Failure to fertilize in vitro in couples with male factor infertility: what next?

Objective: To assess the predictive value of a failure to fertilize in vitro in couples with sperm abnormalities on future fertility. Design: Retrospective file review. Setting: In vitro fertilization and embryo transfer (IVF-ET) program in the Sheba Medical Center during the years 1983 to 1990. Patients: Seventy-six couples with sperm abnormalities who had at least one IVF cycle during which fertilization did not occur. Interventions: None. Main Outcome Measures: Occurrence of fertilization, percentage of fertilization, and pregnancies in additional IVF-ET cycles. Results: Of 44 couples who underwent an additional IVF attempt with husband's sperm, 36 (81.2%) fertilized, with a mean fertilization rate of 47.7% ± 26.6%. Of 17 couples who failed twice, 11 attempted IVF again with husbands' sperm and 7 fertilized, with a median rate of 33%. A higher sperm concentration was found on the cycles during which fertilization occurred. Men with single parameter abnormalities did not fertilize better than those with two or three defective parameters. Conclusions: Failure to fertilize in vitro in couples with male factor infertility does not seem to predict future fertilization in IVF. At least two cycles of IVF should be tried before reverting to other options such as insemination by donor sperm or gamete micromanipulation.