17 LIVE BIRTHS AFTER THE USE OF AN ERBIUM YYTRIUM ALUMINUM GARNET LASER IN THE TREATMENT OF MALE FACTOR INFERTILITY

Mechanical partial zonal dissection (PZD) is one of the microinseminat ion techniques developed to improve the chances of fertilization by in -vitro insemination in subfertile males. We developed a new and safe l aser method (erbium laser ablation) for PZD, with the aim of producing a precise opening as well as ablation of some layers of the zona pell ucida. From February 1992 to March 1993, 104 couples suffering from ma le factor infertility were treated in our centre. All patients were af fected by severe oligoasthenozoospermia and had previously undergone o ne failed in-vitro fertilization attempt each. Photoablation of the zo na pellucida was induced in 512 oocytes by exposure to an erbium - yyt rium aluminium garnet (Yag) laser. The openings obtained were similar to 14 mu m in diameter. Of the laser-treated oocytes, 158 (30%) fertil ized and 139 (88%) cleaved. Nineteen (18.3%) clinical pregnancies resu lted and produced 17 newborns, all in good health. In our series there were four miscarriages, 23 damaged oocytes (4.4%) and 13 with three o r more pronuclei (2.5%). Considering that the incidence of damaged ooc ytes and polyspermy is low, it seems that in some cases of male factor infertility erbium - Yag laser photoablation of the oocyte zona pellu cida can be considered a procedure which is effective in enhancing fer tilization and which is safe, allowing normal embryo development.