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.
RCT Entities:
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.