氧浓度对体外培养胚胎发育的影响

目的:探讨体外受精/卵胞质内单精子注射(IVF/ICSI)后移植前胚胎在不同氧浓度培养条件下的发育情况。方法:将接受IVF或ICSI的患者随机分组成常氧组(体积分数20%的氧浓度,包括IVF卵裂期胚胎患者150例,IVF囊胚期胚胎患者51例,ICSI卵裂期胚胎患者81例,ICSI囊胚期胚胎患者39例)和低氧组(体积分数5%的氧浓度,包括IVF卵裂期胚胎患者108例,IVF囊胚期胚胎患者56例,ICSI卵裂期胚胎患者79例,ICSI囊胚期胚胎患者45例),观察各组胚胎在受精后第3日的卵裂胚和第5日的囊胚发育情况以及临床妊娠结局。结果:在患者年龄、不孕年限、基础FSH值、Gn用量、获卵数和MⅡ卵率组间均无统计学差异的基础上,1与常氧组相比,低氧组的胚胎IVF或ICSI后的受精率、卵裂率以及第3日形成的优质胚胎率无统计学差异(P0.05),临床妊娠率和着床率组间也无统计学差异(P0.05);2低氧组胚胎IVF或ICSI后形成的Ⅴ级囊胚多于常氧组(P0.05),总囊胚形成率组间有显著的统计学差异(P0.01),临床妊娠率和着床率组间无统计学差异(P0.05)。结论:与常氧培养条件相比,低氧培养条件并不能显著促进IVF/ICSI后卵裂期胚胎的发育,但能够促进囊胚的形成,特别是囊胚的孵出,因此低氧培养可以作为囊胚培养的首选条件,但不是卵裂期胚胎培养的必要条件。     

影响冻融胚胎发育潜能及妊娠结局因素的探讨

目的:探讨胚胎冷冻复苏后,卵裂球存活状态对胚胎发育的影响以及体外授精(IVF)和卵胞质内单精子注射(ICSI)2种授精方式对冷冻胚胎复苏后体外发育能力和妊娠结局的影响。方法:回顾性分析142例患者,150个复苏周期,共769个冷冻胚胎复苏后培养至囊胚期进行移植的结果。结果:共复苏胚胎769个,存活胚胎702个,复苏率91.3%。220个胚胎(31%)到达囊胚阶段。在卵裂球全部存活胚胎中,囊胚形成率35%,部分存活胚胎中囊胚形成率24%,两者有统计学差异(P<0.01)。在卵裂球全部存活胚胎中,来源于IVF的胚胎囊胚形成率为40%,来源于ICSI的为26%,两者有统计学差异(P<0.01);部分卵裂球存活胚胎中来源于IVF的胚胎囊胚形成率为26%,来源于ICSI的为19%,差异无统计学意义(P>0.05)。在全部220个囊胚中,IVF组的优质囊胚率为38.6%,ICSI组的优质囊胚率为21.0%,差异有统计学意义(P<0.05)。临床妊娠率IVF组和ICSI组分别为61.05%与61.11%;胚胎种植率分别为37.50%与36.67%,活产率分别为81.03%与78.79%,差异均无统计学意义(P>0.05)。结论:胚胎冷冻复苏后卵裂球的损伤削弱了囊胚形成能力,影响卵裂期胚胎进一步发育,这与ICSI和冷冻胚胎复苏后发育潜能的降低有关,但其对临床结果和妊娠结局的影响不大。     

异常受精胚胎临床利用价值探讨

目的:探讨常规体外受精(IVF)和卵胞浆内单精子注射(ICSI)周期中异常受精胚胎的临床利用价值。方法:回顾性分析2013年4月至2015年6月在白求恩国际和平医院生殖中心接受体外受精-胚胎移植(IVF-ET)治疗(包括常规IVF和ICSI)的955个周期的实验室和临床数据。结果:ICSI周期双原核(2 PN)受精率显著高于IVF周期2 PN受精率(88.20%vs 72.04%,P0.01),而ICSI周期的未见原核(0 PN)、单原核(1 PN)及多原核受精率均低于IVF周期(P0.01),差异有统计学意义。第5天(D5)0 PN的囊胚形成率和可利用囊胚率显著高于2 PN和1 PN组(P0.01)。新鲜移植周期和冻融卵裂胚移植周期,0 PN组种植率和临床妊娠率显著低于2 PN组(P0.01),但是冻融囊胚移植周期,0 PN组的种植率和临床妊娠率与2 PN组相比,差异均无统计学意义(P0.05)。结论:IVF/ICSI周期中没有2 PN胚胎可供选择移植时,可选择0 PN胚胎,囊胚培养是合理利用异常受精胚胎的有效手段。     

体外受精周期中不同原核数发育囊胚使用价值的探讨

目的:比较3种受精卵来源胚胎的囊胚形成率和冻胚移植周期的临床妊娠率,初步探讨异常受精来源囊胚的使用价值。方法:体外受精(IVF)和卵胞浆内单精子注射(ICSI)周期中,比较2PN、1PN和0PN来源胚胎的囊胚形成率、优质囊胚形成率和在冻融胚胎移植(CET)周期中的临床妊娠率。结果:IVF周期中,2PN来源胚胎的囊胚形成率与0PN比较,无显著差异(P0.05),1PN来源胚胎的囊胚形成率显著低于0PN、2PN来源(P0.01)。ICSI周期中,1PN、0PN来源胚胎的囊胚形成率均显著低于2PN来源(P0.05);3种受精卵来源的优质囊胚在CET周期的临床妊娠率无显著差异(P0.05)。结论:1PN、0PN来源的囊胚可视为与2PN来源的囊胚同等价值,可在患者接受产前检查的基础上用于移植。     

精子DNA碎片对IVF-ET胚胎发育和临床结局的影响

目的:探讨精子DNA完整性对体外受精-胚胎移植(IVF-ET)胚胎发育及临床结局的影响。方法:选择190对不孕症夫妇为研究对象,采用密度梯度洗涤及上游法处理精子,检测处理前后的DNA碎片指数(DFI)。通过受试者工作特征(ROC)曲线,根据DFI预测IVF-ET受精率的阈值将患者分为高DFI组和低DFI组。比较两组精液参数及体外受精/卵胞浆内单精子注射(IVF/ICSI)的助孕情况和妊娠结局。结果:(1)DFI预测IVF受精的AUC为0.559(95%CI 0.501～0.617),最大约登指数对应阈值为25%。患者分为高DFI组[≥25%,59对夫妇(IVF 24对,ICSI 35对)]和低DFI组[25%,131对夫妇(IVF101对,ICSI 30对)]。经过密度梯度洗涤及上游后精子DFI显著降低(17.9%vs 1.9%,P0.01)。(2)无论IVF还是ICSI周期,两组前向运动精子比例的差异均有统计学意义[(39.7±17.3)%vs (21.8±19.1)%,P0.01;(28.5±18.3)%vs (13.6±10.9)%,P0.01]。在IVF周期中,低DFI组受精率[(84.0±15.9)%]明显高于高DFI组[(76.3±16.4)%],差异有统计学意义(P0.05),而在ICSI周期中,两组受精率差异无统计学意义[(73.8±19.9)%vs(76.2±20.1)%,P0.05]。(3)两组的卵裂率、优质胚胎率、囊胚形成率、种植率、临床妊娠率、早期流产率、持续妊娠率差异均无统计学意义(P0.05)。结论:高DFI患者的精子活力明显降低,密度梯度洗涤及上游后可显著降低精子DFI。高DFI患者可通过ICSI提高受精率,但是DFI对于IVF/ICSI胚胎发育以及临床结局没有预测价值。     

不同来源精子行ICSI助孕1662个周期治疗结局分析

目的:探讨不同来源精子行卵胞浆内单精子显微注射(ICSI)助孕的妊娠结局。方法:回顾分析我中心2006年1月~2010年6月1662个ICSI治疗周期,按精子来源分为射出精子来源(重度少、弱精子)组1208周期,附睾穿刺取精(PESA)组324周期,睾丸穿刺取精(TESA)组130周期,比较3组胚胎发育情况和妊娠结局等指标。结果:射出精子组及PESA组受精率、卵裂率及2PN率较TESA组高(79.1%,77.9%vs 73.9%;98.7%,98.8%vs 96.6%;74.6%,73.0%vs 69.5%),TESA组1PN率较射出精子组及PESA组高(3.8%vs 2.2%,2.6%),差异均有统计学意义(P<0.05);3组优质胚胎率、胚胎种植率、临床妊娠率、异位妊娠率、流产率、单胎出生率、双胎出生率、畸形率无统计学差异。结论:PESA及TESA来源精子行ICSI助孕可获得与射出精子相似的妊娠结局。     

不同来源精子对卵胞浆内单精子显微注射助孕结局影响研究

目的探讨不同来源精子对卵胞浆内单精子显微注射(ICSI)助孕结局的影响。方法回顾性分析自2015年1月至2017年3月在郑州大学第二附属医院生殖中心行ICSI治疗的584个新鲜取卵移植周期,依据精子来源分为射精组(392个周期)、经皮附睾穿刺取精(PESA)组(86个周期)、睾丸穿刺取精(TESA)组(68个周期)和供精组(38个周期)。分别比较各组相关指标和妊娠结局。结果射精组、PESA组、TESA组的女方年龄、男方年龄、不孕年限、女方体重指数、MⅡ卵数和移植胚胎数间差异均无统计学意义(P0.05)。射精组受精率高于PESA组(P=0.013)和TESA组(P=0.005),卵裂率高于TESA组(P=0.001);3组间优质胚胎率、新鲜移植周期胚胎种植率、临床妊娠率及流产率差异均无统计学意义(P0.05)。TESA组累计妊娠率低于PESA组(P=0.003);射精组与供精组间受精率、卵裂率、优质胚胎率、胚胎种植率、临床妊娠率、流产率及累计妊娠率差异均无统计学意义(P0.05)。结论不同来源的精子可影响ICSI的受精率和卵裂率,但对胚胎发育无显著影响,可获得相似的助孕结局;PESA是治疗梗阻性无精子症的有效方法;对非梗阻性无精症患者,用供精助孕是很好的选择,即使供精解冻后质量欠佳也不影响ICSI助孕结局。     

3106个不同来源精子ICSI周期临床妊娠结局分析

目的:分析精子的来源对卵胞质内单精子注射(ICSI)治疗结局的影响。方法:回顾性分析因男性不育行ICSI的3 106个新鲜周期,按精子来源分为:射精组(A组)、附睾穿刺取精(PESA)组(B组)、睾丸穿刺取精(TESA)组(C组)、冻融PESA精子组(D组)及冻融TESA精子组(E组),比较各组ICSI后胚胎发育及妊娠结局情况。结果:C组2PN受精率、卵裂率显著低于A组及B组;B组临床妊娠率、胚胎植入率显著高于A组及C组,A组、B组及C组间分娩率、异位妊娠率、流产率及新生儿畸形率无统计学差异(P>0.05);E组2PN受精率显著低于D组,但B组与D组之间、C组与E组间2PN受精率、优质胚胎率、多胎率、流产率及异位妊娠率均无统计学差异(P>0.05)。结论:PESA/TESA-ICSI、冻融PESA/TESA精子技术是治疗梗阻性无精子症安全有效的方法,建议首先选择附睾取精,并可将剩余PESA/TESA精子冻存。     

胚胎显微操作与妊娠早期人血清β-hCG值的关系

目的:探讨辅助生殖技术(ART)中的胚胎显微操作与妊娠早期血清β-hCG值的关系。方法:回顾性分析体外受精/卵胞质内单精子注射/胚胎植入前遗传学诊断(IVF/ICSI/PGD)新鲜囊胚移植的259个宫内妊娠周期,根据移植胚胎数及不同周期类型分组,比较移植14 d、18 d血清β-hCG水平的差异。结果:单囊胚移植组中,行IVF周期、ICSI周期和PGD周期间妊娠早期的血清β-hCG有统计学差异,其中常规移植14 d IVF周期血清β-hCG值为877.31±480.40 IU/L,显著高于ICSI周期711.86±485.64 IU/L,P0.05。移植18 d时,两者血清β-hCG无统计学差异(4 198.32±2 306.48 IU/L vs 3 763.75±2 268.87 IU/L,P0.05)。而PGD周期移植14 d血清β-hCG值为556.22±418.94 IU/L,18 d为3 027.22±2 455.80 IU/L,与IVF、ICSI周期相比均有显著统计学差异(P0.05);双囊胚移植组中,IVF周期、ICSI周期及PGD周期各组间14 d、18 d血清β-hCG比较差异均无统计学意义(P0.05)。结论:判断行ICSI、PGD周期患者妊娠与否时适度降低评估患者妊娠早期(移植14 d、18 d)有效妊娠血清β-hCG值标准是可行且必要的。     

早期补救ICSI应用价值的初步探讨

目的:探讨早期补救ICSI的应用价值。方法:回顾性分析IVF受精失败、取卵后20h行补救ICSI者19例(晚补救ICSI,A组)及加精子(IVF)4~6h后未见第二极体(Pb2)的成熟卵行补救ICSI者31例(早补救ICSI,B组),并与544例同期常规ICSI(C组)进行比较,观察受精率、卵裂率、有效胚胎率、优质胚胎率、胚胎种植率、临床妊娠率,评价早补救ICSI有效性。结果:3组年龄及基础FSH均无统计学差异,B组正常受精率显著高于A组,但显著低于C组(71.27%vs55.69%vs81.08%,P<0.05),>2原核(PN)率A、B组间无统计学差异,但显著高于C组(7.73%vs7.78%vs2.73%,P<0.01),卵裂率B组显著高于A组(100%vs94.62%,P<0.05),有效胚胎率3组间无统计学差异,优质胚胎率B组显著高于A组,但低于C组(51.16%vs22.73%vs60.19%,P<0.01),胚胎种植率B组显著高于A组(1.75%vs17.54,P<0.05),与C组比较无统计学差异(17.54%vs18.90%,P>0.05),3组临床妊娠率分别为5.26%,26.67%和34.57%,与C组比,A组临床妊娠率显著下降(P<0.01)。结论:与晚补救ICSI相比,早补救ICSI获得了更高的受精率、卵裂率、优质胚胎率及种植率,但多PN率高于常规ICSI,优质胚胎率仍低于常规ICSI。     

Microtubule organization during rabbit fertilization by intracytoplasmic sperm injection with and without sperm centrosome

Aim  In most mammalian fertilization, the sperm introduces the centrosome, which acts as a microtubule organizing center (MTOC) and is essential for pronuclear movement. In rabbit fertilization, biparental centrosomal contribution in microtubule organization has been suggested. Methods  To reveal the function and inheritance of the centrosome during rabbit fertilization, we compared microtubule organization and early embryonal development following intracytoplasmic sperm injection (ICSI) with and without sperm centrosome. Sperm centrosome was removed by sonication, and the isolated sperm head was injected by a Piezo-driven micromanipulator. Samples were studied by light microscope after immunocytological stain. Results  The sperm aster formation was observed 2–3 h after ICSI with intact sperm. In contrast, microtubules were organized between the male and female pronudeus without a nucleation site in the eggs after ICSI with an isolated sperm head. In the late pronudear stage following ICSI with an isolated sperm head, microtubule organization was the same as in late pronudear stage eggs after intact sperm injection. The first mitotic spindle was organized in eggs following ICSI with an isolated sperm head, as observed in eggs following ICSI with an intact sperm. Conclusions  These results indicate that the MTOC is in oocyte cytoplasm during fertilization and fulfils the function when the sperm centrosome is absent.     

Intracytoplasmic sperm injection overcomes previous fertilization failure with conventional in vitro fertilization

Objective: To evaluate the outcome of intracytoplasmic sperm injection (ICSI) in patients with previous idiopathic fertilization failure (≤20% fertilization rate) after conventional IVF.

Design: Retrospective analysis.

Setting: IVF program at a university medical center.

Patient(s): Twenty-five patients who underwent 38 ICSI cycles after experiencing unexplained fertilization failure with conventional IVF (group A) and 87 patients who underwent 118 ICSI cycles for male factor indications during the same period (group B).

Intervention(s): Intracytoplasmic sperm injection was performed in a subsequent cycle after fertilization failure with conventional IVF.

Main Outcome Measure(s): Outcomes of IVF were compared between groups A and B.

Result(s): Fertilization was achieved with ICSI in all patients with previous fertilization failure. The mean (±SD) fertilization rate (68% ± 21% vs. 64% ± 22%), implantation rate per embryo (22.6% vs. 20%), and delivery rate per cycle (47.3% vs. 49.1%) did not differ significantly between groups A and B. Overall, 72% of patients with previous unexplained fertilization failure had a successful pregnancy after ICSI.

Conclusion(s): Intracytoplasmic sperm injection can overcome unexplained fertilization failure caused by a potentially occult gamete abnormality, with the same fertilization, implantation, and pregnancy rates as are seen in patients with abnormal sperm parameters.     

Effects of sperm viability on fertilization and embryo cleavage following intracytoplasmic sperm injection

Purpose: In the human, intracytoplasmic sperm injection is typically performed using “viable” sperm which has been mechanically rendered nonmotile. The purpose of the present study was to determine the ability of nonviable sperm to fertilize human oocytes and the early developmental normalcy of the resulting embryos. Methods: In this study, immature, prophase I oocytes from a total of 27 consenting patients were matured in vitro and then randomized into two groups: injection with a viable human sperm or injection with a sperm rendered nonviable by freeze-thawing in liquid nitrogen. The rates of fertilization and cleavage were compared between the two groups. Results: The results demonstrated a significantly higher two-pronuclear fertilization rate when oocytes were injected with viable sperm (62.2%) compared to when oocytes were injected with nonviable sperm (16.2%). Oocytes injected with viable sperm also demonstrated a higher cleavage rate (91 vs 33%). Conclusions: These findings suggest that while the intracytoplasmic injection of nonviable human sperm can result in normal fertilization, it does so at a much reduced rate compared to viable sperm and may not result in normally cleaving embryos. Presented at the Fifty-First Annual Meeting of the American Society for Reproductive Medicine, Seattle, Washington, October 7–12, 1995.     

Predictive value of sperm morphology and movement characteristics in the outcome of in vitro fertilization of human oocytes

One hundred fourteen semen samples from Chinese males were analyzed for routine semen parameters including the semen volume, sperm count, percentage motility, and percentage normal morphology. Of these 114 samples, 54 also had movement characteristics of seminal and swim-up sperm evaluated by the computer image analyzer system (Cellsoft; Cryo Resources Co., New York). All semen samples were subjected to the swim-up procedure to harvest the motile sperm before inseminations of human oocytes. Fertilization was considered to have occurred when at least one oocyte was observed with two or more pronuclei. Semen samples were classified as infertile (0% fertilization rate;N=32) or fertile (>0% fertilization rate;N=82) before statistical analyses. There was a significant difference (P<0.005) in percentage normal morphology of seminal sperm between the fertile (mean±SE; 67.3±1.2%) and the infertile (59.3±2.2%) samples. The percentage normal morphology of seminal sperm correlated (r=0.3049;P<0.002) with the fertilization rate and this parameter was selected by the multivariate stepwise discriminant analysis as the discriminator capable of predicting the fertilization rate with 57.9% accuracy. Statistical analyses of samples where sperm movement was also evaluated demonstrated that there was significant differences (P<0.01) between the fertile (N=38) and the infertile (N=16) samples in percentage normal morphology of seminal sperm (67.8±1.8% vs 56.2±2.6%) and curvilinear velocity of swim-up sperm (89.2±3.5 vs 68.2±7.2 m/sec). The fertilization rates correlated with the percentage normal morphology of seminal sperm (r=0.3868;P<0.005) and velocity of swim-up sperm (r=0.3842;P<0.005). Multivariate stepwise discriminant analysis demonstrated that these two sperm parameters in combination were capable of predicting the fertilization rate with 74.1% accuracy. Our results indicate that seminal sperm morphology, coupled with computerassisted image analysis of movement characteristics of swim-up sperm, can help to predict the outcome of in vitro fertilization of human oocytes.     

Cytotoxic sperm antibodies and in vitro fertilization of mature oocytes: A preliminary report

The fertilization rates of mature oocytes during in vitro fertilization and embryo transfer (IVF-ET) using fetal cord serum-supplemented insemination media were 57% for five infertile couples without sperm antibodies (group 1). But they were 50% for four of nine infertile couples (group 2) with cytotoxic sperm antibodies in both partners (n=6) or the husband alone (n=3). Two women in group 1 were successful in achieving normal, full-term pregnancies with the delivery of normal infants (²=4.2, P < 0.05, by chi-square analysis). One of them consistently tested negative for sperm antibodies, while her husband was previously treated with antibiotics for infection and transient sperm antibodies in the seminal plasma. Subsequently, antibody liters in the husband were in the normal range when the successful IVF-ET was performed. One woman in group 2, with antibodies to her autoimmune husband's sperm but not control sperm and with a long-standing poor postcoital test sperm motility, conceived through artificial insemination with donor sperm (AID) after failing to conceive with her husband through IVF-ET. These data suggest that the presence of cytotoxic sperm antibodies in the serum and/ or secretions of both partners reduces the rates of fertilization of mature oocytes in spite of using fetal cord serum in the IVF media. Pregnancy achievement is impaired in this group.     

Cryopreserved sibling oocytes and intracytoplasmic sperm injection rescue unexpectedly poor fertilization in conventional in vitro fertilization

PURPOSE: To report a successful pregnancy from cryopreserved sibling oocytes and intracytoplasmic sperm injection (ICSI) for an infertile couple with an unexpectedly low fertilization rate in the fresh in vitro fertilization (IVF) cycle. METHODS: The woman had bilateral tubal obstruction and polycystic ovarian syndrome. The man had normal semen parameters. The couple underwent a cycle of controlled ovarian hyperstimulation in that 20 oocytes were retrieved. Twelve oocytes were conventionally inseminated and eight were cryopreserved using a slow freezing method. However, only one oocyte was fertilized, and no pregnancy was achieved. In the next cycle, the frozen oocytes were thawed and ICSI was performed. RESULTS: After thawing, seven oocytes (88%) survived and one was damaged. Six were at the metaphase II stage and were injected. Five (83%) achieved normal fertilization, and all of them cleaved (100%). After replacement of the embryos, a singleton pregnancy developed. A healthy female baby was delivered at term. Karyotyping revealed 46, XX. CONCLUSIONS: In addition to well-known indications, cryopreservation of excess sibling oocytes for patients receiving IVF has a possible advantage of preventing unexpectedly low fertilization rate or fertilization failures.     

Influence of individual sperm morphology on fertilization,embryo morphology,and pregnancy outcome of intracytoplasmic sperm injection

OBJECTIVE:To evaluate the influence of morphology of individual spermatozoa on fertilization and pregnancy outcome. DESIGN: Retrospective analysis. SETTING: An IVF center in an institutional research environment. PATIENT(S): Fertilization and embryo quality according to individual sperm morphology were analyzed in 662 consecutive ICSI cycles. Pregnancy outcome was evaluated for these cycles and an additional 1005 consecutive ICSI cycles. INTERVENTION(S): ICSI was performed using sperm cells of ejaculated, epididymal, or testicular origin. Observation through an inverted microscope was used to prospectively classify injected sperm cells as normal or morphologically abnormal. MAIN OUTCOME MEASURE(S): Oocyte fertilization, embryo morphology, and pregnancy outcome of unmixed embryo transfers. RESULT(S): Injection of morphologically abnormal spermatozoa (irrespective of origin) resulted in a lower fertilization rate (60.7%) than did injection of morphologically normal spermatozoa (71.7%). Embryo cleavage quality did not differ between groups. Higher pregnancy and implantation rates were obtained in patients with normal sperm morphology (36.7% and 18.7%, respectively) than in those with abnormal sperm morphology (20.2% and 9.6%). CONCLUSION(S): Individual sperm morphology assessed at the moment of ICSI correlated well with fertilization outcome but did not affect embryo development. The implantation rate was lower when only embryos resulting from injection of an abnormal spermatozoon were available.     

Male partner screening before in vitro fertilization: preselecting patients who require intracytoplasmic sperm injection with the sperm penetration assay

Objectives: To determine the diagnostic accuracy of the sperm penetration assay (SPA) and standard semen parameters for subsequent fertilization in in vitro fertilization-embryo transfer (IVF-ET).

Design: Prospective study.

Setting: Andrology Laboratory, and university research laboratory.

Patients: Two hundred sixteen couples undergoing male-partner screening before IVF-ET (265 cycles).

Intervention(s): Male-partner screening (semen analyses [SA] and SPA), standard IVF-ET procedures, follow-up of fertilization in IVF-ET.

Main Outcome Measure(s): Diagnostic accuracy of SA and SPA for prediction of fertilization in IVF-ET.

Result(s): The SPA predicted IVF fertilization with high negative (84%) and positive (98%) predictive rates, and correct prediction in 88% of cycles. In contrast, sperm concentration, motility, morphology, and complete SA showed poor diagnostic accuracy, with correct prediction of IVF fertilization in 64%, 65%, 45%, and 68% of cycles, respectively.

Conclusion(s): Very low sperm concentration and/or motility were good predictors of poor IVF fertilization, however, low to normal semen parameters were not predictive of successful IVF fertilization. The SPA is a useful screening tool that predicts IVF fertilization with high diagnostic accuracy. The SPA may be useful to discriminate between those couples with a high probability of normal fertilization in IVF and those with a low probability of normal fertilization that may benefit from assisted fertilization by intracytoplasmic sperm injection (ICSI).     

An evaluation of the efficacy of in vitro fertilization with intracytoplasmic sperm injection for sperm with low hypoosmotic swelling test scores and poor morphology

Purpose: To corroborate or refute a previous study demonstrating that in vitro fertilization (IVF) with intracytoplasmic sperm injection (ICSI) is an effective therapy for infertility related to males with subnormal hypoosmotic swelling tests (HOST). The study would also determine if the copresence of poor morphology has any adverse effect on outcome. Methods: Clinical and viable pregnancy rates and implantation rates were evaluated in a second series of patients. The data were further stratified according to whether the semen specimen demonstrated morphology using strict criteria <4% normal vs 4%. Results: Clinical and viable pregnancy rates and implantation rates were 49.1, 45.3, and 23.4% for those with subnormal HOST scores and subnormal morphology vs 38.0, 34.3, and 22.5% for those with low HOST and strict morphology 4% (p = NS, chi-square analysis). Conclusions: In vitro fertilization with ICSI is an effective therapy for infertility related to subnormal HOST scores. Poor morphology does not adversely affect the outcome.