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Abstract
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SUMMARY, CONCLUSION AND
RECOMMENDATIONS
With the introduction and establishment of Infra-cytoplasmic sperm injection (ICSI) in assisted reproductive technology, substantial fertilization and implantation rates, even in couples with severe male infertility can be achieved. The outcome of ICSI treatment is not only affected by patient’s parameters but also by embryo variables. Oocyte features and their influence on fertilization rate and embryo quality are controversial in ICSI.
Our study was conducted on 20 patients who underwent 28 cycles of ICSI treatment. These patients attended assissted reproductive unit in Benha University Hospital complaining of infertility either due to male factor, tuba! factor or PCOS. Their ages ranged from 24-40 years.
All these patients were subjected to the same evaluation program which included history taking, examination (general, abdominal and local), radiological (pelvic ultrasound, hysterosalpingogram) and laboratory evaluation (semen analysis, hormones : TSH, day 3 FSH and LH, day 21 serum progesterone). Also all these patients were subjected to the same long protocol of follicular stimulation. Semen samples were obtained by masturbation and prepared by standard swim up technique in all patients. Oocyte retrieval was done
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36h after hCG administration. The collected oocytes were classified according to the cytoplasmic morphology into 3 grades : grade 1 : with no anomaly, grade 2 : with one anomaly, and grade 3 : with at least two anomalies. By another way oocytes were classified according to the first polar body morphology into 4 grades, grade 1 : round or ovoid 1st PB with smooth surface, grade 2 : round or ovoid 1st PB with rough surface, grade 3 : fragmented 1St PB, grade 4 : large perivitelline space. Microinjection was done and assessment of fertilization was done 16-18h after ICSI and assessment of embryo quality according to degree of fragmentation was done 40-42h after ICSI.
A total number of 243 oocyes were collected. Only 190 oocytes were at MII stage and considered for ICSI. 138 (72.6%) oocyes were fertilized. The fertilization rate and embryo quality were not significantly different among groups of oocytes based on cytoplasmic morphology. On the other hand they were significantly different among groups of oocytes based on first polar body morphology.
So we concluded that first polar body should be considered as a prognostic factor in ICSI. This has been shown by a significantly lower fertilization rate in grade 3 and 4. Our data suggest that in ideal circumstances oocytes showing an enlarged first polar body (grade 4) should not be considered for transfere.
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Summtray ,Tonclusionsui9?..econtmentlations
from this study we recommended that embryo selection should be based on first polar body morphology. Also we recommend another study with more larger number of patients to confirm these results.
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