Effect of artificial oocyte activation in intracytoplasmic sperm injection using testicular spermatozoa on sibling oocytes

Abstract

Artificial oocyte activation (AOA) has been proposed as a suitable means to overcome the problem of failed or impaired fertilization after intracytoplasmic sperm injection (ICSI). To analyze with calcium ionophore after ICSI using testicular spermatozoa improves fertilization, embryonic development and pregnancy outcome in patients with obstructive azoospermia (OA) or non-obstructive azoospermia (NOA). Prospective clinical analysis on sibling oocytes. This prospective study was performed between October 2013 and April 2015. All patients involved gave written consent, and institutional review board approval was granted. This study includes 22 OA and 47 NOA couples. We excluded the couples using only immotile spermatozoa for ICSI. Retrieved oocytes were incubated in culture medium (Universal IVF Medium: UIM) for 2 hours at 37C and 6% CO₂ and were underwent ICSI with motile testicular spermatozoa. When eight or more metaphase M (MII) oocytes were available, AOA was performed on half of the sibling MII oocytes. After ICSI, oocytes were incubated in UIM for 30 minutes, and exposed to 10μM of calcium ionophore A23187 for 15 minutes. The oocytes were then washed and placed in UIM. Two pronuclei (2PN) oocytes, blastocysts development, good-quality blastocysts, biochemical pregnancies, and clinical pregnancies rates were compared between two groups. In terms of OA couples, there were no significant difference in 2PN oocytes, blastocysts development, and good-quality blastocysts rates (73.0%, 56.1%, and 47.8% with AOA and 66.0%, 41.2%, and 45.7% without AOA, respectively). For NOA couples, 2PN oocytes with AOA (74.0%) was significantly higher than those without AOA (61.2%). Blastocysts development, and good-quality blastocysts rates for NOA couples were 53.8% and 38.4% with AOA and 56.7% and 40.5% without AOA, respectively (no significant differences). AOA with calcium ionophore showed favorable effect on fertilization rate in patients with NOA but OA. The sperm source was strongly affect the fertility potential or clinical outcomes. Severe male factor infertility, especially NOA, could be an indication for application of AOA.