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Trial registered on ANZCTR

Registration number
Ethics application status
Date submitted
Date registered
Date last updated
Date data sharing statement initially provided
Type of registration
Retrospectively registered

Titles & IDs
Public title
Can an alternative type of intracytoplasmic sperm injection (ICSI)
improve fertilisation?
Scientific title
Effect of piezo-assisted intracytoplasmic sperm injection (PIEZO ICSI) upon egg fertilisation rates.
Secondary ID [1] 300534 0
Nil Known
Universal Trial Number (UTN)
Trial acronym
Linked study record

Health condition
Health condition(s) or problem(s) studied:
Infertility 316241 0
Condition category
Condition code
Reproductive Health and Childbirth 314528 314528 0 0
Fertility including in vitro fertilisation

Study type
Description of intervention(s) / exposure
PIEZO ICSI is an alternative ICSI method that utilises ultra-fast drilling coupled with a blunt-ended capillary to drill through the eggs membranes, without forced penetration. It is therefore, thought to be a more ‘gentle approach’ than conventional ICSI. No additional requirements outside of the patients standard assisted reproductive technology treatment will be required by participants. The intervention is administered ex-vivo (in the embryology laboratory) by the embryologist performing the insemination of sperm and eggs. Embryologist will monitor the development of the embryos through specific timed observations to ensure normal embryo growth following PIEZO ICSI.
Intervention code [1] 316834 0
Treatment: Devices
Comparator / control treatment
Conventional ICSI involves the use of a beveled spiked pipette to manually penetrate the egg’s plasma membrane with aspiration of the egg’s cytoplasm to activate the egg prior to injection of previously immobilised sperm.
Control group

Primary outcome [1] 322853 0
Fertilization rate.
Outcome assessed: Laboratory analysis for the presence of 2 pronuclear embryo under microscopic observations.
Timepoint [1] 322853 0
14-16 h post ICSI.
Secondary outcome [1] 380030 0
Egg (oocyte) degeneration rate.
Outcome assessed: Laboratory analysis for lysis rates of eggs under microscopic observations.
Timepoint [1] 380030 0
Up to 1 hr post ICSI.
Secondary outcome [2] 380031 0
Embryo development
Outcome assessed: Laboratory analysis for on time embryo development under microscopic observations.
Timepoint [2] 380031 0
Day 3, 4 and day 5 embryo developmental scoring.
Secondary outcome [3] 380032 0
Embryo utilisation.
Outcome assessed: Assessment of medical records from the embryology laboratory to determine the number of embryos frozen/transferred during current treatment cycle.
Timepoint [3] 380032 0
1 week post ICSI insemination.

Key inclusion criteria
1. Any patient for whom ICSI is the clinical management instruction will be eligible where the semen collection method is ejaculation.

2. Patients with equal to or greater than 6 mature eggs for injection post egg retrieval.
Minimum age
18 Years
Maximum age
50 Years
Both males and females
Can healthy volunteers participate?
Key exclusion criteria
1. Cycles involving frozen or surgical retrieved sperm.

Study design
Purpose of the study
Allocation to intervention
Non-randomised trial
Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
Methods used to generate the sequence in which subjects will be randomised (sequence generation)
Masking / blinding
Open (masking not used)
Who is / are masked / blinded?

Intervention assignment
Other design features
Sibling split model.
The number of eggs collected form the patient will be assessed for suitability for injection. If the patient has greater than or equal to 6 mature eggs for injection, their eggs will be split into two groups- conventional ICSI and PIEZO ICSI. In patients where odds numbers of eggs are collected, the larger numerical value after splitting into the two groups will always be inseminated by conventional ICSI. Eggs will be randomly assigned to each treatment arm based on the random order they are denuded. If a patient has less than 6 mature eggs for injection they will be unable to partake in the trial as this is insufficient number of eggs to draw adequate conclusions. All of their eggs will instead be inseminated via conventional ICSI.
Not Applicable
Type of endpoint(s)
Statistical methods / analysis
All categorical outcomes (i.e. fertilisation rate) will be analysed by a binomial regression, with patient and treatment group added as a fixed factor. Continuous data (i.e. embryo utilization) will be analysed by a paired samples T-test. The sibling split design allows for both across group (Piezo vs conventional ICSI) and within patient comparisons for stronger statistical outcomes.

Recruitment status
Date of first participant enrolment
Date of last participant enrolment
Date of last data collection
Sample size
Accrual to date
Recruitment in Australia
Recruitment state(s)
Recruitment hospital [1] 15871 0
Monash IVF - Clayton - Clayton
Recruitment postcode(s) [1] 29320 0
3168 - Clayton
Recruitment postcode(s) [2] 29321 0
4215 - Southport
Recruitment postcode(s) [3] 29322 0
4066 - Auchenflower
Recruitment postcode(s) [4] 29323 0
2151 - North Parramatta

Funding & Sponsors
Funding source category [1] 304946 0
Commercial sector/Industry
Name [1] 304946 0
Monash IVF Group Limited
Address [1] 304946 0
level 1, 21-31 Goodwood Street
Richmond VIC, 3121
Country [1] 304946 0
Primary sponsor type
Commercial sector/Industry
Monash IVF Group Limited
level 1, 21-31 Goodwood Street
Richmond VIC, 3121
Secondary sponsor category [1] 305300 0
Name [1] 305300 0
Address [1] 305300 0
Country [1] 305300 0

Ethics approval
Ethics application status
Ethics committee name [1] 305357 0
Bellberry Limited
Ethics committee address [1] 305357 0
123 Glen Osmond Rd
Eastwood, SA, 5063
Ethics committee country [1] 305357 0
Date submitted for ethics approval [1] 305357 0
Approval date [1] 305357 0
Ethics approval number [1] 305357 0

Brief summary
This study is assessing whether or not an alternative intracytoplasmic sperm injection (ICSI) technique (PIEZO ICSI) in patients undergoing assisted reproductive technology treatment results in improved embryo fertilisation and utilisation rates. We hypothesis that as PIEZO ICSI is a gentler insemination method we will see increased fertilisation and embryo utilisation rates following PIEZO ICSI compared with conventional ICSI.
Trial website
Trial related presentations / publications
Public notes
Previous publications relating to the trial

1. Huang T, et al. The use of piezo micromanipulation for intracytoplasmic sperm injection of human oocytes. J Assist Reprod Genet. 1996 Apr;13(4):320-8.
2. Yanagida K, et al. The usefulness of a piezo-micromanipulator in intracytoplasmic sperm injection in humans. Hum Reprod. 1999 Feb;14(2):448-53.
3. Takeuchi S, et al. Comparison of piezo-assisted micromanipulation with conventional micromanipulation for intracytoplasmic sperm injection into human oocytes. Gynecol Obstet Invest. 2001;52(3):158-62.
4. Hiraoka K, Kitamura S. Clinical efficiency of Piezo-ICSI using micropipettes with a wall thickness of 0.625 µm. J Assist Reprod Genet. 2015 Dec;32(12):1827-33. J Assist Reprod Genet. 2016 Apr;33(4):549.
5. Furuhashi K, et al. Piezo-assisted ICSI improves fertilization and blastocyst development rates compared with conventional ICSI in women aged more than 35 years. Reprod Med Biol. 2019 Aug 24;18(4):357-361
6. Kimura, Y & Yanagimachi, R (1995). Intracytoplasmic sperm injection in the mouse. Biology of Reproduction 52: 709-720.
7. Katayose et al. (1999). Efficient injection of bull spermatozoa into oocytes using a Piezo-driven pipette. Theriogenology 52: 1215-1224.

Principal investigator
Name 100102 0
A/Prof Deirdre Zander-Fox
Address 100102 0
Monash IVF Group Lmt
level 1, 21-31 Goodwood Street
Richmond VIC, 3121
Country 100102 0
Phone 100102 0
+61 03 9429 1629
Fax 100102 0
Email 100102 0
Contact person for public queries
Name 100103 0
Dr Nicole McPherson
Address 100103 0
180 Fullarton Road
Country 100103 0
Phone 100103 0
+61 08 8333 8111
Fax 100103 0
Email 100103 0
Contact person for scientific queries
Name 100104 0
Dr Nicole McPherson
Address 100104 0
180 Fullarton Road,
Country 100104 0
Phone 100104 0
+61 08 8333 8111
Fax 100104 0
Email 100104 0

Data sharing statement
Will individual participant data (IPD) for this trial be available (including data dictionaries)?
No/undecided IPD sharing reason/comment
Due to IP, no data sharing will be available.
What supporting documents are/will be available?
No other documents available
Summary results
No Results