We examined the relationship between the breakage modes occurring during intracytoplasmic sperm injection (ICSI) and survival, fertilization and embryonic development rates after ICSI, and the morphologic quality of the oocytes before ICSI. The tip of each injection pipette was flattened to exclude the factor of tip shape. Oolemma breakage modes were grouped into four types according to oolemma flexibility. Approximately 8% of the mature oocytes treated with ICSI featured an inflexible oolemma, and 50% of such oocytes resulted in cytolysis, but no significant differences were observed in fertilization rates among the surviving oocytes, and no relationship could be traced between breakage modes and morphologic oocyte quality. The selection of oocytes with flexible oolemma is believed to be crucial in obtaining satisfactory results with ICSI, but it is not yet possible to distinguish oocytes that have inflexible oolemma from other oocytes before ICSI.

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