Repeat intracytoplasmic sperm injection. Clinical perspective

OBJECTIVE: To report the results of repeat intracytoplasmic sperm injection (ICSI) after complete failure of fertilization with initial ICSI.

METHODS: The medical records of the couples undergoing repeat ICSI at the Human Reproductive Biology Unit, Soliman Fakeeh Hospital, Jeddah, Kingdom of Saudi Arabia, after complete failure of fertilization by initial ICSI between December 1994 and December 2000 were retrospectively examined.

RESULTS: Seven hundred and eighty two oocytes from 146 women failed to fertilize by initial ICSI. The main indications for the procedure were severe oligoasthenoteratozoospermia or azoospermia. Fresh sperms were used in 136 cases, of which 98 (72%) were ejaculated, 33 (24.3%) were obtained by testicular sperm extraction, and 5 (3.7%) by testicular sperm aspiration. Of the remaining 10: 3 were from cryopreserved semen samples and 7 were from cryopreserved testicular biopsies. The age of the women (mean ± standard deviation) was 31 ± 16.2 years. The duration of infertility was 10.5 ± 9.4 years. A total of 151 (19.3%) oocytes were fertilized after repeat ICSI. The number of cleaved embryos was 125 (15.9%); of which 2 (1.6%) were grade 5, 47 (37.6%) were grade 4, 65 (52%) were grade 3, and 11 (8.8%) were grade 2. A total of 122 embryos were transferred to 71 women. This resulted in one pregnancy and the birth of a healthy full term baby.

CONCLUSION: In cases of complete failure of fertilization with initial ICSI, fertilization and pregnancy can follow repeat ICSI. Further clinical and cytogenetic studies in this area are necessary.