title: Making ICSI Safer and More Effective: A Review of the Human Oocyte and ICSI Practice.
abstract: Intracytoplasmic sperm injection (ICSI) has become an indispensable procedure of every assisted reproduction unit. This has created as much controversy as it has awe. As this is a multistep invasive technique, every part of the procedure has become subject to investigation. We contribute this review aspiring to offer the embryologist insight into all available approaches of securing an effective ICSI practice. Herein we present all the different approaches with respect to handling of the human oocyte, taking into consideration the important steps of the technique such as the oocyte positioning, timing of performing ICSI, the option of viewing the meiotic spindle and further individual action such as artificial oocyte activation, rescue ICSI and in vitro maturation. We enrich this by including our view based on our collective experience and current practice. Published studies have led to various options for performing ICSI, resulting in in vitro fertilization units around the world adopting different approaches. The steps that ICSI technique entails discussed from the oocyte perspective are still a long way from being organized into one secure and optimal protocol. Our stressing of the need to secure an efficient ICSI protocol could be the trigger for further well-designed larger scale studies with all the latest technological advantages. We aim to approach this subject in categories and assess them separately. However, ICSI is a multifaceted procedure involving several consecutive steps and when evaluating one we cannot exclude the end effect of the previous, or the overall effect of the different practitioners involved form beginning to end.
authors.affiliation: Department of Physiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece Assisted Conception Unit, Second Department of Obstetrics and Gynecology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece marasimopoulou@hotmail.com.
authors.forename: Mara
authors.initials: M
authors.lastname: Simopoulou
authors.affiliation: Assisted Conception Unit, Second Department of Obstetrics and Gynecology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: Polina
authors.initials: P
authors.lastname: Giannelou
authors.affiliation: Assisted Conception Unit, Second Department of Obstetrics and Gynecology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Bakas
authors.affiliation: Assisted Conception Unit, Second Department of Obstetrics and Gynecology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: Laertis
authors.initials: L
authors.lastname: Gkoles
authors.affiliation: Assisted Conception Unit, Second Department of Obstetrics and Gynecology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: Theodoros
authors.initials: T
authors.lastname: Kalampokas
authors.affiliation: Centre for Human Reproduction, Genesis Hospital, Athens, Greece.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Pantos
authors.affiliation: Department of Physiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: Michael
authors.initials: M
authors.lastname: Koutsilieris
mesh_terms: D006801:Humans; D007246:Infertility / Q000517:prevention & control*; D008297:Male; D009865:Oocytes / Q000502:physiology*; D020554:Sperm Injections, Intracytoplasmic / Q000379:methods*
keywords: ART; ICSI technique; fertilization; improving ICSI rates; oocyte handling; oocytes; review