THE USE OF INTRACYTOPLASMIC SPERM INJECTION FOR THE TREATMENT OF SEVERE AND EXTREME MALE-INFERTILITY

The outcome of treatment by intracytoplasmic sperm injection (ICSI) is described for patients with severe male infertility. In 296 consecuti ve cycles, a normal fertilization rate of 69% was achieved with 288 cy cles (97%) resulting in embryos suitable for transfer. A total of 32 c linical pregnancies were achieved from the transfer of fresh embryos ( clinical pregnancy rate of 12% per transfer) and an additional 44 clin ical pregnancies were obtained after the transfer of frozen-thawed emb ryos (clinical pregnancy rate of 16% per transfer). Overall, 57 of the 76 pregnancies were ongoing or delivered. An analysis of outcome in 5 male factor subgroups revealed no significant differences in pregnanc y and implantation rates between the categories. However, the fertiliz ation rate was significantly lower in patients with oligoasthenoterato zoospermia and significantly higher in those patients for whom epididy mal sperm were used for insemination. The treatment of patients with e xtreme male infertility is also described; normal fertilization and em bryo development were obtained using ICSI in patients with mosaic Klin efelter's syndrome, severe sperm autoimmunity, round-headed acrosomele ss sperm (globozoospermia), completely immotile sperm selected by hypo -osmotic swelling and sperm isolated from testicular biopsies. Three o ngoing pregnancies were obtained from 6 patients for whom testicular s perm were used. These results demonstrate the value of ICSI in the man agement of severe male infertility, however, the treatment of some typ es of extreme male infertility using ICSI may be limited.