Cl. Hourani et al., CUMULUS REMOVAL AND ADDITION OF FOLLICULAR-FLUID POSSIBLY IMPROVES PREGNANCY RATES WITH IN-VITRO FERTILIZATION FOR MALE FACTOR, Archives of andrology, 34(1), 1995, pp. 47-52
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.