Comparison of the efficacy of selecting sperm with normal nuclei by high magnification for intracytoplasmic sperm injection (ICSI) according to age in refractory in vitro fertilization (IVF) cases.

Abstract

To determine the pregnancy rates according to age in women failing to conceive after three previous embryo transfers or having a husband whose sperm shows a DNA fragmentation index (DFI) > 30% when performing the sperm chromatin structure assay.
Women up to age 45 were included and there was no restriction for low egg reserve. Live delivered pregnancy rates were determined according to three age groups: < or =34, 35-38, 39-45. The data were also analyzed in a group comparable to previous publications using high magnification ICSI, i.e., younger women with normal egg reserve. Pregnancy rates following frozen embryo transfer were also evaluated.
Using all 86 in vitro fertilization-embryo transfer (IVF-ET) cycles the live delivered pregnancy rates were 40% (10/25) for women < or = age 34, 24% (6/25) in women age 35-38, and 13.8% in women aged 39-45. Evaluating the younger group with normal egg reserve with > or =3 previous failed IVF-ET cycles the live delivered pregnancy rate per transfer was 38% (16/42). If one adds the additional six live deliveries from subsequent frozen embryo transfer (6 of 17, 35.3%) this group of women had a 52.3% (22/42) live delivered pregnancy rate from one egg retrieval.
These data were uncontrolled and thus conclusions should be viewed with caution. The results are sufficiently encouraging to warrant a prospective controlled trial and possibly encourage a company to consider commercially manufacturing high magnification microscopes.