CUMULUS REMOVAL AND ADDITION OF FOLLICULAR-FLUID POSSIBLY IMPROVES PREGNANCY RATES WITH IN-VITRO FERTILIZATION FOR MALE FACTOR

This study evaluated the use of in vitro fertilization (IVF) for patie nts with subnormal semen parameters without the use of micromanipulati on. All patients were characterized as having male factor as follows: normal morphology (NM) less than or equal to 10% according to strict c riteria [15] and motile density (MD) less than or equal to 10 x 10(6)/ mL. Strict morphology was divided into three groups: group I (n = 72), less than or equal to 2% group II (n = 24), 3-5%; and group III (n = 29), 6-10%. Modification of standard IVF techniques included manual cu mulus removal (CR) from oocytes, pooling up to ten oocytes together in 1 mt of media, and supplementing media with 20% human follicular flui d (FF). Rates of fertilization and pregnancy were compared. The overal l fertilization rate (FR) was 57.7% and the pregnancy rate (PR) per re trieval cycle was 14.8%. There was no significant improvement in the f ertilization or PRs when IVF was modified using CR and FF, although th e FR was higher in group I for patients who received the modified proc edures. In patients with less than or equal to 5 x 10(6) sperm/mL, the re were no pregnancies in five cycles and four transfers following the conventional method, but two sets of twins with the modified protocol s in seven cycles. Clinical pregnancies were achieved with male factor without the need for micromanipulation. The most severe cases were au tomatically assigned to modified IVF techniques, e.g., CR with or with out FF. Prospective randomized studies are needed to determine if modi fied procedures are superior to conventional therapy.