MALE-INFERTILITY AND CONVENTIONAL IN-VITR O FERTILIZATION RESULTS IN GERMANY FROM 1990-1993

A retrospective study was carried out to compare the results of in vit ro fertilisation (IVF) in 20 936 patients with different sperm paramet ers who underwent IVF in Germany between 1990 and 1993. The study was designed to evaluate prognostic factors for IVF outcome, such as sperm parameters and pre-treatment diagnosis. The percentage of subfertile sperm parameters (<10 millions sperm per mi and/or <30% progressive mo bility and/or <30% normal morphology) increased from 31.4% in 1990 to 51.7% in 1993. The fertilisation rate per puncture varied between 87.9 % in patients with normozoospermia and 38.7% in patients with severe o ligo-astheno-teratozoospermia (OAT). The fertilisation rate in patient s with tubal indication was significantly higher than in patients with male indication and comparable spermatozoa. The pregnancy rate per em bryo transfer was 23% in patients with normozoospermia and 13.8% in pa tients with ''severe OAT syndrome'' in the IVF semen parameters. On th e other hand, patients with male sterility as pre-treatment diagnosis showed significantly higher chances of pregnancy than patients with a tubal factor (24% versus 20%, p <0.05). Comparing percoll and swim-up preparation techniques, we found significantly higher fertilisation ra tes in normozoospermia and significantly higher pregnancy rates in sub fertile patients after percoll sperm preparation. The results of the s tudy demonstrated that patients with moderate subfertile sperm paramet ers have good chances of fertilisation and pregnancy following convent ional IVE. It seems reasonable to set the boundary at a sperm count of 10 millions sperm/ml with 30% progressive motility and 30% normal mor phology. Below these limits intracytoplasmic sperm injection shows bet ter IVF outcome.