Artificial oocyte activation to improve reproductive outcomes in couples with various reproductive problems: a retrospective cohort study

Abstract Research question Does calcium ionophore (A23187) treatment of oocytes improve fertilization rate, embryo development, and outcomes in selected groups of infertile couples? Design This was a retrospective cohort study involving 796 couples undergoing oocyte activation with calcium ionophore after ICSI between the years 2016 and 2018, All metaphase II oocytes of the participants were exposed to 5 μmol/L ionophore for 15 min immediately after ICSI, cultured in vitro to the blastocyst stage, and then transferred to the uteri of recipients at Day 5 or cryopreserved for transfer in the next cycle. The previous cycles of the same patients were treated as the control group. Results On the basis of a cohort of 1261 ICSI cycles and 796 ICSI-artificial oocyte activation (ICSI-AOA) cycles, we found that the rates of implantation, positive β-hCG, clinical pregnancy, and live birth were significantly improved compared with the previous cycles. Additionally, compared with previous cycles, the rates of blastulation and high-quality blastocysts were increased significantly for couples with male factors, young patients with chronic salpingitis, and infertile couples with both factors in the ICSI-AOA cycles. The miscarriage rate was decreased significantly for the couples with male factors, young patients with chronic salpingitis, and patients with polycystic ovary syndrome (PCOS) in the treatment cycles. However, no significant differences were found for fertilization rate, embryo development, or outcomes in patients with primary ovarian insufficiency between the ICSI and ICSI- AOA groups. Conclusions AOA was able to “rescue” the poor reproductive outcomes in certain types of infertile couples with history of failure pregnancy.