Background Total fertilization failure (TFF) or near TFF may lead to cycle cancellation, which is a highly frustrating experience for patients, especially those who have undergone multiple attempts. Early rescue intracytoplasmic sperm injection (R-ICSI) has been shown to yield promising clinical results. In this research, we aimed to investigate whether embryo development and clinical outcomes would be affected in subsequent R-ICSI cycles for couples with successful fertilization in the initial cycle of conventional in vitro fertilization (C-IVF). Methods This retrospective cohort study was conducted from January 2014 to December 2023, including 72 couples who demonstrated normal or nearly normal fertilization potential (≥ 40% 2PN rate) in previous C-IVF cycles but subsequently underwent TFF or near TFF in repeated C-IVF cycles. Only the first embryo transfer was analyzed for comparison in each treatment cycle. A comparative analysis was performed between embryo development parameters and clinical outcomes following early R-ICSI versus previous C-IVF. Results Our data indicated that couples undergoing their first C-IVF cycle demonstrated a significantly higher early R-ICSI rate compared to those in their second or subsequent treatment cycles (4.00 versus 1.09%; p < 0.001 and 4.00 versus 0.68%; p < 0.001). For couples undergoing their second cycles, the 2PN rate following early R-ICSI was comparable to that achieved with previous C-IVF (55.42 versus 55.27%; p = 0.929). The D3 available embryo rate was significantly higher following early R-ICSI compared to conventional C-IVF (79.34 versus 68.71%; p = 0.002). Early R-ICSI demonstrated significantly superior clinical outcomes compared to previous C-IVF, with higher pregnancy (58.06 versus 24.13%; p < 0.001), clinical pregnancy (48.39 versus 20.69%; p = 0.002), ongoing pregnancy (38.71 versus 8.62%; p < 0.001), and live birth rates (38.71 versus 5.17%; p < 0.001). For couples undergoing their multiple cycles (≥ 3), early R-ICSI showed significantly lower 2PN (44.44 versus 62.18%; p = 0.006) and D3 available embryo (52.27 versus 70.10%; p = 0.040) rates compared to previous C-IVF. Early R-ICSI demonstrated no statistically significant differences in clinical outcomes compared to previous C-IVF, including pregnancy (44.44 versus 28.57%; p = 0.398), clinical pregnancy (44.44 versus 14.29%; p = 0.074), ongoing pregnancy (33.33 versus 9.52%; p = 0.109), and live birth (33.33 versus 9.52%; p = 0.109) rates. Conclusion For patients undergoing two or more IVF treatment cycles, fertilization failure is not a predictor of poor treatment outcomes and early R-ICSI can still lead to a favorable outcome.

Effect of early rescue ICSI in multiple cycles of couples with successful fertilization in the initial cycle of conventional IVF

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2025年10月31日

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Mingzhao Li,
Wennan Chen,
Xia Xue,
Juanzi Shi

摘要

Background

Total fertilization failure (TFF) or near TFF may lead to cycle cancellation, which is a highly frustrating experience for patients, especially those who have undergone multiple attempts. Early rescue intracytoplasmic sperm injection (R-ICSI) has been shown to yield promising clinical results. In this research, we aimed to investigate whether embryo development and clinical outcomes would be affected in subsequent R-ICSI cycles for couples with successful fertilization in the initial cycle of conventional in vitro fertilization (C-IVF).

Methods

This retrospective cohort study was conducted from January 2014 to December 2023, including 72 couples who demonstrated normal or nearly normal fertilization potential (≥ 40% 2PN rate) in previous C-IVF cycles but subsequently underwent TFF or near TFF in repeated C-IVF cycles. Only the first embryo transfer was analyzed for comparison in each treatment cycle. A comparative analysis was performed between embryo development parameters and clinical outcomes following early R-ICSI versus previous C-IVF.

Results

Our data indicated that couples undergoing their first C-IVF cycle demonstrated a significantly higher early R-ICSI rate compared to those in their second or subsequent treatment cycles (4.00 versus 1.09%; p < 0.001 and 4.00 versus 0.68%; p < 0.001). For couples undergoing their second cycles, the 2PN rate following early R-ICSI was comparable to that achieved with previous C-IVF (55.42 versus 55.27%; p = 0.929). The D3 available embryo rate was significantly higher following early R-ICSI compared to conventional C-IVF (79.34 versus 68.71%; p = 0.002). Early R-ICSI demonstrated significantly superior clinical outcomes compared to previous C-IVF, with higher pregnancy (58.06 versus 24.13%; p < 0.001), clinical pregnancy (48.39 versus 20.69%; p = 0.002), ongoing pregnancy (38.71 versus 8.62%; p < 0.001), and live birth rates (38.71 versus 5.17%; p < 0.001). For couples undergoing their multiple cycles (≥ 3), early R-ICSI showed significantly lower 2PN (44.44 versus 62.18%; p = 0.006) and D3 available embryo (52.27 versus 70.10%; p = 0.040) rates compared to previous C-IVF. Early R-ICSI demonstrated no statistically significant differences in clinical outcomes compared to previous C-IVF, including pregnancy (44.44 versus 28.57%; p = 0.398), clinical pregnancy (44.44 versus 14.29%; p = 0.074), ongoing pregnancy (33.33 versus 9.52%; p = 0.109), and live birth (33.33 versus 9.52%; p = 0.109) rates.

Conclusion

For patients undergoing two or more IVF treatment cycles, fertilization failure is not a predictor of poor treatment outcomes and early R-ICSI can still lead to a favorable outcome.