Previous fertilization failure with conventional in vitro fertilization is associated with poor outcome of intracytoplasmic sperm injection

Objective: To evaluate the outcome of intracytoplasmic sperm injection (ICSI) in patients with a history of fertilization failure with conventional IVF. Design: Retrospective analysis of 2 years of clinical experience with ICSI. Setting: Clinical IVF-ET program in a tertiary care referral center. Patient(s): The results of ICSI performed between January 1995 and December 1996 were compared between patients with normal semen parameters and a history of fertilization failure (<20% of oocytes) with conventional IVF and patients with male factor infertility. Intervention(s): In vitro fertilization with ICSI. Main Outcome Measure(s): Parameters examined included oocyte survival, fertilization, embryo cleavage, implantation rates, and clinical pregnancy rates. Result(s): Fertilization was achieved with ICSI for all patients during the study period. Although oocyte survival and fertilization did not differ between groups, the pregnancy and implantation rates for patients with a history of idiopathic fertilization failure (20% and 6%, respectively) were significantly lower than those for other patients undergoing ICSI (47% and 22%, respectively). Conclusion(s): The outcome of ICSI varied depending on the indication for treatment. Patients who had a history of failed or poor fertilization in vitro with apparently normal semen parameters had significantly lower pregnancy and implantation rates than did patients with either obstructive azoospermia or impaired semen quality. (C) 1998 by American Society for Reproductive Medicine.