Artificial oocyte activation in intracytoplasmic sperm injection cycles using testicular sperm in humanin vitrofertilization

Abstract

ObjectiveArtificial oocyte activation (AOA) is an effective method to avoid total fertilization failure in human in vitro fertilization-embryo transfer (IVF-ET) cycles. AOA performed using a calcium ionophore can induce calcium oscillation in oocytes and initiate the fertilization process. We evaluated the usefulness of AOA with a calcium ionophore in cases of total fertilization failure in previous cycles and in cases of severe male factor infertility patients with non-motile spermatozoa after pentoxifylline (PF) treatment.MethodsThe present study describes 29 intracytoplasmic sperm injection (ICSI)-AOA cycles involving male factor infertility at Cheil General Hospital from January 2006 to June 2013. Patients were divided into two groups (control, n=480; AOA, n=29) depending on whether or not AOA using a calcium ionophore (A23187) was performed after testicular sperm extraction-ICSI (TESE-ICSI). The AOA group was further split into subgroups according to sperm motility after PF treatment: i.e., motile sperm-injected (n=12) and non-motile sperm-injected (n=17) groups (total n=29 cycles).ResultsThe good embryo rate (52.3% vs. 66.9%), pregnancy rate (20.7% vs. 52.1%), and delivery rate (10.3% vs. 40.8%) were lower in the PF/AOA group than in the control group. When evaluating the effects of restoration of sperm motility after PF treatment on clinical outcomes there was no difference in fertilization rate (66.6% vs. 64.7% in non-motile and motile sperm, respectively), pregnancy rate (17.6% vs. 33.3%), or delivery rate (5.9% vs. 16.7%) between the two groups.ConclusionWe suggest that oocyte activation is a useful method to ensure fertilization in TESE-ICSI cycles regardless of restoration of sperm motility after PF treatment. AOA may be useful in selected patients who have a low fertilization rate or total fertilization failure.

Sperm Selection Procedures for Optimizing the Outcome of ICSI in Patients with NOA

“…Similarly, Kovacic et al reported that if immotile sperm in TESE tissue were cultured with pentoxifylline for 20 min, 97% of them started to move; hence, vital spermatozoa could be distinguished more easily, the procedure was shortened, and the fertilization rates and numbers of embryos increased [ 55 ]. The use of pentoxifylline to stimulate sperm motility in fresh or frozen/thawed suspensions has also been reported in other studies [ 56 , 57 , 58 ]. Since the cAMP level in spermatozoa with normal motility is sufficiently high to activate the subsequent cascades, PDE inhibitors have the most pronounced effect on sperm with poor motility [ 59 ].…”

The combination of calcium ionophore A23187 and GM-CSF can safely salvage aged human unfertilized oocytes after ICSI

“…The use of calcium ionophore A23187 has been found to salvage oocyte activation failure cases, leading to pregnancies in cycles with diminished oocyte reserves [24], although this is still a matter of discussion [25]. Delivery of healthy babies has been reported in severe male factor IVF cycles [18][19][20][26][27][28] and in normozoospermic IVF cycles [21]. Furthermore, A23187 treatment improved embryo development and IVF outcome in couples with embryos showing developmental problems in previous IVF attempts [29].…”

Improving ICSI: A review from the spermatozoon perspective

“…In challenging cases where the issues arising reflect problems on both the oocyte and the sperm the technique of artificial oocyte activation (AOA) in conjunction with methylxanthines treatment has been shown to ensure fertilization. However, it seems that the results are mostly attributed to the AOA rather than the actual use of methylxanthines treatment [Kang et al 2015].…”