Skip to main content
Download PDF

No advantage of laser-assisted over conventional intracytoplasmic sperm injection: a randomized controlled trial [NCT00114725]

Journal of Experimental & Clinical Assisted Reproduction volume 3, Article number: 5 (2006) Cite this article

Abstract

Background

Intracytoplasmic sperm injection (ICSI) is a component of infertility treatment often employed when conventional in vitro fertilization is unlikely to be successful. Despite good clinical results with ICSI, the procedure is typically associated with degeneration of a significant percentage (approximately 10%) of the treated oocytes. The cause of this degeneration remains unclear. Speculation that damage caused by oocyte compression during the injection procedure may be responsible has led to the development of a novel technique known as laser-assisted ICSI. This procedure involves drilling a small hole through the zona pellucida with a laser prior to sperm injection. Preliminary studies have suggested that laser-assisted ICSI may dramatically reduce oocyte degeneration rates. The objective of this study was to examine whether the reported benefits of laser-assisted ICSI could be verified on a larger, less-selected group of patients.

Methods

Oocytes retrieved from 59 patients scheduled for ICSI were randomly divided into equal treatment and control groups. Oocytes in the treatment group were inseminated by laser-assisted ICSI, while oocytes in the control group were inseminated by conventional ICSI. Outcome variables (oocyte fertilization and degeneration, embryo cell numbers and fragmentation on days 2 and 3, and compaction and blastocyst formation rates) were compared between treatment and control groups by paired-sample t-test. Subgroup analysis was performed according to zona pellucida and oolemma breakage patterns.

Results

No significant differences between treatment and control groups were observed for any of the measured outcome variables. However, fragile zonae pellucidae were associated with significantly poorer embryo quality, and fragile oolemmas that broke easily upon insertion of the injection needle were associated with a significantly higher oocyte degeneration rate. Nevertheless, there were also no between-treatment differences in clinical outcomes within these patient subpopulations.

Conclusion

Contrary to previous reports based on smaller sample sizes, the results of this study suggest that there is no benefit of laser-assisted ICSI, either for the general population of ICSI patients, or for patients prone to zona pellucida or oolemma fragility.

References

  1. Palermo G, Joris H, Devroey P, Van Steirteghem AC: Pregnancies after intracytoplasmic injection of single spermatozoon into an oocyte. Lancet. 1992, 340: 17-18. 10.1016/0140-6736(92)92425-F.

    Article  PubMed  CAS  Google Scholar 

  2. Orief Y, Dafopoulos K, Al-Hassani S: Should ICSI be used in non-male factor infertility?. Reprod Biomed Online. 2004, 9: 348-356.

    Article  PubMed  Google Scholar 

  3. Wright VC, Schieve LA, Reynolds MA, Jeng G: Assisted reproductive technology surveillance--United States, 2002. MMWR Surveill Summ. 2005, 54: 1-24.

    PubMed  Google Scholar 

  4. Van Steirteghem AC, Nagy Z, Joris H, Liu J, Staessen C, Smitz J, Wisanto A, Devroey P: High fertilization and implantation rates after intracytoplasmic sperm injection. Hum Reprod. 1993, 8: 1061-1066.

    Article  CAS  PubMed  Google Scholar 

  5. Mansour R: Intracytoplasmic sperm injection: a state of the art technique. Hum Reprod Update. 1998, 4: 43-56. 10.1093/humupd/4.1.43.

    Article  PubMed  CAS  Google Scholar 

  6. Nagy ZP, Liu J, Joris H, Bocken G, Desmet B, Van Ranst H, Vankelecom A, Devroey P, Van Steirteghem AC: The influence of the site of sperm deposition and mode of oolemma breakage at intracytoplasmic sperm injection on fertilization and embryo development rates. Hum Reprod. 1995, 10: 3171-3177.

    Article  CAS  PubMed  Google Scholar 

  7. Palermo GD, Alikani M, Bertoli M, Colombero LT, Moy F, Cohen J, Rosenwaks Z: Oolemma characteristics in relation to survival and fertilization patterns of oocytes treated by intracytoplasmic sperm injection. Hum Reprod. 1996, 11: 172-176.

    Article  CAS  PubMed  Google Scholar 

  8. Ebner T, Yaman C, Moser M, Sommergruber M, Jesacher K, Tews G: A prospective study on oocyte survival rate after ICSI: influence of injection technique and morphological features. J Assist Reprod Genet. 2001, 18: 623-628. 10.1023/A:1013171505702.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  9. Yavas Y, Roberge S, Khamsi F, Shirazi P, Endman MW, Wong JC: Performing ICSI using an injection pipette with the smallest possible inner diameter and a long taper increases normal fertilization rate, decreases incidence of degeneration and tripronuclear zygotes, and enhances embryo development. J Assist Reprod Genet. 2001, 18: 426-435. 10.1023/A:1016634704469.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  10. Schwartz P, Magerkurth C, Michelmann HW: Scanning electron microscopy of the zona pellucida of human oocytes during intracytoplasmic sperm injection (ICSI). Hum Reprod. 1996, 11: 2693-2696.

    Article  CAS  PubMed  Google Scholar 

  11. Rienzi L, Greco E, Ubaldi F, Iacobelli M, Martinez F, Tesarik J: Laser-assisted intracytoplasmic sperm injection. Fertil Steril. 2001, 76: 1045-1047. 10.1016/S0015-0282(01)02861-8.

    Article  PubMed  CAS  Google Scholar 

  12. Abdelmassih S, Cardoso J, Abdelmassih V, Dias JA, Abdelmassih R, Nagy ZP: Laser-assisted ICSI: a novel approach to obtain higher oocyte survival and embryo quality rates. Hum Reprod. 2002, 17: 2694-2699. 10.1093/humrep/17.10.2694.

    Article  PubMed  CAS  Google Scholar 

  13. Eroglu A, Nahum RT, Isaacson K, Toth TL: Laser-assisted intracytoplasmic sperm injection in human oocytes. J Reprod Med. 2002, 47: 199-203.

    PubMed  Google Scholar 

  14. Nagy ZP, Oliveira SA, Abdelmassih V, Abdelmassih R: Novel use of laser to assist ICSI for patients with fragile oocytes: a case report. Reprod Biomed Online. 2002, 4: 27-31.

    Article  PubMed  Google Scholar 

  15. Rienzi L, Ubaldi F, Martinez F, Minasi MG, Iacobelli M, Ferrero S, Tesarik J, Greco E: Clinical application of laser-assisted ICSI: a pilot study. Eur J Obstet Gynecol Reprod Biol. 2004, 115 Suppl 1: S77-9. 10.1016/j.ejogrb.2004.01.017.

    Article  PubMed  CAS  Google Scholar 

  16. Yanagida K, Katayose H, Yazawa H, Kimura Y, Konnai K, Sato A: The usefulness of a piezo-micromanipulator in intracytoplasmic sperm injection in humans. Hum Reprod. 1999, 14: 448-453. 10.1093/humrep/14.2.448.

    Article  PubMed  CAS  Google Scholar 

  17. Tucker MJ, Morton PC, Wright G, Ingargiola PE, Jones AE, Sweitzer CL: Factors affecting success with intracytoplasmic sperm injection. Reprod Fertil Dev. 1995, 7: 229-236. 10.1071/RD9950229.

    Article  PubMed  CAS  Google Scholar 

  18. Bausell RB, Li YF: Power analysis for experimental research: a practical guide for the biological, medical and social sciences. 2002, Cambridge, Cambridge University Press

    Chapter  Google Scholar 

  19. Davis A, Richter KS, Graham J, Carter J, Kearns WG, Tucker MJ: A retrospective analysis of factors influencing oocyte degeneration post-ICSI. Fertil Steril. 2003, 80: S40-1. 10.1016/S0015-0282(03)01911-3.

    Article  Google Scholar 

  20. Vail A, Gardener E: Common statistical errors in the design and analysis of subfertility trials. Hum Reprod. 2003, 18: 1000-1004. 10.1093/humrep/deg133.

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgements

We thank James Graham and Taer Han for assistance in performing ICSI treatments.

Author information

Authors and Affiliations

  1. Shady Grove Fertility Reproductive Science Center, Rockville, MD, 20850, USA

    Kevin S Richter, Alana Davis, Jennifer Carter, Stephen J Greenhouse, Gilbert L Mottla & Michael J Tucker

Authors
  1. Kevin S Richter
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Alana Davis
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jennifer Carter
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Stephen J Greenhouse
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Gilbert L Mottla
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Michael J Tucker
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kevin S Richter.

Additional information

Competing interests

The author(s) declare that they have no competing interests.

Authors' contributions

AD and MT conceived the study. AD, MT, KR, and SG designed the study protocol. AD and JC performed ICSI treatments and collected data. KR performed the statistical analysis. KR, SG and GM drafted the manuscript. All authors read and approved the final manuscript.

Rights and permissions

Open Access This article is published under license to BioMed Central Ltd. This is an Open Access article is distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/2.0 ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Reprints and Permissions

About this article

Cite this article

Richter, K.S., Davis, A., Carter, J. et al. No advantage of laser-assisted over conventional intracytoplasmic sperm injection: a randomized controlled trial [NCT00114725] . J Exp Clin Assist Reprod 3, 5 (2006). https://doi.org/10.1186/1743-1050-3-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1186/1743-1050-3-5

Journal of Experimental & Clinical Assisted Reproduction

ISSN: 1743-1050