In ART while we are performing conventional in vitro fertilization procedures, sometimes it ends with the cancellation of the current treatment cycle due fertilization failure or lack of fertilization. Modern diagnostic methods such as intracytoplasmic sperm injection (ICSI) are limited in their ability to predict and prevent such failures. Intra cytoplasmic sperm injection (ICSI), carried out 16 to 18 hours after fertilization, has been shown to slightly improve fertilization and cleavage rates then conventional in vitro fertilization. Co-culture of short gametes with IVF (ECO-S) along with early rescue ICSI (R-ICSI) have been employed as two solutions to this issue. OBJECTIVES: In vitro fertilization with short-term gamete co-culture (IVF-C) and early intracytoplasmic sperm injection (R-ICSI) in combination with fractionated IVF-ICSI were the two antihypertensive assays investigated in this study. retrospective cohort. It aims to assess the effectiveness of various methodologies. Fertility rate by assisted reproductive technology (ART) cycles. METHODS. One of two treatments (fractional IVF-ICSI or IVF-C with R-ICSI) was used in high-risk couples with reduced fertility during the first cycle of ART. This study assessed fertility, Clinical findings and embryonic quality. RESULTS. The study included 720 couples in the Splitting IVF-ICSI group (Group 1). and 188 couples to the IVF-C & R-ICSI group (Group 2) after comparing propensity scores. The two groups' average fertility rates were comparable. Group 1 outperformed the other groups in terms of both the proportion of numerous pronuclei (10.42% compared 4.50%, p=0.001) and the percentage of embryo utilization (59.84% versus 53.60%, p=0.001). High-quality embryos, embryo transfers, clinical pregnancies, and live deliveries were equally prevalent in both groups. In vitro fertilization rates between groups 1 and 2 were 4.79% and 9.03%, respectively, but no observable differences in fertility or embryonic development were found. In conclusion, fractional IVF-ICSI and early R-ICSI have proven to be effective methods to prevent infertility. Given the advantages of high embryo availability, fewer required ICSI procedures, and equal rates of clinical pregnancy and live birth, IVF with early R-ICSI appears to be the best procedure.