The investigation of idiopathic infertility by in vitro fertilization.

The results of in vitro fertilization of mature oocytes obtained at diagnostic laparoscopy from patients with both known and unknown clinical causes of infertility are presented. A simple regimen involving the use of clomiphene and human chorionic gonadotropin which enabled laparoscopy to coincide with available surgical lists resulted in the recovery of mature oocytes from 15 of the 18 patients treated. Apparently normal embryos developed from five of six oocytes recovered from patients who had blocked fallopian tubes or who were being investigated after 8 to 12 months of artificial insemination by donor. No normal embryos developed from oocytes from nine patients who had sustained infertility of unknown cause for 2 years or more. When this latter group was compared with other groups a high rate of fertilization failure was noted, and severe polyspermy developed in two cases. The results are discussed in relation to the diagnosis of infertility and the management of infertile patients.