[Andrologic indications for in vitro fertilization: is there a true therapeutic gain?]

Andrological indications for human in vitro fertilization (IVF) are assumed if this is not carried out because of gynaecologically conditioned sterility but to overcome poor semen quality. The fertilization rate of human oocytes in IVF is lower when oligo-astheno-terato-zoospermia (OAT syndrome) is present than in the case of normozoospermia, even if it can be guaranteed that the number of spermatozoa incubated is the same in each case. The further development of the fertilized oocyte following embryo transfer, however, does not depend on semen quality. There have been attempts to determine the fertilization ability of spermatozoa prior to their use in IVF in order to enhance the prognosis of the technique. The results of the hamster-oocyte penetration test (HOP test) correlate only poorly with the outcome of human IVF. Testing of the acrosome reaction in vitro is also unsuitable as a predictor of the results of IVF. So far, the "normality" of spermatozoa can only be demonstrated by the direct observation of fertilization of the oocyte. In view of the high costs of IVF, a controlled, randomized study comparing the success rates of IVF in andrological indications and of other treatment procedures is urgently necessary.