Successful live birth after rescue ICSI following failed fertilization
A 32-year-old patient presented to us with unexplained infertility for 6 years, she had previous six failed ovulation induction (OVI) with intrauterine insemination (IUI). After performing all baseline investigations including detailed semen analysis, she was recruited for IVF under agonist protocol. Downregulation was started in mid-luteal phase using luperide 1 mg daily for 14 days followed by stimulation with recombinant FSH 300IU (Gonal F-Merc serono) daily for 9 days after which eight follicles of 17-19 mm were seen with E2 level of 2317 pg/ml. Ovulation trigger was given with HCG 10000 IU and 36 hours later total 6 oocytes were retrieved under general anesthesia by transvaginal ultrasound-guided aspiration. The cumulus–oocytes complex was inseminated 4 hours after ovum pick up with 70000 motile spermatozoa in a 50-΅l embryo culture medium microdroplets under mineral oil and examined for 18 hours postinsemination. None of the oocytes showed any signs of fertilization i.e., presence of two pronuclei (2 PN) and two polar bodies therefore after an informed consent decision was taken to perform rescue ICSI on day 1 with sperm from day 0 insemination. Four oocytes were injected and three of them showed 2 PN. Three good quality embryos (two 6-celled and one 4-celled) were transferred on day 3 after rescue ICSI. Progesterone supplementation was started from the day of oocyte retrieval in the form of intramuscular micronized progesterone 100 mg daily. Serum β-HCG level on 16th day after embryo transfer was 502 IU/L. A clinical pregnancy was confirmed at 6 weeks by a positive fetal heart beat on transvaginal sonography. Her antenatal course was uneventful. She underwent lower segment Cesarean section at 38 weeks in view of patients’ choice and delivered a healthy normal baby weighing 2.7 kg. The baby is now 3 years of age with normal developmental milestones.