INTRACYTOPLASMIC SPERM INJECTION - A NOVEL TREATMENT FOR ALL FORMS OFMALE FACTOR INFERTILITY

Objective: To demonstrate the effectiveness of intracytoplasmic sperm injection to treat male factor infertility and to report on the achiev ement of fertilization and pregnancy compared with standard in vitro i nsemination. Design: Controlled clinical study. Setting: Couples suffe ring from male factor infertility treated in an academic research envi ronment. Patients: Two hundred twenty-seven couples in whom the male p artners were presumed to be the cause of repeated failed attempts at I VF or whose semen parameters were unacceptable for conventional IVF. I nterventions: Oocytes for this study were harvested after superovulati on with GnRH agonist and gonadotropins. After removing the cumulus cel ls, a single spermatozoon was injected directly into the cytoplasm of metaphase II oocytes, and the outcome was analyzed in terms of semen p arameters and origin of semen sample. Main Outcome Measures: Fertiliza tion and pregnancy rates (PRs) in relation to sperm parameters and ori gin of semen sample. Results: Two hundred twenty-seven couples were tr eated by intracytoplasmic sperm injection resulting in an ongoing preg nancy rate of 37.0% per retrieval (84/227). There were 47 singleton pr egnancies (5 of which were vanishing twin pregnancies), 30 twin gestat ions, 6 triplet pregnancies, and 1 quadruplet pregnancy. The concentra tion of the total motile spermatozoa present in the ejaculate as well as the origin of the samples influenced the fertilization rate but not the pregnancy outcome. Conclusions: Intracytoplasmic sperm injection can be used successfully to treat couples who have failed IVF or who h ave too few spermatozoa for conventional methods of in vitro inseminat ion. Sperm parameters do not clearly affect the outcome of this techni que.