I-13: Complete Fertilization Failure after ICSIWhat to Do?

Fertilization in vivo is a complex process consisting of six steps, namely, penetration of the cumulus complex, binding of the sperm to the zona pellucida, fusion of oocyte and sperm, oocyte activation, sperm remodelling, and formation of the pronuclei. Since ICSI bypasses the first three steps any problem related to fertilization failure after ICSI arises from oocyte activation onwards. According to literature approximately 10% of all patients suffering from severe male factor infertility and 5% with insuspicuous sperm count could be affected by this dilemma. Currently three methods are available to treat such patients: usage of an ionophore, a modified ICSI according to Tesarik, or accumulation of highly active mitochondria on the site of fertilization.