Dy. Liu et al., HIGH FERTILIZATION AND PREGNANCY RATES AFTER INTRACYTOPLASMIC SPERM INJECTION IN PATIENTS WITH DISORDERED ZONA-PELLUCIDA-INDUCED ACROSOME REACTION, Fertility and sterility, 67(5), 1997, pp. 955-958
Objective: To determine whether intracytoplasmic sperm injection (ICSI
) is effective treatment for patients with disordered zona pellucida (
ZP)-induced acrosome reaction (AR) who have failure of standard IVF-ET
. Design: Tests of sperm-ZP binding and penetration and the ZP-induced
AR were used to diagnose patients with disordered ZP-induced AR who t
hen were treated with ICSI. Setting: Academic reproductive medicine re
search laboratory associated with a tertiary referral infertility clin
ic. Main Outcome Measure(s): Clinical features and results of previous
IVF-ET, semen analysis and sperm-ZP interaction tests, and ICSI were
analyzed. Result(s): The majority of patients had consistently normal
sperm characteristics and all patients had normal sperm-ZP binding but
failure of sperm-ZP penetration. The AR of sperm bound to the ZP was
significantly lower in the patients (mean 6%, range 0% to 16%) than in
the fertile men (mean 61%, range 27% to 96%). Intracytoplasmic sperm
injection was performed on 34 patients and the normal fertilization ra
te averaged 73% per injected oocyte. Five ongoing and eight term pregn
ancies including two with twins were achieved after an average of two
ET procedures per patient were performed. Two couples have second ongo
ing pregnancies from transfer of frozen embryos after successful first
pregnancies. Overall, the implantation rate was 10.5% per embryo and
the pregnancy rate 19% per ET and 38% per patient. Conclusion(s): Diso
rdered ZP-induced AR is a cause of severe infertility and persistent f
ailure of IVF-ET. Intracytoplasmic sperm injection is effective treatm
ent for this condition. Patients with idiopathic infertility should be
tested for this condition before commencing IVF-ET treatment. (C) 199
7 by American Society for Reproductive Medicine.