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Fertilization after standard in vitro fertilization versus intracytoplasmic sperm injection in subfertile males using
M D Pisarska1, P R Casson, P L Cisneros
1Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas 77030, USA.
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.