Intracytoplasmic sperm injection (ICSI) of round-headed spermatozoa into mature oocyte resulted in normal fertilization, embryo development and pregnancy in a 28 year old female. The husband had a long history of primary infertility. Three ICSI attempts were carried out and fertilization and embryo development occurred in all trials. However, only the third trial led to a pregnancy, which proved to be quadruplet after the transfer of four embryos. One embryo vanished and the remaining triplets were delivered at 35 weeks of gestation by Caesarean section. Two of the babies, a boy weighing 2000 g and a girl weighing 2250 g at birth were discharged in a good condition 1 week after delivery and the third baby, a boy weighing 1550 g, was discharged 3 weeks after delivery.
This study evaluated the results of a management protocol combining a number of investigations and interventions, previously proven beneficial in randomized controlled trials in IVF/intracytoplasmic sperm injection (ICSI) patients with apparently unexplained recurrent implantation failure (defined as two or more previous failed cycles, during which at least six good-quality embryos were transferred). It was a prospective cohort study and included 273 couples with previous recurrent implantation failure. Each patient (all under 40) underwent a pre-treatment work-up, consisting of pelvic ultrasound scan for hydrosalpinx, hysteroscopy and screening for acquired and congenital thrombophilia. Detected abnormalities were dealt with accordingly: proximal occlusion for hydrosalpinx, hysteroscopic management for intrauterine pathology and thromboprophylaxis with daily low-molecular weight heparin from the day of embryo transfer for thrombophilia. The patients then underwent IVF/ICSI with laser-assisted hatching. 112 patients (41%; group 1) had abnormalities detected (17 hydrosalpinx, 11 intrauterine pathology, 63 congenital thrombophilia, 21 acquired thrombophilia) and the remaining 161 (59%; group 2) had normal work-up. The pregnancy rates per cycle started for all patients, group 1 and group 2 were 47%, 55% and 41%, respectively. This suggests that using the described management protocol in couples with previous recurrent implantation failure leads to a favourable chance of success.
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