ICSI as a therapeutic measure for failed conventional in-vitro fertilization cycles: the cornell experience

Abstract

Objective: To determine whether ICSI is an effective tool for improving pregnancy rates among patients with previously unsuccessful IVF cycles resulting from poor or total fertilization failure. Design: A retrospective analysis inclusive of cycles from April 1995 to December 2001 was carried out at our IVF center in a hospital university setting. The study encompassed a patient population where poor or failed IVF attempts were followed by ICSI cycles. Two groups, Insemination and ICSI, were compared using fertilization, clinical pregnancy, implantation, and ongoing pregnancy rates. Materials/Methods: All female patients were <38 years old and possessed more than 3 mature oocytes. Only couples where the male partner presented with optimal semen parameters on the day of oocyte retrieval were included so as to preclude the possibility of a negative impact caused by poor sample quality. Semen characteristics were restricted according to WHO criteria for normality: concentration >20 × 106/ml and motility >40%. Patients with preimplantation genetic diagnosis were excluded from the study. A total of 68 patients underwent 75 insemination cycles and subsequently returned for 89 ICSI cycles. Within the insemination group, the average sperm concentration (±SD) and motility (±SD) was 122.8 × 106/ml ± 80.7 and 60.8% ± 10.3, respectively. The semen characteristics of the ICSI group were: average sperm concentration (±SD): 121.1 × 106/ml ± 69.2 and motility (±SD): 60.4% ± 11.1. Results: Of the attempted 75 insemination cycles, only 56 had preembryos of sufficient quality for transfer while 88 of the 89 ICSI cycles underwent preembryo replacement. In the Insemination group, 13 cycles failed to produce normal fertilization in any oocytes; there were no fertilization failures in the ICSI group. Fertilization, clinical pregnancy and implantation rates were all significantly higher once ICSI was performed. Furthermore,the ongoing pregnancy rate also increased dramatically within the ICSI group (34.1%; 30/88), significantly higher than the Insemination group (10.7%; 6/56) (p <0.05). Table Conclusions: Increased fertilization, clinical pregnancy, and implantation rates within the ICSI group demonstrate that ICSI can overcome certain factors which may cause abnormally low or absent fertilization. Even in these situations, when semen parameters are not compromised, ICSI can play a role in reversing a negative result. Therefore, ICSI should be considered as the first line of treatment once poor fertilization or complete fertilization failure has been documented, so as to optimize subsequent reproductive outcome.TableResults:Insemination CyclesICSI cyclesNo. Matched Patients/ Cycles7589Maternal Age (Mean ± SD)32.8 ± 3.033.6 ± 2.9NSFertlization (2PN/MII injected)319/716 (44.6%)604/784 (77.0%)p < 0.05Mean No. Transferred (± SD)2.7 ± 1.03.4 ± 1.0p < 0.05Clinical Pregnancy/Transfer11/56 (19.6%)37/88 (42.1%)p < 0.05Implantation Rate (No. Sacs/Transferred)15/152 (9.9%)64/296 (21.6%)p < 0.05 Open table in a new tab Supported by: The Center for Reproductive Medicine & Infertility of The Weill Medical College of Cornell University.