Most couples with infertility problems can be treated successfully if they continue treatment. Thereby ART can reach natural fertility rates. Even with the restrictions in place as a result of the German Embryo Protection Law, CLBR reach internationally comparable levels.

Neither the source of spermatozoa nor the etiology of severe male infertility has relevant impact on the results of ICSI cycles as long as fresh motile, morphologically normal spermatozoa are used. Therefore, in case of cryptozoospermia, we recommend to preferentially use ejaculated spermatozoa to prevent those men from an unnecessary testicular biopsy avoiding risks and costs implied.

The primary intention for the choice of fertilization modality between IVF and ICSI is the prevention of a relative or total fertilization failure. Such treatment failure is best prevented through ICSI, which results in slightly higher clinical pregnancy rates per started cycle. After embryo transfer, there are no differences in the success rates of IVF and ICSI. The supposed cumulative live-birth rates are useful as a basis for counselling subfertile couples to help reduce the high discontinuation rate, which is still the main reason for inefficacy in ART. Following an unsuccessful first treatment cycle, the prognosis remains positive, but until success is achieved, more treatment cycles are necessary.

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