INTRACYTOPLASMIC SPERM INJECTION - A MAJOR ADVANCE IN THE MANAGEMENT OF SEVERE MALE SUBFERTILITY

Objective: To determine the success of intracytoplasmic sperm injectio n for severe male infertility. Design: A retrospective survey. Setting : A tertiary infertility service. Patients and Interventions: One hund red fourteen couples had 119 intracytoplasmic sperm injection treatmen ts because of previous failure of standard IVF, poor results with subz onal insemination, sperm concentration < 2 x 10(6)/mL, other sperm def ects, or male genital tract obstruction. Main Outcome Measures: Fertil ization, implantation, and pregnancy rates. Results: Of 1,185 oocytes treated by intracytoplasmic sperm injection, normal fertilization and cleavage occurred in 717 of 1,073 that survived (67% normal fertilizat ion rate). Abnormal fertilization occurred in 113 oocytes (11% abnorma l fertilization rate) and 112 oocytes did not survive the procedure (s urvival rate of 90%). In 117 couples, 251 embryos were transferred fre sh, 409 embryos were cryopreserved, and 224 were transferred after tha wing. The implantation rate was 7.4% (fetal heart per embryo transferr ed). To date 36 clinical pregnancies have been achieved (12% per fresh transfer, 20% per frozen transfer, and 30% overall), 24 are ongoing o r delivered (6% per fresh transfer, 14% per frozen transfer, and 20% p er intracytoplasmic sperm injection). The fertilization rates were the same (65%) with various sperm defects but higher with genital tract o bstructions (75%). Conclusion: Intracytoplasmic sperm injection has im proved the prognosis of severe male infertility.