title: In vitro fertilization and intracytoplasmic sperm injection for couples with unexplained infertility after failed direct intraperitoneal insemination.
abstract: OBJECTIVE
  The objective was to determine the optimal insemination technique in patients undergoing in vitro fertilization (IVF) after failed direct intraperitoneal insemination (DIPI) and the outcome of intracytoplasmic sperm injection (ICSI) in such cases.
  
  
  METHODS
  In case-control studies, 53 couples with unexplained infertility who underwent IVF after four failed DIPI cycles were compared with 75 couples with tubal or endometriosis infertility as controls. Thirty couples with unexplained infertility after failing to conceive with DIPI and conventional IVF who underwent ICSI and 58 couples with male-factor infertility as controls also were compared. Fertilization cleavage, embryo quality, implantation, and pregnancy were compared after IVF and after ICSI.
  
  
  RESULTS
  There was a significant difference in fertilization rates after IVF between cases of unexplained infertility after failing to conceive with DIPI (40.4%) and patients with tubal or endometriosis infertility (67.9%). There also was a significant difference in total fertilization failure rates between the two groups (30.4% and 3.9%, respectively). There was a slight but significant difference in numbers of fertilized oocytes after ICSI between patients with low fertilization rate undergoing IVF after failing to conceive DIPI (85.8%) and patients with male factor (90.4%). Total fertilization failure was not observed in these cases.
  
  
  CONCLUSIONS
  Couples with unexplained infertility after failing to conceive with DIPI show a failed fertilization or a low fertilization rate after IVF. However, they demonstrated a good chance of becoming pregnant after subsequent ICSI, even with statistically significant difference in fertilization rate as compared with male-factor cases.
authors.affiliation: Department of Obstetrics and Gynecology, Mie University School of Medicine, Mie, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Takeuchi
authors.forename: H
authors.initials: H
authors.lastname: Minoura
authors.forename: T
authors.initials: T
authors.lastname: Shibahara
authors.forename: X
authors.initials: X
authors.lastname: Shen
authors.forename: N
authors.initials: N
authors.lastname: Futamura
authors.forename: N
authors.initials: N
authors.lastname: Toyoda
mesh_terms: D000328:Adult; D004622:Embryo, Mammalian / Q000502:physiology; D005260:Female; D006801:Humans; D007246:Infertility / Q000209:etiology / Q000628:therapy*; D007315:Insemination, Artificial / Q000379:methods; D008297:Male; D009865:Oocytes / Q000502:physiology; D010062:Ovulation Induction; D011247:Pregnancy; D018873:Pregnancy Rate; D011379:Prognosis; D020554:Sperm Injections, Intracytoplasmic; D017211:Treatment Failure