Assisted fertilization with intracytoplasmic sperm injection.

OBJECTIVE

To evaluate the significance of intracytoplasmic sperm injection in severe male factor infertility and previous failed fertilization.

DESIGN

Prospective observational study.

SETTING

Private infertility clinic, London.

SUBJECTS

Sixty-nine patients with a long-standing history of infertility of which 48 had previous failed fertilization, 15 had < 1 million progressive motile sperm per ejaculate, and the remaining 6 had obstructive azoospermia.

INTERVENTION

Assisted fertilization with primary intracytoplasmic sperm injection was carried out in 69 IVF.

OUTCOME

Normal (two pronuclei [2PN]) fertilization and pregnancy rates.

RESULTS

A total of 967, oocytes were collected and 785 were subsequently microinjected. Normal fertilization (2PN) occurred in 410 oocytes (52%) and 90.5% of those cleaved. Sixty-four patients underwent ET, with a total of 181 embryos transferred. Twenty-five patients conceived with a pregnancy rate of 39% per transfer. The implantation rate was 16% and the total pregnancy loss rate 24%. Failed fertilization after intracytoplasmic sperm injection occurred in four cases.

CONCLUSIONS

Intracytoplasmic sperm injection is increasingly becoming the treatment of choice in infertile couples where assisted fertilization is indicated. The high fertilization and pregnancy rates observed with this technique, together with a low risk of abnormalities, has revolutionized treatment of male factor infertility.