title: Human sperm can fertilize ova inside the Graafian follicles before ovulation.
abstract: OBJECTIVE
  To report an incidental finding of fertilization of ova inside the ovarian follicles before ovulation.
  
  
  METHODS
  Case report.
  
  
  METHODS
  IVF Center, King Fahd Specialist Hospital, Buraidah, Al-Qassim, Saudi Arabia.
  
  
  METHODS
  One 31-year-old woman with 8 years of primary infertility.
  
  
  METHODS
  Long-protocol superovulation and ovum pickup (OPU).
  
  
  METHODS
  The retrieved nine oocytes were incubated and followed up closely.
  
  
  RESULTS
  Three hours after OPU and only after decoronization of oocytes, sperm were seen attached to the zonae pellucidae of six mature oocytes. Three of them were showing signs of fertilization (two pronuclei). Neither conventional IVF nor intracytoplasmic sperm injection was done, and we decided to continue incubation and observation of all oocytes. From the nine total oocytes, fertilization was demonstrated in six with attached sperm, of which four divided. On day 2 after OPU, three embryos were transferred into the uterus.
  
  
  CONCLUSIONS
  Human sperm can migrate and ascend through the female genital tract to get through the ovarian tissue. Moreover, under certain conditions, it can penetrate the wall of an intact ovarian follicle to reach the ovum and fertilize it just before ovulation.
authors.affiliation: IVF Center, King Fahd Specialist Hospital, Buraidah, Al-Qassim, Saudi Arabia. zmmn@hotmail.com
authors.forename: Zakaria M
authors.initials: ZM
authors.lastname: Nada
authors.forename: Nashaat F
authors.initials: NF
authors.lastname: Assaf
authors.forename: Sushil K
authors.initials: SK
authors.lastname: Dubey
mesh_terms: D000328:Adult; D005260:Female; D005306:Fertilization / Q000502:physiology*; D005307:Fertilization in Vitro; D006801:Humans; D006080:Ovarian Follicle / Q000502:physiology*; D010060:Ovulation / Q000502:physiology*; D010063:Ovum / Q000166:cytology; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000517:prevention & control*; D020554:Sperm Injections, Intracytoplasmic; D013084:Sperm-Ovum Interactions / Q000502:physiology*; D013480:Superovulation