Correction of failed fertilization despite intracytoplasmic sperm injection with oligoasthenoteratozoospermia but with acrosomes present by oocyte activation with calcium ionophore--case report.

PURPOSE: To determine if fertilization and embryo cleavage can be achieved by artificial oocyte activation in circumstances of repeated failed fertilization with sperm that have an acrosome. METHODS: A woman with three IVF cycles with intracytoplasmic sperm injection (ICSI) failed to fertilize any eggs. The sperm had severe oligoasthenoteratozoospermia with no sperm with normal morphology. In the fourth IVF cycle fertilization was evaluated by performing ICSI with the husband's sperm and egg activation with calcium ionophore, ICSI with the husband's sperm without artificial oocyte activation, and ICSI with donor sperm. RESULTS: Five mature oocytes were retrieved. Of the four eggs having ICSI with the husband's sperm only one of the two activated by calcium ionophore fertilized and resulted in a cleaved day 3 embryo. Interestingly, the one egg fertilized by donor sperm did not fertilize. CONCLUSIONS: The data could be consistent with conclusions that in some cases the failure to fertilize may be related to an oocyte activation factor/receptor problem in the oocyte that can be overcome by the use of calcium ionophore.