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Objective: To understand the correlation between normalcy of the sperm, fertilization, and early embryo development, and to establish a detailed classification scoring scale for the individual spermatozoon with the highest predictive fertilizing potential in real time during intracytoplasmic sperm injection (ICSI)., Design: A retrospective and analysis., Setting: Laboratory Drouot., Patient(s): 27 couples with male factor infertility referred for ICSI treatment., Intervention(s): Before ICSI, motile spermatozoa were scored after aspiration., Main Outcome Measure(s): Oocyte fertilization, embryo development and morphology, outcome of scored motile injected spermatozoa., Result(s): Our suggested formula is (Normal head score = 2) + (Lack of vacuole score = 3) + (Normal base score = 1) = (Total score = 6) for a morphologic "normal top" spermatozoon, calculated with the major criteria affecting the outcome of ICSI. We take into account the normalcy of head size and shape, the base of the head, and the lack of vacuoles. Our scoring of three classes of injected spermatozoa revealed a statistically significant difference in fertilization rate: 39 out of 46 (84%), 94 out of 128 (73%), and 27 out of 44 (61%), respectively. Our examination of the contribution of maternal age in correlation to sperm score revealed a distinction between oocytes originating from women younger than 30 years and oocytes from women aged 30 years and older., Conclusion(s): Our suggested classification provides allows the best spermatozoon to be chosen for ICSI, particularly for oocytes from women aged 30 years and older.

Objective: To verify whether microinjection into retrieved oocytes of motile spermatozoa with morphologically normal nuclei, strictly defined by high power light microscopy (x >6000), improves the IVF/intracytoplasmic sperm injection (ICSI) pregnancy rate in couples with repeated ICSI failures., Design: Comparative prospective study testing routine IVF/ICSI outcome parameters against those of modified ICSI based on morphological selection of spermatozoa with normal nuclei., Setting: Male factor fertility laboratory and IVF center., Patient(s): Sixty-two couples, with at least two previous consequent pregnancy failed ICSI cycles, underwent a single ICSI trial preceded by morphological selection of spermatozoa with normal nuclei. Fifty of these couples were matched with couples who underwent a routine ICSI procedure at the same IVF center and exhibited the same number of previous ICSI failures., Intervention(s): Standard ICSI and modified ICSI., Main Outcome Measure(s): ICSI pregnancy rate., Result(s): The matching study revealed that pregnancy rate after modified ICSI was significantly higher than that of the routine ICSI procedure (66.0% vs. 30.0%)., Conclusion(s): Microinjection into retrieved oocytes of selected spermatozoa with strictly defined morphologically normal nuclei improves significantly the incidence of pregnancy in couples with previous ICSI failures.

Objective: To use injection of spermatids into oocytes as a mode of infertility treatment in cases in which spermatozoa are not available., Design: Prospective clinical evaluation and case report., Setting: In Vitro Fertilization Unit, Herzliya Medical Centers, Herzliya-on-Sea, Israel., Patient(s): Thirteen couples with male factor infertility in which the male partner lacked spermatozoa in the ejaculate or testicular biopsy samples., Intervention(s): Round spermatid injection and elongated spermatid injection into oocytes., Main Outcome Measure(s): Evaluation of the rate of two-pronucleated and single-nucleated zygote development., Result(s): The rate of two-pronucleated zygote development after round spermatid injection and elongated spermatid injection was relatively low (27% and 36%, respectively). Single-nucleated zygotes develop more frequently after round spermatid injection and elongated spermatid injection (35% and 17%, respectively) than after intracytoplasmic sperm injection with mature spermatozoa. A normal pregnancy and childbirth resulted from the transfer of 4 cleaving embryos, each of which developed from a single-nucleated zygote in a round spermatid injection treatment cycle with ejaculated spermatids., Conclusion(s): Embryos derived from single-nucleated zygotes after spermatid conception can be viable and give rise to an ongoing clinical pregnancy and childbirth.

Objective: To examine the results of six or more embryos transferred to patients whose IVF-ET cycles repeatedly met with failure., Design: Prospective clinical evaluation of pregnancy rates and pregnancy outcome., Setting: IVF-ET Unit., Patients: Seventy-two IVF patients who had failed at least four previous IVF cycles., Interventions: Forty-one patients (group A) received six or more embryos, and 31 patients (group B) chose to receive five embryos., Main Outcome Measures: Per embryo implantation rate, pregnancy rate, multiple pregnancies, and outcome were evaluated., Results: With the transfer of six or more embryos, the pregnancy rate was significantly higher than with the transfer of five embryos (56% versus 29%, respectively). This was associated with a slight, but insignificant, increase in multiple gestations. No difference in pregnancy outcome was noted among the groups., Conclusions: Patients who have had repeated IVF failures may have higher pregnancy rates if six or more embryos are transferred in subsequent cycles.

Objectives: To determine the existence of differences in the ultrastructural parameters between the medium-washed sperm samples of the affected and nonaffected egg yolk (EY) groups and to verify whether ultrastructural changes occur in the EY-affected spermatozoa after EY preincubation., Setting: The study was performed in the Laboratory of the IVF Unit, Serlin Maternity Hospital, and the Laboratory of Male Fertility, Bar-Ilan University, Ramat Gan, Israel., Patients: The positive group included 12 males who underwent 1.9 IVF cycles with 0% fertilization rate that increased to 68% after EY treatment. The negative group included 11 males with 1.2% fertilization rate in 1.1 IVF cycles with no improvement after preincubation of spermatozoa in EY., Results: Compared with the laboratory standard, patients of both groups exhibited a lower normalcy of the head sperm cell subcellular organelles. With EY treatment, the positive group exhibited a decrease in the frequency of some sperm head organelle specific malformations., Conclusions: Fertilization capacity of mature spermatozoa might be reduced because of an excess of acrosome malformations, postacrosomal lamina, and chromatin caused by in vitro sperm manipulations. The manipulation effect may be avoided by EY treatment.

High fertilization and PRs have been achieved by using thawed donor sperm cryopreserved with medium containing EY. The aim of our study was to examine the possible effect of EY on the fertilizing capacity of fresh sperm in an IVF program. Preincubation of spermatozoa in EY for 2 hours at room temperature significantly improved fertilization (P less than 0.001) in couples who had low fertilization rates in previous cycles, whereas no effect was found concerning couples with high fertilization rates.

Fifty-five patients were treated by ovum donation, and a control group of 165 patients underwent IVF. The number of pregnancies obtained were 28 and 25, respectively. The initial beta-hCG values, as well as the PRs and implantation rates, in the ovum donation series were significantly higher than those of the IVF series. The clinical significance and potential application of these observations are discussed.

A simple, rapid, and sensitive solid-phase immunoassay procedure for the determination of estrone-3-glucuronide (E1-3-G), which uses chemiluminescence as the end point in unextracted morning urine, is described. Thirty-one patients undergoing induction of ovulation in an in vitro fertilization (IVF) unit participated in the study. From day 3 of the menstrual cycle until the day of hCG administration, morning blood samples and morning urine specimens were collected for the determination of serum 17 beta-estradiol (E2) and urine E1-3-G, respectively. A good correlation was noted between E2 measured by radioimmunoassay (RIA) and the E1-3-G measured by chemiluminescence immunoassay (CIA), from day 5 up to the day of hCG administration (0.6 less than r less than 0.85, P less than 0.001). It is evident from this study that the CIA measurement of E1-3-G in morning urine is an accurate and rapid (2.5 hours) method and is convenient for monitoring induction of ovulation with human menopausal gonadotropins.

The term "unexplained infertility" is applied to a couple in whom after an elaborate workup no apparent reason for infertility is found. Between August 1985 and May 1987, 435 patients underwent 720 treatment cycles in an in vitro fertilization-embryo transfer (IVF-ET) unit. Eighty-three of the patients had unexplained infertility as their indication for IVF-ET. Fifty-two (group A) had primary unexplained infertility and 31 (group B) had secondary unexplained infertility. Group A underwent 87 and group B underwent 50 treatment cycles. Forty-six ET were performed in group A and 34 in group B. Clinical pregnancies were achieved in 20 patients of group A (11.5% per treatment cycle) and 13 of group B (26.0%), for a combined rate of 16.8% per cycle. Patients with tubal infertility treated in the program had a pregnancy rate of 18.8% per treatment cycle. The performance of the secondary unexplained infertility group is significantly better than that of the primary unexplained infertility group. However, the overall results with patients with unexplained infertility are similar to those patients treated for tubal infertility.