Abstract
Calcium is a crucial factor in regulating the biological behavior of cells. The imbalance of calcium homeostasis in cytoplasm will cause abnormal behavior of cells and the occurrence of diseases. In intracytoplasmic sperm injection (ICSI) cycle, the dysfunction of oocyte activation caused by insufficient release of Ca2+ from endoplasmic reticulum is one of the main reasons for repeated fertilization failure. Calcium ionophore (A23187) is a highly selective calcium ionophore, which can form stable complex with Ca2+ and pass through the cell membrane at will, effectively increasing intracellular Ca2+ levels. It has been reported that calcium ionophore (A23187) can activate oocytes and obtain normal embryos. However, there are few studies on unfertilized oocytes after calcium ionophore (A23187) rescue activation in ICSI cycle. The purpose of this study was to analyze the effects of calcium ionophore (A23187) rescue activation on the activation of unfertilized oocytes, embryonic development potential, embryonic development timing and chromosomal aneuploidy, and to compare and analyze the clinical data of patients with calcium ionophore (A23187) activation in clinical application. The results showed that a certain proportion of high-quality blastocysts with normal karyotype could be obtained after calcium ionophore (A23187) rescue activation of unfertilized oocytes, and it did not have a significant effect on the timing of embryo development. In clinical practice, direct activation with calcium ionophore (A23187) after ICSI was better than rescue activation the next day. In conclusions, the studies on the effectiveness and safety of calcium ionophore (A23187) rescue activation for oocytes with ICSI fertilization failure can enable some patients to obtain usable, high-quality embryos during the first ICSI cycle.
Highlights
The emergence of assisted reproductive technology (ART) has solved the problems of fertility and genetic diseases and improved the success rate of treatment for infertile couples worldwide
In RA-C group (calcium ionophore (A23187) rescue activation treatment control group), 374 metaphase II (MII) oocytes were collected after routine intracytoplasmic sperm injection (ICSI) from 22 patients; In RA-T group (calcium ionophore (A23187) rescue activation treatment experimental group), the 101 unfertilized MII oocytes from RA-C group without pronuclei and no signs of fertilization 18-24 h post-ICSI were collected for calcium ionophore (A23187) rescue activation
The results showed no significant differences in age, body mass index (BMI), basal follicle stimulating hormone (FSH) levels, and estradiol (E2) levels among the groups (P > 0.05), but significant differences were observed in basal luteinizing hormone (LH) and anti-mullerian hormone (AMH) levels between the RA group and other groups (P < 0.05) (Table 1)
Summary
The emergence of assisted reproductive technology (ART) has solved the problems of fertility and genetic diseases and improved the success rate of treatment for infertile couples worldwide. The ICSI technique, which uses a micromanipulator to inject a single sperm directly into the oocyte cytoplasm to fertilize oocytes, effectively improves the fertilization rate of single sperm, and the normal fertilization rate can reach more than 70%. Repeated fertilization failure or low fertilization still occurs in about 1%−5% of ICSI cycles clinically [2], which may be caused by the premature condensation of sperm chromatin, oocyte activation failure, failure to decondense sperm nuclei by oocytes, pronuclei formation disorder, et al [3]. During the normal fertilization process, the activation is triggered after the sperm head fuses with the oocyte membrane, increasing the level of inositol 1,4,5trisphosphate (IP3) in the oocyte plasma. The continuous increase in Ca2+ level in the oocyte plasma to the formation of pronuclei is an important event for normal fertilization and embryonic development [5]
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