OBJECTIVE: To improve oocyte survival and fertilization rates after intracytoplasmic sperm injection (ICSI) in patients with inherent oocyte fragility. DESIGN: Pilot feasibility study and case report. SETTING: Private hospital. PATIENT(S): Infertile couple with repeated failures of ICSI caused by oocyte degeneration. INTERVENTION(S): Laser-assisted drilling of the zona pellucida followed by ICSI. MAIN OUTCOME MEASURE(S): Oocyte survival, fertilization, and pregnancy. RESULTS: In a couple with four previous ICSI failures because of poor oocyte survival (33.3%, 0%, 20%, and 18%), a fifth attempt using laser-assisted ICSI resulted in the survival of 8 oocytes out of 13 injected. Normal fertilization occurred in 5 oocytes, and a clinical pregnancy was established. CONCLUSION(S): Performing ICSI through a laser-drilled hole in the zona pellucida reduces the risk of oocyte damage related to deformation during the initial phase of the microinjection procedure. This modification of ICSI appears to be suitable for patients whose oocyte show inherent fragility and high degeneration rates after the standard ICSI procedure.
OBJECTIVE: To improve oocyte survival and fertilization rates after intracytoplasmic sperm injection (ICSI) in patients with inherent oocyte fragility. DESIGN: Pilot feasibility study and case report. SETTING: Private hospital. PATIENT(S): Infertile couple with repeated failures of ICSI caused by oocyte degeneration. INTERVENTION(S): Laser-assisted drilling of the zona pellucida followed by ICSI. MAIN OUTCOME MEASURE(S): Oocyte survival, fertilization, and pregnancy. RESULTS: In a couple with four previous ICSI failures because of poor oocyte survival (33.3%, 0%, 20%, and 18%), a fifth attempt using laser-assisted ICSI resulted in the survival of 8 oocytes out of 13 injected. Normal fertilization occurred in 5 oocytes, and a clinical pregnancy was established. CONCLUSION(S): Performing ICSI through a laser-drilled hole in the zona pellucida reduces the risk of oocyte damage related to deformation during the initial phase of the microinjection procedure. This modification of ICSI appears to be suitable for patients whose oocyte show inherent fragility and high degeneration rates after the standard ICSI procedure.
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