A young couple proceeded to three ICSI treatment cycles because of male infertility. The semen samples varied between 10 x 10(6) and 36 x 10(6)/ml, 38 and 51% progressive motility but 0% normal morphology. Different types of sperm heads, mostly round-headed with varying spherical appearance (86%) were presented beside acephalic sperm (pinheads; 12%), both one- or two-tailed and the former also without a tail. Very few sperm (2%) exhibited slightly oval-shaped heads. Electron microscopy revealed the absence of the acrosome combined with disturbance of the chromatin condensation among the round-headed sperm. In all three cycles, the fertilization rate using the round-headed sperm fraction was very low with the best result of 2/18 (11%) two-pronucleate oocytes and one one-pronucleate oocyte obtained in the second ICSI cycle. The three oocytes cleaved and were transferred in the 3-4-cell stage without achieving a pregnancy. Of the 29 unfertilized and prepared oocytes from the last two cycles, 27 were informative and revealed the maternal metaphase II chromosomes in the haploid range and a high rate (85%) of premature chromosome condensation (PCC) of the sperm nucleus with remarkable variation in the degree of condensation. Thus, it appears that nearly all round-headed sperm from this patient were incapable of oocyte activation after ICSI, which could be due to non-release (or absence) of an activating factor. As a consequence, PCC was induced in the sperm nuclei by the chromosome condensing factors which were still active in the oopasm of the arrested oocytes.

This study describes the conduct and results of a recently developed technique for transvaginal catheterization of the Fallopian tube in order to transfer gametes or early embryos. Transvaginal gamete intra-Fallopian transfer (TV-GIFT) was performed in 46 patients after stimulation with human menopausal gonadotrophin (HMG) and human chorionic gonadotrophin (HCG) and transvaginal oocyte retrieval. This resulted in 11 (23.9%) pregnancies. Eight patients delivered healthy children, including one set of twins. Two patients had abortions at 8 and 11 weeks of gestation and one had an ectopic pregnancy. In a first series of 11 women, oocytes were fertilized in vitro and a maximum of three embryos at the 2- to 8-cell stages were transferred into one tube. Three of the 11 cycles with tubal embryo-stage transfer' (TV-TEST) resulted in clinical pregnancy.

Highly purified FSH (Fertinorm HP) was used for follicle stimulation during one cycle of IVF in each of 112 women. In all cases, stimulation was begun with 150 IU FSH per day s.c. after pituitary down-regulation with a GnRH analogue in a Long protocol. Sixteen (14.3%) of the 112 treatment cycles started were stopped before follicle aspiration. The reasons for stopping stimulation were elevated progesterone values with premature luteinisation in 9 (8.0%) patients, inadequate follicle stimulation in 4 (3.6%) cases and threatened overstimulation in 3 (2.7%) cases. The mean duration of stimulation was 11.8 days with 7.8 oocytes obtained per aspiration by the transvaginal rute. Embryo transfer was possible in 77 (68.7%) patients, with a mean of 2.3 embryos per transfer. A total of 23 clinical pregnancies resulted, with a pregnancy rate of 20.5% and 29.9% per cycle and embryo transfer, respectively. There were three cases of multiple pregnancy (13.0%), two (8.7%) miscarriages occurred and one patient (4.3%) had a tubal pregnancy. The rate of successful pregnancies was thus 17.9% per cycle. Five patients (5.2%) required treatment for overstimulation. There were not other treatment complications. These results show that highly purified FSH can also be used successfully in IVF after pituitary down-regulation. The remaining endogenous LH activity in these cases may be regarded as sufficient for follicular development and steroid synthesis. Highly purified FSH can therefore be used for all stimulation protocols in patients with normal gonadotrophin levels. The relatively low rate of miscarriages with this treatment is noteworthy.