Intracytoplasmic sperm injection facilitates fertilization even in the most severe forms of male infertility: pregnancy outcome correlates with maternal age and number of eggs available.

OBJECTIVE To evaluate, in a prospective study, the fertilization and pregnancy rates after intracytoplasmic sperm injection (ICSI) in infertile couples with severe male infertility. DESIGN Intracytoplasmic sperm injection was performed in 229 consecutive IVF cycles on 190 couples with rigorously defined severe male infertility or proven failure of fertilization in prior IVF cycles. Neither male nor female partners were chosen from a waiting list or on any other selective basis, including age, prior or anticipated ovarian response, or oocyte number or quality. There were no upper age limits, in no instance was donor sperm used for ICSI, and cycle cancellation rate was minimal. SETTING Private genetics and fertility center in Fairfax, Virginia. MAIN OUTCOME MEASURES Fertilization, transfer, and pregnancy rates were measured in ICSI-treated couples, and comparisons were made regarding both female age and strictly defined semen categories. RESULTS Two hundred six cycles (90%) resulted in ETs, with initiation of 52 pregnancies (25% per transfer, 23% per cycle). Thirty-eight of 52 (18% per transfer) were clinical pregnancies with established gestational sacs or were ongoing or delivered. Pregnancies were achieved even in older women but were more readily established in younger women producing larger numbers of metaphase II oocytes. The severity of semen abnormalities had some small effect on fertilization rate, but only actual necrospermia was associated with markedly decreased frequency of embryo formation. Pregnancy per transfer was similar across groups. In some cases, pregnancy was initiated with fewer than 100 viable sperm in the ejaculate. CONCLUSIONS Intracytoplasmic sperm injection is a very powerful new treatment for severe male infertility. Paradoxically, egg number and probably egg quality are now the main determinants of success in treating male infertility.

[1]  C. O'neill,et al.  Subzonal insertion of multiple sperm is a treatment for male factor infertility , 1994, Fertility and sterility.

[2]  Y. Ezra,et al.  Defective oocytes: a new subgroup of unexplained infertility. , 1992, Fertility and sterility.

[3]  V. Bolton,et al.  The relationship between chromosomal abnormalities in the human oocyte and fertilization in vitro. , 1994, Human reproduction.

[4]  P. Patrizio,et al.  Can severe male factor infertility be treated without micromanipulation? , 1993, Fertility and sterility.

[5]  P. Devroey,et al.  Cytogenetic and morphological observations of single pronucleated human oocytes after in-vitro fertilization. , 1993, Human reproduction.

[6]  S. Banks,et al.  Characterization and frequency distribution of sperm acrosome reaction among normal and infertile men. , 1994, Human Reproduction.

[7]  H. Seltman,et al.  Sperm morphology as diagnosed by strict criteria: probing the impact of teratozoospermia on fertilization rate and pregnancy outcome in a large in vitro fertilization population. , 1994, Fertility and sterility.

[8]  G. Garrisi,et al.  Age-related decline in female fertility is not due to diminished capacity of the uterus to sustain embryo implantation. , 1994, Fertility and sterility.

[9]  S. Banks,et al.  Acrosome reaction inducibility predicts fertilization success at in-vitro fertilization. , 1994, Human reproduction.

[10]  M. Derde,et al.  Higher success rate by intracytoplasmic sperm injection than by subzonal insemination. Report of a second series of 300 consecutive treatment cycles. , 1993, Human reproduction.

[11]  H. Baker,et al.  Acrosome status and morphology of human spermatozoa bound to the zona pellucida and oolemma determined using oocytes that failed to fertilize in vitro. , 1994, Human reproduction.

[12]  H. Baker,et al.  Assisted fertilization: Diagnosis of sperm defects in selecting patients for assisted fertilization , 1993 .

[13]  H. Tournaye,et al.  Comparison of in-vitro fertilization in male and tubal infertility: a 3 year survey. , 1992, Human reproduction.

[14]  S. Fishel,et al.  Assisted fertilization: Micro-assisted fertilization with human gametes , 1993 .

[15]  R Eliasson,et al.  Laboratory manual for the examination of human semen and semen-cervical mucus interaction. , 1980 .

[16]  Z. Nagy,et al.  Andrology: Intracytoplasmic sperm injection does not require special treatment pf the spermatozoa , 1994 .

[17]  D. Vantman,et al.  Assessment of sperm motion characteristics from fertile and infertile men using a fully automated computer-assisted semen analyzer. , 1989, Fertility and sterility.

[18]  G. Wright,et al.  Routine application of partial zona dissection for male factor infertility. , 1991, Human reproduction.

[19]  D Mortimer,et al.  Sub-zonal insemination for extreme male factor infertility. , 1993, Human reproduction.

[20]  J. Yovich,et al.  Use of the acrosome reaction to ionophore challenge test in managing patients in an assisted reproduction program: a prospective, double-blind, randomized controlled study. , 1994, Fertility and sterility.

[21]  D. Liu,et al.  New tests of human sperm function and fertilization in vitro. , 1992, Reproduction, fertility, and development.

[22]  Zsolt Peter Nagy,et al.  High fertilization and implantation rates after intracytoplasmic sperm injection , 1993 .

[23]  Fivnat.  French National IVF Registry: analysis of 1986 to 1990 data. FIVNAT (French In Vitro National). , 1993, Fertility and sterility.