FACTORS OF IMPORTANCE FOR THE ESTABLISHMENT OF A SUCCESSFUL PROGRAM OF INTRACYTOPLASMIC SPERM INJECTION TREATMENT FOR MALE-INFERTILITY

Objective: To establish an intracytoplasmic sperm injection treatment program for couples with male infertility and to determine those facto rs important for success. Design: A retrospective analysis of 171 cons ecutive cycles of intracytoplasmic sperm injection concerning 145 infe rtile couples. Setting: Infertility clinic in a private hospital assoc iated with a university hospital. Patients: Couples with infertility i n the male partner whose sperm parameters were unacceptable for conven tional IVF or in whom fertilization by conventional IVF failed repeate dly. Interventions: One hundred seventy-one transvaginal oocyte retrie vals were completed after superovulation with GnRH agonist and gonadot ropins. Main Outcome Measures: The parameters evaluated included ferti lization, cleavage, implantation, pregnancy, and spontaneous abortion in relation to patient indications and improved procedures. Results: A fter intracytoplasmic sperm injection, normal fertilization occurred i n 45% of the oocytes (n = 1,499). Of 171 treatment cycles, 93% of the couples had fertilization and 86% had ET. Thirty-six pregnancies were achieved. During the period studied, the mean fertilization rate incre ased from 21.3% during the first 17 weeks to 67.8% during the last 13 weeks, and the pregnancy rate (PR) per started cycle increased from 12 .8% to 31.3%. Conclusions: Technical factors critical for achieving hi gh rates of fertilization and pregnancy were the use of standardized i ntracytoplasmic sperm injection pipettes, the immobilization of sperm before injection, and the aspiration of a minimal amount of ooplasm be fore reinjection with the sperm. Intracytoplasmic sperm injection appe ars to be superior to other micromanipulation methods for alleviating male infertility.