ABSTRACT
Numerous indications for in vitro fertilisation (IVF) are to be taken into consideration especially when other forms of infertility treatment have failed so far. Indications for medical interventions are important in order to perform a cause related therapy which at the same time is adequate in its measures. However, even though reproductive medicine has experienced probably the highest progress in medical development, most of the conditions underlying successful establishment of pregnancy still remain unknown. In light of the demand for a conscious use of financial resources the debate is justified whether in any case a causal therapy should be performed or what is established as the most successful therapy. In our own hands comparing success rates as pregnancies per embryo transfers, intracytoplasmic sperm injection (ICSI) as a special form of IVF achieves a pregnancy rate of 26 per cent while IVF shows a lower pregnancy rate of 20 per cent. Similar trends were observed in other centers. Reasons for this difference cannot be provided, however it was hypothesised that perforation of the zona pellucida could improve implantation rates as it would assist hatching. Purely treating the zona pellucida without injection of sperm could not improve pregnancy rates.
