Mannelijke infertiliteit en in-vitro-fertilisatie

textabstractThis thesis describes the treatment of male infertility by in-vitro-fertilization. IVF was a treatment for infertility caused by tubal blockage. Thereafter IVF was also used as a treatment for male infertility.IVF is the bringing together of the gametes outside the female body. After fertilization the embryo is cultured in an incubator before it will be transplanted to the uterus. The process of development of the gametes and fertilization is described in chapter 1 of this thesis. A mature sperm and oocyte are formed after mitotic and meiotic divisions. The head of the spermatozoa is covered by the acrosome. During passage of the cumulus and the zona pellucida of the oocyte, the acrosome loses its enzymes, the acrosomal reaction. By means of the enzymatic action of the acrosomal proteins and the mechanical force of the beating sperm tail, the sperm penetrates the zona pellu· cida. After contact of the sperm with the cell membrane of the oocyte, the membranes fuse and the oocyte completes its second meiotic division. After this process the embryo is formed. The history of the discovery of the gametes and fertilization and the first successful attempt to achieve a fertilization in-vitro are described in chapter 2. It was only from the beginning of the seventies that it was possible to culture human embryos in· vitro. Since so many patients today are treated by IVF it is possible to compare the results of different groups of patients. In chapter 3 the results of IVF for male infertility on the IVF-laboratory of the Dijkzigt Hospital are described. Patients were grouped according to the concentration of motile sperm in the ejaculate. Seven groups were formed, on a logarithmic ascending scale. Results were studied per ovum pick-up and per patient. Ovum pick-ups with a low sperm concentration did have a lower fertilization rate (total number of punctures with fertilization/total number of punctures in that group) than punctures with a high sperm concentration. Punctures with a concen· tration of motile sperm oflxl06/ml had a fertilization rate of34%, in the group with 4-8x106/ml the fertilization rate was 69% and in the groups with the highest concentrations the fertilization rate was 90% per ovum pick-up. After fertilization had been achieved the percentage of pregnancy was the same for all groups. Other criteria to determine quality of embryo's, such as the number of morphologically good embry· o's being transplanted or the possibility of cryopreservation showed no difference between the sperm group