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Subzonal insertion of multiple sperm is a treatment for male factor infertility
J Catt1, U Krzyminska, L Tilia
1Human Reproduction Unit, Royal North Shore Hospital, St. Leonards, New South Wales, Australia.
Objective:
To determine whether subzonal insemination of multiple sperm is an effective treatment for male factor infertility.
Design:
Subzonal insemination by micromanipulation of sperm and oocytes for male factor patients.
Patients:
Two hundred eight patients were selected on previous fertilization history and/or semen parameters. They could be assigned to one of three groups: group A had previous IVF failure, group B had a low fertilization rate with previous IVF, and group C had insufficient sperm for IVF.
Interventions:
Oocytes were inseminated by subzonal insertion of multiple sperm.
Main Outcome Measures:
Fertilization and pregnancy rates.
Results:
There have been 208 patients treated through 332 treatment cycles. Of 2,789 oocytes inseminated, 784 oocytes were fertilized (28%) and 516 of these (66%) were monospermic. This represents normal fertilization in 207 cycles (62% of total patient cycles). These 207 cycles produced an average of 2.6 +/- 1.8 embryos. The resultant 487 embryos were either transferred or cryopreserved for future transfer. A total of 42 pregnancies (21% per ET) resulted from 200 ET procedures with 397 embryos. Miscarriages or elective terminations have occurred (11/42 pregnancies, 26% to date) and 21 deliveries have resulted in 26 babies. There are nine ongoing pregnancies. Three of the pregnancies have been from cryopreserved embryos. Group B patients had the highest fertilization rate (23%) but the lowest pregnancy rate (7%). No other significant relationships between patient group and outcome were found.
Conclusions:
Subzonal insemination of multiple sperm is an effective treatment for some forms of male factor infertility.