Microsurgical fertilization procedures: the absence of stringent criteria for patient selection.
Subzonal sperm insertion and partial zona dissection were applied in 250 in vitro fertilization cycles in couples (n = 200) with abnormal semen analyses; 61 clinical pregnancies were established (24% per egg retrieval). Patients were selected without using minimal cutoff criteria. The study included patients with 0% normal sperm forms (strict criteria), no motile sperm (but some live cells), and sperm counts which could be assessed only after centrifugation. Patients were categorized into three subsets. Group A (n = 116 cycles) failed to fertilize in a previous cycle. Group B (n = 40) was excluded from IVF due to the severity of sperm profiles, such as a maximum of 2% normal forms. Group C (n = 94) constitutes those patients for whom a standard cycle could possibly result in failure. Monospermic fertilization rates were 18% (A), 19% (B), and 24% (C). The incidences of embryo replacement were 63% (A), 53% (B), and 69% (C). Rates of clinical pregnancy were 22% (A), 23% (B), and 28% (C). The presence of one, two, or three semen abnormalities did not correlate with the outcome of microsurgical fertilization. Twenty-two percent of patients with combined oligoasthenoteratozoospermia became pregnant. Moreover, ongoing pregnancies were established in instances with 0% normal sperm forms and no progressively motile spermatozoa. It is concluded that stringent cutoff criteria may not be necessary when both partial zona dissection and subzonal sperm insertion are performed efficiently.
Cohen
J
J
Department of Obstetrics and Gynecology, New York Hospital-Cornell University Medical Center, New York 10021.
Alikani
M
M
Adler
A
A
Berkeley
A
A
Davis
O
O
Ferrara
T A
TA
Graf
M
M
Grifo
J
J
Liu
H C
HC
Malter
H E
HE
D046508:Culture Techniques; D004622:Embryo, Mammalian / Q000166:cytology; D004812:Epidemiologic Methods; D005260:Female; D005307:Fertilization in Vitro / Q000379:methods*; D006801:Humans; D007315:Insemination, Artificial / Q000379:methods; D008297:Male; D008846:Micromanipulation; D008866:Microsurgery / Q000379:methods*; D012661:Semen / Q000166:cytology; D015044:Zona Pellucida