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Utility of zona pellucida drilling in cases of severe semen alterations in man
1Laboratoire de Biologie de la Reproduction, Centre Hospitalier Universitaire, Nantes, France.
Objective:
To evaluate the utility of zona drilling for human severe sperm alterations in in vitro fertilization (IVF).
Design:
A prospective randomized study was conducted according to random assignment of collected oocytes to a control or zona drilling procedure.
Setting:
Reproductive Biology Laboratory, University Hospital of Nantes, France.
Patients:
Twenty infertile couples with severe semen defects and previous IVF failure.
Interventions:
Ultrasound-guided transvaginal follicular aspiration.
Results:
Fertilization rates were compared to assess the advantages of zona drilling: 93% (80/86) drilled oocytes survived and 18.75% (15) were fertilized, whereas only 3% (3/100) control oocytes were fertilized. The polyspermy rate for fertilized drilled oocytes was high (10/15; 66.6%). The normal fertilization rate after zona drilling remained very low (5/86; 5.8%) and was not statistically different from that of control oocytes (3/100; 3%). One implantation occurred after replacement of five drilled embryos in three patients but resulted in early miscarriage. Replacement of the single control embryo led to a progressive pregnancy and normal male birth.
Conclusions:
This study indicates that zona drilling does not improve IVF results in cases of severe semen alterations.