title: Impact of intracytoplasmic sperm injection on the activation and fertilization process of oocytes.
abstract: Intracytoplasmic sperm injection (ICSI) is used worldwide to treat preferentially severe cases of male factor infertility. In this review, data regarding the processes of oocyte activation and fertilization in non-assisted conception, conventional IVF and ICSI are discussed. The second messenger calcium shows a typical pattern after ICSI, which is different from that after subzonal insemination (SUZI), which is closer to the conditions of normal fertilization. The onset of calcium spikes is delayed. Sometimes a monophasic calcium pattern, in animals typical for parthenogenetic activation, is observed despite normal subsequent oocyte activation. Furthermore, the frequency of spikes is higher after SUZI, and only one phase instead of two is observed after ICSI for the second onset of calcium release. These alterations may be explained by the differences in oocyte activation after ICSI, since no oolemma-sperm contact is present. Sperm decondensation also follows another pattern after ICSI: as long as residuals of the acrosome are present on the sperm head, no sperm decondensation takes place at that site. Therefore, decondensation is delayed and pronucleus formation, especially that of the male pronucleus, takes longer after ICSI as compared with conventional IVF. Since studies have shown that gonosomes are located preferentially in the apical part of the sperm nucleus, this was proposed to be an explanation for a higher incidence of gonosomal aberrations in offspring after ICSI. However, other explanations, taking clinical data like the background risk of the parents into account, can also be offered for this phenomenon. These alternative theories are more likely to be associated with a slight instead of a frank increase in gonosomal aberrations. The inheritance of paternal mitochondrial DNA seems not to be a problem after ICSI, as shown by different studies. Mitochondrial DNA can be demonstrated in embryos after conventional IVF as after ICSI up to the blastocyst stage but not in children born after ICSI. Finally, lesion of the meiotic spindle by the ICSI procedure seems not to be a problem when data from different studies are taken into account. As assumed also at the beginning of the ICSI era, the meiotic spindle is almost always located in an area of < 90 degrees deviation from the polar body axis. Therefore, intrusion of the microinjection needle at the 90 degrees position might not endanger the spindle apparatus. To conclude, several studies using different approaches might show differences in the oocyte activation pattern, the 'choreography of fertilization' and pronucleus formation after ICSI. However, this different pattern does not necessarily mean that ICSI per se is a problem for embryonal development. The different pattern can be explained by the fact that ICSI uses another means of oocyte entry than the normal fertilization process. The clinical data of a high fertilization, cleavage and implantation rate, and especially the data from newborn babies, show that ICSI is a reliable procedure.
authors.affiliation: Department of Gynecology and Obstetrics, University Clinic Hospital Ratzeburger Allee 160 23538 Lübeck Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Ludwig
authors.forename: Annika K
authors.initials: AK
authors.lastname: Schröder
authors.forename: Klaus
authors.initials: K
authors.lastname: Diedrich