INTRACYTOPLASMIC SPERM INJECTION - ACHIEVEMENT OF HIGH PREGNANCY RATES IN COUPLES WITH SEVERE MALE FACTOR INFERTILITY IS DEPENDENT PRIMARILY UPON FEMALE AND NOT MALE FACTORS

Objective: To determine the efficacy and factors affecting outcome of intracytoplasmic sperm injection (ICSI) in patients with severe male f actor infertility. Design: Prospectively designed clinical trial of pa tients selected to participate in the study based upon the following i nclusion criteria: previous total failed fertilization or unsuitable s perm parameters for conventional IVF. Setting: Tertiary care academic center. Patients: Ninety-two consecutive couples undergoing IVF therap y augmented with ICSI during April through December 1994 were studied. Main Outcome Measures: Fertilization and ongoing implantation and pre gnancy rates (PRs). Results: A total of 1,163 preovulatory oocytes wer e manipulated, yielding a diploid fertilization rate of 60.9%; the ooc yte damage rate was 13.2%. The transfer rate was 95% with 43.1% of cyc les having excess embryos that were cryopreserved. Overall, the clinic al and ongoing PRs per transfer were 31.9% and 26.8%, respectively. No ne of the sperm parameters of the original semen analysis correlated w ith ICSI outcome. Female age did not affect fertilization results but had a significant impact on PR (<34 years: 48.9%; 35 to 39 years: 22.9 %; greater than or equal to 40 years: 5.9% clinical PR per transfer). Conclusions: Intracytoplasmic sperm injection offers a new and powerfu l therapeutic option to treat couples with severe male factor infertil ity associated with a variety of sperm abnormalities. An adequate fema le age is a pivotal factor determining a successful outcome.