Intracytoplasmic sperm injection and conventional in vitro fertilization for sibling oocytes in cases of unexplained infertility and borderline semen

Purpose: In a prospective study, conventional IVF and intracytoplasmic sperm injection (ICSI) were performed on sibling oocytes of 22 patients with unexplained infertility (Group A) and 24 patients with borderline semen (Group B).Results: In Group A, there was no significant difference (P=0.070) in the fertilization rate per oocyte between ICSI (63%) and conventional IVF (50.7%), however, there was total failure of fertilization in conventional IVF in 5 of the 22 patients with IVF and none in ICSI. In group B, there was a significant difference (P<0.001) between the fertilization rate per oocyte in ICSI (59%) and conventional IVF (27.1%). There was total failure of fertilization in 11 patients after conventional IVF and none after ICSI.Conclusions: The study showed that 22.7% of unexplained infertility and 45.8% of patients with borderline semen would have lost their chance of embryo transfer completely because of total failure of fertilization if ICSI was not performed on some oocytes in this cycle.Presented in part at the IXth World Congress on In Vitro Fertilization and Alternate Assisted Reproduction, Vienna, Austria, April 3–7, 1995.     

Intracytoplasmic sperm injection as a treatment for unexplained total fertilization failure or low fertilization after conventional in vitro fertilization

OBJECTIVE: To determine whether IVF or intracytoplasmic sperm injection (ICSI) should be the choice of treatment in case of a previous IVF attempt with unexplained total fertilization failure or low fertilization (<25%). DESIGN: Prospective study. SETTING: Leiden University Medical Center. PATIENT(S): Thirty-eight couples undergoing IVF and ICSI on sibling oocytes after a first IVF attempt with total fertilization failure or with low fertilization (<25%). INTERVENTION(S): Performing IVF and ICSI on sibling oocytes. MAIN OUTCOME MEASURE(S): Fertilization and (ongoing) pregnancy rate. RESULT(S): A total of 271 oocytes were collected in 24 oocyte retrievals in the total fertilization failure group. Hundred nine oocytes were randomly allocated to IVF and 12 were fertilized (11%); 162 sibling oocytes were allocated to ICSI and 78 were fertilized (48%). In 8 of the 24 patients fertilization occurred after IVF. The pregnancy rate after transfer of 1 IVF and 1 ICSI embryo (n = 3) was 67% and after the transfer of 2 ICSI embryos (n = 21) this was 52%. In the low fertilization group 169 oocytes were collected in 14 oocyte retrievals. Seventy-two oocytes were randomly allocated to IVF and 16 were fertilized (22%). Ninety-seven sibling oocytes were allocated to ICSI and 58 were fertilized (60%). In 7 of 14 patients fertilization occurred after IVF. The pregnancy rate after the transfer of 1 IVF and 1 ICSI embryo (n = 5) was 80% and after the transfer of 2 ICSI embryos (n = 9) this was 33%. CONCLUSION(S): Performing ICSI on some oocytes of a cohort may avoid total fertilization failures both in patients with a history of total fertilization failure and in patients with a history of low fertilization, as the percentage of fertilization is higher after ICSI compared to IVF and the recurrence of total fertilization failure and low fertilization is high after IVF treatment.     

Intracytoplasmic sperm injection increased fertilization and good-quality embryo formation in patients with non-male factor indications for in vitro fertilization: a prospective randomized study

OBJECTIVE: To compare the fertilization rate and formation of good-quality embryos with conventional IVF and ICSI in patients with non-male factor infertility. DESIGN: Prospective controlled study. SETTING: Infertility clinic. PATIENT(S): Thirty-five patients with non-male factor infertility. INTERVENTION(S): Retrieved sibling oocytes were randomly assigned to conventional IVF or ICSI. Of sibling oocytes assigned to ICSI, only metaphase II oocytes were injected with sperm. MAIN OUTCOME MEASURE(S): Fertilization rate and formation of good-quality embryos per retrieved oocyte. RESULT(S): Per retrieved oocyte, ICSI resulted in better fertilization rate compared with conventional IVF (71.3% [134 of 188] vs. 57.2% [107 of 187]). Per retrieved oocyte, ICSI also resulted in better formation of good-quality embryos at 48 hours after retrieval compared with conventional IVF (64.4% [121 of 188] vs. 47.1% [88 of 187]). CONCLUSION(S): In IVF patients with non-male factor infertility, subjecting some sibling oocytes to ICSI increased the fertilization rate and formation of good-quality embryos per retrieved oocyte. It also avoided the problem of total fertilization failure in almost all cases.     

Cryptic sperm defects may be the cause for total fertilization failure in oocyte donor cycles

In conventional IVF cycles with total fertilization failure, rescue intracytoplasmic sperm injection (ICSI) performed 24h after insemination has yielded poor results. However, when ICSI is used, total fertilization failure is a rare event. The aim of the present study is to investigate the degree of sperm contribution to fertilization failures using the egg-sharing model in oocyte donor cycles. The study included only the oocyte donor cycles of sibling oocytes with total fertilization failure in at least one of the matched recipients. Oocytes from 49 oocyte donor cycles were equally shared among 98 recipients undergoing conventional IVF. Due to total fertilization failure in half of the recipients, rescue ICSI was carried out. Compared with the conventional IVF only group, the rescue ICSI group had a lower pregnancy rate (30.61% versus 71.43%), clinical pregnancy rate (28.57% versus 67.35%) and ongoing pregnancy rate (28.57% versus 63.27%) (all P<0.01). Cryptic sperm defects in apparently normal spermatozoa may be the cause of total fertilization failure, indicating the need for simple routine tests to detect them.     

Comparison of clinical outcomes between conventional in vitro fertilization and intracytoplasmic sperm injection in poor responders with only single oocyte retrieved

ObjectiveTo compare the clinical outcomes between conventional insemination (IVF) and intracytoplasmic sperm injection (ICSI) in poor responders with only a single oocyte retrieved.Materials and methodsThis is a retrospective case–control study. Couples who were treated with assisted reproductive technology (ART) with a single oocyte retrieved in Mackay Memorial Hospital from 1996 to 2016 were recruited. All data were categorized into three groups, according to their fertilization method and semen quality: group A, conventional insemination with non-male factor (IVF-NMF, n = 115), group B, ICSI with male factor (ICSI-MF, n = 30), and group C, ICSI with non-male factor (ICSI-NMF, n = 49).ResultsNo statistically significant difference was observed between IVF and ICSI groups in pregnancy outcomes, including the chemical or clinical pregnancy rate, miscarriage rate, and live birth rate. Similar fertilization rates per oocyte obtained were observed in IVF and ICSI patients, but significantly lower per mature oocyte in the ICSI group (IVF: 91.5%, ICSI-MF: 75.0%, ICSI-NMF: 77.8%). Although there is no statistical significance, the lower live birth rate is observed in group C than others (A:11.5%, B:25%, C:5%, p = 0.187).ConclusionIn this study, pregnancy outcomes of conventional in vitro fertilization and ICSI in poor responders with only a single oocyte retrieved were similar. However, the fertilization rate of matured oocytes in ICSI groups is significantly lower than that in the IVF group, indicating that ICSI procedures might cause oocyte damage. Therefore, the choice of fertilization method should be based on semen quality. A randomized controlled trial should be performed to confirm our findings.     

Fertilization after standard in vitro fertilization versus intracytoplasmic sperm injection in subfertile males using sibling oocytes

OBJECTIVE: To compare conventional IVF with ICSI in the subfertile male population using sibling oocytes. Results from males with isolated severe teratozoospermia also are analyzed. DESIGN: Prospective experimental study. SETTING: University based IVF clinic. PATIENT(S): Group A: 18 patients with one or more abnormalities in count, motility, or morphology. Group B: 20 patients with isolated severe teratozoospermia (< or = 4% Kruger Strict Criteria). INTERVENTION(S): Ovulation induction, random allocation of sibling oocytes, and IVF or ICSI. MAIN OUTCOME MEASURE(s): Fertilization rates (fertilization per cycle, fertilization per oocytes, and fertilization per couple) and embryo quality. RESULT(S): In group A, fertilization occurred in 13 of 18 (72%) of IVF cycles and 17 of 18 (94%) of ICSI cycles. Overall, 69 of 120 (58%) oocytes fertilized after IVF, whereas 80 of 131 (61%) fertilized after ICSI. The mean (+/-SEM) percent of oocytes fertilized per couple was 44.6%+/-9.0% with IVF and 62.7%+/-5.6% with ICSI (not statistically significant). In group B, fertilization occurred in 18 of 20 (90%) cycles after IVF and 20 of 20 (100%) cycles with ICSI. Overall, 54 of 113 (48%) of the oocytes fertilized after IVF, whereas 82 of 124 (66%) fertilized with ICSI. The mean (+/-SEM) percent of oocytes fertilized per couple was 50.9%+/-7.1 % with IVF and 66.6%+/-4.7% with ICSI. No statistically significant difference in embryo quality after IVF versus ICSI was demonstrated. CONCLUSION(S): With severe teratozoospermia, ICSI results in higher fertilization rates than conventional IVF, without altering embryo quality. In our subfertile male population, there is a trend toward improved fertilization with ICSI, with less failed fertilization.     

Outcome of conventional IVF and ICSI on sibling oocytes in patients suffering from teratospermia

OBJECTIVE: To compare the outcomes of conventional IVF and ICSI on sibling oocytes. DESIGN: Retrospective analysis. METHODS: Performance of ICSI on part of the oocytes and IVF on the remaining portion during the same cycle (sibling oocytes). PATIENTS:135 couples (141 cycles) with male subfertility or with idiopathic infertility. RESULTS: Globally, the fertilization rate was not different between the ICSI and IVF, however, in patients with severe teratospermia, it was higher after ICSI (56.2 vs. 44.2 %, p<0.05). The fertilization failure rate was higher in the IVF group than in the ICSI group, globally, (12.1 % vs 2.8 %, p = 0.005), as well in patients with severe teratospermia. In the latter group, a higher number of top quality embryos were obtained after ICSI than after IVF. Of 57 cycles with severe teratospermia, only ICSI-embryos were transferred in 24, while only IVF-embryos were transferred in 11, resulting respectively in 8 and 3 clinical pregnancies. CONCLUSION: This study underscores that ICSI is useful in patients with teratospermia. Nevertheless, considering the chances of obtaining a successful fertilization after IVF and lower risk of chromosomal aberrations, we recommend performing both IVF and ICSI on sibling oocytes during the first treatment cycle in patients with teratospermia.     

Late Fertilization of Unfertilized Human Oocytes in In Vitro Fertilization and Intracytoplasmic Sperm Injection Cycles: Conventional Insemination versus ICSI

Purpose: The aim of this study was to evaluate the efficacyof intracytoplasmic sperm injection (ICSI) in comparisonwith conventional reinsemination using fertilization failedoocytes by conventional in vitro fertilization (IVF). Methods: Oocytes were collected from patients of IVF orICSI cycles. Patients were grouped by fertilizationtechniques: group 1: conventional IVF; group 2: reinseminationafter conventional IVF failure; group 3: regular ICSI; group4: 1-day-old ICSI after conventional IVF failure; group 5:2-day-old ICSI after conventional IVF failure; group 6:re-ICSI after regular ICSI failure. Results: In different insemination groups, normalfertilization rate was higher (P < 0.001) in 1-day-old ICSI (47.1%)and 2-day-old ICSI groups (40.0%) than in reinsemination(14.7%). Abnormal fertilization rate was higher (P < 0.05)in re-ICSI group (21.7%) than any other groups (range:0–8%). Cleavage rate was higher in 1-day-old (36.7%)and 2-day-old ICSI groups (36.0%) than in reinsemination(5.3%, P < 0.001) or re-ICSI groups (17.4%, P < 0.05).Pregnancy rate was 27.6% and 20.0% in conventional IVFand regular ICSI groups, respectively. However, 1-day-oldICSI (group 4) and 2-day-old ICSI (group 5) were attemptedonce embryo transfer (ET) but failed pregnancy occurredin each group. Conclusions: In fertilization failure cycles, late ICSIincreases the rate of fertilization and embryonic developmentand may rescue the completely failed attempt of pregnancy.     

体外受精治疗不明原因不孕受精方法的探讨

目的:探讨不明原因不孕患者体外受精方式的选择。方法:将每例不明原因不孕患者(35例)超促排卵获取的卵母细胞随机分为二组,分别行常规体外受精(A组)和ICSI受精(B组),比较二组的受精结局、妊娠率及着床率。结果:A组受精率(51.2%)低于B组(61.3%,P<0.05);而完全受精失败率(20.0%)明显高于B组(2.8%,P<0.05);二组的优质胚胎率、临床妊娠率、着床率无差异。结论:不明原因不孕患者行首次IVF治疗时,采用部分卵母细胞常规受精、部分卵母细胞ICSI的方法,可降低完全受精失败风险。     

A strategy for treatment of couples with unexplained infertility who failed to conceive after intrauterine insemination

Couples with unexplained infertility treated unsuccessfully with intrauterine insemination often receive further treatment with IVF or intracytoplasmic sperm injection (ICSI). The aim of this study was to evaluate the frequency of fertilization and fertilization failure with respect to the method of fertilization used, when half of the sibling oocytes were fertilized by conventional IVF and insemination and the remainder by ICSI. Included was the first IVF/ICSI treatment of 248 unexplained infertile couples who had failed to conceive after three IUI cycles. An overall pregnancy rate per embryo transfer of 57% was observed. A significantly better fertilization rate was obtained after ICSI as compared with IVF (68 versus 46%) (P < 0.005), and total fertilization failure following ICSI and IVF treatment was seen in 4.4 and 25% of the cycles respectively. The group who experienced total fertilization failure after IVF had normal semen parameters, although significantly lower sperm concentration and motility as compared with the entire study group. Transfer of their ICSI-fertilized oocytes subsequently resulted in a pregnancy rate of 49.2% per transfer. The policy of splitting the sibling oocytes can effectively minimize complete fertilization failure while maintaining high chances of achieving a pregnancy. At the same time, the optimal fertilization method for subsequent treatment cycles can be determined.     

常规IVF中受精失败相关因素及后续处理结果分析

目的:分析常规IVF受精失败原因,以进一步提高IVF受精率。方法:回顾性分析常规IVF中受精率低下或受精失败患者的各种因素及后续处理结果。结果:438个常规IVF取卵周期中,受精率≤25%的周期30个(A组)(6.85%)。其中12个周期第1日行补救性ICSI或重复IVF,最终共20个周期进行了胚胎移植,但均未获得临床妊娠。与受精率正常的周期(B组)相比,A组精子密度、活率、a级精子比例、前向运动精子比例(PMS)及分离后的精子活率、PMS比例、精子密度等均显著降低(P均<0.05)。组间的获卵数无明显差别,但A组MI期及GV期卵的数量明显高于B组(P<0.01)。其他受精失败因素包括对精子因素导致受精失败的7例在随后的周期进行ICSI,5例获得临床妊娠。结论:受精失败的原因是多方面的,但精液各参数下降及卵子发育不成熟是其主要原因;第1日行补救性ICSI或重复IVF的妊娠结局差;对于精子因素造成的受精失败,在以后的周期中行ICSI能获得理想的结果。     

Embryological indicators in cycles with HCG or different doses of GnRH-a for the final oocyte maturation in IVF–ICSI patients

Abstract

So far there is no consensus on the optimal dosage of GnRH-a when using it as a trigger for final oocyte maturation in in vitro fertilization (IVF) cycles. We compared embryological characteristics in IVF–intra-cytoplasmic sperm injection (ICSI) cycles when applying triptorelin at a dose of 0.2?mg (test group 2), 0.5?mg (test group 3) and human chorionic gonadotropin (HCG) at a dose of 10?000?IU (test group 1). In group 1, the average number of oocytes per oocyte retrieval (11.7?±?4.8) was lower in comparison with groups 2 and 3, which can be explained by the differences in the selection of the patients’. The number of oocytes per retrieval in group 3 (20.2?±?6.3) was significantly higher (p?=?0.02) compared to group 2 (17.0?±?6.2). The percentage of mature oocytes (MII) and fertilization rate did not differ between the groups. The rate of blastocyst formation in group 3 (71.9?±?17.1%) was significantly higher (p?=?0.02) in comparison with group 2 (57.9?±?24%). We conclude that the application of triptorelin at a dose of 0.5?mg may be more effective for triggering final oocyte maturation in IVF cycles in comparison with the dose of 0.2?mg, due to the increase in the number of retrieved oocytes and the improved rate of the blastocyst formation.     

Oral antioxidants supplementation for women with unexplained infertility undergoing ICSI/IVF: Randomized controlled trial

Objective: Good oocyte quality and maturity are important prerequisites for high fertilization and implantation rates in IVF/ICSI treatment cycles. Reactive oxygen species (ROS) are produced within ovarian follicles, especially during the ovulation process, and increased ROS activity may be a cause of impaired oocyte maturation and higher rate of failure of IVF/ICSI cycles. Study design: RCT evaluating the effect of antioxidant supplementation on ICSI/IVF outcomes. Two hundred and eighteen women with unexplained subfertility undergoing IVF/ICSI were randomized into two groups. The study group (n = 112) received daily oral antioxidants in the form of multivitamins and minerals (amino acid chelated) while the control group (n = 106) did not. Main outcomes were number of mature metaphase II (MII) oocytes and clinical pregnancy rate. Results: There were no significant changes between the groups as regards age, BMI, basal FSH, number of mature (MII) oocytes (12.7 ± 9.4 vs. 13.2 ± 8.6, P = 0.7) and clinical pregnancy rate per woman randomized (38% vs. 34%; [OR = 1.2; 95% CI, 0.70–2.11]. Conclusion: Oral antioxidants in the form of a combination of multivitamins and minerals (amino acid chelated) did not improve oocyte quality and pregnancy rates in women with unexplained infertility undergoing IVF/ICSI treatment.     

Comparison of in-vitro outcomes from cryopreserved oocytes and sibling fresh oocytes

In Italy, the restrictive IVF law generalizes the indication for oocyte freezing for surplus oocytes in 78.5% of in-vitro assisted reproductive cycles. With a view to understanding better what the prospects for intracytoplasmic sperm injection (ICSI) on frozen-thawed oocytes might be, the consequences of freeze-thaw procedures on fertilization, cleavage rates and embryo quality obtained from frozen-thawed oocytes were studied and compared with the results obtained from sibling fresh oocytes. Eleven IVF and 29 ICSI on 76 and 169 fresh oocytes were performed and the corresponding 40 ICSI on 221 sibling frozen-thawed oocytes. There was no difference in terms of fertilization rate between fresh and sibling frozen-thawed oocytes. The cleavage rate (98.0 and 94.4% with fresh oocytes in IVF and ICSI; 77.3% with frozen-thawed oocytes in ICSI; P < 0.001) and embryo quality (grade I embryos over total embryos: 36.7 and 22.2% with fresh oocytes in IVF and ICSI; 12.1% with frozen-thawed oocytes in ICSI; respectively P < 0.001 and P < 0.05) were statistically lower after oocyte cryopreservation. The significant decrease in meiotic spindle retrieval rate before freezing (62.4%) and after thawing procedures (43.4%; P < 0.001) suggests that cryoconservation induces irreversible damage to microtubule repolymerization. The consequences of oocyte cryopreservation procedures on embryo development are reviewed.     

不明原因不孕患者体外受精方式的探讨

目的探讨不明原因不孕患者行首次体外受精(IVF)治疗时受精方式的选择。方法对2004年6月至2005年12月在北京大学第三医院行IVF治疗的35例不明原因不孕患者,将其卵母细胞分为2组,同时行常规受精和卵胞浆内单精子注射受精(ICSI),比较2组的受精结局、妊娠率及着床率。结果常规受精组受精率(51.2%)低于ICSI组(61.3%),差异有统计学意义(P<0.05);而完全受精失败率(20.0%)明显高于ICSI组(2.8%),差异有统计学意义(P<0.05);2组的优质胚胎率、临床妊娠率、着床率差异无统计学意义。结论不明原因不孕患者行首次IVF治疗时,采用部分卵母细胞常规受精、部分卵母细胞ICSI的方法,可降低完全受精失败风险。     

Comparison of embryo quality between intracytoplasmic sperm injection and in vitro fertilization in sibling oocytes

Background The aim of the present study was to compare the quality of embryos derived from sibling oocytes by in vitro fertilization (IVF) or ICSI. Methods Consecutive patients with a less than 40% fertilization rate in a previous standard IVF cycle or with relative male factor infertility were recruited for the study. The oocytes retrieved from each patient were divided into two groups for either conventional insemination (group A) or ICSI (group B). Power analysis showed that to detect a 25% difference in the rate of high-quality embryos between the groups with a power of 0.8, at least 1,200 oocytes were needed in each group. Results One hundred seventy-seven patients were included in the study. Group A was comprised of 1,526 oocytes and group B of 1,480 sibling oocytes. As expected, the fertilization rate was significantly higher in group B than group A (67.1 vs. 43.6%, p < 0.001). No significant between-group differences were observed in cleavage rate (92.7 and 89.7%, respectively) and the rate of either grade A embryos (22.6 and 23.9%, respectively) or grade A₁ embryos (37.3 and 33.5%, respectively). However, in the subgroup of patients with relative male-factor infertility (n = 36), the rate of grade A₁ embryos was significantly higher in the IVF than the ICSI group (46.4 vs. 29.0%, respectively, p = 0.02). Conclusions Embryo quality does not seem to be influenced by the mode of fertilization (IVF or ICSI). We assume that embryo quality depends on intrinsic factors of the gametes involved rather than on the fertilization process per se. Capsule Embryo quality does not seem to be influenced by the mode of fertilization but depends on intrinsic factors of the gametes involved.     

High proportion of immature oocytes in a cohort reduces fertilization,embryo development,pregnancy and live birth rates following ICSI

Research questionOoplasmic maturity has been studied for some time, but remains poorly defined. This study aimed to evaluate metaphase II (MII) oocyte competence in terms of fertilization, embryo development and cycle outcomes, according to the oocyte maturity ratio.DesignCouples treated by intracytoplasmic sperm injection (ICSI) between 1993 and 2017 with female partners ≤35 years old were included. Cycles were divided into four groups according to proportion of MII oocytes at the time of retrieval: optimal (76–100%), adequate (51–75%), partial (26–50%) and minimal (1–25%).ResultsA total of 7672 ICSI cycles (optimal: 4838; adequate: 2252; partial: 518; minimal oocyte maturity: 64) were included, in which 95,667 MII oocytes were injected using ejaculated spermatozoa. The decreasing proportion of MII significantly reduced normal fertilization (two pronuclei) (78.9% to 71.3%; P < 0.0001) with a corresponding increase in digynic three-pronuclei that rose from 2.6% in the optimal group to 4.7% in the minimal group (P = 0.003). Implantation (33% to 17%; P < 0.0001), clinical pregnancy (63.6% to 37.5%; P < 0.0001) and live birth rates (49.2% to 26.6%; P < 0.0001) were affected by the decreasing proportion of MII oocytes.ConclusionsA high proportion of immature sibling oocytes in the retrieved cohort affects the fertilization rate and embryo developmental competence of MII inseminated oocytes, clinical pregnancy and live birth rates, suggesting that, in addition to nuclear maturity, ooplasmic and membrane maturity are required for developmental competence of MII oocytes. These findings may provide guidance toward ovarian stimulation protocols aimed at achieving a greater proportion of MII oocytes, leading to higher fertilization rates and better pregnancy outcomes.     

Surgically retrieved spermatozoa versus ejaculated spermatozoa in modified natural IVF–ICSI cycles

A retrospective cohort study was performed to evaluate the outcome of modified natural IVF–intracytoplasmic sperm injection (mnIVF–ICSI) cycles to compare 81 mnIVF–ICSI first cycles using ejaculated spermatozoa with 44 mnIVF–ICSI first cycles using surgically retrieved spermatozoa. There were no differences between the two groups in terms of number of oocytes retrieved, oocyte maturity or female age. However, male age was significantly higher in the surgically retrieved compared with the ejaculated group (41.5 versus 36.5 years, P = 0.001). There were no significant differences in fertilization rate or cleavage rate between the ejaculated and the surgically retrieved groups; however the prevalence of embryo transfer was higher in the surgically retrieved group (65.9% versus 45.7%, P = 0.03). Only single-embryo transfer was performed. Biochemical (34.5% versus 37.8%) and clinical (31.0% versus 35.1%) pregnancy rates per embryo transfer were similar between the ejaculated and the surgically retrieved groups. The data suggest that mnIVF–ICSI is an alternative treatment option in couples with severe male factor infertility where surgical sperm retrieval is required.The aim of the present study was to evaluate and compare the outcomes of modified natural IVF–intracytoplasmic sperm injection (mnIVF–ICSI) with surgically retrieved spermatozoa (in male partners with obstructive azoospermia) and ejaculated spermatozoa (in couples with mild-to-moderate male factor). Eighty-one mnIVF–ICSI first cycles using ejaculated spermatozoa were compared with forty-four mnIVF–ICSI first cycles using surgically retrieved spermatozoa. There were no differences between the two groups in terms of number of oocytes retrieved, oocyte maturity or female age. However, male age was significantly higher in the surgically retrieved compared with the ejaculated group. There were no significant differences in fertilization rate, or cleavage rate between the two groups; however, there were more patients having embryo transfers in the surgically retrieved group. Only single-embryo transfer was performed. Biochemical and clinical pregnancy rates per embryo transfer were similar between both groups. The data suggest that mnIVF–ICSI is an alternative treatment option in couples with severe male factor infertility where surgical sperm retrieval is required.     

In vitro fertilization-intracytoplasmic sperm injection split: an insemination method to prevent fertilization failure

OBJECTIVE: To determine whether the performance of intracytoplasmic sperm injection (ICSI) in cases of unexplained infertility and of borderline semen parameters can prevent fertilization failure. DESIGN: Prospective cohort study. SETTING: Hospital-based assisted reproductive technology program. PATIENT(S): Sixty couples with unexplained infertility (group 1) and 50 couples with borderline semen (group 2). INTERVENTION(S): Conventional IVF and ICSI were performed on sibling oocyte cumulus complexes. MAIN OUTCOME MEASURE(S): Rate of fertilization according to patient diagnosis. RESULT(S): The fertilization rate per oocyte cumulus complex in couples with unexplained infertility (group 1) was significantly higher with ICSI (65.3%) compared with IVF insemination (48.1%). Fertilization rates per OCC in couples with borderline semen (group 2) were not significantly different between ICSI (58.1%) and IVF (56.7%). In group 1, failure of fertilization after IVF insemination occurred in 10 of the 60 couples (16.7%) and in none with ICSI. In group 2, 2 of 50 couples (4.0%) failed fertilization by IVF, and 1 (2.0%) failed with ICSI. No couple in group 2 failed both IVF insemination and ICSI. CONCLUSION(S): In couples with unexplained infertility, a higher fertilization rate was achieved through ICSI compared with conventional IVF. No such benefit could be demonstrated for couples with borderline semen parameters. The use of ICSI rescued 12 of 110 cycles (10.9%) where IVF failed. Adoption of the ICSI-IVF insemination split in cases of unexplained infertility may help eliminate fertilization failures.     

Conventional IVF versus ICSI in sibling oocytes from couples with endometriosis and normozoospermic semen

Purpose

This study compares the fertilization rate and embryonic development of oocytes randomly inseminated by conventional IVF or ICSI in patients with endometriosis and normozoospermic semen during IVF cycles.

Methods

Sibling oocytes were randomized to be inseminated either by ICSI or IVF. Rates of fertilization, cleavage, blastulation and embryonic morphology were assessed.

Results

A total of 786 sibling cumulus-oocyte complexes (COC) were randomized between insemination by conventional IVF (387 COC) or ICSI (399 COC). A significantly higher fertilization rate was found in the ICSI group (ICSI versus IVF, 73.3±23 % versus 54.7±31.9 % respectively; P=0.003), yielding a higher mean number of day 2 embryos (5.2±3.4 versus 3.6±2.9 respectively; P=0.002). Triploid fertilization rate (3PN/COC) was significantly higher in the IVF group compared to the ICSI group (3.9±8.7 % versus 0.9±3.1 % respectively; P=0.02). The morphology score and rate of development of day 2 and 3 embryos were not different between the two groups. Comparison of embryo transfer cycles in which either IVF or ICSI only embryos were transferred did not reveal any statistically significant differences in pregnancy or implantation rates.

Conclusion

ICSI appears to be a better treatment option than conventional IVF in endometriosis-associated infertility, since it offers the advantages of higher fertilization rate and mean number of embryos and lower rate of total fertilization failure and triploid fertilization.