Identification of the optimal puncture position by a real-time image analysis for Piezo-intracytoplasmic sperm injection: a prospective randomized sibling oocyte study

Research Question : Unintentional membrane rupture (UMR) during intracytoplasmic sperm injection (ICSI) may result in oocyte degeneration. We developed a novel system, the ICSI position detector (IPD), which categorizes oolemma patterns by an image analysis. These image patterns are associated with the risk of UMR. We herein investigated whether it is possible to identify the optimal puncture position on oolemma using real-time IPD during Piezo-ICSI with the aim of reducing oocyte degeneration. Design : This sibling oocyte study included 917 inseminated oocytes from 113 infertile patients undergoing Piezo-ICSI. Oocytes were randomly divided into two groups: with or without IPD. The rates of UMR, degeneration, fertilization, and embryonic development were compared between the two groups. Results : The rates of UMR (7.0% vs. 12.9%, P<0.01) and degeneration (2.4% vs. 6.1%, P<0.01) were significantly lower in the IPD group than in the non-IPD group. However, no significant differences were observed in the rates of fertilization (2PN, 83.8% vs. 78.9%), blastocyst formation (48.5% vs. 48.8%), or good-quality blastocysts (22.5% vs. 20.5%). Additionally, no significant differences were observed in the rates of pregnancy (29.4% vs. 35.1%) or live births (26.5% vs. 29.7%) in a single embryo transfer setting with or without IPD. Conclusions : The present study demonstrated that a real-time image analysis during Piezo-ICSI markedly reduced oocyte degeneration by avoiding areas associated with a high risk of UMR. Therefore, IPD may increase the number of embryos available for treatment.