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Objective: To assess the effectiveness of intracytoplasmic sperm injection (ICSI) combined with piezoelectric stimulation in infertile couples with a history of total fertilization failure (TFF). Design: Prospective controlled trial. Setting: Clinical IVF laboratory. Patient(s): Seventy-one couples undergoing ICSI on sibling oocytes having at least one previous ICSI attempt with TFF. Intervention(s): ICSI or ICSI with piezoelectric activation. Main Outcome Measure(s): Fertilization rate. Result(s): The patients were allocated to two groups: group I included 21 patients with only one previous TFF and group II included 50 patients with more than one previous TFF. Collectively, a total of 823 metaphase II (MII) oocytes were retrieved in 78 oocyte retrievals. In Group I, combined ICSI with piezoelectric stimulation was applied to 123/211 (58.2%) of MII oocytes (group IA), whereas standard ICSI procedure was applied to 88/211 (41.8%) of MII oocytes (group IB). The fertilization rate was 62% and 12% in group IA and group IB respectively. In group II, piezoelectric activation was applied in all 612 MII oocytes, of which 296 (48.3%) were fertilized. The rates for implantation and pregnancy/embryo transfer were obtained as 30.6% and 44.1%, respectively. Conclusion(s): Piezoelectric activation seems to improve IVF outcome in patients with previous TFF history. [ABSTRACT FROM AUTHOR]

Objective: To review different methods for artificial oocyte activation and its impact on intracytoplasmic sperm injection (ICSI). Design: Literature review. Setting: University-based and university-affiliated medical centers. Patient(s): None. Intervention(s): None. Main Outcome Measure(s): None. Result(s): The ICSI procedure improves fertilization rates in cases of male factor infertility; however, fertilization failure still occurs in 2% to 3% of ICSI cycles. The main cause of failed fertilization is failure to complete oocyte activation. The investigators do not use a variety of mechanical, electrical, and chemical methods to mimic the calcium rise necessary to activate oocytes after ICSI. Chemical activation is the most commonly used method for artificial oocyte activation, resulting in high fertilization rates. Conclusion(s): Artificial oocyte activation (AOA) may be useful in selected patients who have low fertilization potential. Further studies are required to establish the biosafety of AOA, and clinical tests are needed to evaluate the activation potential of semen samples for proper patient selection. [Copyright &y& Elsevier]

Objective: To evaluate the electrical activation of oocytes in patients with previously failed or limited fertilization after intracytoplasmic sperm injection (ICSI) and in patients with possible failure of fertilization. Design: Prospective randomized study. Setting: A private IVF center in Egypt. Patient(s): Two hundred forty-six patients with severe oligoasthenospermia or nonobstructive azoospermia with total teratospermia or totally immotile spermatozoa were selected for the study. Patients who previously had total failure or limited fertilization after ICSI also were included. Intervention(s): Sibling oocytes were randomly divided after ICSI into two groups: the study group (n = 1,640) was subjected to electroactivation, and the control group (n = 1,435), to no electroactivation. Electroactivation was performed by using a double-square direct-current pulse. Embryo transfer was performed with the best available embryos. Main Outcome Measure(s): Fertilization rate, degeneration rate, and pregnancy outcome. Result(s): Two hundred forty-one ICSI cycles were included in the study. The fertilization rate was statistically significantly higher in the electroactivated group as compared with in the control group (68% vs 60%, odds ratio = 1.397, 95% confidence interval = 1.197 to 1.629). The oocyte degeneration rate was not statistically significantly different between the two groups (5.9% vs 4.9%, odds ratio = 0.96, 95% confidence interval = 0.73 to 1.26). In total, 112 clinical pregnancies resulted (pregnancy rate = 46.5%). Total fertilization failure occurred in 5 cycles in the control group, and none failed in the study group. Conclusion(s): Oocyte electroactivation after ICSI significantly improved the fertilization rate in severe oligoasthenoteratospermia and nonobstructive azoospermia. [Copyright &y& Elsevier]