FAILED FERTILIZATION IN-VITRO - 2ND-DAY MICROMANIPULATION OF OOCYTES VERSUS REINSEMINATION

Objective: To compare routine reinsemination with 2nd day micromanipul ation in patients with poor day 1 fertilization. Design: A retrospecti ve review of patient records. Setting: The Mount Sinai Medical Center Assisted Reproductive Technologies Program. Participants: Patients und ergoing IVF-ET who had poor fertilization (<35%) with standard insemin ation and underwent second day reinsemination of oocytes (group I, n = 84) compared with patients who underwent 2nd day micromanipulation wi th subzonal insemination (group II, n = 12). Main Outcome Measures: Fe rtilization rate, cleavage rate, number of embryo transfers, and pregn ancy rate. Results: Fertilization rate and cleavage rate were signific antly higher in group II patients. Pregnancies per transfer were simil ar between groups I (3/21, 14.3%) and II (0/9, 0%). Second day fertili zation was possible in 9 of 12 group II patients, and fertilization ra te was higher than day 1 in all nine, however, only 50% achieved cleav age, and none achieved pregnancy. Conclusions: Although micromanipulat ing oocytes that fail to fertilize may identify occult male factor inf ertility, may help the clinician plan future cycles, and may result in fertilization and even transfer of embryos in some cycles, there were no pregnancies in our series, and, for now, the clinical efficacy of this procedure remains in question.