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Case reports to suggest an algorithm for management of total fertilisation failure prior to use of donor gametes

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Abstract

Purpose

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.

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Authors and Affiliations

  1. Lister Fertility Clinic, Lister Hospital, Chelsea Bridge Rd, London, SW1W 8RH, UK

    James D. M. Nicopoullos, E. Whitney, V. Wells, S. Batha, R. Faris & H. Abdalla

Authors
  1. James D. M. Nicopoullos
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  2. E. Whitney
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  3. V. Wells
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  4. S. Batha
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  5. R. Faris
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  6. H. Abdalla
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Corresponding author

Correspondence to James D. M. Nicopoullos.

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Capsule

Case reports to develop an algorithm to highlight the importance of oocyte-activation techniques and investigation prior to the use of donor gametes.

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Nicopoullos, J.D.M., Whitney, E., Wells, V. et al. Case reports to suggest an algorithm for management of total fertilisation failure prior to use of donor gametes. J Assist Reprod Genet 32, 1679–1684 (2015). https://doi.org/10.1007/s10815-015-0564-5

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  • DOI: https://doi.org/10.1007/s10815-015-0564-5

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