Perinatal and neonatal outcomes of pregnancies after early rescue intracytoplasmic sperm injection in women with primary infertility compared with conventional intracytoplasmic sperm injection: a retrospective 6-year study

Abstract

Background: Early rescue intracytoplasmic sperm injection (ICSI) has been used in clinic as appropriate currently. While the outcomes of children born after this method were not well assessed. The purpose of this study was to evaluate the effect of early rescue ICSI on women with primary infertility. Methods: Fresh embryo transfer cycles after rescue (n = 214) and conventional (n = 546) ICSI were retrospectively evaluated from women with primary infertility who underwent their first assisted reproductive technology cycles at our center in 2012-2017. The conventional ICSI group was subdivided into ICSI-1 (semen suitable for in vitro fertilization, IVF) and ICSI-2 (poor semen quality) to minimize bias from differences in semen quality. Pregnancy, delivery and neonatal outcomes were compared between groups. Results: There was a higher rate of polyspermy and a lower rate of top-quality embryos (TQE) on day 3 for oocytes subject to rescue ICSI compared with conventional ICSI. This reduced the total number of TQE and the number of TQE transferred in the rescue ICSI group. There was no significant difference between groups in clinical pregnancy, ongoing pregnancy, early miscarriage and live birth. For pregnant women, gestational age, route of delivery, risk of preterm birth and gestational diabetes mellitus were also comparable. Neonatal outcomes including sex ratio, birth weight, neonatal intensive care unit admission and birth defects were also similar after rescue and conventional ICSI. Moreover, no differences were observed with the different ICSI subgroups. Conclusions: For women with primary infertility who have a high risk of IVF fertilization failure (FF), rescue ICSI provides a safe and efficient alternative to minimize FF after initial IVF, but results in fewer TQE on day 3.

Delaying Effects of Prolactin and Growth Hormone on Aging Processes in Bovine Oocytes Matured In Vitro

“…The antiapoptotic and development-promoting effects of PRL on aging oocytes, together with its suppressive effect on oocyte SPA, point to the possible usefulness of its application in human and animal ART, and primarily in rescue ICSI. According to modern protocols, early rescue ICSI can be performed 4–6 h after insemination, i.e., 8–10 h after ovum pick-up [ 6 ], which is sufficient for the initiation of aging processes. Furthermore, there is a physiological rationale for the application of PRL.…”

“…As a consequence, when fertilization or the artificial activation of the matured ovum fail to occur at the appropriate time, its quality is compromised, leading to impaired embryo development and offspring health [ 2 , 4 , 5 ]. The rapid loss of M-II oocyte fitness is one of the factors limiting the efficiency of assisted reproductive technologies (ART) in various species, including humans [ 6 , 7 ]. In addition, the spontaneous activation and apoptosis associated with ovum aging are believed to be contributing to the decline in the population of some threatened mammalian species [ 8 ].…”

Effect of early rescue ICSI and split IVF‐ICSI in preventing low fertilization rate during the first ART cycle: A real‐world retrospective cohort study

“… 31 Also, no differences in sex, birth weight, and birth defects were found between newborns delivered by conventional IVF, ICSI, or early R‐ICSI. 32 , 33 However, possible risks associated with the extra manipulation during fertilization assessment after IVF‐S still exist. Therefore, only four or five oocytes/zygotes per patient, rather than all oocytes/zygotes, were chosen for polar body observation.…”

“…31 Also, no differences in sex, birth weight, and birth defects were found between newborns delivered by conventional IVF, ICSI, or early R-ICSI. 32,33 However, possible risks associated with the extra manipulation during fertilization assessment after IVF-S still exist.…”

Usefulness of expanding the indications of early rescue intracytoplasmic sperm injection

“…Early rescue ICSI is indicated for cases suspected of TFF, in which not even a single oocyte from which a second polar body has been extruded 4–8 h after insemination is obtained. 6 , 7 , 8 , 9 , 10 , 11 , 12 Although studies reported that rescue ICSI was performed in cases where the second polar bodies had been extruded from some oocytes, 13 , 14 , 15 , 16 they targeted cases in which the ratio of oocytes from which the second polar bodies had been extruded was <50%. It is expected that many unfertilized oocytes can be saved, but a study reported a high polyspermy rate in rescue ICSI performed in cases with an IVF fertilization rate of >25%, 14 thus raising concerns that unnecessary rescue ICSI may be performed if the indications are expanded.…”