Conventional in vitro fertilization versus intracytoplasmic sperm injection in patients with borderline semen: a randomized study using sibling oocytes.

OBJECTIVE: To determine whether patients with borderline semen should be treated with conventional IVF or intracytoplasmic sperm injection (ICSI). DESIGN: Randomized study. SETTING: A university medical center in The Netherlands. PATIENT(S): One hundred six couples with borderline semen who were undergoing IVF and ICSI on sibling oocytes. INTERVENTION(S): Performing IVF and ICSI on sibling oocytes. MAIN OUTCOME MEASURE(S): Fertilization and pregnancy rates. RESULT(S): One thousand five hundred eighteen oocytes were collected in 106 oocyte retrievals: 849 oocytes were randomly allocated to ICSI, of which 761 were microinjected, and 669 oocytes were randomly assigned to IVF. In 26 of the 106 patients, there was fertilization only after ICSI and not after IVF (IVF- group). The fertilization rate was 51% (92/182 oocytes). In 78 patients, there was fertilization after both IVF and ICSI (IVF+ group); the fertilization rate was 51% for both the IVF- and ICSI-treated oocytes (271/528 oocytes and 334/658 oocytes, respectively). In 2 patients, there was no fertilization after either IVF (0/6 oocytes) or ICSI (0/9 oocytes). Patients of the IVF+ group had a higher total motile sperm count after preparation than did those of the IVF- group. More high-quality embryos were obtained after ICSI in patients of the IVF+ group. In 101 patients, embryo transfer was performed: 26 in the IVF- group and 75 in the IVF+ group. No significant differences were found with regard to pregnancy rates between those two groups: pregnancy rates were 54% in the IVF- group and 48% in the IVF+ group. CONCLUSION(S): Performing ICSI on at least some of the oocytes will avoid unnecessary fertilization failure in patients with borderline semen: in this study, 26 of 104 cycles (25%) were rescued by ICSI.

Cumulative live birth rates in cohorts of patients treated with in vitro fertilization or intracytoplasmic sperm injection.

OBJECTIVE: Follow-up of IVF/intracytoplasmic sperm injection (ICSI) patients to obtain accurate information concerning chances of live birth as well as early treatment dropout. Comparison of the cumulative pregnancy rates, established in cohorts, with those estimated with life table analysis to determine which method provides the most accurate data without overestimation. DESIGN: Retrospective longitudinal cohort study. SETTING: Academic medical IVF center. PATIENT(S): All 750 patients from the Leiden IVF center and another 706 patients from cooperating clinics starting IVF/ICSI treatment in the period 1996-2000. INTERVENTION(S): All observations were part of standard IVF/ICSI and cryopreservation protocols. MAIN OUTCOME MEASURE(S): Endpoints of this study were a first live birth or termination of treatment. Treatment cycles were followed until the end of 2002, pregnancy follow-up through September 2003. RESULT(S): The cumulative live birth rate for the Leiden cohort was 59.1%. In yearly cohorts this varied from 54.8% to 67.1%. Cumulative live birth rates were 61.8%-63.2% for unexplained infertility (n = 229), endometriosis (n = 19), and andrologic indication (n = 223). For tubal (n = 129) and hormonal (n = 46) indications the rates were 55.8% and 45.7%, respectively. The group of egg donation or surrogacy (n = 10) reached 40.0%, and patients with two or more indications (n = 84) 56.0%. For women < or = 35 years of age the cumulative live birth rate was 64.6%, for women 36-39 years of age it was 48.7%, and for women 40-42 years of age 31.0%. CONCLUSION(S): In contrast to estimation of expected cumulative pregnancy rates the cohort measurement does not overestimate success rates. It accurately reflects chances of both live birth as well as early treatment dropout. The cumulative live birth rate was 59.1%. Over time results improved and the contribution of cryopreservation increased.

Intracytoplasmic sperm injection as a treatment for unexplained total fertilization failure or low fertilization after conventional in vitro fertilization.

OBJECTIVE: To determine whether IVF or intracytoplasmic sperm injection (ICSI) should be the choice of treatment in case of a previous IVF attempt with unexplained total fertilization failure or low fertilization (<25%). DESIGN: Prospective study. SETTING: Leiden University Medical Center. PATIENT(S): Thirty-eight couples undergoing IVF and ICSI on sibling oocytes after a first IVF attempt with total fertilization failure or with low fertilization (<25%). INTERVENTION(S): Performing IVF and ICSI on sibling oocytes. MAIN OUTCOME MEASURE(S): Fertilization and (ongoing) pregnancy rate. RESULT(S): A total of 271 oocytes were collected in 24 oocyte retrievals in the total fertilization failure group. Hundred nine oocytes were randomly allocated to IVF and 12 were fertilized (11%); 162 sibling oocytes were allocated to ICSI and 78 were fertilized (48%). In 8 of the 24 patients fertilization occurred after IVF. The pregnancy rate after transfer of 1 IVF and 1 ICSI embryo (n = 3) was 67% and after the transfer of 2 ICSI embryos (n = 21) this was 52%. In the low fertilization group 169 oocytes were collected in 14 oocyte retrievals. Seventy-two oocytes were randomly allocated to IVF and 16 were fertilized (22%). Ninety-seven sibling oocytes were allocated to ICSI and 58 were fertilized (60%). In 7 of 14 patients fertilization occurred after IVF. The pregnancy rate after the transfer of 1 IVF and 1 ICSI embryo (n = 5) was 80% and after the transfer of 2 ICSI embryos (n = 9) this was 33%. CONCLUSION(S): Performing ICSI on some oocytes of a cohort may avoid total fertilization failures both in patients with a history of total fertilization failure and in patients with a history of low fertilization, as the percentage of fertilization is higher after ICSI compared to IVF and the recurrence of total fertilization failure and low fertilization is high after IVF treatment.

Successful intracytoplasmic sperm injection after failed in vitro fertilization due to multipronuclear oocytes.

OBJECTIVE: To report a case of IVF with apparently normal female and male gametes that resulted in the development of only multipronuclear oocytes (instead of oocytes containing two pronuclei) and was successfully treated with ICSI. DESIGN: Case report. SETTING: A university hospital. PATIENT(S): A 35-year-old woman with unexplained infertility and her partner, a 38-year-old man with normozoospermia. INTERVENTION(S): Intracytoplasmic sperm injection. MAIN OUTCOME MEASURE(S): Oocyte fertilization and pregnancy. RESULT(S): Normal fertilization and an ongoing pregnancy occurred after transfer of two embryos. CONCLUSION(S): Although the usual indication for ICSI is male subfertility, it can also be used to successfully treat oocyte defects.