3 demonstrated that a threshold of 20% of hamster oocytes penetrated had a 98% positive predictive value and a 2% false positive rate in predicting the chances of fertilization of fewer than 50% of oocytes in an IVF cycle with conventional insemination. Several studies have demonstrated that this test is a useful predictor of fertilization in conventional in vitro fertilization (IVF). 2 This test known as the hamster egg penetration test measures the ability of sperm to undergo capacitation, the acrosome reaction, fusion with the egg membrane, and decondensation within the cytoplasm of the oocyte resulting in the formation of the male pronucleus 1 ( Figure 1). 1 In 1976, Yanagimachi and colleagues observed that upon removal of the zona pellucida of hamster ova, the eggs allowed penetration of sperm by other species. The hamster egg penetration test (HEPT) was first developed in the 1970s. However, male infertility continues to be a significant clinical challenge because some men with normal semen parameters can be infertile, and there is a need for the development of functional sperm assessment tools. The routine semen analysis remains the cornerstone of the male fertility evaluation. A policy of HEPT for males with abnormal morphology saves cost in selecting couples for a fertilization method. The HEPT is similar to the World Health Organization edition 5 (WHO-5) morphology in predicting successful conventional fertilization while allowing decreased utilization of ICSI. In 1000 simulated cycles with an abnormal morphology, a policy of HEPT was cost saving compared to universal ICSI, yet produced similar fertilization rates. There was no difference in the mean conventional fertilization rates between subjects with a normal morphology without a hamster test and those with a normal HEPT without a morphology assessment. Among patients with a normal HEPT, there was no difference in the mean conventional fertilization rates between those with a normal and an abnormal morphology. We performed a cost-effectiveness analysis of a policy of HEPT versus universal ICSI in couples with an abnormal morphology. We performed a univariate analysis on the primary outcome comparing clinically interesting subjects. The mean conventional and intracytoplasmic sperm injection (ICSI) fertilization rates were calculated in each group. Cycles where both the hamster egg penetration test (HEPT) and semen analysis were performed within 2 years prior to IVF cycles were stratified into four groups based on a normal or an abnormal HEPT and morphology. This was a cohort study of in vitro fertilization (IVF) subjects at the University of Utah, Salt Lake City (UT, USA) utilizing partner sperm.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |