In vitro fertilization and intracytoplasmic sperm injection for couples with unexplained infertility after failed direct intraperitoneal insemination

Purpose: The objective was to determine the optimal insemination technique in patients undergoing in vitro fertilization (IVF) after failed direct int raperitoneal insemination (DIPI) and the outcome of intracytoplasmic sperm injection (ICSI) in such cases. Methods: In case-control studies, 53 couples with unexplained infertility w ho underwent IVF after four failed DIPI cycles were compared with 75 couple s with tubal or endometriosis infertility as controls. Thirty couples with unexplained infertility after failing to conceive with DIPI and conventiona l IVF who underwent ICSI and 58 couples with male factor infertility as con trols also were compared. Fertilization cleavage, embryo quality, implantat ion and pregnancy were compared after IVF and after ICSI. Results: There was a significant difference in fertilization rates after IV F between cases of unexplained infertility after failing to conceive with D IPI (40.4%) and patients with tubal or endometriosis infertility (67.9%). T here also was a significant difference in total fertilization failure rates between the two groups (30.4% and 3.9%, respectively). There was a slight bur significant difference in numbers of fertilized oocytes after ICSI betw een patients with low fertilization rate undergoing IVF after failing to co nceive DIPI (85.8%) and patients with male factor (90.4%). Total fertilizat ion failure was not observed in these cases. Conclusions: Couples with unexplained infertility after failing to conceive with DIPI show a failed fertilization or a low fertilization rate after IV F. However; they demonstrated a good chance of becoming pregnant after subs equent ICSI, even with statistically significant difference in fertilizatio n rate as compared with male-factor cases.