title: Clinical application of sperm-oocyte interaction tests in in vitro fertilization--embryo transfer and intracytoplasmic sperm injection programs.
abstract: OBJECTIVE
  To review the clinical value of sperm-oocyte interaction tests for the diagnosis and management of infertility by standard IVF or intracytoplasmic sperm injection (ICSI).
  
  
  METHODS
  Review of recent publications on relationships among sperm-oocyte interaction tests, sperm characteristics, and results of IVF and determination of frequency of defective sperm-oocyte interaction in infertile men.
  
  
  METHODS
  Fertilization rates with IVF, sperm characteristics, sperm-zona pellucida (ZP) binding, ZP-induced acrosome reaction (AR), and sperm-ZP penetration.
  
  
  RESULTS
  Sperm defects associated with low sperm-ZP binding or impaired ZP-induced AR and sperm-ZP penetration are the major causes of failure of fertilization when all or most oocytes from a couple do not fertilize in standard IVF. There is a high frequency of defective sperm-ZP interaction in men with oligozoospermia (<20 x 10(6)/mL) and severe teratozoospermia (strict normal sperm morphology < or =5%). Sperm morphology correlates with sperm-ZP binding, and sperm concentration correlates with ZP-induced AR in infertile men with sperm concentrations >20 x 10(6)/mL. Defective ZP-induced AR may cause infertility in up to 25% men with idiopathic infertility. These patients require ICSI despite the normal standard semen analyses.
  
  
  CONCLUSIONS
  Sperm-oocyte interaction tests are useful for diagnosis of subtle sperm defects that cause infertility in men without severe abnormalities of semen analysis. Pre-IVF diagnosis of these sperm defects will assist in the clinical assignment of patients to treatment with either standard IVF or ICSI.
authors.affiliation: Department of Obstetrics and Gynecology and Reproductive Services, The Royal Women's Hospital, University of Melbourne, Melbourne, Victoria, Australia. dyl@unimelb.edu.au
authors.forename: De Yi
authors.initials: DY
authors.lastname: Liu
authors.forename: Claire
authors.initials: C
authors.lastname: Garrett
authors.forename: H W Gordon
authors.initials: HW
authors.lastname: Baker
mesh_terms: D004624:Embryo Transfer; D005260:Female; D005307:Fertilization in Vitro; D006801:Humans; D008297:Male; D020554:Sperm Injections, Intracytoplasmic; D013084:Sperm-Ovum Interactions