Virology & Mycology Infectious Diseases
» Journals
A
Accounting & Marketing
Addiction Research & Therapy
Advances in Automobile Engineering
Advances in Crop Science and Technology
Advances in Dairy Research
Advancements in Genetic Engineering
Advances in Pharmacoepidemiology & Drug Safety
Advances in Robotics & Automation
Advance Research in Meteorological Sciences
Advanced Techniques in Biology & Medicine
Aeronautics & Aerospace Engineering
Aging Science
Agrotechnology
AIDS & Clinical Research
Allergy & Therapy
Alternative & Integrative Medicine
Air & Water borne Diseases
Alcoholism and Drug Dependence
Alzheimer’s Disease & Parkinsonism
Analytical & Bioanalytical Techniques
Anaplastology
Anatomy & Physiology
Andrology-Open Access
Anesthesia & Clinical Research
Angiology: Open Access
Antivirals & Antiretrovirals
Anthropology
Applied & Computational Mathematics
Applied Mechanical Engineering
Aquaculture Research & Development
Architectural Engineering Technology
Arthritis
Arts and Social Sciences Journal
Astrobiology & Outreach
Astrophysics & Aerospace technology
Autacoids
Autism-Open Access

B
Bacteriology & Parasitology
Bioanalysis & Biomedicine
Bioceramics Development and Applications
Biochemistry and Analytical Biochemistry
Biochemistry & Pharmacology
Biochips & Tissue Chips
Biodiversity & Endangered Species
Bioenergetics: Open Access
Bioengineering & Biomedical Science
Bioequivalence & Bioavailability
Biofertilizers & Biopesticides
Biological Systems-Open Access
Biology and Medicine
Biometrics & Biostatistics
Biomolecular Research & Therapeutics
Biochemistry & Physiology: Open Access
Bioprocessing & Biotechniques
Bioremediation & Biodegradation
Biosafety
Biosafety & Health Education
Biosensors & Bioelectronics
Biotechnology & Biomaterials
Bioterrorism & Biodefense
Blood Disorders & Transfusion
Blood & Lymph
Bone Marrow Research
Brain Disorders & Therapy
Business and Economics Journal
Business and Financial Affairs

C
Cancer Science & Therapy
Carcinogenesis & Mutagenesis
Cardiovascular Diseases & Diagnosis
Cardiovascular Pharmacology: Open Access
Cell & Developmental Biology
Cell Science & Therapy
Chemical Engineering & Process Technology
Chemical Sciences Journal
Chemotherapy: Open Access
Child and Adolescent Behavior
Chromatography & Separation Techniques
Civil & Environmental Engineering
Civil & Legal Sciences
Clinical & Cellular Immunology
Clinical Case Reports
Clinical & Experimental Cardiology
Clinical & Experimental Dermatology Research
Clinical & Experimental Ophthalmology
Clinical & Experimental Pathology
Clinical & Experimental Pharmacology
Clinical Pharmacology & Biopharmaceutics
Clinical Research & Bioethics
Clinical Research on Foot & Ankle
Clinical Toxicology
Clinical Trials
Clinical Microbiology: Open Access
Cloning  & Transgenesis
Communication Disorders, Deaf Studies & Hearing Aids
Community Medicine & Health Education
Computer Science & Systems Biology
Current Synthetic & Systems Biology
Cytology & Histology
D
Data Mining in Genomics & Proteomics
Defense Management
Dentistry
Depression and Anxiety
Developing Drugs
Diabetes & Metabolism
Drug Designing
Drug Metabolism & Toxicology

E
Earth Science & Climatic Change
Ecosystem & Ecography
Endocrinology & Metabolic Syndrome
Entomology, Ornithology & Herpetology
Environmental & Analytical Toxicology
Epidemiology: Open Access
Emergency Medicine: Open Access
Ergonomics
Electrical & Electronics
Enzyme Engineering
Entrepreneurship & Organization Management

F
Family Medicine & Medical Science Research
Fermentation Technology
Fertilization: In Vitro - IVF-Worldwide
Fisheries and Aquaculture Journal
Fisheries & Livestock Production
Food Processing & Technology
Forensic Research
Forest Research: Open Access

G
Gastrointestinal & Digestive System
Genetic Syndromes & Gene Therapy
General Medicine
Gene Technology
Geography & Natural Disasters
Geology & Geosciences
Geophysics & Remote Sensing
Gerontology & Geriatric Research
Global Economics
Glycobiology
Glycomics & Lipidomics
Gynecology& Obstetrics

H
Hematology & Thromboembolic Diseases
Hair : Therapy & Transplantation
Health & Medical Informatics
Hereditary Genetics
Homeopathy & Ayurvedic Medicine
Horticulture
Hotel & Business Management
Human Genetics & Embryology
Hydrology: Current Research
Hypertension- Open Access

I
Industrial Engineering & Management
Irrigation and Drainage Systems Engineering
Information Technology & Software Engineering
Intellectual Property Rights: Open Access
Infectious Diseases and Therapy
Integrative Oncology
Internal Medicine
International Journal of Advance Innovations, Thoughts & Ideas
International Journal of Economics & Management Sciences
International Journal of Genomic Medicine
International Journal of Physical Medicine & Rehabilitation

L
Liver
Leukemia

M
Marine Science: Research & Development
Mass Communication & Journalism
Material Sciences & Engineering
Medicinal Chemistry
Medicinal & Aromatic Plants
Medical Diganostic Methods
Medical Microbiology & Diagnosis
Medical & Surgical Urology
Membrane Science & Technology
Metabolic Syndrome
Metabolomics:Open Access
Microbial & Biochemical Technology
Molecular Biology
Molecular Biomarkers & Diagnosis
Molecular and Genetic Medicine
Molecular Imaging & Dynamics
Modern Chemistry & Applications
Mycobacterial Diseases
N
Nanomedicine & Biotherapeutic Discovery
Nanomedicine & Nanotechnology
Natural Products Chemistry & Research
Neonatal Biology
Nephrology & Therapeutics
Neurology & Neurophysiology
Novel Physiotherapies
Nuclear Medicine & Radiation Therapy
Neurological Disorders
Nutrition & Food Sciences
Nutritional Disorders & Therapy
Nursing & Care

0
Obesity & Weight Loss Therapy
Occupational Medicine & Health Affairs
Oceanography-Open Access
OMICS Journal of Radiology
Osteoporosis and Physical Activity
Oral Health and Dental Management
Oral Hygiene & Health
Biological Systems- Open Access
Organic Chemistry: Current Research
Orthopedic & Muscular System: Current Research
Otolaryngology

P
Pain & Relief 
Palliative Care  & Medicine
Pancreatic Disorders & Therapy
Pediatrics & Therapeutics
Petroleum & Environmental Biotechnology
Pharmaceutica Analytica Acta
Pharmaceutical Regulatory Affairs: Open Access
Pharmacovigilance
Pharmacogenomics & Pharmacoproteomics
Physical Chemistry & Biophysics
Plant Pathology & Microbiology
Plant Biochemistry & Physiology
political Sciences & public affairs
Pollution Effects & Control
Poultry, Fisheries & Wildlife Sciences
Powder Metallurgy & Mining
Primatology
Primary Health Care: Open Access  
Probiotics & Health
Proteomics & Bioinformatics
Phylogenetics & Evolutionary Biology
Psychology & Psychotherapy
Psychological Abnormalities in Children
Pulmonary & Respiratory Medicine

R
Reproductive System & Sexual Disorders
Rheumatology: Current Research
Rice Research: Open Access

S
Sleep Disorders & Therapy
Socialomics
Sports Medicine & Doping Studies
Spine
Stem Cell Research & Therapy
Steroids & Hormonal Science
Stock & Forex Trading
Single Cell Biology
Sociology and Criminology-Open Access
Surgery: Current Research

T
Telecommunications System & Management
Textile Science & Engineering
Theoretical and Computational Chemistry: Open Access
Thermodynamics & Catalysis
Thyroid Disorders & Therapy
Tissue Science & Engineering
Translational Medicine
Transplantation Technologies & Research
Trauma & Treatment
Tropical Medicine and Surgery
Tourism & Hospitality

V
Vaccines & Vaccination
Vascular Medicine & surgery
Veterinary Science & Technology
Virology & Mycology
Vitamins & Minerals

W
Women's health Care

Y
Yoga & Physical Therapy
» Browse by Subjects
Clinical
AIDS & Clinical Research
Anesthesia & Clinical Research
Angiology
Cancer Science & Therapy
Carcinogenesis & Mutagenesis
Cell Science & Therapy
Chemotherapy
Child & Adolescent Behavior
Clinical & Cellular Immunology
Clinical Case Reports
Clinical & Experimental Cardiology
Clinical & Experimental Dermatology Research
Clinical & Experimental Ophthalmology
Clinical & Experimental Pharmacology
Clinical & Experimental Pathology
Clinical Microbiology: Open Access
Clinical Research & Bioethics
Clinical Research on Foot & Ankle
Clinical Toxicology
Clinical Trials
Communication Disorders, Deaf Studies & Hearing Aids
Cytology & Histology
Forensic Research
Integrative Oncology
Neurology & Neurophysiology
Pulmonary & Respiratory Medicine
Stem Cell Research & Therapy
Transplantation Technologies & Research

Pharmaceutical Sciences
Advances in Pharmacoepidemiology & Drug Safety
Alcoholism and Drug Dependence
Bioanalysis & Biomedicine
Biochemical Pharmacology
Bioequivalence & Bioavailability
Cardiovascular Pharmacology: Open Access
Clinical Pharmacology & Biopharmaceutics
Developing Drugs
Drug Designing
Drug Metabolism & Toxicology
Medicinal & Aromatic Plants
Molecular Pharmaceutics & Organic Process Research
Pharmaceutica Analytica Acta
Pharmaceutical Regulatory Affairs: Open Access
Pharmacovigilance
Vaccines & Vaccination

Omics
Data Mining in Genomics & Proteomics
Ergonomics
Glycomics & Lipidomics
Health & Medical Informatics
Metabolomics:Open Access
OMICS Journal of Radiology
Pharmacogenomics & Pharmacoproteomics
Phylogenetics & Evolutionary Biology
Proteomics & Bioinformatics
Transcriptomics

Chemistry
Analytical & Bioanalytical Techniques
Chemical Sciences Journal
Chromatography & Separation Techniques
Medicinal Chemistry
Modern Chemistry & Applications
Natural Products Chemistry & Research
Organic Chemistry
Physical Chemistry & Biophysics
Plant Biochemistry & Physiology
Thermodynamics & Catalysis
Theoretical and Computational Chemistry:Open Access

Environmental
Advance Research in Meteorological Sciences
Anthropology
Aquaculture Research & Development
Astrobiology & Outreach
Biodiversity & Endangered Species
Earth Science & Climatic Change
Ecosystem & Ecography
Environmental & Analytical Toxicology
Fisheries & Livestock Production
Geography & Natural Disasters
Hydrology: Current Research
Oceanography-Open Access
Petroleum & Environmental Biotechnology
Pollution Effects & Control
Poultry, Fisheries & Wildlife Sciences

Management
Accounting & Marketing
Arts and Social Sciences Journal
Business and Economics Journal
Business and Financial Affairs
Civil & Legal Sciences
Defense Management
Entrepreneurship& Organization Management
Hotel & Business Management
Intellectual Property Rights: Open Access
International Journal of Economics & Management Sciences
Mass Communication & Journalism
political Sciences & public affairs
Stock & Forex Trading
Socialomics
Tourism & Hospitality

Life  Sciences
Advanced Techniques in Biology & Medicine
Advancements in Genetic Engineering
Advances in Crop Science & Technology
Advances in Dairy Research
Aging Science
Agrotechnology
Air & Water Borne Diseases
Antivirals & Antiretrovirals
Autism-Open Access
Bacteriology & Parasitology
Biochemistry & Physiology: Open Access
Biochemistry and Analytical Biochemistry
Bioenergetics
Bioengineering & Biomedical Science
Biofertilizers & Biopesticides
Biological Systems- Open Access
Biometrics & Biostatistics
Biomolecular Research & Therapeutics
Bioremediation & Biodegradation
Biosafety
Biosafety & Health Education
Biosensors & Bioelectronics
Biotechnology & Biomaterials
Bioterrorism & Biodefense
Cell & Developmental Biology
Current Synthetic & Systems Biology
Entomology, Ornithology & Herpetology
Enzyme Engineering
Fermentation Technology
Fertilization: In Vitro - IVF-Worldwide
Fisheries and Aquaculture Journal
Forest Research: Open Access
Fungal Genomics and Biology
Gene Technology
Glycobiology
Horticulture
Homeopathy & Ayurvedic Medicine
Marine Science: Research & Development
Membrane Science & Technology
Microbial & Biochemical Technology
Molecular Biology
Molecular Imaging & Dynamics
Nanomedicine & Biotherapeutic Discovery
Nanomedicine & Nanotechnology
Nutrition & Food Sciences
Plant Pathology & Microbiology
Primatology
Probiotics & Health
Rice Research: Open Access
Single Cell Biology
Sociology and Criminology-Open Access
Tissue Science & Engineering
Tropical Diseases
Transcriptomics: Open Access
Veterinary Science & Technology
Vitamins & Minerals
Virology & Mycology

Engineering
Advances in Automobile Engineering
Advances in Robotics & Automation
Aeronautics & Aerospace Engineering
Applied & Computational Mathematics
Applied Mechanical Engineering
Architectural Engineering Technology
Astrophysics & Aerospace technology
Biochips & Tissue Chips
Bioprocessing & Biotechniques
Chemical Engineering & Process Technology
Civil & Environmental Engineering
Computer Science & Systems Biology
Electrical & Electronics
Food Processing & Technology
Geology and Geosciences
Geophysics & Remote sensing
Industrial Engineering & Management
Information Technology & Software Engineering
International Journal of Advance Innovations, Thoughts & Ideas
Irrigation and Drainage Systems Engineering
Material Sciences & Engineering
Powder Metallurgy & Mining
Telecommunications System & Management
Textile Science & Engineering

Medical Sciences
Addiction Research & Therapy
Allergy & Therapy
Alternative & Integrative Medicine
Alzheimer’s Disease & Parkinsonism
Anaplastology
Anatomy & Physiology
Ancient Diseases & Preventive Remedies
Andrology
Arthritis
Autacoids
Bioceramics Development and Applications
Biology and Medicine
Blood & Lymph
Blood Disorders & Transfusion
Bone Marrow Research
Brain Disorders & Therapy
Cardiovascular Diseases & Diagnosis
Cloning & Transgenesis
Community Medicine & Health Education
Dentistry
Depression and Anxiety
Diabetes & Metabolism
Emergency Medicine
Endocrinology & Metabolic Syndrome
Epidemiology: Open Access
Family Medicine & Medical Science Research
Gastrointestinal & Digestive System
General Medicine
General Practice
Genetic Syndromes & Gene Therapy
Gynecology& Obstetrics
Global Economics
Gerontology & Geriatrics Research
Hematology & Thromboembolic Diseases
Hair: Therapy & Transplantation
Health Care : Current Reviews
Hereditary Genetics
Human Genetics & Embryology
Hypertension-Open Access
International Journal of Genomic Medicine
Internal Medicine
International Journal of Physical Medicine & Rehabilitation
Leukemia
Liver
Medical & Surgical Urology
Medical Diagnostic Methods
Medical Microbiology & Diagnosis
Metabolic Syndrome
Molecular Biology
Molecular Biomarkers & Diagnosis
Molecular and Genetic Medicine
Mycobacterial Diseases
Neonatal Biology
Nephrology & Therapeutics
Neurological Disorders
Novel Physiotherapies
Nuclear Medicine & Radiation Therapy
Nursing & Care
Nutritional Disorders & Therapy
Obesity & Weight Loss Therapy
Occupational Medicine & Health Affairs
Oral Health and Dental Management
Oral Hygiene & Health
Orthopedic & Muscular System
Osteoporosis & Physical Activity
Otolaryngology
Pain & Relief
Palliative Care & Medicine
Pancreatic Disorders & Therapy
Pediatrics & Therapeutics
Primary Health Care: Open Access
Psychological Abnormalities in Children
Psychology & Psychotherapy
Reproductive System & Sexual Disorders
Rheumatology: Current Research
Sleep Disorders & Therapy
Spine
Sports Medicine & Doping Studies
Steroids & Hormonal Science
Surgery: Current Research
Thyroid Disorders & Therapy
Translational Medicine
Trauma & Treatment
Tropical Medicine and Surgery
Vascular Medicine & surgery
Women's Health Care
Yoga & Physical Therapy
» Conferences
 
Upcoming Conferences

2nd International Conference and Exhibition on Pathology, August 05-07, 2013 Las Vegas, USA

International Conference on Integrative Biology Summit, August 05-07, 2013 Las Vegas, USA

2ndInternational Conference on Translational Medicine, August 05-07, 2013 Chicago, USA


International Conference and Exhibition on Predictive, Preventive and Personalized Medicine & Molecular Diagnostics, August 05-07, 2013 Chicago, USA
2nd International Conference on Biodiversity & Sustainable Energy Development, August 12-14, 2013 Raleigh, USA

International Conference on Genetic Engineering & Genetically Modified Organisms, August 12-14, 2013 Raleigh, USA

4th World Congress on Diabetes & Metabolism, August 14-16, 2013 Chicago, USA

International Conference on Radiology and Imaging, August 14-16, 2013 Chicago, USA

2nd International Conference and Exhibition on Orthopedics & Rheumatology, August 19-21, 2013 Las Vegas, USA

International Conference on Dental & Oral Health, August 19-21, 2013 Las Vegas, USA

International Conference and Exhibition on Physical Medicine & Rehabilitation, August 19-21, 2013 Las Vegas, USA

International Conference on Molecular Epidemiology and Evolutionary Genetics, August 21-23, 2013 Miami, USA

International Conference on Oceanography, August 21-23, 2013 Orlando, USA

International Conference on Biodefense & Natural Disasters, August 21-23, 2013 Miami, USA

World Congress on Endocrinology, August 26-28, 2013 Raleigh, USA

2nd International Conference on Hydrology and Groundwater Expo, August 26-27, 2013 Raleigh, USA

2nd International Conference on Tissue Science & Regenerative Medicine, August 26-28, 2013 Raleigh, USA

International Conference on Omics Studies, September 04-06, 2013 Orlando-FL, USA

International Symposia on Entomology , September 04-06, 2013 Miami, USA

2nd International Conference on Surgery & Anesthesia, September 16-18, 2013 Las Vegas, USA

2nd International Conference on Clinical Microbiology & Microbial Genomics , September 16-18, 2013 Las Vegas, USA

2nd International Conference and Exhibition on Biowaivers & Biosimilars, September 23-25, 2013 Raleigh, USA

4th World Congress on Biotechnology, September 23-25, 2013 Raliegh, USA

International Conference on Hematology & Blood Disorders, September 23-25, 2013 Raliegh, USA

International Conference on Psychology, Autism and Alzheimer's Disease, September 30-October 01, 2013 San Antonio, USA

International Conference and Exhibition on Mechanical & Aerospace Engineering, September 30-October 02, 2013 San Antonio, USA

2nd International Summit on Toxicology, October 07-09, 2013 Las Vegas, USA

International Conference and Exhibition on Biochemical & Molecular Engineering, October 07-09, 2013 San Antonio, USA

International Conference and Exhibition on Lasers, Optics & Photonics, October 07-09, 2013 San Antonio, USA

2nd International Conference and Exhibition on Materials Science & Engineering, October 07-09, 2013 Las Vegas, USA

2nd International Conference on Clinical & Cellular Immunology, October 15-17, 2013 Las Vegas, USA

2nd International Conference on Medicinal Chemistry & Computer Aided Drug Designing, October 15-17, 2013 Las Vegas, USA

4th International Conference and Exhibition on Analytical & Bioanalytical Techniques, October 15-17, 2013 Las Vegas, USA

International Conference and Exhibition on Pharmacognosy, Phytochemistry and Natural Products, October 21-23, 2013 Hyderabad, India

3rd World Congress on Cancer Science & Therapy, October 21-23, 2013 California, USA

3rd International Conference on Pharmaceutical Regulatory Affairs, October 21-23, 2013 California, USA

2nd International Conference and Exhibition on Cell & Gene Therapy October 23-25, 2013 Orlando, USA

2nd International Conference and Exhibition on Probiotics & Functional Foods, October 23-25, 2013 Orlando, USA

International Conference on HIV/AIDS, STDs, & STIs October 24-25, 2013 Orlando-FL, USA

International Conference on Fermentation Technology, Bioprocess and Cell Culture, October 28-30, 2013 Kansas City, USA

2nd International Conference and Exhibition on Food Processing & Technology, October 28-30, 2013 Kansas City, USA

International Conference on Functional and Comparative Genomics & Pharmacogenomics, November 12-14, 2013 Chicago, USA

2nd International Conference and Exhibition on Cosmetology & Trichology, November 12-14, 2013 Chicago, USA

2nd International Summit on GMP, QA & QC, November 12-14, 2013 Chicago, USA

2nd International Conference and Exhibition on Pharmacovigilance & Clinical Trials, November 18-19, 2013 San Antonio, USA

International Summit on Clinical Pharmacy & Dispensing, November 18-20, 2013 San Antonio, USA

World Congress on Petrochemistry and Chemical Engineering, November 18-20, 2013 San Antonio, USA

3rd World Congress on Virology, November 20-22, 2013 Baltimore, USA

International Congress on Bacteriology and Infectious diseases, November 20-22, 2013 Baltimore, USA

3rd World Congress on Cell Science & Stem Cell Research, November 20-22, 2013 San Antonio, USA

2nd International Conference and Exhibition on Obesity & Weight Management, December 02-04, 2013 Las Vegas, USA

International Conference on Nursing & Emergency Medicine, December 02-04, 2013 Las Vegas, USA

3rd International Conference on Nanotek & Expo, December 02-04, 2013 Las Vegas, USA

International Conference and Exhibition on Traditional & Alternative Medicine, December 09-11, 2013 Hyderabad, India

2nd International Conference on Agricultural & Horticultural Sciences, February 03-05, 2014 Hyderabad, India





Previous Conferences Organized/Co-organized
2nd International Conference on Nephrology & Therapeutics, July 29-31, 2013 Las Vegas, USA
3rd International Conference on Vaccines & Vaccination, July 29-31, 2013 Las Vegas, USA

2nd International Conference on Earth Science & Climate Change, July 22-24, 2013 Las Vegas, USA

2nd International Conference and Exhibition on Addiction Research & Therapy, July 22-24, 2013 Las Vegas, USA

International Conference on Animal & Dairy Sciences, July 23-24, 2013 Las Vegas, USA

3rd International Conference on Proteomics & Bioinformatics, July 15-17, 2013 Philadelphia Center City, USA

2nd International Conference and Exhibition on Nutritional Science & Therapy, July 15-17, 2013 Philadelphia, USA

4th International Conference on Biomarkers & Clinical Research, July 15-17, 2013 Philadelphia, USA


2nd International Conference and Exhibition on Biosensors & Bioelectronics, June 17-19, 2013 Chicago, USA

2nd International Conference and Exhibition on Neurology & Therapeutics, June 17-19, 2013 Chicago, USA

2nd International Conference on Gastroenterology & Urology, June 10-12, 2013 Chicago, USA

2nd International Conference and Exhibition on Biometrics & Biostatistics, June 10-12, 2013 Chicago, USA

4th World Congress on Bioavailability & Bioequivalence, May 20-22, 2013 Beijing, China

3rd International Conference on Clinical & Experimental Ophthalmology, April 15-17, 2013 Chicago, USA

3rd International Conference on Clinical & Experimental Cardiology, April 15-17, 2013 Chicago, USA

3rd International Conference on Clinical & Experimental Dermatology, April 15-17, 2013 Chicago, USA

2ndInternational Conference and Exhibition on Metabolomics & Systems Biology, April 08-10, 2013 Chicago, USA

3rd International Conference and Exhibition on Pharmaceutics & Novel Drug Delivery Systems, April 08-10, 2013 Chicago, USA

International Exhibition and Conference on Water Technologies, Environmental Technologies & Renewable Energy, February 13-14, 2013 Mumbai, India

International Conference and Exhibition on Obesity and Weight Management, December 03-05, 2012 DoubleTree by Hilton Philadelphia, USA

International Summit on GMP & GCP: USA, Europe, Japan, Asia Pacific, December 03-05, 2012 DoubleTree by Hilton Philadelphia Center City, USA

International Conference on QA, QC and Validation, December 03-05, 2013 DoubleTree by Hilton Philadelphia Center City, USA

2nd International Conference on Nanotek and Expo, December 03-05, 2012 at DoubleTree by Hilton Philadelphia Center City, USA

International Conference on Hair Transplantation & Trichology November 26-28, 2012 San Antonio, USA

International Conference on Anesthesia & Perioperative Care November 26-28, 2012 San Antonio, USA

International Toxicology Summit & Expo November 26-28, 2012 Hilton San Antonio Airport, USA

International Conference and Exhibition on Surgery & Transplantation November 26-28, 2012 San Antonio, USA

International Conference and Exhibition on Food Processing and Technology November 22-24, 2012 Hyderabad, India

3rd International Conference and Exhibition on Analytical & Bioanalytical Techniques November 22-24, 2012 Hyderabad International Convention Center, India

2ndInternational Conference and Exhibition on Pharmaceutical Regulatory Affairs November 23-24, 2012 HICC Hyderabad, India

International Conference and Exhibition on Cosmetology & Cosmetics November 23-24, 2012 HICC Hyderabad, India

Global Biofuels and Bioproducts Summit November 19-21, 2012 San Antonio, USA

International Conference on Genetic Syndromes & GeneTherapy November 19-21, 2012 at Hilton San Antonio Airport, USA

International Conference and Exhibition on Probiotics-2012, November 19–21, 2012, Hilton San Antonio Airport, USA

2nd World Congress on Cell Science & Stem Cell Research November 12-14, 2012 San Antonio, USA

International Conference on Clinical Microbiology & Microbial Genomics November12-14, 2012 San Antonio, USA

International Conference on Regenerative and Functional Medicine November 12-14, 2012 San Antonio, USA

International Conference and Exhibition on Computer Aided Drug Design & QSAR October 29-31, 2012 Chicago, USA
International Conference on Pulmonary & Respiratory Medicine August 27-29, 2012 Philadelphia, USA.

International Expo & Conference on Analytrix & HPLC October 22-24, 2012 Hilton Northbrook, Chicago, USA

International Conference and Expo on Material science and Engineering October 22-24, 2012 DoubleTree by Hilton Chicago-North Shore, USA

International Conference on Clinical and Cellular Immunology October 22-24, 2012 DoubleTree by Hilton Chicago-North Shore, USA

International Conference on Forensic Research & Technology October 15-17, 2012 DoubleTree by Hilton Chicago-North Shore, USA

International Conference and Exhibition on Otolaryngology October 15-17, 2012 DoubleTree by Hilton Chicago-North Shore, USA

International conference on Biothreats and Biodefense October 15-17, 2012 DoubleTree by Hilton Chicago-North Shore, USA

International Conference on Tissue Science and Engineering October 1-3, 2012 DoubleTree by Hilton Chicago-North Shore, USA

International conference and Exhibition on Pharmacovigilance and Clinical Trials October 1-3, 2012 DoubleTree by Hilton Chicago-North Shore, USA

International Conference on Emerging Cell Therapies October 1-3, 2012 DoubleTree by Hilton Chicago-North Shore, USA

Omics International Integrative Biology summit October 1-3, 2012 DoubleTree by Hilton Chicago-North Shore, USA

3rdWorld Congress on Diabetes & Metabolism September 24-26, 2012 Marriott Convention Center, Hyderabad, India

2ndInternational Conference on Pediatrics & Gynecology September 24-26, 2012, Hyderabad Marriott Hotel & Convention Centre , Hyderabad, India

International Conference on Translational medicine September 17-19,2012 Holiday Inn San Antonio, Texas, USA

3rd World Congress on Biotechnology September 13-15, 2012 HICC, Hyderabad, India

International Conference on Biodiversity & Sustainable Energy Development September 14-15, 2012 Hyderabad, India

International Conference on Hotel and Business Management September 14-15, 2012 Hyderabad International Convention Center, India

International Conference on Agricultural & Horticultural Sciences September 14-15, 2012 Hyderabad International Convention Center, India

International Conference on Hydrology and Groundwater Expo September 10-12, 2012 San Antonio, USA

2nd World Congress on Cancer Science & Therapy September 10-12, 2012 San Antonio, USA

International Conference and Exhibition on Biowaivers and Biosimilars September 10-12, 2012 San Antonio, TX, USA

International Conference on Central Nervous System September 5-7, 2012 Double by Hilton Philadephia, USA.

International Conference on Occupational Health and Safety Summit September 5-7, 2012 Philadelphia, USA

International Conference and Exhibition on pathology August 27-29, 2012 Philadelphia, USA

International Conference and Exhibition on Nutritional Science & Therapy-2012 August 27-29, 2012 Philadelphia, USA

International Conference and Exhibition on Addiction Research & Therapy Aug 20-22, 2012 Las Vegas, USA

2nd World Congress on Virology Aug 20-22, 2012 Las Vegas, USA

International Conference and Exhibition on Nephrology and Therapeutics August 20-22, 2012, Chicago Chicago, USA

2nd International Conference on Vaccines & Vaccination August 20-22, 2012 at Chicago, USA.

World Congress on Earth Science & Climate Change 21–22 Aug 2012, Chicago, USA 20-22 Aug 2012 Las Vegas, USA

International Conference and Exhibition on Orthopedics Aug 13th–15th, 2012 Chicago, USA

International Conference and Exhibition on Rheumatology and Therapeutics Aug 14–15, 2012 at Chicago, USA

3rd International Conference on Biomarkers & Clinical Research July 2-4, 2012 Las Vegas, USA

2nd International Conference on Proteomics & Bioinformatics July 2-4, 2012 Las Vegas, USA

International Conference and Exhibition on Neurology & Therapeutics May 14-16, 2012 Las Vegas, USA

International Conference and Exhibition on Biosensors & Bioelectronics May 14-16, 2012 Las Vegas, USA.

3rd World Congress on Bioavailability & Bioequivalence: Pharmaceutical R & D Summit March 26-28, 2012 Marriott Hotel, Hyderabad, India

International Conference & Exhibition on Nanotechnology and Nanomedicine March 12-14, 2012 Omaha, USA

World Congress on Gastroenterology and Urology March 12-14, 2012 Omaha, USA

International Conference & Exhibition on Biometrics & Biostatistics March 5-7, 2012 Omaha, USA

2nd World Congress on Clinical & Experimental Dermatology March 5-7, 2012 Omaha Marriott, USA

2nd World Congress on Clinical & Experimental Cardiology March 5-7, 2012 Omaha Marriott, USA

2nd World Congress on Clinical & Experimental Ophthalmology March 5-7, 2012 Omaha Marriott, USA

International Conference and Exhibition on Metabolomics & Systems Biology February 20-22, 2012 San Francisco, USA

2nd World Congress on Pharmaceutics & Novel Drug Delivery Systems February 20-22, 2012 San Francisco, USA

2nd world Congress on Analytical and Bioanalytical Techniques 16-17 December 2011San franscico, USA.

2nd World Congress on Diabetes & Metabolism 6-8 December 2011 Philadelphia, USA.

International Conference on Pediatrics & Gynecology 6-8 December 2011 Philadelphia, USA.

International Conference and Exhibition on Cell Science & Stem Cell Research 29 Nov-1 Dec 2011 Philadelphia, USA.

2nd World Congress on Biotechnology 29 Nov -1 Dec 2011 Philadelphia, USA.

International Conference and Exhibition on Vaccines & Vaccination 22-24 November 2011 Philadelphia, USA.

2nd World Congress on Biomarkers & Clinical Research 12-14 September 2011 Baltimore, USA.

International Conference and Exhibition on Virology 5-7 September 2011 Baltimore, USA.

International Conference and Exhibition on Pharmaceutical Regulatory Affairs 6-7 September 2011 Baltimore, USA.

International Conference and Exhibition on Cancer Science & Therapy 15-17 August 2011 Las Vegas, USA.

International Conference on Clinical Research: Dermatology, Ophthalmology and Cardiology 5-6 July 2011 San Francisco, USA.

International Conference & Exhibition on Proteomics & Bioinformatics 6-8 June 2011 HICC, Hyderabad, India.

International Conference & Exhibition on Pharmaceutical Biotechnology 6-8 June 2011 HICC, Hyderabad, India.

2nd World Congress on Bioavailability & Bioequivalence: Pharmaceutical R & D Summit 6-8 June 2011 Las Vegas, USA.

International Conference on Pharmaceutics & Novel Drug Delivery Systems 7-8 June Las Vegas, USA.

World Congress on Biotechnology 21-23 March 2011 Hyderabad, India.

International Conference on Diabetes and Metabolism 13-14 December 2010 Santa Clara, USA.

International Conference on Biomarkers & Clinical Research 22-23 November 2010 Santa Clara, USA

International Conference and Exhibition on Analytical and Bioanalytical Techniques: Pharmaceutical R & D Summit 01 - 03 November 2010 Hyderabad, India

International Conference & Exhibition on Bioequivalence & Bioavailability 2010, Pharmaceutical R & D Summit March 01-03, 2010.

Integrating Glycomics with other Omics in Cancer Detection and Diagnosis, January 19-20, 2010, Stanford University School of Medicine.

3rd World Congress of Gene-2009, December 1-7, 2009.

7th Annual World Congress of International Drug Discovery Science & Technology, October 22-25.

2nd WSA-2009, July 18-20, 2009

1st CCSB-2009, February 16-17, 2009

2nd PRICPS-4th AOHUPO, June 22-26, 2008

95th ISCA, January 5-8, 2008
Open Access PublicationsOpen Access Journals listInternational Scientific Conferences

Search :     Advanced Search 

HomeHome   |   Join Join   |   Contact Contact     

Reproductive System & Sexual Disorders Video Reproductive System & Sexual Disorders Linkdein - Reproductive System & Sexual Disorders Twitter - Reproductive System & Sexual Disorders Facebook - Reproductive System & Sexual Disorders Reproductive System & Sexual Disorders Blog
Journal Details
 
Article usage
Total views: 0
[From(publication date):
-- Dec 27, 2014]
Breakdown by view type
HTML page views :
PDF downloads :
XML downloads :
 
 
 
Review Article Open Access
Physiological IMSI (pIMSI) Improves Results Obtained with IMSI in Patients with Idiopathic Infertility
1Centro Fecondazione Assistita, Clinica Villa del Sole, Via Manzoni 15, 80122 Napoli, Italy
2Facolta di Medicina e Chirurgia, II Università degli Studi di Napoli,Via Costantinopoli, 16, 80100 Napoli, Italy
*Corresponding author: Dr. Martin Wilding
Centro Fecondazione Assistita
Clinica Villa del Sole, Via Manzoni 15
80122 Napoli, Italy
Tel: 081641689
Fax: 0815479251
Email: martinwilding@hotmail.com
 
Received October 17, 2011; Accepted February 09, 2012; Published February 15, 2012
 
Citation: Wilding M, Coppola G, Fabozzi G, Scotto di Frega A, Di Matteo L, et al. (2012) Physiological IMSI (pIMSI) Improves Results Obtained with IMSI in Patients with Idiopathic Infertility. Reproductive Sys Sexual Disord S3:001. doi:10.4172/2161-038X.S3-001
 
Copyright: © 2012 Wilding M, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
 
Abstract
 
Study Background: Intracytoplasmic morphology-selected sperm injection (IMSI) is a procedure in which spermatozoa are digitally analysed prior to injection into the oocyte. This increases the chance of selecting a good sperm, but physiological selection is not carried out. Here, we combine physiological pre-selection of spermatozoa with IMSI for patients with idiopathic infertility.
 
Methods: 290 patients, attending for assisted reproduction, were prepared for oocyte retrieval using standard controlled ovarian hyperstimulation protocols. Spermatozoa were preselected for ICSI with either digitalised morphological selection (IMSI) or IMSI combined with hyaluronic acid (HA) pre-selection techniques (pIMSI). Biological and clinical parameters were recorded and the clinical pregnancy rate noted.
 
Results: HA- pre-selection of mature spermatozoa led to a significant increase in pregnancy and implantation rates in patients treated with IMSI.
 
Conclusions: These data suggest that the combination of HA pre-determination of spermatozoa and advanced morphological analysis enables sperm selection on both a physiological and morphological basis and increases the probability of selecting a high quality spermatozoa.
 
Keywords
 
ICSI; IMSI; Idiopathic infertility; Assisted reproduction; Hyaluronic acid
 
Introduction
 
Idiopathic infertility is described as the failure to conceive after at least a year of unprotected intercourse in the absence of known pathologies. The proportion of patients attending for assisted reproduction that are diagnosed with idiopathic infertility is currently about 25-30%. As research and clinical techniques advance, this number tends to decline as causes are discovered. However, these groups of patients remain difficult to treat with assisted reproductive technologies.
 
A recent probable cause of male-factor infertility has been attributed to the presence of high levels of fragmented DNA in spermatozoa [1-4]. These data indicate that apparently normal spermatozoa often fertilise the oocyte creating an embryo in which the male genome is damaged to the extent that implantation and formation of a healthy foetus cannot occur. Although fragmented DNA in spermatozoa can be diagnosed, techniques enabling the selection of normal spermatozoa from the population contained within an ejaculate are still experimental.
 
Two techniques that enable to some extent the selection of physiologically normal spermatozoa have recently been developed. One of these is termed intracytoplasmic morphology-selected sperm injection (IMSI). Here, spermatozoa are selected for ICSI and analysed digitally prior to the microinjection procedure in order to deselect morphologically abnormal spermatozoa. With this technique, abnormalities not visible in standard ICSI procedures have been observed [5-11]. IMSI increases the pregnancy rate during ICSI cycles, and some data suggests that the level of pregnancy termination is also decreased [7,11-15]. Abnormalities in spermatozoa observed with MSOME have been correlated with the presence of fragmented DNA by TUNEL assay [16,17]. A second technique recently introduced to assisted reproduction is that of sperm selection with hyaluronic acid (HA). In this technique, mature sperm with HA receptors are distinguished from immature and abnormal sperm since these do not express such receptors. This technique is otherwise referred to as ‘physiological ICSI’ (pICSI) since the HA selection mimics the binding of spermatozoa to the zona pellucida of the oocyte – a physiological sperm selector [18-23]. It has been shown that HA-bound sperm have lower levels of persistent histones, fragmented DNA, apoptotic markers and aneuploidies than unbound spermatozoa [24-28].
 
The combination of HA sperm selection and IMSI are perfectly compatible in the assisted reproduction routine, and have been applied to the selection of spermatozoa for IMSI [29]. We applied this technique to couples affected by idiopathic infertility during IMSI procedures. We have termed this technique physiological IMSI (pIMSI). In this work, we compare pIMSI to the standard IMSI technique.
 
Materials and Methods
 
Patients
 
All patients in the present work were attending the Centro Fecondazione Assistita, Clinica Villa del Sole, Naples for assisted reproduction technology. Couples were characterised with idiopathic infertility when the female partner had no apparent cause of infertility after normal hysterosalpingography, hysteroscopy and ultrasound monitoring of the menstrual cycle; where hormonal values were within the normal range i.e. basal FSH <10IU/l, body mass index (BMI=weight (kg)/height (m)2) < 29, menstrual cycle range 24-35 days (intra-individual variability ± 3 days); if the karyotype of both subjects of the couple was normal and if the male partner was normospermic. Female patients were prepared using standard controlled ovarian hyperstimulation protocols including downregulation of the pituitary gland with a GnRH agonist (Decapeptyl, Ipsen, Italy) followed by ovarian stimulation with exogenous FSH (Gonal-F, Serono, Italy). A single member of the medical staff co-ordinated all stimulation protocols ensuring standardisation. Oocyte retrieval was performed 36 hours after the administration of 10,000 IU hCG when 2-3 follicles of 18-20 mm diameter were observed by ultrasound examination, and blood 17 β-oestradiol levels reached 150-200 pg/ml/follicle over 18 mm. Luteal phase supplementation was achieved with intramuscular injections of prontogest 50 mg/day. Sperm samples were collected by masturbation and examined after liquefaction. All samples were washed using a silicon-based gradient of 40% overlaid over an 80% silicon solution (COOK Sperm Gradient, Ireland). The sample was centrifuged for 20 minutes at 1000 G, followed by a wash in Hams F-10. The final precipitate was resuspended to a final concentration of 1 x 106 sperm/ml and conserved in an atmosphere of 37°C and 6% CO2 until required.
 
Intracytoplasmic sperm injection was performed on all patients diagnosed with idiopathic infertility to avoid the risk of failed fertilization. All oocytes in the present project were treated with ICSI 3 hours after oocyte retrieval (60 minutes after removal of the cumulus complex). A single team of biologists co-ordinated all biological work, ensuring that both culture protocols and embryo assessment were standardised. Oocytes were processed for ICSI using commercial IVF medium (COOK, Limerick, Ireland), pre-equilibrated to 37°C and 6% CO2.In standard procedures, spermatozoa previously selected by the IMSI or pIMSI technique were placed in a drop of PVP in a Falcon 1006 ICSI dish (Beckton Dickinson, New Jersey, USA), and microinjected using an ICSI setup consisting of a Nikon Eclipse Ti-U microscope, stage heated to 37°C and Hoffman contrast objectives. Micromanipulation was performed with Narishige micromanipulators and COOK microtools (ICSI and holding pipette, COOK, Ireland). Zygote quality was scored 16-17 hours after ICSI. Embryo quality on day 3 was assessed 64-65 hours after insemination. Zygote and embryo evaluation was performed according to previous data [30]. Two or three embryos were transferred in all cases on the third day after oocyte retrieval. The establishment of a pregnancy was considered as a positive β-hCG test of over 60 IU/l 14 days after embryo transfer. The implantation rate was calculated by the observation of foetal heart beats after ultrasound analysis, 8 weeks after the establishment of pregnancy.
 
Intracytoplasmic morphology-selected sperm injection (IMSI) was offered to patients after at least two cycles of ICSI in which pregnancy was not obtained. In the standard IMSI procedure, motile spermatozoa were preselected on the basis of morphology using a 40x Nomarski objective. Purified sperm samples were placed in a solution of 10% PVP in a Willco GWSt-5030 glass-bottomed petri dish (WillCo Wells BV, Amsterdan, Netherlands) and individual spermatozoa immobilised, captured and placed in groups of 10 in a separate drop of diluted PVP solution (5% final concentration) in the same dish and analysed under differential interference contrast optics using a 100x oil-immersion objective. The resolution (r) obtained with this system is defined as r=λ/2NA or 0.2 μm with λ defined as 560 nm. Computer-enhanced analysis and measurement of individual spermatozoa was achieved through digital recording of individual cells with a Nikon Digital Sight DS-2MBW camera followed by image analysis and measurement using the Nikon NIS-Elements image enhancement package (Nikon NISElements, Florence, Italy). Spermatozoa were considered morphologically suitable for ICSI procedures where the head of the sperm was a regular oval shape, 4.5-4.9 μm in length and 3.1-3.5 μm in width, and was characterised by a maximum of a single vacuole not more than 4% the total area of the sperm head (5). The midpiece was also required to be a regular, rectangular shape of between 4.0 and 5.0 μm in length (16). Upon selection of a sufficient number of spermatozoa to complete the technique, selected spermatozoa are replaced into the PVP drop of a standard prepared Falcon 1006 ICSI dish and subsequently injected into oocytes through standard ICSI procedures.
 
HA-binding of sperm samples
 
HA-binding of sperm samples was performed using the Sperm Slow kit (Origio, Denmark). A 1 μl drop of the prepared sperm samples was placed in a 10 μl drop of Gamete buffer (COOK, Ireland) on a Willco GWSt-5030 glass-bottomed petri dish (WillCo Wells BV, Netherlands). This was then gently fused with a 10 μl drop of Sperm Slow (Origio, Denmark) in order to maintain the integrity of the HA solution. Spermatozoa binding to the HA were characterised by vigorous tail beating with slow forward progression, whereas those that did not bind maintained rapid progression despite the presence of HA. The proportion of spermatozoa exhibiting HA binding was calculated by random selection of a pool of spermatozoa. Spermatozoa preselected by HA treatment were then placed in a drop of 5% PVP solution on the same dish and analysed for morphology as above.
 
Prospective, randomised trial
 
Two hundred and ninety couples diagnosed with idiopathic infertility agreed to be inserted into the trial during a cycle of assisted reproduction. These couples were assigned a number, and patients were selected for standard IMSI or pIMSI by picking numbers with random number tables. Couples were included in the trial after at least 1 year of unprotected intercourse, two cycles of assisted reproduction without pregnancy and a failed cycle of IMSI in our centre within the past year.
 
Statistical analysis
 
All data were plotted as mean ± standard deviation, or as percentages, unless stated. All plots and statistical analysis was calculated using Excel (Microsoft, USA) or web-based statistical analysis sites. Significance of data was tested with either Student’s t-test, ANOVA or the chi-squared test. The z-test with Yates correction was used to test the significance of proportions where necessary. Power of the test was calculated to be 98.6% in the present data.
 
Results
 
Statistical analysis of ICSI cycles in CFA Naples during the period 2007-2010 revealed a pregnancy rate of 29.8% for patients affected by idiopathic infertility (194/652 patients, maternal age 34.6 ± 5.5 years, Table 1). Since this group of patients, although apparently fertile, are difficult to treat successfully, we tested new techniques for the selection of spermatozoa. IMSI cycles in our laboratory have been previously shown to increase the pregnancy rate for a wide range of infertility diagnoses in patients where the male partner was affected by sub optimal semen characteristics [16]. However, in patients affected with idiopathic infertility, little benefit was observed. In a pool of 86 patients affected with idiopathic infertility treated with IMSI between 2009 & 2010, a pregnancy rate of 32.5% (28 couples), not significantly greater than that of ICSI in the same class of patients (Table 1) was achieved. We noted that in this patient population, the proportion of spermatozoa selectable for ICSI was higher than previous data (77.9%, [16], see Table 1), suggesting that the population of spermatozoa in idiopathic infertility is not highly affected by morphological abnormalities visible with high power optics.
 
Table 1: ICSI, IMSI and pICSI cycles for idiopathic infertility.
 
Physiological intracytoplasmic sperm injection (pICSI) is a technique in which physiologically mature spermatozoa are selected through their capacity to bind hyaluronic acid [18-20]. We compared the hyaluronic acid binding capacity parameters of spermatozoa from idiopathic and tubal factor infertility patients. In 15 control samples (no selection criteria), 53.5 ± 4.6% of spermatozoa analysed appeared bound to the HA (Figure 1). In a pool of 10 tubal factor infertility patients (in which there is no presumable male factor), 55.3 ± 4.8% of spermatozoa were bound to the HA, not significantly different from that of controls (Figure 1). Interestingly, a pool of 12 patients affected with idiopathic infertility were characterised by a significantly lower proportion of spermatozoa bound to HA (161/453 sperm examined, 35.5%, Figure 1). Individual patients were characterised by a wide range of HA binding capacities in idiopathic infertility patients (Figure 2). These data suggest that patients affected by idiopathic infertility are often characterised by low ratios of sperm binding to HA. We tested whether the pICSI technique could assist in sperm selection in patients affected by idiopathic infertility. In a group of 12 patients, 3 pregnancies were obtained (25%), not significantly higher than that of the control population (Table 1).
 
Figure 1: Proportions of hyaluronic acid bound semen in specific patient groups.
 
Figure 2: Variation of HA binding in individual patients affected by idiopathic infertility.
 
Recent work has suggested that HA-binding of spermatozoa does not select for normal morphology forms (28). We tested whether physiological selection of spermatozoa also selected sperm of good morphology by examining spermatozoa selected by HA binding in high power optics. A total of 1765 spermatozoa from 18 patient semen samples were analysed. Interestingly, no morphological selection appeared to have occurred. 16.28 ± 5.95% spermatozoa, examined from the control population (i.e. not bound to HA) were found to have good morphology after Kruger morphology analysis. After HA pre-selection, a total of 17.22 ± 6.42% (6.92 ± 23.27 % improvement) were found to have normal morphology. Again, a large variation in individual patients was noted (Figure 3). These data suggest that HA selection of spermatozoa does not enrich for normal morphology forms.
 
Figure 3: HA-binding and morphology enrichment in idiopathic infertility.
 
Since the IMSI technique selects spermatozoa on the basis of morphology alone, and pICSI selects spermatozoa on the basis of physiology without advanced morphological selection, we tested whether a combination of the techniques i.e. physiological selection of spermatozoa followed by morphological analysis, could improve the pregnancy rate in this group of patients. We therefore initiated a prospective, randomised trial to test this hypothesis. In total, 290 patients were selected for the trial after informed consent. Patients were divided into two groups of 145 patients (Table 2). After controlled ovarian hyperstimulation, 5 couples selected for IMSI, and 2 couples in the pIMSI group had their cycles cancelled due to poor response to the therapy (Table 2). Table 2 summarises the clinical data obtained during the trial. Interestingly, the percentage of fertilisation was not statistically significant between the two groups, 83.3 ± 9.1% of injected oocytes fertilised after IMSI, whereas 84 ± 11.1% of oocytes fertilised after pIMSI (Table 2). Furthermore, sufficient numbers of grade A embryos were produced to permit transfer of grade A embryos in all cases (Table 2). In the present trial, the group of patients undergoing IMSI achieved a total of 50 pregnancies out of the 140 transfers completed (35.6%). Cycles of pIMSI however resulted in 85 pregnancies (59.6%). The pregnancy rate was highly statistically significant between groups (p=0, z-test). The implantation rate of pIMSI patients was also significantly greater than that of IMSI patients. For the IMSI group, 55 gestational sacs were observed out of the 364 embryos transferred (15.1%). In the group of patients undergoing pIMSI, 107 gestational sacs were observed after the transfer of 355 embryos (30.1%). No significant differences were observed in patients undergoing IMSI and pIMSI treatments with respect to the number of pregnancies to term, or the percentage of gestational sacs that resulted in live births (Table 2).
 
Table 2: Clinical data for trial.
 
Discussion
 
Idiopathic infertility remains a ‘pathology’ which is difficult to treat with assisted reproduction. This is in large part due to the fact that the underlying cause of failure to conceive has not been diagnosed, leaving the couple untreated. In recent years, improvements in diagnostic techniques and the advancement of genetic testing has led to the reduction in the percentage of patients left undiagnosed. Tests on the physiology of spermatozoa such as the DNA fragmentation assay have been introduced to diagnose male factor infertility in cases where no apparent pathology is present [16]. One of the problems with males diagnosed with high levels of fragmented DNA is how to positively select for unfragmented DNA in a population of spermatozoa such as that obtained in an ejaculate. Gradients, glass wool filtration and other tests select for live spermatozoa, but no or little physiological selection is achieved.
 
IMSI is a technique whereby high resolution optics and digital analysis have revealed morphological abnormalities in spermatozoa [5-11]. This has aided in the selection of high quality spermatozoa for ICSI, and leads to an increase in pregnancy rates over classical ICSI techniques [7,11-15]. However, the technique does not detect physiological abnormalities or sperm maturity. Hyaluronic acid binding of spermatozoa detects physiological maturity of spermatozoa, but gives a low level of selection for morphology. However, this technique has been shown to increase pregnancy rates in assisted reproduction cycles.
 
In the present data, we found little increase in pregnancy rates after either IMSI or pICSI alone in patients affected by idiopathic infertility. However, our data suggests that the two techniques are based on mutually exclusive selection criteria i.e. IMSI selects for good morphology, but not necessarily mature spermatozoa and pICSI selects physiologically mature spermatozoa, but without enrichment for morphologically normal forms. Since the application of hyaluronic acid sperm selection techniques and morphological selection of spermatozoa with IMSI are not mutually exclusive, we combined them into a new technique which we termed ‘physiological intracytoplasmic morphology-selected sperm injection (pIMSI). This technique will enable the selection of morphologically normal, physiologically mature spermatozoa. We compared the clinical results obtained with this technique with IMSI alone in a group of patients diagnosed with idiopathic infertility. Couples in the two groups had previously attempted 2 cycles of IVF and a third cycle with IMSI without success prior to the pIMSI cycle. Couples were characterised by similar characteristics such as age, BMI and response to gonadotrophins. Couples were randomly selected for IMSI or pIMSI to exclude bias in the patient characteristics.
 
In this trial, patients treated by IMSI or pIMSI had similar clinical results with respect to fertilisation rate, percentage of grade I embryos, number of grade I embryos transferred, pregnancies and birth rates. However, the percentage of pregnancies achieved after pIMSI was significantly higher than the results achieved in standard IMSI cycles. Furthermore, the implantation rate of embryos produced with pIMSI was also significantly higher than that of IMSI.
 
The data suggest that the combination of physiological selection of spermatozoa with hyaluronic acid prior to the morphological examination of these spermatozoa for intracytoplasmic sperm injection improves results over either physiological or morphological selection alone in patients with no known infertility pathology. The data suggest that a population of spermatozoa contains both physiologically mature and morphologically normal subpopulations, but these do not necessarily correlate. The proportion of physiologically and morphologically normal spermatozoa in an ejaculate may therefore be a determinant of fertility in an otherwise normospermic male. Interestingly, the selection of physiologically and morphologically mature spermatozoa does not lead to an increase in either fertilisation rate of an improvement in embryo quality, suggesting that no quality classification criterion currently available to the major part of assisted reproduction laboratories can assist in the selection of embryos in these patients. We suggest that pIMSI could develop into a powerful tool for the treatment of patients affected by idiopathic infertility.
 
Acknowledgements
 
We thank Vincenzo Monfrecola for his contribution to the work.
 
References
 






























 
 
 
This article
DOWNLOAD
» XML (67 kB)
» PDF (1,641 kB)
»
Export citation
»
Blog this article
   
CONTRIBUTE
» Write a response
» Read other responses
» Publishing with OPG
   
SHARE
» E-mail this article
» Print this article
» Rights and permissions
   
Share
EXPLORE
Related article at
» Pubmed
» DOAJ
» Scholar Google
 
 
 
 
 
OMICS Publishing Group is the member of / publishing partner of/source content provider to
       
OMICS Publishing Group, An Open Access Publisher and Scientific Events Organizer for the Advancement of Science & Technology. All Published content, except where otherwise noted, is licensed under a Creative Commons Attribution License
Please ensure that you are using the latest version of Adobe reader. If you do not have this software installed on your system, you can download the free Adobe Reader by simply clicking on the following link: http://www.adobe.com/products/acrobat/readstep2.html
Best viewed in Mozilla Firefox | Google Chrome | Above IE 7.0 version Copyright © 2013 OMICS Group, All Rights Reserved.