In Vitro Fertilization Or Intracytoplasmic Sperm Injection For Unexplained Infertility

ObjectiveTo research which way is better for unexplained infertility with different clinical factors, in vitro fertilization or intracytoplasmic sperm injection.Methods198 patients who were diagnosed unexplained infertility were analyed retrospectively,which were done from January 2002 to December 2009 in our reproductive center.116 paitents applied IVF,62 paitents applied ICSI,20 paitents applied half IVF and half ICSI.Infertility is customarily defined as the inability to conceive after 1 year of regular unprotected intercourse.Diagnosis of Unexplained Infertility:The basic infertility evaluation is normal, including:a semen analysis, assessment of ovulation (tests for ovarian reserve), a hysterosalpingogram,and, if possible, laparoscopy.The fertilization rate, the rate of top quality embryos were observed and analyzed according to different way of fertilization (IVF or ICSI), female age, duration of infertility,primary infertility or secondary infertility,times of AIH, times of in vitro fertilization. Results1.Applying of ICSI remarkably increased the the fertilization rate compared to applying of IVF. In different patients, the fertilization rate of ICSI was remarkably high compared to IVF(73.1% VS 51.9%) (P<0.01), but there was no difference between the two groups in the total fertilization failure rate, the top quality embryos rate of ICSI was also remarkably high compared to IVF(65.6% VS 49.7%) (P＜0.01).In patients who applied half IVF and half ICSI, the fertilization rate of ICSI was remarkably high compared to IVF(79.1% VS 58.6%) (P＜0.05), but there was no difference in the total fertilization failure rate and the top quality embryos rate.2. The fertilization rate and the top quality embryos rate of IVF gradually decreased with the age growed, the fertilization rate of ICSI didn't change much,but the top quality embryos rate of ICSI gradually decreased with the age growed.3.The fertilization rate of IVF gradually decreased with the duration of infertility prolonged. In patients who applied half IVF and half ICSI, when the duration of infertility≥5 years, the fertilization rate of IVF is remarkably low compared to ICSI (52.8% VS 86.0%) (P＜0.01),the top quality embryos rate of IVF is also remarkably low compared to ICSI(48.6% VS 65.5%) (P＜0.05)4. In patients who were primary infertility, the fertilization rate of ICSI was remarkably high compared to IVF. In different patients, whether primary infertility or secondary infertility, the fertilization rate of ICSI was remarkably high compared to IVF. the top quality embryos rate of ICSI was remarkably high compared to IVF in patients who were secondary infertility (66.1% VS 46.1%) (P＜0.05). In patients who applied half IVF and half ICSI, the fertilization rate of ICSI was remarkably high compared to IVF In patients who were primary infertility (80.3% VS 61.2%) (P＜0.05),while in patients who were secondary infertility, there was no difference.5.When the times of AIH> 2, the fertilization rate of ICSI was remarkably high compared to IVF,but there was no difference in the top quality embryos rate. The fertilization rate of ICSI was 73.9%, while IVF was 46.0% in patients who had 2 times of AIH; The fertilization rate of ICSI was 72.0%, while IVF was 49.2% in patients who had 3 times of AIH; The fertilization rate of ICSI was 80.8%, while IVF was 57.8% in patients who had≥4 times of AIH;6. If the former fertilization rate of IVF>1/3, the fertilization rate of the later IVF didn't decrease much (P>0.05), if not, applying ICSI would remarkably increase the fertilization rate (P＜0.01).ConclusionsAs to patients who were diagnosed unexplained infertility,if there were fators such as primary infertility, the age≥40 ys, the duration of infertility≥5 ys, the times of AIH≥2, we should consider ICSI as the way of fertilization. For patients who get more than 10 oocytes we can apply half IVF and half ICSI.