What is total fertilization failure after ICSI?

Intracytoplasmic sperm injection (ICSI) is an in vitro fertilization procedure in which a single sperm is injected directly into an egg. ICSI is generally performed following an in vitro fertilization procedure to extract one to several oocytes from a woman.

For both patient and doctor, failed fertilization comes as a shock. Although, the fertilization failure after ICSI is less common but considerable chances cannot be ruled out. Generally, fertilization failure after IVF is because of sperm problem. However, fertilization failure after ICSI is rarely because of sperm problem.

Surprisingly, most of the patients are in this notion that failure of ICSI is because of sperm problem. The much known fact that 50 per cent of the DNA comes from the sperm, becomes the reason to believe that fertilization failure after ICSI is because of sperm problems.

Now, ICSI is performed on infertile men with low sperm count or poor sperm motility. Hence, it is logical to conclude that failed fertilization is because of the abnormal sperm DNA in men, which prevents the sperm from fertilizing the eggs. 

The actual truth is that the failed fertilization after ICSI is not because of sperm but the egg. Why? After the sperm is injected inside the egg, most of its work is done. The rest of the fertilization process is driven by energy which is provided by the powerhouses of the cells – the mitochondria, which are present in the cytoplasm of the egg. The sperm has very little role to play after the ICSI has been performed.

Now why the eggs look completely normal? This is because there is no way to distinguish between a normal and an abnormal egg even if the failure has occurred because of eggs. Even if the egg functionally incompetent, it looks normal.

Failure of fertilization after ICSI can only be found out when the embryologist does the fertilization check 16 hours after ICSI. If the eggs do not get fertilized (i.e. it does not have any pronuclei) then fertilization fails.

Rarely, the incubator malfunction can damage the eggs or embryologist can also damage the eggs when doing ICSI. But, remember that failed fertilization after ICSI is usually because of an egg problem. Women, those with poor ovarian reserve and a poor ovarian response encounter these problems.

IVF with ICSI involves the use of specialized micromanipulation tools and equipment and inverted microscopes that enable embryologists to select and pick up individual sperm in a specially designed ICSI needle.

The needle is carefully advanced through the outer shell of the egg and the egg membrane - and the sperm is injected into the inner part (cytoplasm) of the egg. This usually results in normal fertilization in about 75-85% of eggs injected with sperm.

However, first the woman must be stimulated with medications and have an egg retrieval procedure so we can obtain several eggs for in vitro fertilization and ICSI.

Dr Neeraj Pahlajani

Obstetrician & IVF Specialist

(MS, DNB, FMAS, DRM - Germany)

MBBS - Lady Harding Medical College - New Delhi

MS - Obstetrics and Gynecology (PGI - Rohtak)

DNB - Obstetrics and Gynecology

FMAS - World Association of Laparoscopic Surgeons

DRM - Diploma in Reproductive Medicine (Germany)

Fellow in IVF & Embryology – (USA)

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