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PubMed1997

Birth of a healthy female after intracytoplasmic sperm injection of cryopreserved human oocytes.

OBJECTIVE: To describe the first birth achieved after intracytoplasmic sperm injection (ICSI) of cryopreserved human oocytes. DESIGN: Case report. SETTING: University of Bologna Hospital, Department of Obstetrics and Gynecology, Reproductive Endocrinology Unit, IVF and Infertility Center. PATIENT(S): One patient undergoing IVF. INTERVENTION(S): Transvaginal ultrasound-guided oocyte retrieval followed by oocyte freezing. Artificial preparation of the endometrium with E2 and P, oocyte thawing, and ICSI. RESULT(S): Four of 12 cryopreserved oocytes survived; using ICSI, 2 underwent normal fertilization but only 1 cleaved. One good-quality 4-cell embryo was transferred. A single gestation was confirmed by ultrasound at the 7th week. Amniocentesis was performed at the 16th week and demonstrated a normal female karyotype of 46,XX. After a normal pregnancy, a healthy female infant was born at the 38th week of gestation. CONCLUSION(S): The combination of ICSI and oocyte cryopreservation is a new tool in assisted reproductive technology.

Adult↗
PubMed2002

Germ cell transplantation into X-irradiated monkey testes.

BACKGROUND: An intense debate is ongoing regarding options for fertility protection in oncological patients. Germ cell transplantation has been applied to restore mouse spermatogenesis. Here, an attempt to apply autologous germ cell transplantation to a primate animal model is described. METHODS: Five adult male cynomolgus monkeys were biopsied to retrieve and cryopreserve germ cells before both testes were irradiated (dose 2 Gy). Six weeks later, each monkey received an infusion of its own cell suspension into the right testis, while the left testes were infused with saline. Testis size, sperm counts and serum concentrations of inhibin, FSH and testosterone were analysed weekly for 9 months. Spermatogenic recovery was determined histologically at the end of the study. RESULTS: In four monkeys, the germ cell-infused right testes showed a slight to moderate increase in the rate of regrowth in comparison with the left testes. In two monkeys the right testis proceeded to recover more prominently, resulting in larger right testis volumes and better or full spermatogenic recovery at the study end. Restoration of spermatogenesis occurred as an all-or-nothing event. Inhibin B concentrations increased, while FSH and testosterone concentrations decreased with testicular regrowth. Sperm counts did not recover. CONCLUSIONS: The present study demonstrates the immaturity and complexity of germ cell transplantation as a clinical approach.

Animals↗
PubMed1986

Fine structure of spermatozoa retrieved from retrograde ejaculates.

The proportion of viable, motile spermatozoa retrieved from retrograde ejaculates has been consistently low. Electron microscopic studies of spermatozoa of retrograde ejaculates collected in Baker's buffer and washed in Ham's F10 medium supplemented with 2% human serum albumin revealed considerable ultrastructural lesions to the sperm head and the midpiece. Swelling and/or loss of plasma membrane was observed in most of the sperm. In others, the membrane continuity was disrupted, and tattered remnants of it remained attached to a grossly abnormal acrosome. The acrosomal cap in the majority of the spermatozoa was swollen and irregular in shape. Some of the spermatozoa lacked the acrosome, and the sperm heads of these were lined by the inner acrosomal membrane. Subcellular derangement in the midpiece of retrograde spermatozoa was characterized by mitochondrial swelling and lysis, indicating definite cytotoxic injury to the spermatozoa. These EM observations are consistent with the findings of high sperm wastage in semen from men with retrograde ejaculation.

Adult↗
PubMed2004

Healthy girl born after cryopreservation of gametes and ICSI in a patient with seminoma.

This study reports birth in a case of intracytoplasmic sperm injection with cryopreserved oocytes and spermatozoa banked after radiotherapy and prior to chemotherapy due the occurrence of two non-synchronous seminomas. A 30-year-old male with a diagnosis of seminoma cryopreserved six vials of spermatozoa. After oncological treatment was completed, his partner, a 24-year-old woman, underwent ovarian stimulation. Seventeen oocytes were retrieved; one was at the germinal vesicle stage and two were injected, resulting in two embryos. Fourteen metaphase II oocytes were frozen. The woman presented moderated ovarian hyperstimulation syndrome, and embryo cryopreservation was indicated. After endometrial preparation, two embryos were transferred and a pregnancy was achieved. The woman suffered eclampsia during week 28 of gestation. Caesarean section was performed and a preterm girl weighing 1000 g was born, but died 2 weeks after delivery. A year later, a second procedure was begun. Frozen oocytes and one vial of semen were thawed. Eight of the 14 oocytes survived and were microinjected; two became fertilized and one good quality cleaved embryo was transferred. Pregnancy was achieved and a healthy girl was born with a birth weight of 2800 g. Oocyte cryopreservation associated with sperm banking in cancer patients is a useful tool for couples seeking deferred parenthood.

Adult↗
PubMed2006

[Preimplantation genetic diagnosis (PGD): results from a Parisian center].

OBJECTIVE: To report the results of preimplantation genetic diagnosis (PGD) cycles performed in our unit from 2000 to 2004. Materials and methods. One hundred and seventy-one couples were enrolled in the PGD program over this period. The collected oocytes were inseminated by intracytoplasmic sperm injection (ICSI). The resulting embryos were biopsied on the third day of development and the genetic analysis was performed on the same day. Embryo transfers were carried out on the fourth day. RESULTS: The 416 stimulation cycles started yielded 280 oocyte pick-ups, 3506 oocytes retrieved, of which 2966 were suitable for ICSI. Among the 1982 embryos obtained, 1337 embryos were biopsied and genetic diagnosis was performed for 1083 (81%) of them. 381 embryos were transferred during the course of 189 transfer procedures. There were 51 clinical and 46 ongoing (35 single, 11 twin) pregnancies. In addition, 25 frozen embryo replacement cycles were initiated, leading to 6 embryo transfers and 1 ongoing pregnancy. A total of 58 unaffected children were born. CONCLUSION: PGD has gained a place among the choices offered to couples at risk of transmission of a serious and incurable genetic disease. It might be a realistic alternative to prenatal diagnosis for patients carrier of chromosomal rearrangements, single gene defects, X-linked disesases or mitochondrial DNA disorders.

Adult↗
PubMed1993

Partial zona dissection enhances the fertilization rate in cases of sperm defect only when total failure has occurred in previous in-vitro fertilization attempts.

The value of partial zona dissection (PZD) was assessed in a randomized protocol of in-vitro fertilization (IVF) including 30 couples (44 cycles) with at least two sperm defects. Couples were divided into three groups according to previous IVF status, i.e. group I: total failure of previous IVF; group II: marginal success of previous IVF, and group III: no previous IVF. Both PZD and untreated oocytes were inseminated using the swim-across method. Although PZD did not enhance the overall proportion of fertilized eggs resulting in diploid cleaving embryos per retrieved oocyte (14.7 versus 17.1%), this rate was higher with PZD than with IVF when previous IVF attempts had failed (group I: 16.1 versus 4.5%, P < 0.01). The rate was similar for PZD and IVF in group II, and lower for PZD than IVF in group III (15.1 versus 30.8%, P < 0.01). The higher polyspermy rate associated with PZD in groups in which classical IVF worked, could partially explain these results. The role of a possible deleterious effect of PZD on the oocytes is discussed. Out of the 44 cycles, 20 reached the embryo transfer stage and four pregnancies were obtained. In our opinion PZD should be carried out in cases of sperm defects only when previous IVF attempts have failed.

Embryo Transfer↗
PubMed1996

Transport intracytoplasmic sperm injection (ICSI): a cost-effective alternative.

PURPOSE: Transport in vitro fertilization (IVF) programs are operational in a lot of countries and especially popular in The Netherlands, where IVF activities are strictly regulated. Since the introduction of intracytoplasmic sperm injection (ICSI) in the IVF laboratory, many laboratories are now setting up this new technique, which necessitates major investments in terms of infrastructure and specialized personnel. METHODS: We present a cost effective alternative, consisting of patient selection, preparation, and oocyte retrieval at one center and transport of oocytes to a second center, where the ICSI procedure and embryo transfer are performed. Since early 1994 several Dutch centers have a transport ICSI program running with the Gent University Infertility Center, and we wish to present the results of our cooperation with two major centers, comparing them to our local results, for the first 10 months of 1994. Patient selection was similar at all three centers: only couples with previously failed in vitro fertilization or having been refused for routine IVF were enrolled in the program. Stimulation schemes and follow-up of the stimulation were different at all three centers. Transport of oocytes was carried out in a transport box or by attaching the closed tubes containing the follicular aspirates to the chest of the husband. Transport times varied between 1.5 and 3 hr, depending on traffic conditions. RESULTS: Up to November 1, 1994, a total of 77 transport ICSI cycles and 294 own ICSI cycles were carried out. Although locally significantly more oocytes were retrieved and thus available for ICSI than in transport cycles, fertilization and pregnancy rates were not different between the two groups. CONCLUSIONS: These results suggest that long-distance transport of human oocytes seems not to be harmful to their capacity to be successfully injected and to further embryonic development and their implantation potential. Transport ICSI seems to be a valuable and cost-effective approach to treat high numbers of patients at a restricted number of highly specialized IVF laboratories, especially in countries where ICSI is not commonly available.

Academic Medical Centers↗
PubMed2001

Intracytoplasmic sperm injection could minimize the incidence of prematurely condensed human sperm chromosomes.

OBJECTIVE: To compare the fertilization and prematurely condensed human sperm chromosomes (PCCs) rates between two intracytoplasmic sperm injection (ICSI) techniques. DESIGN: A retrospective study. SETTING: The data were obtained from the University of British Columbia in vitro fertilization (IVF) laboratory. PATIENT(S): ICSI cycles (n = 105) were performed for couples suffering from severe male-factor infertility and dysfunction of fertilization. INTERVENTION(S): Two types of ICSI techniques were used for ICSI procedures. MAIN OUTCOME MEASURE(S): Fertilization and pregnancy rates in group B using the improved ICSI technique were compared with those of group A using the standard ICSI technique. Unfertilized oocytes from the two groups were studied with cytogenetic methods. RESULT(S): Oocyte damage dropped from 14.8% in group A to 5.3% in group B. Normal fertilization for each group was 57.3% and 88.4%, respectively (P<.05). Pregnancy rate per egg retrieval was 15.6% in group A and 27.4% in group B (P<.05). PCCs occurred in 19.4% of unfertilized oocytes in group A and did not occur in group B. CONCLUSION(S): This study indicates that ICSI not only yields high fertilization rates, but also minimizes the incidence of PCCs. It may be directly related to two crucial steps (immobilization of sperm and aspiration of oocyte cytoplasm) used in ICSI procedures. This study also suggests that it is possible to overcome one cause of IVF failure resulting from the formation of PCCs by using the improved ICSI technique.

Chromosomes↗
PubMed2005

Sperm and assisted reproduction.

When optimization of the male and female partner has failed, techniques of assisted reproduction may be employed. Their common rationale is to enhance the probability of fertilization by bringing the spermatozoa closer to the oocyte(s). Assisted reproductive techniques are not a curative treatment but they intend to circumvent some functional deficits in gametes. The choice of the most appropriate assisted-reproduction treatment for the individual couple is often based on the quality of the ejaculate or the source of the gametes. Intrauterine insemination (IUI) may be considered as the first-line approach when after semen preparation at least 1 x 10(6) spermatozoa can be harvested. IVF is to be considered when dealing with longstanding infertility in a couple with a normal fertility status in the female partner. The choice between IVF and intracytoplasmic sperm injection (ICSI) is difficult since performing 3 ICSI treatments can prevent one complete fertilization failure even in couples with borderline semen characteristics. When less than 1 x 10(6) progressively motile spermatozoa are available after preparation, ICSI may be the treatment of choice. ICSI can also be performed using surgically-retrieved spermatozoa. In men with obstructive azoospermia spermatozoa can be retrieved through different techniques. However, in azoospermic men with primary testicular dysfunction, excisional biopsies are to be preferred. But even then, spermatozoa may only be obtained in about half of these men when no preliminary selection has been made on the basis of a diagnostic biopsy. Patients with extreme oligozoospermia or azoospermia should be informed about the possible genetic background of their condition that is transmissible to their children and about the limitations of the currently available genetic screening methods. Although currently there is no convincing evidence that ICSI is associated with a substantial higher incidence of congenital malformations, we should not draw the premature conclusion that ICSI is safe. ICSI must be applied with caution and only when no other treatment option is available.

Humans↗
PubMed2006

Oocyte degeneration after intracytoplasmic sperm injection: a multivariate analysis to assess its importance as a laboratory or clinical marker.

OBJECTIVE: Oocyte degeneration has historically been associated with the intracytoplasmic (ICSI) technique. We sought to determine whether oocyte degeneration rates were associated with the technician performing the procedure, the baseline characteristics of the patient, and/or ovarian stimulation variables. We also evaluated whether the degeneration rate could serve as a surrogate marker for implantation potential. DESIGN: Cohort study. SETTING: Academic medical center. PATIENT(S): Couples undergoing ICSI. INTERVENTION(S): Six thousand six hundred fifty-three injected oocytes were analyzed to determine whether the degeneration rate was technician dependent. Two hundred thirty first-entry down-regulated cycles were examined to identify predictors associated with oocyte degeneration. Multivariate analyses were performed using generalized linear model routines. MAIN OUTCOME MEASURE(S): Oocyte degeneration rates and implantation rates. RESULT(S): Neither the ICSI technician nor the stripping technician was associated with the oocyte degeneration rate. However, the day 3 FSH, number of mature oocytes retrieved, and E2 levels on the day of hCG were significant independent predictors of degeneration rate. Physician-adjustable ovarian stimulation variables were not associated with the degeneration rate. The degeneration rate did not appear to be associated with the implantation rate. CONCLUSION(S): These data suggest that oocyte degeneration is not technician or physician dependent. Degeneration is likely a function of the inherent oocyte quality in women who underwent ovarian stimulation. However, the remaining cohort of retrieved oocytes appears to be unaffected by virtue of an uncompromised implantation rate.

Adult↗
PubMed2004

A comparison of 3-day and daily follicle-stimulating hormone injections on stimulation days 1-6 in women undergoing controlled ovarian hyperstimulation.

OBJECTIVE: To evaluate the efficacy of ovarian hyperstimulation by intermittent doses of 450 IU of recombinant human (h)FSH compared with daily 150-IU doses of recombinant hFSH. DESIGN: A pilot, open, randomized, parallel-group study. SETTING: Center for Reproductive Medicine, Düsseldorf, Germany. PATIENT(S): Infertile women with indication for IVF/intracytoplasmic sperm injection after at least 1 year of unprotected intercourse. INTERVENTION(S): Recombinant hFSH was administered daily or intermittently (3-day intervals) from days 1 to 6 of stimulation and thereafter by daily injection. MAIN OUTCOME MEASURE(S): Number of preovulatory follicles, retrieved oocytes, two-pronuclei (2PN) zygotes, implantation, and pregnancy rates. RESULT(S): The number of oocytes in the daily-dose group was significantly greater. There were no significant differences in mean values for number of follicles > or =11 mm (except for day 7) and > or =14 mm, 2PN zygotes, and number of transferred embryos. Implantation and pregnancy rates per cycle were in favor of the intermittent 450-IU dose regimen; implantation rates were 17.0% and 9.8% in the 3-day-dose and daily-dose groups, respectively, and biochemical and clinical pregnancy rates were 33.3% and 15.7% and 25.5% and 13.7%, respectively. CONCLUSION(S): Intermittent administration of recombinant hFSH significantly reduces the total number of recombinant hFSH injections, compared with a conventional FSH regimen, without detrimental effects on implantation rate or pregnancy rate.

Adult↗
PubMed2006

In vitro embryo production and embryo transfer in domestic and non-domestic cats.

Over a 5-year interval, multiple laparoscopic oocyte retrievals were done in fishing cats (Prionailurus viverrinus), caracals (Caracal caracal) and domestic cats after ovarian stimulation with gonadotropins. From 21 retrievals in five fishing cats, 579 preovulatory oocytes (mean = 27.6) were recovered and 348 embryos were produced in vitro (mean = 16.6). A total of 452 preovulatory oocytes (mean = 25.1) were recovered from 18 of 24 retrievals in six caracals and 297 (mean = 16.6) embryos were produced. An additional 16 caracal embryos (19%) were produced after in vitro maturation of 83 oocytes, 59 of which came from six retrievals producing only immature oocytes. The presence of corpora lutea at oocyte retrieval occurred in each species (1) at a similar frequency (33%) and (2) more frequently during January through May (11 of 15 retrievals) than during the latter half of the year (4 of 30 retrievals). Of the 12 embryo transfer procedures done in fishing cats, one pregnancy (8%) was obtained and one live kitten born after the auto-transfer of 10 Day-6 embryos. In caracals, a total of 46 Day-4 or Day-5 embryos were auto-transferred to six recipients, one of which delivered two live kittens. Then, 109 caracal embryos were cryopreserved before thawing and transferring to nine recipients (mean = 12.1) on Days 5 or 6. From three pregnancies established (33%), a total of three kittens were born. Two to six gonadotropin treatments/oocyte retrievals were done in domestic cats during 1999 through 2003; an average of 24.9, 23.5, 22.0, 23.1, 23.5 and 40.9 oocytes (P > 0.05) were recovered at the first through the sixth treatment cycles from 138, 138, 97, 49, 22, and seven retrievals, respectively.

Animals↗
PubMed1995

Functional and structural characteristics of human epididymal spermatozoa retrieved by transcutaneous aspiration.

The present paper describes the development of a simple, repeatable technique for transcutaneous aspiration of epididymal spermatozoa in patients with inoperable excretory azoospermia. Some functional and structural parameters of the retrieved spermatozoa were also evaluated. Epididymal spermatozoa from patients and ejaculated spermatozoa from fertile donors showed similar percentages of acrosome-reacted cells after incubation for 6 or 15 h in capacitating medium. Penetration of zona-free hamster oocytes, expressed as the percentage of penetrated ova, was significantly lower (p < 0.01) for spermatozoa from patients than for ejaculated spermatozoa from fertile donors. The percentage of epididymal spermatozoa with stable nuclei in sodium dodecyl sulphate was lower (p < 0.001) than for ejaculated spermatozoa from fertile donors. A positive linear correlation (r = 0.74, p < 0.005) was evident between the oocyte penetration rate and the percentage of spermatozoa with stable nuclei. In conclusion the percutaneous retrieval of epididymal spermatozoa in excretory azoospermia allows collection of motile spermatozoa, which can be evaluated for their structural and functional characteristics before repetition of the technique for retrieval of spermatozoa for assisted fertilization techniques.

Adult↗
PubMed2005

Clinical benefit of metaphase I oocytes.

BACKGROUND: We studied the benefit of using in vitro matured metaphase I (MI) oocytes for ICSI in patients with a maximum of 6 mature metaphase II (MII) oocytes at retrieval. METHODS: In 2004, 187 ICSI cycles were selected in which maximum 6 MII oocytes and at least one MI oocyte were retrieved. MI oocytes were put in culture to mature until the moment of ICSI, which was performed between 2 to 11 hours after oocyte retrieval (day 0). In exceptional cases, when the patient did not have any mature oocyte at the scheduled time of ICSI, MI oocytes were left to mature overnight and were injected between 19 to 26 hours after retrieval (day 1). Embryos from MI oocytes were chosen for transfer only when no other good quality embryos from MII oocytes were available. Outcome parameters were time period of in vitro maturation (IVM), IVM and fertilization rates, embryo development, clinical pregnancy rates, implantation rates and total MI oocyte utilization rate. RESULTS: The overall IVM rate was 43%. IVM oocytes had lower fertilization rates compared to in vivo matured sibling oocytes (52% versus 68%, P < 0.05). The proportion of poor quality embryos was significantly higher in IVM derived oocytes. One pregnancy and live birth was obtained out of 13 transfers of embryos exclusively derived from IVM oocytes. This baby originated from an oocyte that was injected after 22 hrs of IVM. CONCLUSION: Fertilization of in vitro matured MI oocytes can result in normal embryos and pregnancy, making IVM worthwhile, particularly when few MII oocytes are obtained at retrieval.

Cell Culture Techniques↗
PubMed1999

Pronuclear stage cryopreservation after intracytoplasmic sperm injection and conventional IVF: implications for timing of the freeze.

OBJECTIVE: To compare clinical outcomes of frozen embryo transfers using cryopreserved pronuclear stage oocytes that had undergone either intracytoplasmic sperm injection (ICSI) or conventional IVF. DESIGN: Observational. SETTING: A tertiary referral reproductive medicine unit. PATIENT(S): Couples undergoing either ICSI or conventional IVF from January 1, 1995 to December 31, 1997. INTERVENTION(S): Patients underwent a standard controlled ovarian hyperstimulation protocol and transvaginal ultrasound-guided oocyte retrieval. All normally fertilized (2PN) oocytes exceeding a specified embryo number designated for fresh transfer were immediately cryopreserved at the pronuclear stage. Our cryopreservation method included timing of the freeze according to pronuclear morphology. Subsequent frozen embryo thaw-transfer cycles were usually performed by thawing only the intended number of embryos for transfer. MAIN OUTCOME MEASURE(S): Thaw survival rate, implantation rate, clinical pregnancy rate, delivery rate. RESULT(S): Ninety-six thaw-transfer cycles (n = 72) and 93 thaw-transfer cycles (n = 67) were undertaken in patients who had previously undergone conventional IVF or ICSI, respectively. Embryo thaw survival rates (IVF, 90.4%; ICSI, 91.1%) were similar. Clinical pregnancy (IVF, 40.6%; ICSI, 44.1%) and delivery (IVF, 36.4%; ICSI, 39.8%) rates per transfer, as well as implantation (IVF, 19.1%; ICSI, 19.9%) rates, were also similar. There were only four clinical pregnancy losses in both groups. CONCLUSION(S): Embryo thaw survival is similar for cryopreserved pronuclear stage oocytes derived from ICSI and conventional IVF. Clinical pregnancy, implantation and delivery rates were also similar for the two groups. In addition, there was no increase in the rate of pregnancy loss in ICSI patients after frozen embryo transfers.

Adult↗
PubMed2004

Cryopreserved sibling oocytes and intracytoplasmic sperm injection rescue unexpectedly poor fertilization in conventional in vitro fertilization.

PURPOSE: To report a successful pregnancy from cryopreserved sibling oocytes and intracytoplasmic sperm injection (ICSI) for an infertile couple with an unexpectedly low fertilization rate in the fresh in vitro fertilization (IVF) cycle. METHODS: The woman had bilateral tubal obstruction and polycystic ovarian syndrome. The man had normal semen parameters. The couple underwent a cycle of controlled ovarian hyperstimulation in that 20 oocytes were retrieved. Twelve oocytes were conventionally inseminated and eight were cryopreserved using a slow freezing method. However, only one oocyte was fertilized, and no pregnancy was achieved. In the next cycle, the frozen oocytes were thawed and ICSI was performed. RESULTS: After thawing, seven oocytes (88%) survived and one was damaged. Six were at the metaphase II stage and were injected. Five (83%) achieved normal fertilization, and all of them cleaved (100%). After replacement of the embryos, a singleton pregnancy developed. A healthy female baby was delivered at term. Karyotyping revealed 46, XX. CONCLUSIONS: In addition to well-known indications, cryopreservation of excess sibling oocytes for patients receiving IVF has a possible advantage of preventing unexpectedly low fertilization rate or fertilization failures.

Adult↗
PubMed2005

[Intracytoplasmic sperm injection using cryopreserved-thawed testicular spermatozoa with testicular fine needle aspiration].

OBJECTIVE: To evaluate the effect of intracytoplasmic sperm injection (ICSI) using cryopreserved-thawed testicular spermatozoa with testicular fine needle aspiration (TEFNA) in patients with non-obstructive azoospermia. METHODS: Sixty-two patients underwent TEFNA. Mature testicular spermatozoa were found in 35 cases of patients and the testicular tissues were cryopreserved for later ICSI. Ovarian stimulation included a long protocol of GnRHa/FSH/hCG. Oocyte retrieval was performed under transvaginal ultrasound guidance, and ICSI conducted with cryopreserved-thawed testicular spermatozoa. RESULTS: A total of 35 couples underwent 35 ICSI cycles using cryopreserved-thawed testicular spermatozoa with testicular fine needle aspiration. The clinical pregnancy rate was 37.14% (13/35). CONCLUSION: ICSI using cryopreserved-thawed testicular spermatozoa with testicular fine needle aspiration is a main and effective method in the treatment of non-obstructive azoospermia, which can avoid further testicular fine needle aspiration.

Adult↗
PubMed1997

The role of in vitro fertilization and intracytoplasmic sperm injection in couples with unexplained infertility after failed intrauterine insemination.

OBJECTIVE: To determine an optimal insemination technique in patients undergoing IVF after failed IUI and the role of intracytoplasmic sperm injection (ICSI) in such cases. DESIGN: Prospective, randomized study in couples with unexplained infertility (n = 63) and mild endometriosis (n = 7) undergoing IVF after four IUI cycles. Sibling oocytes were randomized into standard IVF or ICSI insemination according to the order of retrieval. SETTING: In vitro fertilization program at the Instituto Valenciano de Infertilidad, Valencia, Italy. PATIENT(S): Seventy couples with unexplained infertility undergoing IVF after failing to conceive with controlled ovarian stimulation and IUI. INTERVENTION(S): In vitro fertilization and ICSI. MAIN OUTCOME MEASURE(S): Fertilization, cleavage, and embryo quality were compared in IVF- and ICSI-inseminated oocytes. RESULT(S): There was no significant difference in fertilization rates between ICSI (60.4%) and conventional IVF (54.0%). Similarly, there was no difference in embryo quality between both groups. There was no total fertilization failure in ICSI-inseminated oocytes, whereas 8 (11.4%) of 70 cases showed absence of fertilization when conventional IVF was used. CONCLUSION(S): Couples with unexplained infertility and mild endometriosis failing to conceive with IUI and undergoing IVF have an 11.4% chance of fertilization failure that can be overcome easily by using ICSI in at least some oocytes. ICSI, however, is not superior to IVF as an insemination technique in most cases. These data should be used in counseling patients.

Adult↗