Outcome of first IVF/ICSI-cycle in couples who failed conceiving during intrauterine insemination

Abstract

Objective: The choice between conventional in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) as fertilization method is usually based on evaluation of traditional semen parameters. There are however many couples who experience total fertilization failure during IVF despite normal semen parameters. The introduction of ICSI has resulted in high pregnancy rates, in particular in patients with male factor infertility, but also in patients with previous fertilization failure after IVF. This study was set up in order to choose the most effective fertilization method for couples with the diagnosis unexplained infertility who had failed conceiving during previous intrauterine inseminations (IUI). Design: Retrospective study. Materials and Methods: A total of 252 infertile couples undergoing their first IVF/ICSI-treatment were included in this prospective randomised study. All patients were diagnosed as having unexplained infertility and they all had failed conceiving in at least 3 previous intrauterine inseminations (IUI). The sibling oocytes were randomised to two groups, for either conventional in-vitro fertilization or intracytoplasmic sperm injection (50/50). Results: In the total study population a pregnancy rate per embryo transfer of 53% was seen. A significantly better fertilization rate was obtained after ICSI compared to IVF (68 versus 46%). ICSI resulted in significantly fewer cycles with total fertilization failure compared to conventional IVF (3 versus 25%). The group who experienced total fertilization failure after conventional IVF had significantly lower sperm concentration and motility compared to the entire study group, although they had a normal semen quality according to the criteria set up by the World Health Organization (WHO 1999). In cycles with complete fertilization failure after IVF, couples achieved a positive pregnancy test of 50% per transfer, with the transferred ICSI-embryos. Conclusion: ICSI is the most effective fertilization method for patients diagnosed with unexplained infertility and > 3 previous intrauterine inseminations. The strategy of splitting the sibling oocytes can effectively hinder the complete failure of fertilization and save the cycle with high chances of achieving a pregnancy. Better predictors of sperm fertilization potential than WHO-criteria are needed in order to select the best fertilization method for ART-techniques.