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IVF and Male Factor Infertility
2. Belsey MA, Eliasson R, Gallegos AJ, Moghissi KS, Paulsen CA, Prasad MRN: Laboratory Manual for the Examination of Human Semen and Semen-Cervical Mucus Interaction. Singapore, Press concern, 1980 3. Knuth VA, Yeung C-H, Nieschlag E: Computerized semen analysis: objective measurement of semen characteristics is biased by subjective parameter setting. Fertil Steril 48:118, 1987
IVF and Male Factor Infertility
To the Editor: We were interested to read the article by Awadalla et al. l but would express reservations about the presentation of the data. The treatment of male factor infertility by in vitro fertilization and embryo transfer can often give an exaggerated reduction in the overall fertilization rate because the male factor group contains an increased incidence of men who achieve no fertilization at all. Data from our unit illustrates this, where 20/193 (10.4%) normospermic cases had no fertilization, compared with an incidence of 7/12 (58.3%) in oligospermic cases with <20 X 106 spermatozoa/ml semen. 2 Fertilization Rate (Oocytes Fertilized/Inseminated) Group
All patients
Failed fertilization excluded
Oligospermic Normospermic
15/47 (31.9%) 565/823 (68.7%)
15/22 (68.2%) 5651770 (73.4%)
The overall fertilization rate for oligospermic cases is significantly reduced (P < 0.001) compared with the normospermic group. However, once the cases with no fertilization are excluded, the fertilization rate is similar in both groups. A further analysis of their data would allow Awadalla et al. to determine the extent to which fertilization is impeded in men whose spermatozoa have demonstrated some functional capacity by fertilizing at least one oocyte.
Phillip L. Matson, Ph.D. Stephen A. Troup, B.Sc. (Hons). Barry Lowe, M.R.C.O.G. Brian A. Lieberman, F.R.C.O.G. St. Mary's Hospital Whitworth Park, Manchester August 26, 1987 REFERENCES 1. Awadalla SG, Friedman CI, Schimdt G, Chin NO, Kim MH: In vitro fertilization and embryo transfer as a treatment for male factor infertility. Fertil Steril 47:807, 1987 2. Yovich JL, Stanger JD: The limitations of in vitro fertiliza· Vol. 49, No.1, January 1988
tion from males with severe oligospermia and abnormal sperm morphology. J In Vitro Fert Embryo Transfer 1:172, 1984
Reply of the Author: Weare grateful for the interest which Matson et al. have expressed in our data. We agree that it would be ideal if there were some method of differentiating those male factor individuals who will never fertilize from those who will fertilize at some point. Such a method would, if prospective in nature, allow us to select those individuals with male factor infertility who can benefit from in vitro fertilization. We believe that such a method may be the hamster ova penetration assay (SPA). When applied to male factor patients, the SPA displayed a positive predictive value of 100% and a sensitivity of 50%. Separating the analysis of fertilization rates based on whether fertilization fails completely or occurs to some extent requires the performance of at least one in vitro fertilization cycle in order to predict. Also, it is of limited value in terms of future counseling since some individuals who fertilize initially may fail to do so later and vice versa. Nevertheless, we have prepared the subsequent table to differentiate between the group of ever-fertilizers versus never-fertilizers. Fertilization Rate (Oocytes Fertilized/Inseminated) Failed fertilization excluded
Group
All patients
Male factor Controls Pvalue
18/110 (16.4%) 85/133 (63.9%) <0.001
18/40 (45.0%) 851122 (69.7%)
<0.01
x2 Even after the exclusion of cases in which fertilization failed completely, the fertilization rate in the male factor group is less than that in the control group (P < 0.01). We would like to stress that it is quite difficult to compare results for male factor individuals in an interinstitutional fashion. The patients described in our article displayed a "clinical male factor," meaning that, in addition to oligospermia and/or asthenospermia, they had demonstrated in vivo failure to fertilize, given a normal female reproductive tract.
Sherif G. Awadalla, M.D. Division of Reproductive Endocrinology West Virginia University Charleston, West Virginia October 5, 1987 Letters-to-the-editor
185
IVF and Male Factor Infertility
To the Editor: We were interested to read the article by Awadalla et al. l but would express reservations about the presentation of the data. The treatment of male factor infertility by in vitro fertilization and embryo transfer can often give an exaggerated reduction in the overall fertilization rate because the male factor group contains an increased incidence of men who achieve no fertilization at all. Data from our unit illustrates this, where 20/193 (10.4%) normospermic cases had no fertilization, compared with an incidence of 7/12 (58.3%) in oligospermic cases with <20 X 106 spermatozoa/ml semen. 2 Fertilization Rate (Oocytes Fertilized/Inseminated) Group
All patients
Failed fertilization excluded
Oligospermic Normospermic
15/47 (31.9%) 565/823 (68.7%)
15/22 (68.2%) 5651770 (73.4%)
The overall fertilization rate for oligospermic cases is significantly reduced (P < 0.001) compared with the normospermic group. However, once the cases with no fertilization are excluded, the fertilization rate is similar in both groups. A further analysis of their data would allow Awadalla et al. to determine the extent to which fertilization is impeded in men whose spermatozoa have demonstrated some functional capacity by fertilizing at least one oocyte.
Phillip L. Matson, Ph.D. Stephen A. Troup, B.Sc. (Hons). Barry Lowe, M.R.C.O.G. Brian A. Lieberman, F.R.C.O.G. St. Mary's Hospital Whitworth Park, Manchester August 26, 1987 REFERENCES 1. Awadalla SG, Friedman CI, Schimdt G, Chin NO, Kim MH: In vitro fertilization and embryo transfer as a treatment for male factor infertility. Fertil Steril 47:807, 1987 2. Yovich JL, Stanger JD: The limitations of in vitro fertiliza· Vol. 49, No.1, January 1988
tion from males with severe oligospermia and abnormal sperm morphology. J In Vitro Fert Embryo Transfer 1:172, 1984
Reply of the Author: Weare grateful for the interest which Matson et al. have expressed in our data. We agree that it would be ideal if there were some method of differentiating those male factor individuals who will never fertilize from those who will fertilize at some point. Such a method would, if prospective in nature, allow us to select those individuals with male factor infertility who can benefit from in vitro fertilization. We believe that such a method may be the hamster ova penetration assay (SPA). When applied to male factor patients, the SPA displayed a positive predictive value of 100% and a sensitivity of 50%. Separating the analysis of fertilization rates based on whether fertilization fails completely or occurs to some extent requires the performance of at least one in vitro fertilization cycle in order to predict. Also, it is of limited value in terms of future counseling since some individuals who fertilize initially may fail to do so later and vice versa. Nevertheless, we have prepared the subsequent table to differentiate between the group of ever-fertilizers versus never-fertilizers. Fertilization Rate (Oocytes Fertilized/Inseminated) Failed fertilization excluded
Group
All patients
Male factor Controls Pvalue
18/110 (16.4%) 85/133 (63.9%) <0.001
18/40 (45.0%) 851122 (69.7%)
<0.01
x2 Even after the exclusion of cases in which fertilization failed completely, the fertilization rate in the male factor group is less than that in the control group (P < 0.01). We would like to stress that it is quite difficult to compare results for male factor individuals in an interinstitutional fashion. The patients described in our article displayed a "clinical male factor," meaning that, in addition to oligospermia and/or asthenospermia, they had demonstrated in vivo failure to fertilize, given a normal female reproductive tract.
Sherif G. Awadalla, M.D. Division of Reproductive Endocrinology West Virginia University Charleston, West Virginia October 5, 1987 Letters-to-the-editor
185