OBJECTIVE:To determine the success of intracytoplasmic sperm injection for severe male infertility.DESIGN:A retrospective survey.SETTING:A tertiary infertility service.PATIENTS AND INTERVENTIONS:One hundred fourteen couples had 119 intracytoplasmic sperm injection treatments because of previous failure of standard IVF, poor results with subzonal insemination, sperm concentration < 2 x 10(6)/mL, other sperm defects, or male genital tract obstruction.MAIN OUTCOME MEASURES:Fertilization, implantation, and pregnancy rates.RESULTS:Of 1,185 oocytes treated by intracytoplasmic sperm injection, normal fertilization and cleavage occurred in 717 of 1,073 that survived (67% normal fertilization rate). Abnormal fertilization occurred in 113 oocytes (11% abnormal fertilization rate) and 112 oocytes did not survive the procedure (survival rate of 90%). In 117 couples, 251 embryos were transferred fresh, 409 embryos were cryopreserved, and 224 were transferred after thawing. The implantation rate was 7.4% (fetal heart per embryo transferred). To date 36 clinical pregnancies have been achieved (12% per fresh transfer, 20% per frozen transfer, and 30% overall), 24 are ongoing or delivered (6% per fresh transfer, 14% per frozen transfer, and 20% per intracytoplasmic sperm injection). The fertilization rates were the same (65%) with various sperm defects but higher with genital tract obstructions (75%).CONCLUSION:Intracytoplasmic sperm injection has improved the prognosis of severe male infertility.

With the introduction of intracytoplasmic sperm injection (ICSI) as a practical successful treatment for male infertility, we are able to offer the procedure to a group of patients who probably could never father a child of their own. From a patient with mosaic Klinefelter's syndrome, sufficient motile sperm for intracytoplasmic sperm injection were obtained from a fresh ejaculate estimated to contain < 100 motile sperm. In the first IVF-ICSI attempt, out of seven oocytes that were collected from the wife, four were mature and were injected by ICSI. Fertilization occurred in all four oocytes but only one cleaved and was transferred to the uterus. Pregnancy test was negative 16 days after ET. In the second treatment cycle four out of eight oocytes were selected for ICSI. All four fertilized, three cleaved at the right time, and two were transferred into the wife's uterus. One embryo was frozen. Pregnancy test 16 days after ET was negative. The high fertilization rate achieved in this case indicates the potential of ICSI to treat extreme male infertility. Its use offers hope to those patients with conditions previously considered to be untreatable.

The outcome of treatment by intracytoplasmic sperm injection (ICSI) is described for patients with severe male infertility. In 296 consecutive cycles, a normal fertilization rate of 69% was achieved with 288 cycles (97%) resulting in embryos suitable for transfer. A total of 32 clinical pregnancies were achieved from the transfer of fresh embryos (clinical pregnancy rate of 12% per transfer) and an additional 44 clinical pregnancies were obtained after the transfer of frozen-thawed embryos (clinical pregnancy rate of 16% per transfer). Overall, 57 of the 76 pregnancies were ongoing or delivered. An analysis of outcome in 5 male factor subgroups revealed no significant differences in pregnancy and implantation rates between the categories. However, the fertilization rate was significantly lower in patients with oligoasthenoteratozoospermia and significantly higher in those patients for whom epididymal sperm were used for insemination. The treatment of patients with extreme male infertility is also described; normal fertilization and embryo development were obtained using ICSI in patients with mosaic Klinefelter's syndrome, severe sperm autoimmunity, round-headed acrosomeless sperm (globozoospermia), completely immotile sperm selected by hypo-osmotic swelling and sperm isolated from testicular biopsies. Three ongoing pregnancies were obtained from 6 patients for whom testicular sperm were used. These results demonstrate the value of ICSI in the management of severe male infertility, however, the treatment of some types of extreme male infertility using ICSI may be limited.

Objective: To investigate the use of intracytoplasmic sperm injection with sperm collected by fine needle biopsy of the testis as a treatment for male genital tract obstruction.Design: Sperm isolated from a fine needle biopsy of the testis were used to inseminate oocytes by intracytoplasmic sperm injection.Setting: A hospital-based tertiary referral infertility service.Patients: Case studies of two couples in whom the male partner had a genital tract obstruction.Main Outcome Measures: Fertilization and pregnancy.Results: In the first ease, 9 oocytes fertilized normally out of 13 injected. After the transfer of fresh (one cycle) and frozen (four cycles) embryos, a single intrauterine fetal heart pregnancy was achieved. In the second case, five oocytes fertilized normally from nine oocytes injected; two embryos were transferred fresh and three were frozen. A single fetal heart intrauterine gestation was obtained after the initial transfer of two fresh embryos.Conclusions: A high normal fertilization rate and pregnancies are possible with intracytoplasmic sperm injection using sperm collected directly from the testis. Sperm retrieval by fine needle biopsy offers a viable alternative to microsurgical aspiration and is also suitable for treating patients with intratesticular blockage.

Sperm preparation for intracytoplasmic sperm injection (ICSI) is described and the effect of high speed centrifugation during preparation on fertilization rate is evaluated. No significant differences were found in the 2-pronuclear or abnormal fertilization rates between sibling oocytes injected with sperm prepared by swim-up or mini-Percoll combined with high speed centrifugation. The high fertilization rate obtained with both methods indicates that high speed centrifugation is not necessary to prepare sperm for ICSI. Fertilization rates were also compared for sperm obtained from ejaculates, fresh and frozen epididymal aspirates, and testicular biopsies. High fertilization rates were obtained from all groups but they were significantly higher in those oocytes injected with epididymal sperm (78% per oocyte surviving injection). The high fertilization rate with epididymal sperm may reflect sperm quality or may result from the method of sperm preparation for injection. Fertilization after the injection of sperm from which the tail was dislodged during immobilization was compared with that obtained using intact sperm. A significantly lower rate of 2-pronuclear fertilization was found in those oocytes injected with sperm heads only (55%) compared with intact sperm (68%), although cleavage rates between the two groups were similar. The use of hypo-osmotic medium to select potentially live sperm from an immotile sample is also described and fertilization was obtained after the injection of sperm with a structural defect which were selected using this technique. These results indicate that high fertilization rates can be obtained with ejaculated, epididymal and testicular sperm without special treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Australian and New Zealand Journal of Obstetrics and GynaecologyVolume 26, Issue 3 p. 206-209 The Establishment of a Successful Programme of Gamete Intra-Fallopian Transfer (GIFT): Preliminary Results D. Molloy MRACOG, D. Molloy MRACOG Reproductive Biology Unit, The Royal Women's Hospital, Melbourne Senior Registrar.Search for more papers by this authorA. L. Speirs MRCOG FRACOG, A. L. Speirs MRCOG FRACOG Reproductive Biology Unit, The Royal Women's Hospital, Melbourne Gynaecologist.Search for more papers by this authorY. DuPlessis BSc, Y. DuPlessis BSc Reproductive Biology Unit, The Royal Women's Hospital, Melbourne Scientist.Search for more papers by this authorS. Gellert BSc Hons., S. Gellert BSc Hons. Reproductive Biology Unit, The Royal Women's Hospital, Melbourne Scientist.Search for more papers by this authorH. Bourne BSc Hons, H. Bourne BSc Hons Reproductive Biology Unit, The Royal Women's Hospital, Melbourne Scientist.Search for more papers by this authorW. I. H. Johnston MGO, FRCOG, FRACOG, W. I. H. Johnston MGO, FRCOG, FRACOG Reproductive Biology Unit, The Royal Women's Hospital, Melbourne Chairman.Search for more papers by this author D. Molloy MRACOG, D. Molloy MRACOG Reproductive Biology Unit, The Royal Women's Hospital, Melbourne Senior Registrar.Search for more papers by this authorA. L. Speirs MRCOG FRACOG, A. L. Speirs MRCOG FRACOG Reproductive Biology Unit, The Royal Women's Hospital, Melbourne Gynaecologist.Search for more papers by this authorY. DuPlessis BSc, Y. DuPlessis BSc Reproductive Biology Unit, The Royal Women's Hospital, Melbourne Scientist.Search for more papers by this authorS. Gellert BSc Hons., S. Gellert BSc Hons. Reproductive Biology Unit, The Royal Women's Hospital, Melbourne Scientist.Search for more papers by this authorH. Bourne BSc Hons, H. Bourne BSc Hons Reproductive Biology Unit, The Royal Women's Hospital, Melbourne Scientist.Search for more papers by this authorW. I. H. Johnston MGO, FRCOG, FRACOG, W. I. H. Johnston MGO, FRCOG, FRACOG Reproductive Biology Unit, The Royal Women's Hospital, Melbourne Chairman.Search for more papers by this author First published: August 1986 https://doi.org/10.1111/j.1479-828X.1986.tb01568.xCitations: 14 AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL References 1 Asch RH, Ellsworth LR, Balmaceda JP, Wong PC. Pregnancy following translaparoscopic intrafallopian transfer: GIFT. Lancet 1984; 2: 1034. 2 Asch RH, Balmaceda JP, Ellsworth LR, Wong PC. Gamete Intra Fallopian Transfer (GIFT): A New Treatment for Infertility. Int J Fertil 1985; 30: 41– 45. 3 Molloy D, Speirs AL, du Plessis Y, Gellert S, Bourne H, Johnston I. Gamete Intra Fallopian Transfer (Letter) Med J Aust 1985; 143: 428. 4 McBain J, Trounson A. Patient Management — Treatment Cycle. In C Wood, A Trounson (eds) Clinical In Vitro Fertilization. 1st Edition, Berlin , Springer-Verlag, 1984; 5: 49– 68. 5 Mclntosh JF, Matthews CD, Crocker JM, Broom TJ, Cox LW. Predicting the Luteinizing Hormone Surge: Relationship between the Duration of the Follicular and Luteal Phases and the Length of the Human Menstrual Cycle. Fertil Steril 1980; 34: 125– 130. 6 Leung PC, Hyne RV, Clarke ON, Johnston WIH. A Technique for Enrichment of Motile Spermatozoa from Oli-gospermic and Asthenospermic Patients. Aust and NZ J Obstet Gynaecol 1984; 24: 210– 214. 7 Downing B. Oocyte Pickup. In C Wood, A Trounson (eds), Clinical In Vitro Fertilization 1st Edition, Berlin , Springer-Verlag, 1984; 6: 69– 81. 8 Veeck L. Extracorporeal Maturation; Norfolk 1984. In M Seppala, RG Edwards (eds), In Vitro Fertilization and Embryo Transfer, New York , Annals of the New York Academy of Sciences, 1985; 442: 357– 367. 9 McBain J, and Pepperell RJ. Unexplained Infertility In RJ Pepperell, B Hudson, C Wood (eds), The Infertile Couple 1st Edition, Edinburgh , Churchill Livingstone, 1980; 8: 164– 182. Citing Literature Volume26, Issue3August 1986Pages 206-209 ReferencesRelatedInformation

A study was undertaken as a controlled comparison of two different superovulation induction protocols currently in use in major Australian in vitro fertilization (IVF) clinics. Thirty patients each from the Monash University and the Royal Women's Hospital (RWH) IVF programs were stimulated for ovulation induction by the other program. Once timing for oocyte retrieval was scheduled, all care reverted to the program from which the patient first came. Results given as pregnancies per patient commencing stimulation were: RWH patients on Monash protocol, 27%; RWH control patients, 15%; Monash patients on RWH protocol, 7%; Monash control patients, 13%. In the year preceding the trial pregnancy rates were 16.9% at Monash and 10.6% at RWH. Stimulation protocols were also compared with respect to each of administration, cost, and patient stress. The results of this cross-over trial demonstrated major differences between the two ovulation induction protocols studied, although it was not possible to conclude that differences in pregnancy rate were due to stimulation alone.

Medical Journal of AustraliaVolume 143, Issue 9 p. 428-428 Letter to the Editor Gamete intra-fallopian transfer D. Molloy MRACOG, D. Molloy MRACOG Reproductive Biology Unit, The Royal Women's Hospital, Carlton, VIC, 3053Search for more papers by this authorA. Speirs FRACOG, A. Speirs FRACOG Reproductive Biology Unit, The Royal Women's Hospital, Carlton, VIC, 3053Search for more papers by this authorY. Du Plessis BSc, Y. Du Plessis BSc Reproductive Biology Unit, The Royal Women's Hospital, Carlton, VIC, 3053Search for more papers by this authorS. Gellert BSc(Hons), S. Gellert BSc(Hons) Reproductive Biology Unit, The Royal Women's Hospital, Carlton, VIC, 3053Search for more papers by this authorH. Bourne BSc(Hons), H. Bourne BSc(Hons) Reproductive Biology Unit, The Royal Women's Hospital, Carlton, VIC, 3053Search for more papers by this authorW.I.H. Johnston FRACOG, W.I.H. Johnston FRACOG Reproductive Biology Unit, The Royal Women's Hospital, Carlton, VIC, 3053Search for more papers by this author D. Molloy MRACOG, D. Molloy MRACOG Reproductive Biology Unit, The Royal Women's Hospital, Carlton, VIC, 3053Search for more papers by this authorA. Speirs FRACOG, A. Speirs FRACOG Reproductive Biology Unit, The Royal Women's Hospital, Carlton, VIC, 3053Search for more papers by this authorY. Du Plessis BSc, Y. Du Plessis BSc Reproductive Biology Unit, The Royal Women's Hospital, Carlton, VIC, 3053Search for more papers by this authorS. Gellert BSc(Hons), S. Gellert BSc(Hons) Reproductive Biology Unit, The Royal Women's Hospital, Carlton, VIC, 3053Search for more papers by this authorH. Bourne BSc(Hons), H. Bourne BSc(Hons) Reproductive Biology Unit, The Royal Women's Hospital, Carlton, VIC, 3053Search for more papers by this authorW.I.H. Johnston FRACOG, W.I.H. Johnston FRACOG Reproductive Biology Unit, The Royal Women's Hospital, Carlton, VIC, 3053Search for more papers by this author First published: 01 October 1985 https://doi.org/10.5694/j.1326-5377.1985.tb123121.xCitations: 11AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume143, Issue9October 1985Pages 428-428 RelatedInformation