Fertilization is a process whereby two specialized parental cells, gametes, unite to form a new entity the embryo. Even though the process of fertilization is usually considered as completed as soon as the zygote—a new cell resulting from the fusion between the male gamete (spermatozoon) and the female gamete (oocyte)—is ready to enter the first embryonic mitotic division, the exact time point at which fertilization begins is much less clearly defined. The outcome of fertilization, i.e., a viable embryo, depends on a variety of events beginning with the selection of the one spermatozoon which will eventually fuse with the oocyte and culminate in the signaling events that result from the interaction between sperm-derived and oocyte-derived molecules after gamete union which initiates the early embryonic development. It is in this broader sense that the topic of fertilization is dealt with in this chapter.

Aware of the fact that the mere description of the cellular and molecular events underlying fertilization would outreach the space allowed, this biological background is reduced to a strict minimum necessary for the understanding of clinically relevant fertilization abnormalities, their diagnosis, and treatment. Particular attention is paid to the current possibilities to predict embryo developmental potential by using data obtained by noninvasive methods of fertilization assessment in assisted reproduction treatment (ART) techniques. Possibilities of alleviating fertilization anomalies in couples at risk are discussed.

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