The choice of the most appropriate microfertilization technique for human male factor infertility

1994 ◽  
Vol 6 (1) ◽  
pp. 37 ◽  
Author(s):  
AO Trounson
Keyword(s):  
Semen Quality ◽  
Fertilization Rate ◽  
World Health ◽  
Gamete Intrafallopian Transfer ◽  
Male Factor Infertility ◽  
Motile Sperm ◽  
Male Factor ◽  
Cleavage Rate ◽  
Pronuclear Formation

Comparisons were made among techniques used to treat male factor infertility. Patients with semen quality below that recognized by World Health Organization criteria as normal had a better success rate when treated by gamete intrafallopian transfer than by in vitro fertilization (25% v. 7% pregnancy rate per patient). When < 2 x 10(6) motile sperm were recovered, the fertilization rate and embryo cleavage rate were higher for microdrop insemination than for conventional insemination. When 7000-370,000 motile sperm were recovered, microdrop insemination resulted in a higher fertilization rate (46%) and a higher incidence of pregnancies (23% of patients treated) than subzonal sperm microinjection (SUSM). However, for patients with 5000-50,000 motile sperm, the immediate transfer of SUSM oocytes to the Fallopian tube increased pregnancy rates for this technique to 24% of patients treated. Direct microinjection of epididymal sperm from azoospermic men into the cytoplasm of oocytes resulted in pronuclear formation in 27% of oocytes; in comparison, pronuclear formation occurred in 5% of SUSM oocytes. These data led to formulation of a logical treatment programme for male factor infertility.

Microinjection: choice of embryo transfer technique

1994 ◽  
Vol 6 (1) ◽  
pp. 57 ◽  
Author(s):  
RI McLachlan ◽  
G Fuscaldo ◽  
I Calderon ◽  
O Lacham-Kaplan ◽  
C Poulos ◽  
...  
Keyword(s):  
Pregnancy Rate ◽  
Fallopian Tube ◽  
Controlled Trial ◽  
Initial Study ◽  
Gamete Intrafallopian Transfer ◽  
Male Factor Infertility ◽  
Motile Sperm ◽  
Male Factor ◽  
Vitro Fertilization

Subzonal sperm microinjection (SUZI) is indicated in severe oligoasthenozoospermia, in which the total count of motile sperm is inadequate for in vitro fertilization (IVF), and in cases with repeated failure of fertilization. Sperm for microinjection are selected following centrifugation on a Percoll gradient and stimulation with pentoxifylline and 2-deoxyadenosine. Motile sperm (2-10 per egg) are injected into the perivitelline space and fertilized oocytes are then cultured for two days prior to transfer into the Fallopian tube (tubal embryo stage transfer, TEST) or uterus. During 1992, SUZI results showed a total fertilization rate of 30% (19% were 2 pronuclear, 11% were polyspermic), a transfer rate of 55% and pregnancy rates of 15.2% per transfer and 8.3% per cycle. Recent pregnancy data in mild-moderate male factor infertility showed that gamete intrafallopian transfer (GIFT) results were consistently superior to TEST or IVF, suggesting a beneficial effect of the tubal environment on fertilization and early embryonic development. Accordingly, the combination of SUZI followed by the immediate transfer of injected oocytes into the Fallopian tube, the MIFT procedure, was explored. An initial study of 21 consecutive microinjection candidates showed a clinical pregnancy rate of 24% per cycle. Information regarding fertilization and polyspermy rates was available from supernumerary oocytes in 90% of patients. A randomized, controlled trial comparing MIFT with SUZI or TEST in severe male factor infertility is required to confirm the improved pregnancy rate in MIFT cycles.

scholarly journals Post-wash total motile sperm count a useful predictor in the decision to perform IVF/ICSI in patients with non-male factor infertility

2020 ◽  
Vol 3 (2) ◽  
pp. 99-106
Author(s):  
Sara Mahmood Qureshi ◽  
Salma Kafeel ◽  
Riffat Bibi ◽  
Jawad Mohmand
Keyword(s):  
Sperm Quality ◽  
Sperm Count ◽  
Adverse Outcomes ◽  
Male Factor Infertility ◽  
Motile Sperm ◽  
Operating Characteristics ◽  
Male Factor ◽  
Vitro Fertilization ◽  
Total Motile Sperm Count

Introduction: The unrestricted use of intracytoplasmic sperm injection (ICSI) for non-male factor infertility is associated with adverse outcomes. Post-wash total motile sperm count (PW-TMSC) offers prognostic value to assess sperm quality and aid in the decision to perform in vitro fertilization (IVF) or ICSI. Objectives: The aim of this study was to identify the effect of PW-TMSC on fertilization rates in patients undergoing IVF cycles exclusively with non-male factor infertility. It also aimed to identify whether unnecessary ICSI could be avoided in such cases, thus maximizing optimal outcomes. Materials & Methods: We retrospectively analyzed age, semen volume, prewash TMSC, and PW-TMSC in 68 conventional IVF cycles of infertile couples with non-male factor infertility. Clinical characteristics including female age, number of follicles, level of estradiol on trigger day, mature cumulus-oocyte complexes (COCs) collected, were also included. Results: Incidence of <30% fertilization was significantly higher in the 4-<10 Million group compared with the ≥20 Million post-wash TMSC group (P<0.001). Furthermore, Receiver operating characteristics (ROC) analysis revealed post-wash TMSC as a significant predictor (P<0.05) of total failed fertilization (TFF) and of ≥30% fertilization (P<0.05) with area under curve (AUC) of 0. 79 and 0.77, respectively, with a deemed cutoff of 10.89 Million. Conclusion: Post-wash TMSC is a good predictor of fertilization; it can help in avoiding potentially low or even total fertilization failure (TFF). A cut-off point of 10.89 Million or less should warrant the use of ICSI.

Intracytoplasmic sperm injection — ICSI

1994 ◽  
Vol 3 (3) ◽  
pp. 199-207 ◽  
Author(s):  
AC Van Steirteghem ◽  
P Nagy ◽  
J Liu ◽  
H Joris ◽  
J Smitz ◽  
...  
Keyword(s):  
Fertilization Rate ◽  
Male Factor Infertility ◽  
Male Factor ◽  
The Past ◽  
Partial Zona Dissection ◽  
Tubal Disease ◽  
Sizeable Number ◽  
Assisted Fertilization ◽  
Normal Fertilization

For more than a decade in vitro fertilization (IVF) has been successful in the treatment of couples with long-standing infertility due to various aetiologies such as tubal disease, male-factor infertility, unexplained infertility and endometriosis. The usual fertilization rate in IVF for nonmale infertility cases is 60–70% of the inseminated cumulus-oocyte complexes and in andrological infertility it is only 20–30%. The lower the number of normally fertilized oocytes, the less chance there is of available embryos, so that patients may have no embryos to transfer. It has been the experience of all centres for reproductive medicine, including our own, that a certain number of couples with male-factor infertility cannot be helped by standard IVF treatment. After insemination with progressively motile spermatozoa the number of two-pronuclear oocytes was either zero or less than 5%. Furthermore, a sizeable number of couples cannot be accepted for IVF if the number of progressively motile spermatozoa in the ejaculate is below a certain threshold number such as 500 000. In the past five years, assisted fertilization procedures have been developed to circumvent the barriers that prevent sperm access to the ooplasma, namely the zona pellucida and the ooplasmic membrane. Pregnancies and births have been reported after partial zona dissection (PZD) and subzonal insemination (SUZI). The success rate of PZD and SUZI has remained moderate: the normal fertilization rate (two-pronuclear oocytes) has never exceeded 20–25% of the micromanipulated oocytes; only two-thirds of the patients have had embryo transfers of, usually, a low number of embryos, resulting in a reduced pregnancy and take-home baby rate.

scholarly journals The Impact of Intracytoplasmic Sperm Injection in Non-Male Factor Infertility—A Critical Review

2021 ◽  
Vol 10 (12) ◽  
pp. 2616
Author(s):  
Tanya L. Glenn ◽  
Alex M. Kotlyar ◽  
David B. Seifer
Keyword(s):  
Intracytoplasmic Sperm Injection ◽  
Live Birth Rate ◽  
Fertilization Rate ◽  
Male Factor Infertility ◽  
Fertilization Failure ◽  
Male Factor ◽  
Vitro Fertilization ◽  
Total Fertilization Failure ◽  
The Impact

Intracytoplasmic sperm injection (ICSI) was originally designed to overcome barriers due to male factor infertility. However, a surveillance study found that ICSI use in non-male factor infertility increased from 15.4% to 66.9% between 1996 and 2012. Numerous studies have investigated fertilization rate, total fertilization failure, and live birth rate per cycle (LBR), comparing the use of ICSI versus conventional in vitro fertilization (IVF) for non-male factor infertility. The overwhelming conclusion shows no increase in fertilization rate or LBR per cycle with the use of ICSI for non-male factor infertility. The overuse of ICSI is likely related to the desire to avoid a higher rate of total fertilization failure in IVF. However, data supporting the benefit of using ICSI for non-male factor infertility is lacking, and 33 couples would need to be treated with ICSI unnecessarily to avoid one case of total fertilization failure. Such practice increases the cost to the patient, increases the burden on embryologist’s time, and is a misapplication of resources. Additionally, there remains conflicting data regarding the safety of offspring conceived by ICSI and potential damage to the oocyte. Thus, the use of ICSI should be limited to those with male factor infertility or a history of total fertilization factor infertility due to uncertainties of potential adverse impact and lack of proven benefit in non-male factor infertility.

Biological factors affecting subzonal sperm microinjection results

1994 ◽  
Vol 6 (1) ◽  
pp. 63
Author(s):  
L Gianaroli ◽  
MC Magli ◽  
AP Ferraretti ◽  
D Fortini ◽  
E Feliciani ◽  
...  
Keyword(s):  
Embryo Transfer ◽  
Embryo Development ◽  
Fertilization Rate ◽  
Early Embryo ◽  
Male Factor Infertility ◽  
Biological Factors ◽  
Male Factor ◽  
Cleavage Rate ◽  
Early Embryo Development ◽  
Factors Affecting

One hundred and sixteen couples with severe male factor infertility underwent 139 subzonal sperm microinjection cycles. In total, 1343 oocytes were microinjected, resulting in a fertilization rate of 24%, followed by a cleavage rate of 65%. In 26% of the zygotes, fertilization was delayed and embryos derived from these zygotes demonstrated a poor capacity for further growth and implantation. In 102 of 139 cycles (73%) embryo transfer was performed, resulting in 9 pregnancies. This study followed the fate of injected oocytes and early embryo development to investigate biological factors that influence the results of subzonal injection.

scholarly journals In vitro fertilisation (IVF) versus intracytoplasmic sperm injection (ICSI) in patients without severe male factor infertility: study protocol for the randomised, controlled, multicentre trial INVICSI

BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e051058
Author(s):  
Sine Berntsen ◽  
Bugge Nøhr ◽  
Marie Louise Grøndahl ◽  
Morten Rønn Petersen ◽  
Lars Franch Andersen ◽  
...  
Keyword(s):  
Live Birth ◽  
Intracytoplasmic Sperm Injection ◽  
Controlled Trial ◽  
Male Partner ◽  
In Vitro Fertilisation ◽  
Male Factor Infertility ◽  
Male Factor ◽  
Fertilisation Rate ◽  
Randomised Controlled

IntroductionOver the last decades, the use of intracytoplasmic sperm injection (ICSI) has increased, even among patients without male factor infertility. The increase has happened even though there is no evidence to support that ICSI results in higher live birth rates compared with conventional in vitro fertilisation (IVF) in cases with nonmale factor infertility. The lack of robust evidence on an advantage of using ICSI over conventional IVF in these patients is problematic since ICSI is more invasive, complex and requires additional resources, time and effort. Therefore, the primary objective of the IVF versus ICSI (INVICSI) study is to determine whether ICSI is superior to standard IVF in patients without severe male factor infertility. The primary outcome measure is first live birth from fresh and frozen-thawed transfers after one stimulated cycle. Secondary outcomes include fertilisation rate, ongoing pregnancy rate, birth weight and congenital anomalies.Methods and analysisThis is a two-armed, multicentre, randomised, controlled trial. In total, 824 couples/women with infertility without severe male factor will be recruited and allocated randomly into two groups (IVF or ICSI) in a 1:1 ratio. Participants will be randomised in variable block sizes and stratified by trial site and age. The main inclusion criteria are (1) no prior IVF/ICSI treatment, (2) male partner sperm with an expected count of minimum 2 million progressive motile spermatozoa following density gradient purification on the day of oocyte pick up and (3) age of the woman between 18 and 42 years.Ethics and disseminationThe study will be performed in accordance with the ethical principles in the Helsinki Declaration. The study is approved by the Scientific Ethical Committee of the Capital Region of Denmark. Study findings will be presented, irrespectively of results at international conferences and submitted for publication in peer-reviewed journals.Trial registration numberNCT04128904. Pre-results.

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