title: An effective, simplified, and practical approach to intracytoplasmic sperm injection at multiple IVF centers.
abstract: OBJECTIVE
  Our purpose was to use effectively a simplified approach for intracytoplasmic sperm injection (ICSI) that achieves high levels of fertilization, embryo cleavage, and subsequent establishment of clinical pregnancies.
  
  
  METHODS
  In a multicenter clinical analysis, 1814 mature oocytes were injected with a single sperm using a finely beveled (30 degrees) pipette without a spiked tip that was backfilled with an inert, silicone polymer. The injection system was composed of a sterile water-filled tubing interconnecting the pipette and a 20-gauge needle attached to a three-way stopcock and 5-ml disposable syringe. The efficiency of the ICSI procedure was assessed by analyzing fertilization, lysis, and cleavage rates, as well as pregnancy outcomes.
  
  
  RESULTS
  High levels of normal fertilization (2PN; 56.4-73.5% of all eggs injected) and reasonably low lysis rates (9-16%) were produced. The efficiency of embryo formation was high (87-93%), with only 6 of 177 (3.4%) patients failing to produce an embryo. Clinical pregnancies were established by each IVF center (18-34% ongoing pregnancy/birth rate).
  
  
  CONCLUSIONS
  Effective ICSI was achieved using a novel, simplified technique involving sharply beveled pipettes (without additional tip modification), simple sperm washing/handling procedures, and a disposable syringe injection system that offered extremely fine control for sperm manipulation.
authors.affiliation: Institute for Fertility Research, California Fertility Associates, Santa Monica 90404, USA.
authors.forename: M C
authors.initials: MC
authors.lastname: Schiewe
mesh_terms: D001755:Blastocyst / Q000378:metabolism; D002455:Cell Division; D002470:Cell Survival; D004624:Embryo Transfer; D005260:Female; D005306:Fertilization; D005307:Fertilization in Vitro; D006801:Humans; D008297:Male; D008845:Microinjections / Q000295:instrumentation / Q000379:methods*; D009865:Oocytes / Q000378:metabolism; D011247:Pregnancy; D011256:Pregnancy Outcome; D013094:Spermatozoa / Q000378:metabolism*