不同精子来源及授精方式对剩余胚胎继续囊胚培养结局的影响

目的:探讨不同精子来源及不同授精方式对胚胎继续发育能力的影响。方法:分析499例患者499个取卵周期剩余胚胎继续培养形成囊胚的情况,按精子来源不同分为供精IVF(D-IVF)组和夫精IVF(H-IVF)组,按授精方式不同分为IVF组和ICSI组,ICSI组按精子来源分为新鲜精液组、附睾精子和睾丸精子组,比较不同精子来源及授精方式获得剩余胚胎的囊胚形成率、胚胎利用率和无囊胚移植率。结果:① D-IVF组和H-IVF组受精率、卵裂率、优质胚胎率、第3日和第5日胚胎种植率、临床妊娠率和流产率均无统计学差异(P0.05),组间剩余胚胎囊胚形成率、胚胎利用率和无囊胚移植率亦无统计学差异(P0.05);②ICSI组与IVF组比较,其受精率较高(P0.05),但优质胚胎率显著下降,有统计学差异(55.11%vs 61.30%,P0.05),组间第3日卵裂期胚胎和剩余胚胎囊胚种植率、临床妊娠率无统计学差异(P0.05),但ICSI组与IVF组比较,其剩余胚胎囊胚形成率、胚胎利用率稍低,无囊胚移植率较IVF组稍高,差异有统计学意义(56.13%vs 65.32%,48.18%vs 55.39%,21.68%vs 13.20%,P0.05)。③新鲜精液组的优质胚胎率、胚胎利用率显著低于附睾精子和睾丸精子组(P0.05),各组囊胚移植的种植率和临床妊娠率无统计学差异(P0.05)。结论:D-IVF可获得H-IVF相似的结局,其剩余胚胎都有较高的发育潜能,ICSI获得的剩余胚胎发育潜能低于IVF组。附睾精子和睾丸精子ICSI后获得的胚胎比新鲜精液精子ICSI后胚胎发育潜能高。针对不同的授精方式可能需要制定相应的剩余胚胎囊胚培养标准。     

体外受精-胚胎移植中的胚胎污染与预防

胚胎污染在体外受精-胚胎移植中发生率虽不高,但发生后常导致胚胎死亡,甚至危及整个培养体系,后果极为严重。体外受精的各个环节都有可能导致胚胎污染的发生,精液是污染的主要来源,其次为卵泡液和IVF培养体系及环境。细菌对精子的结构和功能都会造成不同程度的影响,由细菌释放的内毒素也对配子和胚胎有着明显的毒性效应,需要引起生殖医学临床医生和实验室人员的共同重视。严格的会阴部清洗后取精、单纯的普通上游法处理精液和使用含有微量抗生素的培养液处理精子、卵子均可有效去除其中的绝大部分细菌。     

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。     

精子形态对体外受精胚胎移植妊娠结局的影响

目的：分析男性精液参数与卵裂率、优质胚胎率及妊娠率的相关性,探讨体外受精-胚胎移植（IVF-ET）周期中精子形态对精子功能的影响。方法：分析82个受精率100%的IVF-ET周期。以Diff-Quickstain方法染色,密度梯度离心法处理精液,WHO精子形态学标准评估精子形态,精子正常形态率≥14%为正常组,〈14%者为异常组。观察精液处理前后精子参数变化,比较妊娠组与未妊娠组的年龄、移植日子宫内膜厚度和精液各参数的情况。比较精液处理前后精子正常形态率与两组的正常受精率、卵裂率、优质胚胎率和妊娠率。结果：①密度梯度离心法处理后82例精液密度明显降低,活动力明显提高,差别有统计学意义。②精液处理前精子正常形态率：正常组11例（13.41%）,异常组71例（86.59%）;处理后正常组34例（41.46%）,异常组48例（58.53%）。异常组精液处理后正常精子形态的比例提高,中位数（P25,P75）分别为8.15%（6.38%,10.50%）vs.12.41%（9.98%,18.58%）,差别有统计学意义（P〈0.01）。③精液处理前精子正常形态率正常组和异常组的密度和活动力差别无统计学意义（P〉0.05）。④精液处理前后精子正常形态率正常组和异常组的妊娠率和优质胚胎率差异均无统计学意义（P〉0.05）;精子正常形态率正常组的卵裂率高于异常组（P〈0.05）。⑤妊娠组和未妊娠组除男女双方年龄差异有统计学意义外,移植日子宫内膜厚度和各精液参数差异均无统计学意义。结论：精子形态对妊娠结局无预测,密度梯度离心法能提高正常精子形态百分数,需根据精液处理后的结果选择受精方式。     

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。     

体外受精-胚胎移植周期透明带透亮致密患者的受精与临床结局

目的：探讨卵子透明带透亮致密患者行常规体外受精（IVF）或卵胞质内单精子显微注射（ICSI）后受精、胚胎发育情况及临床结局。方法：回顾性分析体外受精过程中卵子出现透明带透亮致密的43个周期,其中IvF周期27例,ICSI周期16例,比较受精率与正常受精比例、胚胎质量、临床妊娠结局。结果：27例IVF周期均未受精,行早期补救ICSI,其中23例完全不受精。补救后IVF总体受精率达64．83％,正常受精率59.32％;16例ICSI周期均受精,受精率和正常受精率分别为85．11％和79．01％,均显著高于IVF组（P〈0．05）。IVF组和ICSI组卵裂率分别为97．96％、95．65％,优质胚胎率分别为52．67％、43．75％,组间差异无统计学意义（P〉0．05）。IVF组妊娠率为37．04％,种植率为33．33％;ICSI组妊娠率为31．25％,种植率为25．00％,组间临床结局相近,无统计学差异（P〉0．05）。结论：透明带透亮致密患者的自然受精能力下降,需要采用ICSI方式授精。常规IVF受精失败后采用早期补救ICSI或直接行ICSI能明显改善透明带透亮致密患者的受精结局,但不能改善妊娠结局。     

体外受精失败后补行卵胞浆内单精子注射的临床价值探讨

目的:探讨卵胞浆内单精子注射(ICSI)在体外受精完全失败或受精率低于25%的常规IVF周期中的临床价值。方法:回顾分析2001.01-2004.12在我院生殖医学中心接受常规IVF治疗的35例非男性因素不育患者,取卵后体外受精培养16-18h,发现卵母细胞完全未受精或受精率低于25%,立即行ICSI再授精。结果:在24个常规IVF低于25%的周期中,共有197个未受精卵,其中159个MⅡ期卵,显微注射159个,受精123个,最终形成胚胎96个,受精率为77.4%,卵裂率为78.1%,在22个新鲜移植周期(每周期的移植胚胎由来源于常规体外受精卵和补救ICSI后受精卵的胚胎组成),共有4例临床妊娠;在8个冷冻移植周期中(每周期的移植胚胎完全来源于补救ICSI后的受精卵),有1例临床妊娠。在11个常规IVF完全失败周期中,共有89个未受精卵,其中78个MⅡ期卵,显微注射78个,受精63个,卵裂51个,受精率为80.7%,卵裂率为80.9%,在10个新鲜移植周期(每周期的移植胚胎完全来源于补救ICSI后的受精卵)中共有2例临床妊娠;在2个冷冻移植周期(每周期的移植胚胎完全来源于补救ICSI后的受精卵)中有1例单胎妊娠,妊娠早期流产。胚胎来源于常规体外受精卵和补救ICSI后受精卵的移植周期临床妊娠率为18%;胚胎完全来源于补行ICSI后受精卵的移植周期临床妊娠率为20%。结论:ICSI可作为常规IVF失败后的有效补救措施。     

未成熟卵母细胞体外培养在体外受精中对卵巢低反应性者的补救性应用

目的:探讨未成熟卵母细胞体外培养(IVM)在体外受精(IVF)中对卵巢低反应性者的补救性治疗效果。方法:30例行IVF时表现为卵巢低反应者(实验组)在B超引导下经阴道行卵泡穿刺术,取卵后对不同期未成熟卵母细胞行IVM,再行胞浆内单精子注射(ICSI)受精;对成熟卵母细胞则进行常规受精,胚胎形成后行移植术。取同期进行ICSI周期治疗的63例作为对照组。结果:应用IVM行IVF-ET补救治疗的30个周期中有29个周期获胚胎移植,临床妊娠9例(31%),胚胎种植率18.47%,但该组未成熟卵培养成熟后的受精率、卵裂率均低于对照组;总妊娠率及胚胎种植率比常规ICSI组低。结论:IVM技术联合IVF为卵巢低反应性者提供了一种有效的补救措施,明显减少了IVF周期的取消率,提高了妊娠机会。     

精子DNA碎片与体外受精结局的关系

目的:探讨精子DNA碎片与体外受精(in vitro fertilization,IVF)结局的关系。方法:采用染色质扩散实验(sperm chromatin dispersion,SCD)对242例接受IVF的男方进行精子DNA碎片率(DNAfragmentation index,DFI)检测,按照WHO标准进行精液常规分析,将精子DFI、精液常规参数和IVF受精率、卵裂率、可移植胚胎率、优质胚胎率进行Spearman相关分析,将精子DFI、精液常规参数对生化妊娠、临床妊娠的影响进行Logistic回归分析。结果:精子DFI与精子前向活动率呈负相关(r=-0.355,P<0.001);密度梯度法处理前、后精子DFI均与IVF受精率呈负相关(r=-0.223,P<0.001)(r=-0.136,P<0.05);精子DFI、精液常规参数与卵裂率、可移植胚胎率、优质胚胎率无相关性;精子DFI与生化妊娠、临床妊娠结局无相关性。结论:精子DFI影响精子活力与IVF受精率,精子DFI检测对预测IVF受精率有一定的临床意义。     

IVF周期精子处理前、后凋亡率与受精率和胚胎质量的相关性分析

目的:探讨体外受精-胚胎移植(IVF-ET)中精子处理前、后凋亡率的变化以及处理前、后精子凋亡率与受精率和胚胎质量的相关性。方法:收集行IVF者的精液55例,密度梯度离心结合上游法处理精液,IVF当日通过流式细胞术检测处理前、后精子凋亡指标——caspase-3(CP3)活化率,于受精后16 h、48 h、72 h分别观察受精率、卵裂率、优质胚胎率。结果:共获卵690枚,平均受精率、卵裂率、优质胚胎率分别为:84.49±14.92%、94.62±11.09%、47.11±27.17%;处理后精子CP3活化率较处理前有明显降低(22.84±6.05%vs 34.80±6.56%,P<0.05);处理前精子CP3活化率与受精率、卵裂率、优质胚胎率均无显著相关性(Spearman相关系数:0.056,0137,-0.060,P>0.05),处理后精子CP3活化率与受精率及优质胚胎率呈显著负相关(Spearman相关系数:-0.375,-0.416,P<0.01),与卵裂率无显著相关性(Spearman相关系数:-0.156,P>0.05)。结论:密度梯度离心结合上游法处理精子后可以显著降低精子凋亡率,处理后精子凋亡率可能影响受精率和优质胚胎率,可为临床预测受精结局及胚胎发育情况提供参考指标。     

Effect of contaminated preprocessed semen on fertilization rate and embryo quality in assisted reproductive techniques.

We aimed to identify the sources and prevalence of semen contamination from mastrubation and determine the effect of bacterospermia on fertilization rate and embryo quality in standard in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI). This was a prospective controlled study, in an IVF unit of a university teaching hospital, of 93 consecutive couples undergoing IVF-embryo transfer cycles. We evaluated handwashing; semen collection and processing; and assisted reproductive technology using semen provided by masturbation. The main outcome measures were presence and type of micro-organisms in the semen samples and embryo culture medium; the effect of hand washing on rate of contamination; and the effect of semen contamination on fertilization rate and embryo quality. The first consecutive 52 men of the 93 couples were not instructed to wash their hands before masturbation, and the remainder were so instructed. Forty-nine semen cultures (94.2%) in the first group were contaminated compared to only 16 (39%) in the second (p < 0.016); 27 of the 65 positive cultures (41.5%) were contaminated by more than one organism. The most common contaminators were bacteria usually found on the skin. All but four embryo medium cultures were negative. There was no significant difference in fertilization rate and embryo quality by culture findings in either the IVF or the ICSI procedures. We found that a high percentage of manually obtained semen for standard IVF or ICSI procedures was contaminated, but this had no effect on fertilization rate and embryo quality.     

体外受精过程中胚胎污染及其来源的探讨

目的 探讨体外受精过程中胚胎污染的发生率、污染菌种和污染的来源。方法 回顾性分析1999年1月至2003年6月,2174个体外受精-胚胎移植(IVF-ET)周期中胚胎污染的发生率及污染菌种;随机抽取IVF-ET中61例精液分析正常男性的精液和34例卵泡液进行细菌培养。结果 发生胚胎污染11例,发生率为0.51％(11/2174);污染菌种主要为大肠埃希菌(4例)和真菌(4例)。精液原液、处理后的精液上清液、精液原液与培养液的混合液及卵泡液细菌培养的阳性率分别为97％(29/30)、10％(3/30)、6％(2/31)及9％(3/34)。结论 在体外受精的过程中,可发生部分胚胎污染,污染的菌种主要为大肠埃希菌和真菌。精液中的细菌可能是胚胎污染的主要来源。     

Positive bacterial culture of semen from infertile men with asymptomatic leukocytospermia

OBJECTIVE: To examine results of semen culture in a population of infertile men with asymptomatic leukocytospermia, and to determine the correlation between culture results and sperm characteristics in these patients. METHODS: Semen samples were collected from a group of infertile men (n = 80) after 2-3 days of sexual abstinence. Standard semen analysis was performed according to World Health Organization (WHO) guidelines. Seminal leukocyte concentrations were determined by a myeloperoxidase staining technique. Culture of semen was performed on enriched and specific culture media. RESULTS: Based on the results of semen culture, the samples were classified into three groups: group 1 (enteric gram-negative bacilli [Enterobacteriaceae], n = 13), group 2 (bacteria other than Enterobacteriaceae, n = 15), and group 3 (negative cultures, n = 52). No correlation was found between positive semen culture and sperm characteristics (concentration, motility, and morphology). However, seminal leukocyte concentrations were negatively correlated with percentages of motile sperm and normal sperm morphology. CONCLUSION: Our data indicate that semen samples from infertile men with asymptomatic leukocytospermia may have bacterial contamination, evidenced by positive bacterial cultures. Lack of correlation between positive semen cultures and sperm characteristics may be indicative of early or mild (subclinical) infection.     

Transfer of IVF-contaminated blastocysts with removal of the zona pellucida resulted in live births

Purpose

Bacterial contamination may cause loss or damage to cultured oocytes or embryos, resulting in cancelation or delaying of a fresh embryo transfer. While live births have been reported following the transfer of embryos contaminated with yeast, very little information is available on how to handle embryos with bacterial contamination. We report two cases of successful pregnancy in patients with bacterial contamination of embryo culture dishes.

Methods

We retrospectively reviewed 878 oocyte retrievals performed between January 2011 and December 2014. Bacterial contamination was recorded in two split IVF/ICSI cases, where contamination occurred in embryo culture drops containing embryos from conventional insemination but not from ICSI on day 3.

Results

To minimize the adverse effects of bacterial contamination on transfer outcomes, we removed the zona pellucida of contaminated frozen blastocysts and successfully obtained clinical pregnancies following transfer of zona-free blastocysts that were previously contaminated during IVF culture.

Conclusions

Removal of the zona pellucida is an appropriate approach to handle blastocysts contaminated with bacteria during in vitro culture.

     

Abnormal bacterial colonisation of the vagina and implantation during assisted reproduction

OBJECTIVE: To evaluate the efficiency of our treatment of vaginal infection for couples included in an IVF program. PATIENTS AND METHODS: Microbiologic screening of vaginal flora and semen has been performed one month prior to in vitro fertilization for 951 couples in 2000. Antibiotic treatment was prescribed in case of positive culture. RESULTS: Positive microbial growths were observed from endocervical and vaginal cultures in 218 women (22.9%). The clinical pregnancy rate was 30.29% in the group of patients without growth and 30.27% in the group with positive microbial growth. The implantation rate was significantly diminished in case of bacterial growth: 14.6 compared to 19.3% (P <0.02) for sterile endocervical culture. Five main bacterial species were found at the cervical level: Candida albicans (69 cases), Ureaplasma urealyticum (49 cases), Gardnerella vaginalis (43 cases), Streptococcus B or D (24 cases) and Escherichia coli (22 cases). Positive cultures from both vagina and semen were observed for 77 couples whose clinical pregnancy rate was 19.5 vs 36.2% in case of vaginal infection alone (P <0.01) with a spontaneous miscarriage rate of 46.7 compared to 17.6% (P <0.01). DISCUSSION AND CONCLUSION: Endocervical microorganisms, even treated with adapted antibiotics, may affect embryonic implantation. Positive culture from both female and male partner may enhance this negative effect. In this case, the best strategy would be to cancel the IVF treatment.     

Studies on the significance of positive bacterial semen cultures in male fertility in Nigeria

OBJECTIVE: Early warning signals (EWS) of altered reproductive potential may be very important in the prevention and management of male infertility. The presence of bacteria in semen (bacterisemia) may be an EWS. This was evaluated by determining the incidence of bacteria in semen of males with fertility problems in Benin City by culturing their semen. METHODS: Diluted semen samples were cultured on blood agar, chocolate agar, MacConkey agar, nutrient agar, and sabouraud dextrose agar slants for the isolation of micro-organisms. Colonies of a single type of micro-organism (>10(3) cfu/mL) were picked for identification and sensitivity tests using antibacterial agents. Each semen sample was further processed for spermatozoal morphology and motility, presence of peroxidase-positive cells, and other accompanying cells. Correlative studies on the relationship between bacterisemia and semen/spermatozoa variables such as total number and motility were also done. RESULTS: Pathogenic micro-organisms were present in 78/163 (47.1%) semen samples. The microbial isolates were Staphylococcus aureus 35 (43.7%), Klebsiella species 22 (28.2%), Escherichia coli 9 (11.5%), and Candida albicans 6 (7.7%). The bacterial isolates were most sensitive to ceftazidime and pefloxacin, and least to amoxycillin and tetracycline. There was a positive correlation (r = .9774) between azoospermia in males and presence of Candida albicans in semen, as well as between the presence of micro-organisms and poor semen quality (r = .8563), and the presence of micro-organisms and reduced motility (r = .8246). CONCLUSION: Presence of pathogenic micro-organisms in semen, which may be related to a breach in the integrity of the blood-testes barrier, may provide early warning signals of impairment of male fertility.     

Examination of bacterial contamination at the time of embryo transfer, and its impact on the IVF/pregnancy outcome

Purpose This study was designed to examine the effect of bacterial contamination on in vitro fertilization treatment outcomes. Method In a prospective clinical trial, 152 patients aged 23–38 years, mean 33.3 ± 4.6, undergoing IVF treatment were selected for this study. During embryo transfer, separate samples were collected for microbial examination from the following sites: the fundus of the vagina, the cervix, the embryo culture medium prior and post-embryo transfer, the tip of the catheter, and the external sheet. All the samples were separately cultured to identify any bacteria or yeast present. Results Pregnancy rates in patients testing positive for Entrobacteriaceae (22.2% versus 51%) and Staphylococcus species (17.6% versus 44%) were significantly lower than those in the negative culture group (p < 0.001). The pregnancy rates do not seem to be affected by the other isolated microorganisms. Conclusion This study shows that the presence of vaginal–cervical microbial contamination at the time of embryo transfer is associated with significantly decreased pregnancy rates. The presence of vaginal-cervical microbial contamination, examined at embryo transfer, has revealed to negatively affect in-vitro fertilization treatment outcome     

Bacteriospermia and male infertility: a method for increasing the sensitivity of semen culture.

OBJECTIVE: To test a method for increasing the sensitivity of semen culture. Design-Prospective and transverse. Setting-Andrology clinic at a tertiary care health institution in Mexico City. PATIENTS: 65 infertile patients with abnormal semen, bacteriospermia detected on Gram stain and at least two previous negative semen cultures (<3 months) were included to test routine semen culture and a method including centrifugation of semen at 10,00 rpm for 20 minutes. Localization cultures were also carried out in all patients. MAIN OUTCOME MEASURE: Bacterial isolation in semen samples. RESULTS: Routine semen culture was positive in 22% of patients, while centrifuged aliquots of the same semen sample were positive in 52% of patients (chi2 = 6.60, P < .01). Enterococcus was isolated in 43% of patients, E. coli in 24%, coagulase-negative Staphylococcus in 19%, and U. urealyticum in 14%. Ninety percent of isolates corresponded to specimens from the urethra and the prostato-vesicular region. CONCLUSION: Sensitivity of semen culture increased with centrifugation of semen samples. Localization pattern and type of isolates suggest that these patients had chronic prostatitis and that episodic elimination of bacteria might also explain false negative semen cultures in patients with chronic asymptomatic infection of the accessory sex glands.     

Disordered zona pellucida-induced acrosome reaction and failure of in vitro fertilization in patients with unexplained infertility

OBJECTIVE: To determine the relationship between the zona pellucida (ZP)-induced acrosome reaction (AR) and fertilization rate and pregnancy rate in standard IVF and the frequency of disordered ZP-induced AR (DZPIAR) in patients with unexplained infertility. DESIGN: Prospective study. SETTING: Academic research and teaching tertiary hospital. PATIENTS: Patients with unexplained infertility with normal semen analysis. INTERVENTION: None. MAIN OUTCOME MEASURE: Semen analysis, the ZP-induced AR, and measurements of fertilization rate and pregnancy rate with in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI). RESULT(S): A statistically significant correlation was found for the ZP-induced AR and fertilization rate with standard IVF (n = 65). Patients with DZPIAR (ZP-induced AR of 16%, who had an average fertilization rate of 61%. The sensitivity and specificity of DZPIAR for prediction of IVF rates <30% and >or=30% were 80% and 86%, respectively. Of 260 patients screened, the frequency of DZPIAR was 29%. Ten patients with DZPIAR had an average fertilization rate of 15% and no pregnancy with initial IVF cycles, and a fertilization rate of 61% (with three live-birth pregnancies) with subsequent ICSI cycles. Another 33 patients with DZPIAR were treated with ICSI alone, with an average fertilization rate of 71% and a live-birth pregnancy rate of 17% per embryo transfer. Sixteen of the patients had live-birth pregnancies (including one set of twins) after undergoing an average of 3.2 embryo transfers. CONCLUSION(S): Patients with DZPIAR have a low or zero fertilization rate with standard IVF but high fertilization and pregnancy rates with ICSI. Up to 29% of patients with unexplained infertility with normal semen analysis may have this condition, which should be diagnosed and treated with ICSI rather then standard IVF.