The use of intracytoplasmic sperm injection for the treatment of severe and extreme male infertility

Abstract

The outcome of treatment by intracytoplasmic sperm injection (ICSI) is described for patients with severe male infertility. In 296 consecutive cycles, a normal fertilization rate of 69% was achieved with 288 cycles (97%) resulting in embryos suitable for transfer. A total of 32 clinical pregnancies were achieved from the transfer of fresh embryos (clinical pregnancy rate of 12% per transfer) and an additional 44 clinical pregnancies were obtained after the transfer of frozen-thawed embryos (clinical pregnancy rate of 16% per transfer). Overall, 57 of the 76 pregnancies were ongoing or delivered. An analysis of outcome in 5 male factor subgroups revealed no significant differences in pregnancy and implantation rates between the categories. However, the fertilization rate was significantly lower in patients with oligoasthenoteratozoospermia and significantly higher in those patients for whom epididymal sperm were used for insemination. The treatment of patients with extreme male infertility is also described; normal fertilization and embryo development were obtained using ICSI in patients with mosaic Klinefelter's syndrome, severe sperm autoimmunity, round-headed acrosomeless sperm (globozoospermia), completely immotile sperm selected by hypo-osmotic swelling and sperm isolated from testicular biopsies. Three ongoing pregnancies were obtained from 6 patients for whom testicular sperm were used. These results demonstrate the value of ICSI in the management of severe male infertility, however, the treatment of some types of extreme male infertility using ICSI may be limited.

Comparison of cryopreservation outcome following intracytoplasmic sperm injection and conventional in vitro fertilization

“…This pregnancy rate is in agreement with that of 16-21% reported by others for ICSI multicellular embryos (11)(12)(13) and is comparable to that reported for the transfer of frozen-thawed embryos originating from conventional IVF (16). However, to assess adequately the potential vulnerability of ICSIderived embryos to freezing and whether comparable results could be obtained from the transfer of these embryos, one should compare the outcome of ICSIderived thawed embryos to those of conventional IVF performed during the same period and under identical clinical conditions.…”

“…For fresh ET the pregnancy rate for ICSI cycles seems to be comparable to that of conventional IVF attempts (5,6). This rate is somewhat lower for frozen-thawed ET cycles of both ICSI and conventional IVF and is reported to range between 12.9 and 21% (7)(8)(9)(10)(11)(12)(13).…”

Implantation rates of embryos generated from slow cooled human oocytes from young women are comparable to those of fresh and frozen embryos from the same age group

“…Oocytes were transferred to QHEPES for 10 min followed by incubation in QFERT for a minimum of 1 h before ICSI was performed. The ICSI procedure has been previously reported [26]. Oocytes were subsequently cultured in QFERT and assessed for pronuclei at 16-18 h post injection.…”

Live birth following transfer of a cryopreserved embryo generated from a cryopreserved oocyte and a cryopreserved sperm: Case report

“…Cryopreserved donor sperm was prepared by density gradient centrifugation and intracytoplasmic sperm injection was performed as previously described [11]. Post injection oocytes were cultured in Quinn's Advantage Fertilisation medium for 17 h and assessed for the presence of pronuclei before being transferred to Quinn's Advantage Cleavage medium.…”