Can severe male factor infertility be treated without micromanipulation?
OBJECTIVE
To present data on IVF in severe male factor infertility using modified IVF laboratory methods and to compare them with the reported data of gamete micromanipulation.


METHODS
Retrospective, not randomized.


METHODS
University of California, Irvine, Center for Reproductive Health.


METHODS
Seventy-one patients with severe oligoasthenozoospermia defined as total motile count in the pretreatment sample of < 5 x 10(6). Two groups were identified, group I with total motile count between 1.5 and 5 x 10(6) and group II with total motile count < 1.5 x 10(6).


METHODS
Treatment of the semen samples with mini-Percoll and the modification of standard IVF techniques. These modifications include insemination with larger numbers of sperm, the use of culture tubes for insemination of oocytes, and pooling oocytes together in one or more culture tubes.


METHODS
Fertilization and pregnancy rates (PRs). Additionally, the number of patients achieving cryopreservation and patients with previous failure to fertilize are specified.


RESULTS
Eighty percent of the patients achieved fertilization with an overall rate of 38% per oocyte. Fifty-three ETs were performed and 23 clinical pregnancies (43% per transfer and 35% per cycle) were achieved. Fifty percent of the patients had excess embryos for cryopreservation. In group I the fertilization rate was 54% with a PR of 56% per transfer and 48% per cycle. In group II the fertilization rate was 25% with a PR per transfer of 32% and 24% per cycle. Of 28 patients who had previous failure of fertilization, 25 fertilized and 8 pregnancies were established.


CONCLUSIONS
These data demonstrate that by the modification of standard laboratory methods for IVF, monospermic fertilization, cleavage, and a high clinical PR can be achieved in cases of severe male factor infertility without having to resort to micromanipulation.
Department of Obstetrics and Gynecology, University of California, Irvine.
T
T
Ord
P
P
Patrizio
J P
JP
Balmaceda
R H
RH
Asch
D000328:Adult; D005307:Fertilization in Vitro / Q000379:methods*; D006801:Humans; D007248:Infertility, Male / Q000209:etiology; D008297:Male; D008866:Microsurgery; D009845:Oligospermia / Q000150:complications; D011205:Povidone / Q000494:pharmacology*; D012189:Retrospective Studies; D012822:Silicon Dioxide / Q000494:pharmacology*; D013076:Sperm Count; D013081:Sperm Motility / Q000187:drug effects
C016039:Percoll; D012822:Silicon Dioxide; D011205:Povidone