At ReproMed, we are committed to provide our patients with a state-of-the-art approach for their problems. In this context, we are relentlessly exploring all areas of our practice that are in need of improvement. Our ultimate goal is to introduce innovative techniques that eventually lead to improvement of fertility management.
Our current research studies include:
| 1. |
Strategies to improve sperm preparation techniques by enhancing the retrieval of viable, mobile sperm.
Assisted reproductive techniques have become the treatment of choice in many cases of male and female infertility; however, the current success rates of these procedures remain sub optimal. Programmed cell death (apoptosis) most likely contributes to the failure of assisted reproduction and to the decrease in sperm quality after cryopreservation. There is likelihood that some sperm selected for ART will display features of apoptosis despite their normal appearance, which may be partially responsible for the low fertilization and implantation rates seen with ART.
One of the classical features of apoptosis is the externalization of phospholipid phosphatidylserine (PS) residues, which are normally present on the inner leaflet of the sperm plasma membrane. Annexin-V has a high affinity for PS but cannot pass through an intact sperm membrane; therefore when annexin-V binds to spermatozoa, it signifies that the integrity of the membrane has been disturbed.
Colloidal super-paramagnetic microbeads (~50 nm in diameter) conjugated with annexin-V may be used to separate dead and apoptotic spermatozoa by magnetic cell sorting (MACS). Cells with externalized PS and deteriorated plasma membranes will bind to these microbeads. When placed into a separation column containing super-paramagnetic annexin V conjugated microbeads and passed through a strong magnetic field, the apoptotic and dead spermatozoa (annexin -positive) are retained in the column. On the other hand, non-apoptotic cells with intact membranes (annexin-negative) do not attach to super-paramagnetic annexin V conjugated microbeads and pass freely through the column.
Recently, we have conducted a series of experiments to investigate if the MACS technology can be used to improve the outcomes of ART. Our results clearly indicated that integrating MACS as a part of sperm preparation techniques will improve semen quality and cryosurvival rates by eliminating apoptotic sperm. Annexin-negative spermatozoa prepared by MACS display higher quality, reflected by an increased oocyte penetration potential; thus, the selection of non-apoptotic spermatozoa by MACS should be considered to enhance ART success rates. |
| 2. |
Optimization of sperm cryopreservation protocols in compromised semen specimens and those from cancer patients.
Patients diagnosed with cancer are referred to sperm banks for sperm cryopreservation. These patients may have poor sperm quality, and after freezing and thawing, it is estimated that the sperm motility further decreases. Therefore, cryopreservation protocols should be properly selected to compensate for these defects. At ReproMed, we have conducted a series of experiments to investigate different cryopreservation protocols with an aim of identifying the most suitable method for freezing sperm from cancer patients. In our research, we have concluded that standard protocol is the most optimum method for sperm cryopreservation in cancer patients and that sperm washing prior to cryopreservation should not be recommended. We have also documented that specimens collected remotely via CryoFly(tm) kit display cryopreservation tolerance. |
| 3. |
Assessment of predictive factors for successful sperm donor insemination and egg donor cycles.
With the advent of modern Assisted Reproductive Techniques, intrauterine insemination (IUI) has been a mainstay of therapy for couples suffering from various forms of infertility. Even following the standardization of intracytoplasmic sperm injection (ICSI), donor intrauterine insemination (DIUI) represents a cost-effective line of therapy with high success rates. Several factors have been accepted as being prognostic to the success of IUI cycles. These include the woman’s age, etiology of infertility, sperm quality, and controlled ovarian stimulation. Technical aspects of ART such as catheter technologies were also established as outcome predictors.
At ReproMed we are analyzing all of these factors in order to predict successful outcomes. Our preliminary data show that the most important factor is the female age. Success rates are significantly diminished, in women with an age of 40 years or more. Other factors that seem to have an impact are the uterus condition and the insemination technique to a lesser extent. |
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