Evaluation of 225 patients undergoing subzonal insemination for the procurement of fertilization in vitro.

OBJECTIVE

To evaluate subzonal insemination for the procurement of fertilization in infertile males.

DESIGN

The spermatozoa of infertile males was used, where possible, for in vitro fertilization (IVF) and subzonal insemination with the same cohort of oocytes obtained from their partner.

SETTING

An individual unit in a general hospital, Clinical Nomentana, Rome, Italy.

PATIENTS

Males who had repeatedly failed to achieve conception in vitro by IVF or in whom seminal parameters were unacceptable for IVF were treated.

INTERVENTIONS

Two hundred twenty-five transvaginal oocyte retrievals were performed.

MAIN OUTCOME MEASURES

The incidence of fertilization, cleavage, and pregnancy was evaluated in relation to the numbers of spermatozoa injected and the individual spermatozoa parameters.

RESULTS

Fertilization occurred in 39% of patients and 16% of eggs, and 12 clinical pregnancies were established. Fertilization increased with increasing numbers of spermatozoa injected. Fertilization with subzonal insemination was significantly greater (39%) than after in vitro insemination (6%) (P less than 0.0001).

CONCLUSIONS

Subzonal insemination improved the incidence of fertilization in this series of patients, and a new classification of spermatozoa based on total motile count aided prognosis for fertilization.