centrosome is responsible for normal syngamy and early embryonic development.

As early as 1887, it was postulated that the mature oocyte possesses all of the elements necessary for embryonic development with the exception of an active division centre, and that the spermatozoon contains such a centre, but lacks the substrate in which to operate. This division centre is called the centrosome. The precise definition of this structure is still a subject for debate.

Evolution of pregnancies and initial follow-up of newborns delivered after intracytoplasmic sperm injection.

Objective: To analyze the in vivo development of embryos conceived after intracytoplasmic sperm injection (ICSI), as well as obstetric outcome, occurrence of chromosomal abnormalities, and rate of congenital malformations in neonates born as a result of this treatment.

Design: Retrospective study.

Setting: University-based in vitro fertilization (IVF) clinic.

Aggressive sperm immobilization prior to intracytoplasmic sperm injection with immature spermatozoa improves fertilization and pregnancy rates.

This study was conducted to determine whether the mode of sperm immobilization prior to intracytoplasmic sperm injection (ICSI) influences fertilization by immature spermatozoa. Of the 837 ICSI cycles evaluated, 81 were performed with epididymal or testicular spermatozoa; 35 cycles with epididymal spermatozoa immobilized in the standard fashion resulted in fertilization and pregnancy rates of 48.3 and 51.

Laparoscopic techniques for extracting ovarian teratomas.

We performed two techniques for laparoscopic extraction of benign ovarian teratomas. For cysts up to 5 cm, we used the pouch technique, with partial extraction followed by enlargement of the hypogastric port. A skin incision was enlarged to allow the use of a scalpel in the pouch.

Oolemma characteristics in relation to survival and fertilization patterns of oocytes treated by intracytoplasmic sperm injection.

The aim of this study was to analyse the various reactions displayed by the oolemma to the penetrating pipette during intracytoplasmic sperm injection (ICSI) and correlate them with clinical factors, oocyte survival and fertilization patterns. Three types of oolemma responses were observed: normal breakage, when the injection needle created an invagination that ruptured at the approximate centre of the egg; sudden breakage, when the membrane broke without creating a funnel; and difficult breakage, when the membrane did not break or broke after several penetration attempts. A total of 2928 oocytes were analysed with the following observations: 73.

Genetics of abnormal human fertilization.

The purpose of this study was to assess the genetic status of abnormal zygotes following assisted fertilization. Dispermic, monopronucleated and digynic zygotes were allowed to cleave intact or after enucleation, and on the biopsied blastomeres, multiplex polymerase chain reaction and fluorescent in-situ hybridization were performed. It was found that the distal pronucleus was usually male in origin in dispermic embryos, and that the sex ratio was restored when they were enucleated; however, they became mosaic at metaphase and their genetic heterogeneity was not restored after enucleation.