Microassisted Fertilization of Human Oocytes and Spermatozoa by Intracytoplasmic Sperm Injection

Moon, S Y; Kim, S H; Jung, B J; Jee, B C; Choi, S M; Kim, H S; Ryu, B Y; Pang, M G; Oh, S K; Suh, C S; Choi, Y M; Kim, J K; Lee, J Y

Abstract

The recent advent of intracytoplasmic sperm injection (ICSI) in IVF-ET has revolutionized the management of male factor infertility. In patients with poor semen analysis, disordered acrosome reaction, severe oligoasthenoteratozoospermia (OAT), and even azoospermia, all were able to conceive successfully with IVF-ET using ICSI. However, it is extremely important to establish the strict indications for ICSI to avoid the unnecessary application of ICSI and its overuse, and to prevent the possibility of transmitting genetic abnormalities, although long-term data is not yet available. The present study was designed to establish the clinical indications of ICSI, and to evaluate the effectiveness of ICSI in the management of male factor infertility. From February, 1996 to August, 1997, a total of 156 cycles of ICSI was performed in 83 IVF-ET patients, and grouped according to the results of three andrologic tests including strict morphology of sperm, acrosome reaction after ionophore challenge (ARIC) test, and sperm penetration assay (SPA) developed in this study: Group I -39 patients (72 cycles) with at least one abnormal andrologic test or fertilization rate <30% in the previous conventional IVF-ET cycles, Group II-22 patients (41 cycles) with severe OAT which made it impossible to perform the andrologic tests, and Group III-22 patients (43 cycles) with nonobstructive azoospermia. The fertilization rate was 72.0+/-22.6% in Group I , 65.7+/-23.6% in Group II, and 61.6+/-22.7% in Group III. The clinical pregnancy rate per ET was 19.7% (14/71), 15.0% (6/41), and 19.0% (8/42), respectively. There was no significant difference in the fertilization and clinical pregnancy rates among three groups. In summary, strict morphology, ARIC test and SPA can be valuable tools as the prognostic indicators of fertilization capacity in ICSI. The effective management with microassisted fertilization(MAF) by ICSI can dramatically improve the pregnancy rate in couples with male factor infertility, and contribute much to the management of all infertile couples.