Skripsi

The effect of male factor infertility (azoospermia and severe oligozoospermia) on embryo quality (number of embryos with 8 cells after second cleavage) among infertile patients undergoing in-vitro fertilization.

Male factor infertility was initially considered a contraindication to IVF because abnormal sperm are less likely to fertilize oocytes than normal sperm. However, subsequent experience starting just over a decade ago indicated that fertilizations and subsequent live births were possible despite impaired sperm quality. The literature regarding the influence of sperm factors, usually the sperm concentration and the percentages of motile and/or morphologically normal spermatozoa, on in-vitro fertilization success is confusing. This study sets out to evaluate the correlation between male factor infertility (azoospermia and severe oligozoospermia) and embryo quality (number of embryos with 8 cells after second cleavage). As a cross-sectional study, this research used data from medical records of 303 infertile patients who underwent 347 IVF-ET cycles between January 2005 and January 2011 at Yasmin Clinic, Infertility and Reproductive Immunoendocrinology Center, Dr. Cipto Mangunkusumo National Referral Hospital, Jakarta, Indonesia. There were 241 cycles in the good-embryo group where the non-good embryo group comprised of 106 cycles. However, only 332 cycles were included in further analysis due to missing data. The Chi Square test results obtained in this study showed that male factor infertility was not correlated with embryo quality in IVF (sensitivity 42%, specificity 48.5%, PPV 65.1%, NPV 26.8%). Multivariate analysis showed that if the endometrial thickness exceeded 10.95 mm and the number of cells with 2pn exceeded 1.5, greater probability of achieving good embryos would result (OR 0.793 and 0.562). This finding might be due to intracytoplasmic sperm injection (ICSI) which enables fertilization using ejaculated sperm samples with very poor conventional sperm parameters, since the only absolute prerequisite for successful ICSI is the presence of one spermatozoon per oocyte. Also, sperm motility and sperm morphology which might influence fertilization and embryo development were not evaluated in this study.
Keywords: Male factor infertility, azoospermia, severe oligozoospermia, embryo quality, in-vitro fertilization (IVF).