Conventional in vitro fertilization versus intracytoplasmic sperm injection in patients with borderline semen: a randomized study using sibling oocytes.
OBJECTIVE
To determine whether patients with borderline semen should be treated with conventional IVF or intracytoplasmic sperm injection (ICSI).


METHODS
Randomized study.


METHODS
A university medical center in The Netherlands.


METHODS
One hundred six couples with borderline semen who were undergoing IVF and ICSI on sibling oocytes.


METHODS
Performing IVF and ICSI on sibling oocytes.


METHODS
Fertilization and pregnancy rates.


RESULTS
One thousand five hundred eighteen oocytes were collected in 106 oocyte retrievals: 849 oocytes were randomly allocated to ICSI, of which 761 were microinjected, and 669 oocytes were randomly assigned to IVF. In 26 of the 106 patients, there was fertilization only after ICSI and not after IVF (IVF- group). The fertilization rate was 51% (92/182 oocytes). In 78 patients, there was fertilization after both IVF and ICSI (IVF+ group); the fertilization rate was 51% for both the IVF- and ICSI-treated oocytes (271/528 oocytes and 334/658 oocytes, respectively). In 2 patients, there was no fertilization after either IVF (0/6 oocytes) or ICSI (0/9 oocytes). Patients of the IVF+ group had a higher total motile sperm count after preparation than did those of the IVF- group. More high-quality embryos were obtained after ICSI in patients of the IVF+ group. In 101 patients, embryo transfer was performed: 26 in the IVF- group and 75 in the IVF+ group. No significant differences were found with regard to pregnancy rates between those two groups: pregnancy rates were 54% in the IVF- group and 48% in the IVF+ group.


CONCLUSIONS
Performing ICSI on at least some of the oocytes will avoid unnecessary fertilization failure in patients with borderline semen: in this study, 26 of 104 cycles (25%) were rescued by ICSI.
van der Westerlaken
Lucette
L
Department of Reproductive Medicine, Leiden University Medical Center, Leiden, The Netherlands. l.a.j.van_der_westerlaken@lumc.nl
Naaktgeboren
Nico
N
Verburg
Harjo
H
Dieben
Sandra
S
Helmerhorst
Frans M
FM
D000328:Adult; D002970:Cleavage Stage, Ovum; D004624:Embryo Transfer; D005260:Female; D005306:Fertilization; D005307:Fertilization in Vitro; D006801:Humans; D007248:Infertility, Male / Q000473:pathology / Q000503:physiopathology* / Q000628:therapy*; D008297:Male; D009865:Oocytes; D011247:Pregnancy; D018873:Pregnancy Rate; D012661:Semen; D013076:Sperm Count; D020554:Sperm Injections, Intracytoplasmic; D013081:Sperm Motility