Treating the fragile egg syndrome

Fragile Egg during ICSI (NO Indentation in Cytoplasm)

If we do not see any indentation when the ICSI pipette is advanced into the egg, it is advisable not to aspirate the cytoplasm, because this can damage the fragile egg.
However, this is a tricky call, because if we do not aspirate Cytoplasm, we may end up having no fertilization as the cell membrane may not break, and the sperm maybe deposited outside the membrane.

We need to treat Each Egg as an individual Patient , rather than doing ICSI for all the eggs at one time.
Injecting 1 egg at a time is the best option when we are suspecting Eggs to be Fragile.
This can help to minimize damage to the Eggs, because the embryologist is much more aware, and can modify his technique for each individual egg.

The Embryologist can inject 1 Egg; put it back into the incubator, wait for some time, and then observe after a few minutes if the egg has degenerated or not. This is because it can take time for a dead egg to look dead ( the cytoplasm turns dark), and if the embryologist injects all the eggs in a single batch, he may not even realise he has killed a lot of the eggs until it is too late.

After evaluating the fate of the first Egg, the Embryologist can then decide about whether or not to aspirate the cytoplasm for the other eggs. This way he can modify and adapt his technique, depending upon how the eggs behave.

This needs patience, and self-awareness on the part of the embryologist, but this can make a world of a difference to the patient !

Authored by : Dr Aniruddha Malpani, MD and reviewed by Dr Anjali Malpani.