Cosmetic microsurgery improves implantation and pregnancy rates in patients with history of implantation failure

To evaluate the effect of fragment removal and coarse granulation removal from the perivitelline space (cosmetic microsurgery) on rates of implantation and pregnancy in patients with a history of implantation failure.
Thirty intracytoplasmic sperm injection cycles with etiology of male factor and history of implantation failure were included in this prospective randomized study. The patients were divided into three groups of experiment (n=10), sham (n=10) and control (n=10). Embryos with ≥10% and ≤50% were entered the study. In the experiment group, fragments and coarse granules were removed from embryos before transfer into the uterus. In the sham group, laser assisted zona hatching was performed and in the control group no intervention was done. Implantation and pregnancy rates were compared between different groups. SPSS was used for data analysis. One-way ANOVA and Kruskal-Wallis tests were used for evaluating numerical data and categorical data were compared between the groups using chi-square test.
No significant differences were seen in terms of age, duration of infertility, serum estradiol, LH, FSH, ovulation induction protocol between the three groups. Also, the number of retrieved oocytes, metaphase II oocytes, fertilized oocytes, embryo formation rate and transferred embryos were similar between groups. Fragments pattern (localized or diffused), size and degree of embryo fragmentation (14.5±4.9%, 24.6±5.6% and 21.5±4.3%, in experiment, sham and control groups respectively) were similar between groups. However, the rates of implantation and clinical pregnancy in the experiment group (35% and 70%, respectively) were significantly higher compared with the sham (10% and 30.8%, respectively) and control (0% and 0%, respectively) groups (p The cosmetic micromanipulation of human embryos at the cleavage stage improves rates of implantation and pregnancy in patients with previous history of failed implantation.