Case reports to suggest an algorithm for management of total fertilisation failure prior to use of donor gametes.
OBJECTIVE
Total fertilisation failure (TFF), even with intracytoplasmic sperm injection (ICSI), occurs in approximately 3 % of cycles, can be recurrent and the exact cause is difficult to elucidate. Differentiation between oocyte and sperm-related cause of TFF is possible using mouse oocyte-activation techniques, but is not an option within most clinical settings. Therefore, the management of these couples is clinically driven, and the endpoint, if recurrent, is often the use of donor gametes. However, with the invariable lack of a definitive cause of TFF, any decision between the use of donor sperm or oocytes remains an emotive one. We present two case reports demonstrating the importance of appropriate investigation, activation techniques (mechanical and chemical) and clinical management options to develop a clinical algorithm prior to the use of donor gametes.


METHODS
This study is composed of two case reports of assisted reproduction investigation and treatment within an assisted conception unit for couples with recurrent total fertilisation failure.


RESULTS
Using appropriate investigation (endocrine, urological and embryological) and treatments (ICSI, IMSI, oocyte-activation techniques), a fertilisation rate of 48 % was achieved in two cycles in couples following a total of nine previous cycles (and 200 previously collected eggs) with TFF.


CONCLUSIONS
Oocyte activation requires the triggering of intracellular calcium oscillations by the release of a sperm-specific factor (phospholipase C zeta (PLCζ)) into the oocyte cytoplasm. Although, PLCζ deficiencies have been demonstrated as putative causes of failed activation, impaired oocyte responsiveness may also be a factor. The use of donor gametes is often recommended and is often the required endpoint of treatment. However, these reports outline a clinical algorithm that potentially offers success without donation, and also offers a systematic approach to help decide whether donor oocytes or sperm should be recommended.
Lister Fertility Clinic, Lister Hospital, Chelsea Bridge Rd, London, SW1W 8RH, UK. jamesn@lfclinic.com.
James D M
JD
Nicopoullos
Lister Fertility Clinic, Lister Hospital, Chelsea Bridge Rd, London, SW1W 8RH, UK.
E
E
Whitney
Lister Fertility Clinic, Lister Hospital, Chelsea Bridge Rd, London, SW1W 8RH, UK.
V
V
Wells
Lister Fertility Clinic, Lister Hospital, Chelsea Bridge Rd, London, SW1W 8RH, UK.
S
S
Batha
Lister Fertility Clinic, Lister Hospital, Chelsea Bridge Rd, London, SW1W 8RH, UK.
R
R
Faris
Lister Fertility Clinic, Lister Hospital, Chelsea Bridge Rd, London, SW1W 8RH, UK.
H
H
Abdalla
D000328:Adult; D000465:Algorithms; D061207:Calcium Ionophores / Q000494:pharmacology; D005260:Female; D005307:Fertilization in Vitro / Q000379:methods*; D006801:Humans; D059471:In Vitro Oocyte Maturation Techniques / Q000379:methods*; D008297:Male; D018587:Oocyte Donation; D009865:Oocytes / Q000187:drug effects; D011247:Pregnancy; D020554:Sperm Injections, Intracytoplasmic / Q000379:methods; D017211:Treatment Failure; D010738:Type C Phospholipases / Q000032:analysis / Q000378:metabolism*
D061207:Calcium Ionophores; D010738:Type C Phospholipases
Donor gametes; Fertilisation failure; ICSI; Oocyte activation