The value of single versus repeated insemination in intra-uterine donor insemination cycles.

Pregnancy rates per cycle of intra-uterine donor insemination following ovulation induction were compared retrospectively for those patients having a single, and those having repeated insemination using frozen donor semen. Single insemination was performed in 69 cycles in which 15 women became pregnant (pregnancy rate = 22%). Of 65 cycles in which repeated insemination was performed, 16 women became pregnant (pregnancy rate = 25%). This difference in pregnancy rates was not statistically significant (chi 2 = 3.6, P = 0.84). We conclude that cycle fecundity may not be increased by repeating insemination.

Intramural pregnancy following difficult embryo transfer.

We report an intramural pregnancy following a difficult embryo transfer in a 31 year-old woman, having in-vitro fertilization and embryo transfer for tubal factor infertility. The creation of a 'false passage' at a previous instrumentation of the cervix may be implicated in the ectopic placement of embryos.

Assisted fertilization with intracytoplasmic sperm injection.

OBJECTIVE: To evaluate the significance of intracytoplasmic sperm injection in severe male factor infertility and previous failed fertilization. DESIGN: Prospective observational study. SETTING: Private infertility clinic, London. SUBJECTS: Sixty-nine patients with a long-standing history of infertility of which 48 had previous failed fertilization, 15 had < 1 million progressive motile sperm per ejaculate, and the remaining 6 had obstructive azoospermia. INTERVENTION: Assisted fertilization with primary intracytoplasmic sperm injection was carried out in 69 IVF. OUTCOME: Normal (two pronuclei [2PN]) fertilization and pregnancy rates. RESULTS: A total of 967, oocytes were collected and 785 were subsequently microinjected. Normal fertilization (2PN) occurred in 410 oocytes (52%) and 90.5% of those cleaved. Sixty-four patients underwent ET, with a total of 181 embryos transferred. Twenty-five patients conceived with a pregnancy rate of 39% per transfer. The implantation rate was 16% and the total pregnancy loss rate 24%. Failed fertilization after intracytoplasmic sperm injection occurred in four cases. CONCLUSIONS: Intracytoplasmic sperm injection is increasingly becoming the treatment of choice in infertile couples where assisted fertilization is indicated. The high fertilization and pregnancy rates observed with this technique, together with a low risk of abnormalities, has revolutionized treatment of male factor infertility.

Experience with assisted fertilization in severe male factor infertility and unexplained failed fertilization in vitro.

We present results of in-vitro fertilization (IVF) cycles using assisted fertilization at our centre. Assisted fertilization was performed in those couples who had failed to fertilize oocytes with conventional IVF, or where this was predicted by the presence of severe male factor infertility. In 20 consecutive assisted fertilization cycles 223 oocytes were subjected exclusively to subzonal insemination (SUZI). Subsequently in 32 consecutive assisted fertilization cycles 418 oocytes were subjected to intra-cytoplasmic sperm injection (ICSI). More oocytes were damaged by ICSI (8.9%) than by SUZI (2.3%) (P = 0.03), but normal fertilization resulted more often after ICSI (56.9%) than SUZI (35.8%) (P = 0.004). Sperm parameters, other than sufficient numbers to perform the procedures, had no effect on fertilization or pregnancy rates. Every cycle led to the transfer of at least one embryo. Pregnancy resulted from eight of the SUZI cycles (40%) and nine of the ICSI cycles (28%). Implantation rates were calculated as 25 and 12% for SUZI and ICSI respectively. The presence of living spermatozoa is the only semen parameter limiting assisted fertilization. At present more centres are able to perform SUZI than ICSI and we feel it is premature to abandon SUZI altogether. Local conditions and success rates should be considered when decisions are made in assisted fertilization cycles.