Abstract
Purpose: The objective was to determine the optimal insemination technique in patients undergoing in vitro fertilization (IVF) after failed direct intraperitoneal insemination (DIPI) and the outcome of intracytoplasmic sperm injection (ICSI) in such cases.
Methods: In case–control studies, 53 couples with unexplained infertility who underwent IVF after four failed DIPI cycles were compared with 75 couples with tubal or endometriosis infertility as controls. Thirty couples with unexplained infertility after failing to conceive with DIPI and conventional IVF who underwent ICSI and 58 couples with male-factor infertility as controls also were compared. Fertilization cleavage, embryo quality, implantation, and pregnancy were compared after IVF and after ICSI.
Results: There was a significant difference in fertilization rates after IVF between cases of unexplained infertility after failing to conceive with DIPI (40.4%) and patients with tubal or endometriosis infertility (67.9%). There also was a significant difference in total fertilization failure rates between the two groups (30.4% and 3.9%, respectively). There was a slight but significant difference in numbers of fertilized oocytes after ICSI between patients with low fertilization rate undergoing IVF after failing to conceive DIPI (85.8%) and patients with male factor (90.4%). Total fertilization failure was not observed in these cases.
Conclusions: Couples with unexplained infertility after failing to conceive with DIPI show a failed fertilization or a low fertilization rate after IVF. However, they demonstrated a good chance of becoming pregnant after subsequent ICSI, even with statistically significant difference in fertilization rate as compared with male-factor cases.
Keywords: intracytoplasmic sperm injection, unexplained infertility, in vitro fertilization, direct intraperitoneal insemination, failed fertilization
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REFERENCES
- 1.Collins J, Crosignani P. Unexplained infertility: A review of diagnosis, prognosis, treatment efficacy, and management. Int J Obstet Gynecol. 1992;39:267–275. doi: 10.1016/0020-7292(92)90257-j. [DOI] [PubMed] [Google Scholar]
- 2.Crosignani PG, Lauretis LD, Ragni G, Olivares MD, Finzi G, Perotti L. Intraperitoneal insemination in the treatment of male and unexplained infertility. Fertil Steril. 1991;55:333–337. [PubMed] [Google Scholar]
- 3.Turhan NO, Artini PG, Ambrogio G, Droghini F, Volpe A, Genazzani AR. Studies on direct intraperitoneal insemination in the management of male factor, cervical factor, unexplained and immunological infertility. Hum Reprod. 1992;7(1):66–71. doi: 10.1093/oxfordjournals.humrep.a137561. [DOI] [PubMed] [Google Scholar]
- 4.Minoura M, Takeuchi S, Xiaoxiong S, Shibahara T, Fumamura N, Toyoda N. Increasing the pregnancy rate after combined treatment with hMG/hCG and direct intraperitoneal insemination. J Reprod Med. 1999;44(1):18–22. [PubMed] [Google Scholar]
- 5.Gurgan T, Urman B, Yarali H, Kisnisci HA. The results of in vitro fertilization-embryo transfer in couples with unexplained infertility failing to conceive with superovulation and intrauterine insemination. Fertil Steril. 1995;64:93–97. [PubMed] [Google Scholar]
- 6.Ruiz A, Guanes PP, Remohi J, Simon C, Minguez Y, Pellicer A. The role of in vitro fertilization and intracytoplasmic sperm injection in couples with unexplained infertility after failed intrauterine insemination. Fertil Steril. 1997;68:171–173. doi: 10.1016/s0015-0282(97)81497-5. [DOI] [PubMed] [Google Scholar]
- 7.Manual for the Examination of Human Semen and Semen Cervical Mucus Interaction. 3rd ed. New York: Cambridge University Press; 1993. pp. 43–44. [Google Scholar]
- 8.Kimura Y, Yanagimachi R. Intracytoplasmic sperm injection in the mouse. Biol Reprod. 1995;52:709–720. doi: 10.1095/biolreprod52.4.709. [DOI] [PubMed] [Google Scholar]
- 9.Aboulghar MA, Mansour RT, Serour GI, Amin Y, Abbas AM, Salash IM. Ovarian superstimulation and intrauterine insemination for the treatment of unexplained infertility. Fertil Steril. 1993;60:303–306. doi: 10.1016/s0015-0282(16)56102-0. [DOI] [PubMed] [Google Scholar]
- 10.Kahn JA, Sunde A, During VV, Sordal T, Molne K. Treatment of unexplained infertility, fallopian tube sperm perfusion (FSP) Acta Obstet Gynecol Scand. 1993;72:193–199. doi: 10.3109/00016349309013371. [DOI] [PubMed] [Google Scholar]
- 11.Asch RH, Balmaceda JP, Ellsworth LR, Wong PC. Preliminary experience with gamate intrafallopian transfer (GIFT) Fertil Steril. 1986;45:366. [PubMed] [Google Scholar]
- 12.Audibert F, Hedon B, Arnal F. Results of IVF attempts in patients with unexplained infertility. Hum Reprod. 1989;4:766–771. doi: 10.1093/oxfordjournals.humrep.a136982. [DOI] [PubMed] [Google Scholar]
- 13.Tomas C, Orava M, Tuomivaara L, Martikainen H. Low pregnancy rate is achieved in patients treated with intracytoplasmic sperm injection due to previous low or failed fertilization in in vitro fertilization. Hum Reprod. 1998;13:65–70. doi: 10.1093/humrep/13.1.65. [DOI] [PubMed] [Google Scholar]
- 14.Miller K, Falcone T, Goldberg JM, Attaran M. Previous fertilization failure with conventional in vitro fertilization is associated with poor outcome of intracytoplasmic sperm infection. Fertil Steril. 1998;69:242–206. doi: 10.1016/s0015-0282(97)00465-2. [DOI] [PubMed] [Google Scholar]
- 15.Tesarik J, Sousa M, Testart J. Human oocyte activation after intracytoplasmic sperm injection. Hum Reprod. 1994;9:511–518. doi: 10.1093/oxfordjournals.humrep.a138537. [DOI] [PubMed] [Google Scholar]
- 16.Gabrielsen A, Petersen K, Mikkelsen AL, Lindenberg S. Intracytoplasmic sperm injection does not overcome an oocyte defect in previous fertilization failure with conventional in vitro fertilization and normal spermatozoa. Hum Reprod. 1996;11:1963–1965. doi: 10.1093/oxfordjournals.humrep.a019525. [DOI] [PubMed] [Google Scholar]
- 17.Svalander P, Forsberg AS, Jakobsson AH, Wikland M. Factors of importance for the establishment of a successful program of intracytoplasmic sperm injection treatment for male infertility. Fertil Steril. 1995;63:828–837. doi: 10.1016/s0015-0282(16)57489-5. [DOI] [PubMed] [Google Scholar]
- 18.Munne S, Alikani M, Tomkin G, Grifo J, Cohen J. Embryo morphology, developmental rates, and maternal age are correlated with chomosome abnormalities. Fertil Steril. 1995;64:382–391. [PubMed] [Google Scholar]