Uncommon but devastating event: total fertilisation failure following intracytoplasmic sperm injection

Area of Science:

• Reproductive biology
• In vitro fertilisation
• Gamete interactions

Background:

• Intracytoplasmic sperm injection (ICSI) involves complex spermatozoon-oocyte interactions.
• Total fertilization failure (TFF) is a frustrating event occurring in up to 3% of ICSI cycles.
• Counselling for subsequent cycle management is crucial after TFF.

Purpose of the Study:

• To analyze ICSI cycles over a decade to document TFF cases.
• To identify predictive factors for successful outcomes after initial TFF.
• To evaluate the efficacy of assisted oocyte activation (AOA) and specific sperm selection methods in subsequent cycles.

Main Methods:

• Retrospective analysis of ICSI cycles over a 10-year period.
• Documentation of initial TFF cases and their subsequent ICSI cycles.
• Application of AOA using calcium ionophore and Hypo-osmotic swelling test (HOST)/pentoxifilline for sperm selection in subsequent cycles.

Main Results:

• Successful fertilization was achieved in 85% of cases with a history of TFF.
• Improved oocyte quantity and better sperm morphology were significant factors for success in subsequent cycles.
• Initial TFF is often technically modifiable, while repeated TFF may indicate underlying gamete defects.

Conclusions:

• Sporadic TFF in the first ICSI cycle is typically a technically modifiable issue.
• Repeated TFF might suggest gamete defects not easily overcome by modified ICSI protocols.
• Optimizing oocyte quantity and sperm morphology are critical for improving fertilization rates after TFF.