Human Reproduction, Vol 13, 65-70, Copyright © 1998 by Oxford University Press
C Tomas, M Orava, L Tuomivaara and H Martikainen
The main indications for intracytoplasmic sperm injection (ICSI) are severe
male factor and fertilization failure or a low fertilization rate in
previous in-vitro fertilization (IVF) treatments. The fertilization and
pregnancy rates after ICSI, however, are seldom reported separately for
these two different indications. The aim of this study was to compare the
treatment outcome and pregnancy rate after ICSI between 65 patients with
previous failed fertilization or a low fertilization rate without male
factor, and 219 patients with a primary male factor. From the 2726 oocytes
collected, 2087 (77%) were micro-injected and 1355 (65%) achieved normal
fertilization. The oocyte fertilization rate was similar in the group with
previous failed fertilization or a low fertilization rate and the group
with a male factor (65 and 65% respectively), as was the cleavage rate of
normally fertilized oocytes (92 and 94% respectively). Despite the similar
fertilization and cleavage rates and the similar number and morphological
quality of embryos transferred in both groups, the pregnancy rate was
significantly lower (P < 0.05) in the group with previous failed
fertilization or a low fertilization rate than in the group with a male
factor (19.6 versus 33.5% respectively; 95% confidence intervals for the
difference, 2-26%). The implantation rate was also lower (P = 0.01) in
patients with previous failed fertilization or a low fertilization rate
(9.6%) than in the group with a male factor (19.5%). We conclude that
patients with previous failed fertilization or a low fertilization rate in
standard IVF without male factor have a significantly smaller chance of
becoming pregnant after subsequent ICSI than patients with a primary male
factor. This poor outcome probably reflects intrinsic oocyte defects not
bypassed by ICSI.
ARTICLES
Low pregnancy rate is achieved in patients treated with intracytoplasmic sperm injection due to previous low or failed fertilization in in-vitro fertilization
IVF Unit, Department of Obstetrics and Gynecology, University of Oulu, Finland. ctomas@cc.oulu.fi
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