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Intracytoplasmic sperm injection: a major advance in the management of severe male subfertility
O Harari1, H Bourne, M McDonald
1Reproductive Biology Unit, Royal Women's Hospital, Carlton, Victoria, Australia.
Objective:
To determine the success of intracytoplasmic sperm injection for severe male infertility.
Design:
A retrospective survey.
Setting:
A tertiary infertility service.
Patients And Interventions:
One hundred fourteen couples had 119 intracytoplasmic sperm injection treatments because of previous failure of standard IVF, poor results with subzonal insemination, sperm concentration < 2 x 10(6)/mL, other sperm defects, or male genital tract obstruction.
Main Outcome Measures:
Fertilization, implantation, and pregnancy rates.
Results:
Of 1,185 oocytes treated by intracytoplasmic sperm injection, normal fertilization and cleavage occurred in 717 of 1,073 that survived (67% normal fertilization rate). Abnormal fertilization occurred in 113 oocytes (11% abnormal fertilization rate) and 112 oocytes did not survive the procedure (survival rate of 90%). In 117 couples, 251 embryos were transferred fresh, 409 embryos were cryopreserved, and 224 were transferred after thawing. The implantation rate was 7.4% (fetal heart per embryo transferred). To date 36 clinical pregnancies have been achieved (12% per fresh transfer, 20% per frozen transfer, and 30% overall), 24 are ongoing or delivered (6% per fresh transfer, 14% per frozen transfer, and 20% per intracytoplasmic sperm injection). The fertilization rates were the same (65%) with various sperm defects but higher with genital tract obstructions (75%).
Conclusion:
Intracytoplasmic sperm injection has improved the prognosis of severe male infertility.