Partial zona dissection of human oocytes when failure of zona pellucida penetration is anticipated

Partial zona dissection (PZD) of human oocytes facilitates spermpenetration through mechanically made holes in the zona pellucida.Only 1 of 69 eggs was damaged when sucrose was used to shrinkthe ooplasm during micromanipulation. The fertilization rateof micromanipulated oocytes in 18 couples with male factor infertilitywas 68% (34/50), which compared favourably with inseminationof non-micromanipulated controls (21/45, 47%). PZD was advantageousin oligozoospermic patients, but not in cases of asthenozoospermia,combined semen problems or immunological infertility. Threetwin and two singleton pregnancies resulted following replacementof 23 micromanipulated and eight control embryos in 14 patients.No differences in embryo morphology and development rates werefound between the micromanipulated and control groups. The incidenceof polyspermy in couples with abnormal semen analyses was relativelylow (<20%) possibly due to partial activation of the oocytesfollowing exposure to sucrose. Polyspermy was high (57%) innormozoospermic patients with either immunological infertility(n= 3) or failure of fertilization in previous cycles (n= 4).In the three immunological patients, nine of 11 hyaluronidaseand sucrose-exposed control embryos fertilized and six implanted,possibly indicating that cumulus and corona cells are contributingfactors inhibiting fertilization in such cases.