Ionomycin Oocyte Activation with Teratozoospermic Male Partners in Couples Undergoing Intracytoplasmic Sperm Injection: A Comparative Prospective Study
Amr El-Helaly, Khaled Moussa, Hassan Morsi, Dalia Abu-Sharia, Jack Hamer, Amr Farag
Keywords :
Infertility, Intracytoplasmic, Oocyte, Original research, Sperm, Teratozoospermia
Citation Information :
El-Helaly A, Moussa K, Morsi H, Abu-Sharia D, Hamer J, Farag A. Ionomycin Oocyte Activation with Teratozoospermic Male Partners in Couples Undergoing Intracytoplasmic Sperm Injection: A Comparative Prospective Study. Int J Infertil Fetal Med 2023; 14 (1):12-17.
Background: Fertilization failure can be defined as the improper transition of the metaphase G1 phases within metaphase II (MII) oocytes. This can be partially attributed to the sperms’ inability to appropriately activate the oocyte. To overcome failed oocyte activation after intracytoplasmic sperm injection (ICSI), many different measures have been previously trialed.
Aim: To evaluate the efficacy of artificial oocyte activation (AOA) using ionomycin in improving fertilization and pregnancy rates in ICSI for couples with teratozoospermic male partners.
Materials and methods: A total of 114 infertile couples having ICSI, with 100% teratozoospermic male partners, were divided after ovum pick up. Group I included 61 cases that underwent ICSI using surgically retrieved sperms with ionomycin AOA immediately after sperm injection. Group II included 53 cases which underwent ICSI using fresh semen samples, with some oocytes activated from each sample using ionomycin (case group), and the rest were not activated (control group). Embryos were assessed for cleavage and quality 48–72 hours after ICSI and two high-quality embryos were transferred on day 3 or 5 of fertilization.
Results: Within all activated and nonactivated samples, the median number of cultured oocytes of each sample was 7 (5–11) vs 4 (3–6), respectively, while the median number of fertilized oocytes was 4 (3–8) vs 3 (2–4), respectively. The median fertilization rate was 72.1 vs 66.7% (p = 0.156). The median number of grade A embryos was 2 (1–3) vs 1 (1–2), respectively. Among group II, grade A embryo production rate was greater within the activated group (40%) as compared to the nonactivated group (33.3%); however, statistical significance was not achieved (p = 0.051). The overall pregnancy rate was 58/114 (50.9%).
Conclusion and clinical significance: Ionomycin oocyte activation may help increase fertilization and pregnancy rates; however, in this study, the effect was not clinically significant. Albeit, there may be a favorable effect on early cleavage and grade A embryo production pending further research.
Tesarik J, Mendoza C, Greco E. The activity (calcium oscillator?) responsible for human oocyte activation after injection with round spermatids is associated with spermatid nuclei. Fertil Steril 2000;74(6):1245–1247. DOI: 10.1016/s0015-0282(00)01598-3
Razavi S, Javdan Z, Tavalaee M, et al. Artificial oocyte activation in severe teratozoospermia undergoing intracytoplasmic sperm injection. Fertil Steril 2008;90(6):2231–2237. DOI: 10.1016/j.fertnstert.2007.10.047
Imani H, Razavi S, Mardani M, et al. Can sperm protamine deficiency induce sperm premature chromosomal condensation? Andrologia 2006;38(3):92–98. DOI: 10.1111/j.1439-0272.2006.00721.x
Escalier D. Failure of differentiation of the nuclear-perinuclear skeletal complex in the round-headed human spermatozoa. Int J Dev Biol 1990;34(2):287–297. DOI: 10.1387/IJDB.2201396
Murase Y, Araki Y, Mizuno S, et al. Pregnancy following chemical activation of oocytes in a couple with repeated failure of fertilization using ICSI: case report. Hum Reprod 2004;19(7):1604–1607. DOI: 10.1093/humrep/deh294
Zini A, Mak V, Phang D, et al. Potential adverse effect of semen processing on human sperm deoxyribonucleic acid integrity. Fertil Steril 1999;72(3):496–499. DOI: 10.1016/s0015-0282(99)00295-2
Check JH, Adelson HG, Bollendorf A, et al. Evaluation of sperm morphology using Kruger's strict criteria. Arch Androl 1992;28(1):15–17. DOI: 10.3109/01485019208987674
Tanbo T, Storeng R, Byholm T, et al. Routine morphological scoring systems in assisted reproduction treatment fail to reflect age-related impairment of oocyte and embryo quality. Reprod Biomed Online 2010;21(1):118–125. DOI: 10.1016/j.rbmo.2010.03.018
Battaglia DE, Koehler JK, Klein NA, et al. Failure of oocyte activation after intracytoplasmic sperm injection using round-headed sperm. Fertil Steril 1999;68(1):118–122. DOI: 10.1016/s0015-0282(97)81486-0
Ozil JP, Huneau D. Activation of rabbit oocytes: the impact of the Ca2+ signal regime on development. Development 2001; 128(6):917–928. DOI: 10.1242/dev.128.6.917
Tesarik J, Sousa M. More than 90% fertilization rates after intracytoplasmic sperm injection and artificial induction of oocyte activation with calcium ionophore. Fertil Steril 1995;63(2):343–349. DOI: 10.1016/s0015-0282(16)57366-x
Nicholls DG. Mitochondrial dysfunction and glutamate excitotoxicity studied in primary neuronal cultures. Curr Mol Med 2004;4(2):149–177. DOI: 10.2174/1566524043479239
Baxter DF, Kirk M, Garcia AF, et al. A novel membrane potential-sensitive fluorescent dye improves cell-based assays for ion channels. J Biomol Screen 2002;7(1):79–85. DOI: 10.1177/108705710200700110
Anifandis G, Michopoulos A, Daponte A, et al. Artificial oocyte activation: physiological, pathophysiological and ethical aspects. Syst Biol Reprod Med 2019;65(1):3–11. DOI: 10.1080/19396368.2018.1516000
Fawzy M, Emad M, Mahran A, et al. Artificial oocyte activation with SrCl2 or calcimycin after ICSI improves clinical and embryological outcomes compared with ICSI alone: results of a randomized clinical trial. Hum Reprod 2018;33(9):1636–1644. DOI: 10.1093/humrep/dey258
Chansel-Debordeaux L, Dandieu S, Bechoua S, et al. Reproductive outcome in globozoospermic men: update and prospects. Andrology 2015;3(6):1022–1034. DOI: 10.1111/andr.12081
Jia L, He S, Su W, et al. Effects of A23187 and ionomycin on oocyte activation in patients with previous total fertilization failure of severe oligo-astheno-teratozoospermia: a 9-year retrospective study. Fertil Steril 2020;114(3):e116. DOI: 10.1016/j.fertnstert.2020.08.348
Murugesu S, Saso S, Jones BP, et al. Does the use of calcium ionophore during artificial oocyte activation demonstrate an effect on pregnancy rate? A meta-analysis. Fertil Steril 2017;108(3):468–482. DOI: 10.1016/j.fertnstert.2017.06.029
Ebnar T, Shebl O, Oppelt P. First live births after application of a ready-to-use ionomycin in cases of failed artificial oocyte activation (AOA) using calcimycin. Fertil Steril 2021;116(3): e199. DOI: 10.1016/j.fertnstert.2021.07.545
Hao DY, Zhang R, Zhang X, et al. A control study of artificial oocyte activation in the same period. Zhonghua Yi Xue Za Zhi 2016; 96(43):3489–3493. DOI: 10.3760/cma.j.issn.0376-2491.2016.43.010
Bonte D, Ferrer-Buitrago M, Dhaenens L, et al. Assisted oocyte activation significantly increases fertilization and pregnancy outcome in patients with low and total failed fertilization after intracytoplasmic sperm injection: a 17-year retrospective study. Fertil Steril. 2019;112(2):266–274. DOI: 10.1016/j.fertnstert.2019.04.006
Eftekhar M, Mohammadian F, Yousefnejad F, et al. Effect of calcium ionophore on unfertilized oocytes after ICSI cycles. Iran J Reprod Med 2012;10(2):83–86. PMID: 25242978; PMCID: PMC4163267.
Li J, Zheng X, Lian Y, et al. Artificial oocyte activation improves cycles with prospects of ICSI fertilization failure: a sibling oocyte control study. Reprod Biomed Online 2019;39(2):199–204. DOI: 10.1016/j.rbmo.2019.03.216
Aydinuraz B, Dirican EK, Olgan S, et al. Artificial oocyte activation after intracytoplasmic morphologically selected sperm injection: a prospective randomized sibling oocyte study. Hum Fertil (Camb) 2016;19(4):282–288. DOI: 10.1080/14647273.2016.1240374
Moaz MN, Khattab S, Aboul-Foutouh I, et al. Chemical activation of oocytes in different types of sperm abnormalities in cases of low or failed fertilization after ICSI: a prospective pilot study. Reprod Biomed Online 2006;13(6):791–794. DOI: 10.1016/s1472-6483(10)61025-5
Chen C, Sun T, Yin M, et al. Ionomycin-induced mouse oocyte activation can disrupt preimplantation embryo development through increased reactive oxygen species reaction and DNA damage. Mol Hum Reprod 2020;26(10):773–783. DOI: 10.1093/molehr/gaaa056