Human Reproduction, Vol 13, 1928-1932, Copyright © 1998 by Oxford University Press
H Shibahara, M Mitsuo, M Inoue, A Hasegawa, M Shigeta and K Koyama
The zona-free hamster egg penetration test (HEPT) is widely used for
evaluating the fertilizing ability of human spermatozoa. However, the
relationship between the HEPT and microassisted fertilization has yet to be
determined. To evaluate the efficiency of HEPT in selecting the most
appropriate method of in-vitro fertilization (IVF), including
intracytoplasmic sperm injection (ICSI) in couples with male factor
infertility, clinical laboratory data was analysed retrospectively. The
patients were divided into groups according to the sperm penetration index
as determined by the HEPT: group A (sperm penetration index = 0), group B
(sperm penetration index < 15) and group C (sperm penetration index >
or = 15). A total of 405 oocytes were collected and inseminated by
conventional methods in 69 couples with male factor infertility. In all, 31
out of 148 (20.9%) oocytes fertilized in group A; 35 out of 117 (29.9%) in
group B; and 73 of 140 (52.1%) in group C. The clinical pregnancy rates per
transfer in groups A, B and C were 0% (0/13), 0% (0/14) and 25.9% (7/27)
respectively. Both the fertilization rate and pregnancy rate in group C was
significantly higher than in groups A and B. ICSI was carried out in a
total of 57 couples and 334 oocytes in metaphase II stage were manipulated.
The normal fertilization (2 pronuclear) rate per oocyte was 65.6 +/- 26.0%
(mean +/- SD). Out of 127 oocytes, 76 (59.8%) fertilized in group A, 57 out
of 87 oocytes (65.5%) in group B and 86 out of 120 oocytes (71.7%) in group
C. Of the 56 transfers, 17 clinical pregnancies were obtained, giving an
average pregnancy rate of 30.4% per transfer. The clinical pregnancy rates
per transfer in groups A, B and C were 17.4% (4/23), 40.0% (4/10) and 39.1%
(9/23) respectively. No significant differences were observed in the
fertilization rates or in the pregnancy rates between the three groups. In
addition, there were no differences in the fertilization and pregnancy
rates between the ICSI and IVF patients in group C. These findings suggest
that the results of the HEPT are well correlated with the fertilizing
ability of human spermatozoa in the patients treated by conventional IVF.
Couples suffering from male factor infertility with a sperm penetration
index of < 15 (as determined by HEPT) should consider treatment with
ICSI, while those with a sperm penetration index of > or = 15 should
attempt conventional IVF.
ARTICLES
Relationship between human in-vitro fertilization and intracytoplasmic sperm injection and the zona-free hamster egg penetration test
Department of Obstetrics and Gynecology, Hyogo College of Medicine, Nishinomiya, Japan.
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