title: Pregnancy with oocytes characterized by narrow perivitelline space and heterogeneous zona pellucida: is intracytoplasmic sperm injection necessary?
abstract: OBJECTIVE
  This retrospective study analyzed fertilization protocols and pregnancy outcomes for oocytes with with narrow perivitelline space and heterogeneous zona pellucid (NPVS/HZP).
  
  
  METHODS
  In 63 in-vitro fertilization cycles filled with NPVS/HZP oocytes (abnormal oocytes group) and 521 cycles with normal oocytes (normal oocytes group), major clinical and laboratory parameters were recorded and compared in different fertilization cycles (conventional IVF cycles, rescue ICSI cycles, and traditional ICSI cycles).
  
  
  RESULTS
  NPVS/HZP oocytes meant lower MIIoocytes rates in both IVF and ICSI cycles compared with normal oocytes (p < 0.05). The 2PN rates for abnormal oocytes were significantly lower than those for normal oocytes in both conventional IVF cycles (58.8% VS 71.3%, P < 0.05) and rescue ICSI cycles (58.0% VS 78.0%, P = 0.0000). The high-quality embryo rates in normal oocytes groups were significantly higher than those in abnormal oocytes groups in different fertilization cycles (52.2% VS 35.0%, P < 0.01; 42.9% VS 23.9%, P < 0.001; 50.6% VS 31.0%, P = 0.0000, respectively). No clinical pregnancy was obtained from abnormal oocytes in 11 conventional IVF cycles. The clinical pregnancy rates in rescue ICSI and traditional ICSI cycles were comparatively lower in abnormal oocytes groups, but there was no significant difference as compared with normal oocytes groups (35.0% VS 48.1% and 26.7% VS 50.7%, P > 0.05, respectively).
  
  
  CONCLUSIONS
  Retrieval of oocytes characterized by NPVS/PZP from cycle to cycle was one of the reasons for obscure infertility. ICSI may be the right way to avoid fertilization failure and get pregnancy in women with NPVS/HZP oocytes.
authors.affiliation: Center for Reproductive Medicine, Provincial Hospital Affiliated to Shandong University, Jinan, People's Republic of China.
authors.forename: Mei
authors.initials: M
authors.lastname: Li
authors.forename: Shui-Ying
authors.initials: SY
authors.lastname: Ma
authors.forename: Hui-Jun
authors.initials: HJ
authors.lastname: Yang
authors.forename: Ke-Liang
authors.initials: KL
authors.lastname: Wu
authors.forename: Wan-Xia
authors.initials: WX
authors.lastname: Zhong
authors.forename: Guan-Ling
authors.initials: GL
authors.lastname: Yu
authors.forename: Zi-Jiang
authors.initials: ZJ
authors.lastname: Chen
mesh_terms: D000328:Adult; D004624:Embryo Transfer / Q000379:methods; D005260:Female; D005307:Fertilization in Vitro; D006801:Humans; D007247:Infertility, Female; D008297:Male; D009865:Oocytes / Q000254:growth & development*; D011247:Pregnancy; D011256:Pregnancy Outcome; D018873:Pregnancy Rate; D020554:Sperm Injections, Intracytoplasmic; D015044:Zona Pellucida