Interet de la microinjection de spermatozoides sous la zone pellucide pour le traitement de certaines sterilites masculines

Sub-zonal insemination (SUZI) was evaluated, in a randomized prospective study, as a treatment for certain specific types of male factor infertility. Patients were classified according to the results of an extensive semen analysis as being either IVF failure with either normal or subnormal semen quality, specific (e.g. absent outer dynein arms) or non-specific flagellar dyskinesia, or oligoasthenoteratozoospermia. SUZI was found to be an efficient technique for achieving fertilization and pregnancy for all these indications, while there was a total failure of fertilization in the control, in-vitro inseminated oocytes. A total of 395 oocytes were microinjected and 133 fertilized, among which 75 (19% overall) were diploid. More than 81% of these zygotes cleaved normally, and 31 embryo transfers resulted in seven pregnancies. However, results varied widely between the various indications, suggesting that the underlying pathology responsible for the sterility may influence gamete interaction and early embryonic development independantly of the SUZI technique.