Dianna Payne

Successful Treatment of Severe Male Factor Infertility in 100 Consecutive Cycles Using Intracytoplasmic Sperm Injection

In this report, we present the results of our first 100 consecutive cycles of intracytoplasmic sperm injection (ICSI). Overall, fertilization occurred in 98% of cycles and embryos were transferred in 94% (2.6 embryos per cycle). About 50% of patients had embryos frozen. The overall fertilization rate was 71%, of which 4% were abnormally fertilized (three pronuclei). A total of 30 clinical pregnancies were established (32% per transfer), resulting in 18 singleton, six twin and one triplet ongoing pregnancies. The implantation rate per embryo was 15%. There were no significant differences in the fertilization or pregnancy rates between patients who had only occasional motile spermatozoa in the ejaculate, semen that was too poor for routine in-vitro fertilization (IVF), or who had failed routine IVF and/or subzonal sperm injection (SUZI). A group of 18 patients were treated with both ICSI and routine IVF on their first cycle because of the high likelihood of failed fertilization due to poor sperm morphology < 20% normal). In this group, ICSI oocytes had a fertilization rate of 76% compared to only 15% for the routine IVF (control) oocytes, and six patients conceived after transfer of ICSI embryos (33%), indicating that ICSI can be used successfully on 50% of the oocytes if fertilization failure is expected. Similarly, patients who had failed to become pregnant with SUZI achieved excellent results after ICSI. There were no significant differences between ICSI and routine IVF in the proportions of grade 1, 2 or 3 embryos on day 3 post-oocyte recovery.(ABSTRACT TRUNCATED AT 250 WORDS)

What Is the Best Strategy for Using Embryos and Presenting Results in Assisted Reproductive Technology? A Strategy for Valid Comparisons of Results

Presentation of results is now an important facet of assisted reproductive technology (ART), for quality control, counseling of patients, research and development, accreditation of clinics, and establishment of national and international registers (1). Results can also have a financial impact on clinics, especially in countries such as the United Kingdom, where publication and public scrutiny of clinical results are requirements for accreditation by the Human Fertilization and Embryology Authority (HFEA), or in countries in which there is vigorous commercial competition between clinics. An enormous number of factors influence ART results: cultural, financial, ethical, clinical, and administrative practices and clinical factors such as female age at treatment, etiology of infertility, ovarian stimulation regimes, patient history, previous treatment cycles, treatment modality, number of oocytes available for insemination, number of embryos transferred, and embryo selection (2–4). One cannot, and therefore should not, make comparisons of results unless equivalent data sets are being compared. The introduction of undue variance due to uncontrolled factors can skew the results and suggest differences that do not exist, and this in turn can lead to misinformation and unwarranted changes in clinical practice. For example, one should not compare in vitro fertilization (IVF) pregnancy rates for the United States, where it is common practice to transfer three, four, or five or more embryos, with those for other countries where only two embryos are routinely transferred, because the pregnancy rate is correlated with the number of embryos transferred (4). Another perception that arises from invalid comparisons is that one form of treatment is more effective than another. A good example of this is intracytoplasmic sperm injection (ICSI). The high initial pregnancy rates achieved after the widespread introduction of ICSI (5–7) prompted some practitioners to speculate that we should inject all oocytes and abandon routine IVF insemination. This was short-sighted for several reasons, not least of which was that it completely ignored the issue of congenital abnormalities and the developmental outcome of children produced by ICSI (8) at a time