Is there any need for diagnostic laparoscopy in couples undergoing intracytoplasmic sperm injection for severe male-factor infertility?

Purpose: Our purpose was to determine whether there is a need for a preliminary diagnostic laparoscopy in couples undergoing intracytoplasmic sperm injection (ICSI) because of severe male-factor infertility. Methods: In this retrospective study, the results of diagnostic laparoscopy in 342 women with a normal fertility workup undergoing ICSI were evaluated and sperm parameters were correlated with the findings at laparoscopy. Subgroups of patients were defined according to sperm quality, which was expressed as total normal motile count [TNMC = volume (mi) X concentration (10(6)/ml) X percentage progressive motility/100 X percentage normal morphology/100]. Results: When sperm morphology was evaluated according to Kruger's strict criteria, the probability of finding pathology on laparoscopy in the normal male group (16.7%) was statistically higher than that in the group with severely abnormal sperm (1.8%; P < 0.01). Conclusions: There is no need to perform a preliminary diagnostic laparoscopy in the female partner if a full workup is normal in couples with severe male-factor infertility willing to undergo ICSI.