Prognosis for Clinical Pregnancy and Delivery After Total Fertilization Failure During Conventional In Vitro Fertilization (IVF) or Intracytoplasmic Sperm Injection (ICSI)

Abstract

A result of total fertilization failure after IVF or ICSI can be a very frustrating experience for patients as well as clinicians, and very little information exists for patient counseling regarding the future hope of a successful pregnancy. The objective of this study was to determine the prognosis for clinical pregnancy and delivery after total fertilization failure by examining the experience at Boston IVF. Retrospective analysis of treatment cycles of Boston IVF patients who had total fertilization failure during a cycle of conventional IVF or ICSI. Records of treatment cycles from 1/1/00-12/31/03 at Boston IVF were reviewed. Out of 6,420 total cycles of conventional IVF at our clinic during these years, 307 (5%) experienced total fertilization failure. Out of 3,607 ICSI cycles, 126 (3%) experienced total fertilization failure. Subsequent treatment cycles of these patients and pregnancy outcomes were reviewed. 73 IVF patients elected to discontinue treatment after fertilization failure but 234 (76%) had 486 subsequent cycles. 417 (86%) of these cycles resulted in embryo transfers (37 were cancelled before retrieval due to poor stimulation; in 5 cycles no mature eggs were retrieved; and 27 cycles again resulted in total fertilization failure). Out of these 234 patients, 109 (47%) eventually became pregnant and delivered or have an ongoing clinical pregnancy. 52 ICSI patients discontinued treatment but 74 (59%) had 147 subsequent cycles. 116 (79%) of these cycles resulted in embryo transfers (15 were cancelled before retrieval due to poor stimulation; in 4 cycles no mature eggs were retrieved; and 12 cycles again resulted in total fertilization failure). Out of these 74 patients, 25 (34%) eventually became pregnant and delivered or have an ongoing clinical pregnancy. The number of subsequent cycles (n), # embryo transfers (ET), treatment choices and clinical pregnancy (pg) results (% per ET) are summarized in the table: Tabled 1 Regardless of whether total fertilization failure occurred during IVF or ICSI, a large number of patients who continued treatment were able to achieve a clinical pregnancy within one or two cycles, with a large majority of them using homologous gametes. The results obtained from this patient population show that the prognosis for pregnancy is good in subsequent cycles even after total fertilization failure.