Background: Chemical activation is the most frequently used method for artificial oocyte activation (AOA), results in high fertilization rate. Objective: To evaluate the efficiency of oocyte activation with calcium ionophore on fertilization and pregnancy outcomes after intracytoplasmic sperm injection (ICSI) in patients with previous fertilization failure. Design: prospective controlled study Materials and methods: One hundred and eight patients with history of previous fertilization failure undergoing IVF/ICSI treatment with long agonist protocol were randomly divided into two groups: group A (n=54) and group B (n=54) ; a total of 756 metaphase II (MII) oocytes were retrieved . In the oocytes of group A(n=350 oocyte), routine ICSI was applied; while in oocytes in group B (n=406 oocyte) immediately after ICSI, were entered in culture medium supplemented with 5 µΜ calcium ionophore (A23187) for 10 minutes and then washed at least five times with MOPS solution. Main outcome measures: In both groups, the fertilization was evaluated after 16-18 hours. Results: The number of fertilized oocytes and embryos obtained were significantly different between two groups (p=<0.001*). Fertilization rate was significantly higher in group B -where calcium ionophore was applied-compared to group A(control group) (32.2% vs. 9.1%, respectively ,p=0.01*); and Cleavage rate also was significantly higher in group B compared to group A (27.4% vs 12.5% respectively, p=0.028*). Implantation rate was significantly higher in group B than in group A (18.32% vs. 3.12 % respectively, p=0.035*) Pregnancy rate also was significantly higher in group B than in group A (22.2% vs. 1.85% respectively, p=0.042*). Conclusion: Chemical oocyte activation with calcium ionophore resulted in a significant improvement in fertilization, cleavage, implantation and pregnancy rates after ICSI in infertile patients with previous fertilization failure.
Objective:-to evaluate the impact of N-Acetyl cysteine supplementation during controlled ovarian hyperstimulation on follicular fluid homocysteine and to correlate the results with ICSI cycle parameters particularly oocyte yield and cycle outcome in terms of clinical pregnancy rates. Subjects and Methods:-90 women prepared for ICSI using long agonist protocol randomized to receive N-Acetyl cysteine or placebo during stimulation. Results:-Mean follicular fluid homocysteine level was 4.4mg/L in supplemented group versus 6.6 mg/L in non-supplemented group and this was statistically significant. (p<0.0001) Number of oocytes retrieved and clinical pregnancy rates were also significantly higher in supplemented group. (19 versus 12 and 73% versus 49%) (p<0.001, and <0.03 respectively) Conclusion:-Supplementing long agonist controlled ovarian hyperstimulation with 600 mg of oral NAC improved oocyte yield and increased clinical pregnancy rates in ICSI cycles. This favorable impact is correlated, and probably partially explained by reducing follicular fluid homocysteine.
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