Artificial oocyte activation with CALCIUM IONOPHORE (A+23187) following ICSI fertilization failure

Abstract

To assess the CALCIUM IONOPHORE (A+23187) use in patients with total failure or low fertilization rate on previous ICSI cycle/s. Retrospective, case- control study. Patients with a history of one or more ICSI cycle/s with low (<50%) or total fertilization failure who underwent a subsequent cycle of ICSI+ CALCIUM IONOPHORE (A+23187) were included. We enrolled 45 patients under 38 years old, with FSH< 10 UI and more than 4 mature oocytes retrieved, from January 2009 to December 2014. Data were analyzed using the Statistical Package for the Social Sciences (SPSS 18.0). Fertilization rate was significantly higher following the utilization of CALCIUM IONOPHORE (A+23187) (case group) when compared with the previous cycle/s (control group), with a mean increase of 34% (±28%) [IC 95% 25, 84- 42,9] (p<0,001). In the 75% of the patients, the fertilization rate increased over 50% and in 46% of the cases, over 70%. Furthermore, previous cycle/s fertilization rate was divided in 3 categories according to the mean fertilization rate was: 0 to 20% (category 1), 21 to 35% (category 2) and 36 to 49% (category 3). In the 3 groups, a significant increase of the fertilization rate was observed with a mean difference of 44,69%, 30,55% and 31,76% respectively. (p=0,003, p< 0,001, p< 0,001)Secondary outcomes: cleavage rate: 87%. Biochemical pregnancy rate: 48%; clinical pregnancy rate: 35%; implantation rate: 17%; abortion rate: 27%; live birth rate: 26%, term birth rate: 82%; mean neonatal weight: 2875 grams (±759 grams). Cesarean section rate was 72%. No congenital anomalies were found.Complete information of the previous cycle/s was available only in 37 cases in which a comparative sub analysis between the previous cycle/s and ICSI + CALCIUM IONOPHORE (A+23187) cycle was performed. No significant increase of the cleavage rate (76,44% vs 85,86%) (p=0,114) was found. Biochemical pregnancy rate: 13,7% vs 42,8% (p=0,028); clinical pregnancy rate: 6,89% vs 31,4% (p=0,03); implantation rate: 3% vs 15% (p=0,03); live birth rate: 3,5% vs 20% (p=0,10); abortion rate: 50%vs 36,3% (p=0,67). CALCIUM IONOPHORE (A+23187) following ICSI fertilization failure, showed to be useful in increasing the fertilization rate with acceptable clinical outcomes and no evidence of congenital anomalies. In addition, we evidenced that the clinical outcomes were improved after the utilization of CALCIUM IONOPHORE (A+23187) as showed in the comparative sub analysis, however, no increase of the live birth rate, was found.On the other hand, the use of CALCIUM IONOPHORE (A+23187) did not show to be beneficial in all the patients included in the study. This could be due to an oocyted- related fertilization failure or even though another sperm- related factor different from the incapacity of the sperm to activate the oocyte.