186 COMPARISON OF IVF AND ICSI TREATMENTS ON THE FERTILIZATION, EMBRYO CLEAVAGE, EMBRYO TRANSFER, PREGNANCY, AND EMBRYO IMPLANTATION RATES IN IMMUNOLOGICALLY INFERTILE PATIENTS

Abstract

The objective of the present work was to study the response to in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) techniques in regard to fertilization, embryo cleavage, embryo transfer (ET), pregnancy, and embryo implantation rates using semen from immunologically infertile men. Ninety-four men with antisperm antibodies (ASA) detected in their semen and serum by slide agglutination and tray microagglutination tests were involved in IVF (IVF group) or ICSI (ICSI group) treatment. All male patients underwent sperm penetration assay (SPA) using zona-free hamster oocytes. Men with positive SPA were admitted to the IVF protocol (n = 46) and men with negative SPA were involved in the ICSI protocol (n = 48). The female patients had normal ovulatory cycles and normal reproductive hormone concentrations (FSH, LH, prolactin, estradiol and progesterone). They received human menopausal gonadotropin (hMG) and human chorionic gonadotropin (hCG) for the induction of ovulation. Follicular growth was monitored by serial vaginal sonography and measurement of estradiol concentrations. Sperm viability was assayed by a hypo-osmotic swelling test (HOST) prior to oocyte insemination. Student t-test and Chi-Square test were used for statistical analysis of the data. The clinical data of the female patients (including age, body mass index (kg/m²), infertility duration, total number of hMG ampoules, estradiol concentration on cycle Day 3 and at day of hCG injection, and endometerial thickness) in the IVF and ICSI groups were not significantly different between the groups (P > 0.05). The oocyte recovery rate per patient was 6.34 (292/46) in the IVF group and 6.87 (330/48) in the ICSI group. The fertilization and embryo cleavage rates were similar (P > 0.05) in the IVF and ICSI groups (61.86% (133/215) vs. 56.50% (139/246) and 78.95% (105/133) vs. 72.66% (101/139), respectively). The percentage of embryos of transferable quality (ET rate) and the number of transferred embryos per patient were significantly higher (P < 0.05) in the IVF group compared to the ICSI group (73.33% (77/105) vs. 58.42% (59/101) and 1.67 vs. 1.22, respectively). The pregnancy rate per patient and embryo implantation rate were similar (P > 0.05) in both IVF and ICSI groups (28.26% vs. 25% and 21.74% vs. 18.75%, respectively). It was concluded from the results of the present study that the higher ET rate and the number of the transferred embryos per patient in the IVF group may be due to the superior quality of IVF sperm compared to ICSI sperm. Both IVF and ICSI embryos showed no significant differences in their pregnancy and embryo implantation rates; this may indicate that both types of embryos are viable and have similar pregnancy and embryo implantation potentials following ET, provided that the female patients have normal ovulatory cycles and normal concentrations of reproductive hormones. SPA and HOST were found to be useful tests for the selection of spermatozoa in ASA positive male patients for involvement in IVF or ICSI procedures.