[Diagnostic in-vitro fertilization]

Unexplained sterility is one of the major problems in the treatment of childless couples. The reason for sterility can be the result of different factors such as andrological or anatomic-physiological dysfunctions. The therapeutic approach to treat patients with unexplained sterility at the Department of Obstetrics and Gynecology, University of Goettingen, is, to exclude those patients from further therapies who obviously have no chance to become pregnant by any technique of reproductive medicine. A so called "diagnostical IVF" gives information about the fertilization capacity of male and female gametes in vitro. The results of a one year study with 85 couples (tubal sterility = 57; idiopathic sterility = 28) indicated, that even with no differences in the number of oocytes retrieved, the fertilization and cleavage rates were significantly higher in the group of patients with tubal sterility (fertilization rate: 63.1% vs 46.1%; cleavage rate: 57.5% vs 40.6%). Thus the transfer rate in patients with unexplained sterility was about 15% lower (68.9%) than in patients with tubal sterility (85.6%). On the other hand, after embryo transfer the pregnancy rate was double in those patients with unexplained sterility (38.7 vs 15.7%). If there is no fertilization of the oocytes in at least two IVF cycles all attempts to fulfill the patients desire for a child seem useless. In contrast successful in vitro fertilization provide the bases for further intrauterine insemination cycles which can be assisted by psychotherapy. This regimen seems helpful to classify patients with unexplained sterility and avoids long lasting frustrating therapies.