The Prediction And Rescue For Fertilization Failure In Vitro Fertilization

Objective The purpose of this study is to assess the value of rescue ICSI performed 5 hours post insemination (hpi) with short co-incubation in IVF-ET.Methods The second polar body was observed 3,4, and 5 hpi, and only oocytes extruded the second polar body were regarded as fertilized. If the second polar body extrusion rate was less than 65% by 5 hpi, the remaining oocytes with only the first polar body would accept rescue ICSI. One thousand and fifty patients undergoing IVF were divided into two groups:GroupⅠ:partly performed rescue ICSI; GroupⅡ: without rescue ICSI. Oocytes in Group I were divided into two parts, some oocytes were performed rescue ICSI, others were only performed IVF. Two hundreds and one patients were thought as Control Group.Results①The second polar body extrusion rate in groupⅠwas lower than groupⅡ(P<0.05), and the ratio of primary infertility and unexplained infertility in groupⅠwere higher than groupⅡ(P<0.05).②No difference existed among the rescue ICSI oocytes of groupⅠ,control group, and groupⅡin fertilization rate, polyspermic rate, clinical pregnancy rate, and implantation rate (P>0.05). The rate of high quality embryo oriented from rescue ICSI oocytes in groupⅠwas lower than groupⅡand control group.Conclusions Early rescue ICSI performed 5 hpi resulted in remarkable improvement in fertilization rate, and a satisfactory pregnancy rate was achieved. Low fertilization rate was more common in primary infertility and unexplained infertility. Objective The aim of this study was to access the application of chemical activation in unfertilized oocytes performing ICSI.Methods (1) the unfertilized oocytes were given chemical activation in 22 hours after ICSI if the fertilization rate was lower than 30%. The patients were divided into two groups randomly:Group of A23187 combined with puromycin:The unfertilized oocytes of one patient were exposed to the A23187 for 5 minutes and followed by puromycin for 4 hours. Group of A23187:The unfertilized oocytes of one patient were exposed only to the A23187 for 30 minutes. The fertilization and embryo outcomes were analyzed. (2) The scientific donated oocytes were performed ICSI with the sperm from patient with totle fertilization failure. The fertilization rate was analyzed. This study was approved by the Reproductive Medical Review Board of Shandong Provincial Hospital. Informed consent was obtained from all patients who participated in this study.Results (1) Group of A23187 combined with puromycin:32 oocytes received activation in 9 patients.22 oocytes were activated(68.75%). In activated oocytes,7 oocytes showed two pronuclei with extrusion of a second polar body (2PN2PB),16 developed to the 2-4cell stage, three developed to the 5-6cell stage, no embryo developed to 7-cell or more. Group with A23187:39oocytes received activation in 7 patients.34 oocytes were activated(87.18%). In activated oocytes,8 oocytes showed 2PN2PB,23 developed to the 2-4cell stage,2 developed to the 5-6cell stage,1 embryo developed to 7-cell or more. There were no significant difference between these two groups. (2) 8 patients with totle fertilization failure received scientific research. No patients had totle fertilization failure again.Conclusions (1) There were no difference between A23187 followed by puromycin and A23187 only in the activation of unfertilized oocytes after ICSI. A23187 activation for 30 minutes could be selected preferred from the view of simple and safety. (2) The lower fertilization rate or totle fertilization failure in most patients with normal-shaped sperm injected were due to the oocyte-origin factor. Objective The aim of this study was to access the application of calcium ionophore(A23187) in patients with lower fertilization rate repeatedly after ICSI.Methods Group of A23187:If the fertilization rate of one patient was less than 30% in at least one ICSI cycle,1/2-2/3 oocytes would be exposed to A23187 for 5 minutes half an hour after ICSI. Control group:the rest oocytes without activation. The rates of fertilization、high embryo、biochemical pregnancy、clinical pregnancy and implantation were analyzed and compared between these two groups.This study was approved by the Reproductive Medical Review Board of Shandong Provincial Hospital. Informed consent was obtained from all patients who participated in this study.Results 66 oocytes received activation in 11 patients in Group A23187.45 ocytes were activated(68.18%).39 oocytes showed 2PB2PN. The rate of high embryo was 46.15%.7 patients were transferred.6 patients were biochemical pregnancy(85.71%). 5 patients were clinical pregnancy(71.43%). The implantation rate was 40.00%.19 embryos were worth to be cultured to blastcyst after transferred and 5 high quality blastcyst were cryopreserved. There were 48 oocytes in 11 patients in control group. 17 ocytes were activated(35.42%). Only 4 oocytes showed 2PN2PB. The others 13 oocytes were all cleaved but not any pronucleur. The 17 cleaved embryos were all 2-4cell stage and low quality. There were significant difference between Group A23187 and Control Group(P<0.05).Conclusions Activation with A23187 for 5 minutes could be one alternation of avoid lower fertilization rate in those patients with higher risk. It could acquire considerable clinical pregnancy. Objective The aim of this study was to access the application of calcium ionophore(A23187) in patients with all severe teratospermia.Methods 1/2-2/3 oocytes would be exposed to A23187 for 5 minutes half an hour after ICSI if all sperm were severe abnormal-shaped. The rate of fertilization、high embryo、biochemical pregnancy、clinical pregnancy and implantation were analyzed. This study was approved by the Reproductive Medical Review Board of Shandong Provincial Hospital. Informed consent was obtained from all patients who participated in this study.Results There were two patients whose sperm were all severe abnormal-shaped. The sperm of one patient was all round-head.2 of 4 oocytes in this patient were received activation.1 oocyte was activated and this oocyte was 2PN2PB. The rest 2 oocytes without activation were no fertilized and cleaved. One high quality embryo was transferred to this patient and get clinical pregnancy. All sperm of the other patient was all pinhead sperm.2 of 4 oocytes in this patient were received activation. No oocyte was activated after activation and also no fertilization in the oocytes without activation. No embryo was transferred.Conclusion Activation with A23187 for 5 minutes could be one way of avoid lower fertilization rate in those patients with all round-head sperm. It can acquire considerable clinical pregnancy. But the application of activation with A23187 for 5 minutes in those patients with all pinhead sperm still need to be studied further.