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Világszerte egyre több pár keres fel meddőség miatt asszisztált reprodukciós központot. Vitatott kérdés, hogy a kivizsgálás és a kezelés során szükséges-e a sperma rutinszerű bakteriológiai szűrése. Az ondó a mintanyerés higiéniai szabályainak betartása mellett is gyakran tartalmaz baktériumokat. Egyre több tanulmány foglalkozik a sperma mikrobiomjának vizsgálatával. Bacteriospermia nemcsak fertőzés, hanem kontamináció vagy kolonizáció folytán is kialakulhat. A panaszokat okozó fertőzéseket vagy szexuális úton terjedő betegségeket kezelni kell, de megoszlanak a vélemények a tünetmentes pozitív tenyésztési leletek jelentőségéről. Számos kutatás szerint lehet oki szerepe a húgyúti fertőzéseknek a férfimeddőség kialakulásában, és az ondó minőségét ronthatja az emelkedett baktérium- vagy fehérvérsejtszám. Ellentmondók azonban az eredmények a bacteriospermia és a leukocytospermia kezelésének a spermaképre gyakorolt hatásáról. A mikrobákkal szennyezett sperma megfertőzheti a létrejövő embriókat is, és ezzel veszélyeztetheti a kezelés sikerességét. Ezzel szemben a legtöbb tanulmány nem talált szignifikáns különbséget az in vitro fertilizációs kezelés eredményességében bacteriospermia jelenlétében vagy hiányában. Ez magyarázható a sperma-előkészítési technikákkal, a tenyésztőoldatok antibiotikumtartalmával és az intracitoplazmatikus spermiuminjekció módszerének használatával. Így megkérdőjelezhető a kezelés során rutinszerűen végzett ondótenyésztés szükségessége és a tünetmentes bacteriospermia kezelése. Orv Hetil. 2023; 164(17): 660–666.

Objectives: During human in vitro fertilisation (IVF) treatments, embryologists attempt to select the most viable embryos for embryo transfer (ET). Previously, embryos were evaluated based on light microscopic morphological parameters. However, this is currently accomplished by morphokinetic analysis of time-lapse recordings. This technique provides us the opportunity to observe cytoplasmic strings at the blastocyst stage. The aim of this work was to examine the relationship between the presence of cytoplasmic strings (CS) and the embryo viability in human in vitro fertilised embryos.Study design: Herein, we present an evaluation of the morphokinetic data on the development of embryos obtained during IVF treatments performed at the Division of Assisted Reproduction between December 2020 and March 2021. The dynamics of embryo development, embryo morphology, and morphokinetic scores generated by a time-lapse system were compared between the presence of cytoplasmic strings (CS+) and their absence (CS-) at the blastocyst stage.Results: The development of 208 embryos from 78 patients was examined. Moreover, 81.2% of the embryos had CS in the blastocyst stage; 77% of CS existed in embryos created by conventional IVF, while 86% of CS existed in embryos fertilised by intracytoplasmic sperm injection (ICSI) (p = 0.08). A greater number of CS+ embryos developed into a higher quality blastocyst (52.1% vs. 20.5%, p = 0.02). The morphokinetic score values characterising the development of embryos, such as Known Implantation Data Score (KIDScore) and Intelligent Data Analysis (iDAScore), were higher in CS+ groups (KID: 6.1 ± 2.1 vs. 4.7 ± 2.07; iDA: 8.0 ± 1.9 vs. 6.8 ± 2.3, p < 0.01). The dynamics of the early embryo development were similar between the two groups; however, CS+ embryos reached the blastocyst stage significantly earlier (tB: 103.9 h vs. tB: 107.6 h; p = 0.001).Conclusion: Based on our results, the number of embryos with cytoplasmic strings was higher than that without cytoplasmic strings, and its presence is not related to the fertilisation method. These embryos reached the blastocyst stage earlier, and their morphokinetic (KIDScore and iDAScore) parameters were better. All these results suggest that the presence of CS indicates higher embryo viability. The examination of this feature may help us make decisions about the embryos with higher implantation potential.

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Study question Our aim is presenting a clinical case of pregnancy using intracytoplasmatic sperm injection with bacterial contamination of embryo culture after failed conventional in vitro fertilisation. Summary answer Intracytoplasmatic sperm injection (ICSI) can be an effective and safe method to prevent embryo culture infection in case of microbial contamination of semen. What is known already Contamination of embryo culture is rare, but can be detrimental. The most common sources are semen and follicular fluid. We currently have no standard protocols for monitoring biological fluids. Semen often contains bacteria even if hygiene rules for collection are followed. Most studies found no significant difference in the effectiveness of in vitro fertilisation treatment in the presence or absence of bacteriospermia. This can be explained by sperm preparation techniques, antibiotic content of culture media and use of ICSI. Most centres advise against contaminated embryo transfers, but some achieved pregnancy after removing the zona pellucida or using ICSI. Study design, size, duration This is a case report of two consecutive in vitro fertilisation - ICSI cycles at the Division of Assisted Reproduction, Department of Obstetrics and Gynecology, Semmelweis University, Budapest in 2022. Participants/materials, setting, methods First we performed conventional in vitro fertilisation in a couple with secondary infertility because of oligoasthenozoospermia. For the second time we suggested ICSI due to bacterial growth observed in the embryo culture medium. Microbiological analyses were carried out. We video-recorded the cytoplasmic infection of one oocyte following ICSI with time-lapse microscopy. Main results and the role of chance After conventional in vitro fertilisation we observed a proliferation of rods in the embryo culture medium. The control culture medium was sterile. The semen and infected embryo culture medium contained Escherichia coli and Staphylococcus hominis. The oocytes did not fertilize and degenerated. The husband was asymptomatic and did not have alteration in physical examination therefore he was not treated with antibiotics. In next cycle we performed ICSI. 2 of 14 oocytes fertilized normally and developed into high-quality blastocysts. One embryo was transferred resulting in live birth and one embryo was cryopreserved. We video-documented proliferation of bacteria in one fertilised oocyte but not in the others. Infected oocyte was removed from culture and its culture medium showed Escherichia coli and Cutibacterium acnes. Fungal culture and sexually transmitted diseases were negative. The semen only contained Escherichia coli. The cervix culture was negative. Escherichia coli was resistant to gentamicin contained in culture medium. Limitations, reasons for caution We only had one case of bacterial contamination in 30 years and therefore can not conclude to the routine use of ICSI if microbial infections of biological fluids are present. Wider implications of the findings ICSI can be offered to patients with bacterial contamination of semen and can help reducing the risk of infection of embryo culture. We can prevent the disadvantages of excessive antibiotic treatments. New guidelines are needed how to handle bacterial contamination of embryo culture media. Trial registration number not applicable