Use of Intracytoplasmic Sperm Injection (ICSI) in In-Vitro Fertilization (IVF) Cycles with Failed or Poor Fertilization

Abstract

Objective: When fertilization is poor or fails, ICSI can be performed in an attempt to overcome the fertilization failure and thus obtain embryos that can be transferred and that will hopefully implant. In this study we set out to evaluate our results of cycles where ICSI was performed on day 2 after poor or failed standard IVF. Design: Retrospective comparative study of assisted reproductive technology (ART) cycles. We compared the results of cycles in patients who had day 2 ICSI because of poor or failed fertilization with those of subsequent cycles in which ICSI was performed following oocyte retrieval (Day 1 ICSI). Materials and Methods: Between February 1996 and December 1999 twelve infertile couples went through 17 treatment cycles. Day 2 ICSI was performed in 11 cycles and subsequently day 1 ICSI was performed in 6 cycles. Two of the day 2 ICSI cycles involved oocyte donation. Day 2 ICSI was prompted by failure or poor standard in-vitro fertilization (IVF). Only 2 out of 138 oocytes (fertilization rate of 1.5%) fertilized prior to day 2 ICSI. Four of the 11 couples (36.4%) had more than one infertility factor. Six couples had 1 treatment cycle, 4 couples had 2 treatment cycles and one couple had 3 treatment cycles. The mean age of the female partner was 33.2 ± 1.14 (mean ± SEM). Results: The fertilization rate for day 2 ICSI cycles was 50.6% (39/77) compared to 57.9% (44/76) for day 1 ICSI cycles (p= 0.3684, Chi square test). Embryo quality on day of transfer was not different in the two groups. No pregnancies occurred in day 2 ICSI cycles whereas 50% (3/6) of subsequent cycles in which day 1 ICSI was done resulted in a clinical pregnancy. The average number of embryos transferred per cycle in day 1 ICSI cycles was 2.9 and the implantation rate was 20% (4/20). One of the pregnancies was miscarried. The other two pregnancies occurred in a third treatment cycle. One of them revealed 2 gestational sacs but only one contained fetal heart motion. The ongoing pregnancies yielded 2 live born babies. Conclusions: (1) Day 2 ICSI can accomplish fertilization in oocytes that failed to fertilize using standard IVF and yields good quality embryos. (2) Despite their good morphology, embryos fertilized by ICSI after failed standard fertilization do not implant. (3) Day 1 ICSI is the preferred method to overcome failed IVF because of poor or no fertilization.