Assisted oocyte activation is not beneficial for all patients with a suspected oocyte-related activation deficiency.
ABSTRACT Despite the success of ICSI, total fertilization failure (TFF) still occurs in 1-3% of all ICSI cycles. ICSI followed by assisted oocyte activation (ICSI-AOA) can restore fertilization, most efficiently in cases of sperm-related fertilization deficiency. The indication for ICSI-AOA is less obvious when the capacity of the sperm to activate oocytes is considered normal, as proved by a heterologous ICSI model, such as the mouse oocyte activation test (MOAT). In this study, we verified whether ICSI-AOA is beneficial for patients in whom an oocyte-related activation deficiency is suspected.
A prospective study was conducted including patients presenting with a history of TFF or low fertilization (LF) following conventional ICSI in our centre (in-house cases, n= 2) or elsewhere (out-house cases, n= 12). In all cases a sperm deficiency was refuted by the MOAT. In a next treatment cycle, ICSI-AOA was performed on half of the sibling metaphase II oocytes and conventional ICSI on the rest ('split ICSI-AOA cycle'). The main outcome parameters were fertilization, pregnancy and live birth rates.
Overall, ICSI-AOA was able to improve fertilization rates in couples with a suspected oocyte-related fertilization problem, with a mean fertilization rate of 74.2% following ICSI-AOA compared with 43.5% following conventional ICSI (P< 0.001). Cumulative pregnancy rate and live birth rate per cycle were 35.7 and 14.3%, respectively. Considering the out-house patients only, fertilization rates with ICSI-AOA were higher in couples with previous TFF than with conventional ICSI (P< 0.001). Interestingly, for out-house patients who had experienced low, but not zero, fertilization elsewhere, ICSI-AOA could not enhance the fertilization rate. For the two in-house patients, both suffering from previous LF following conventional ICSI, the ICSI-AOA procedure enhanced the mean fertilization rate (25 versus 75%, respectively).
For patients with a suspected oocyte-related activation deficiency, as diagnosed by a heterologuous ICSI model, the indication for ICSI-AOA still remains debatable. Our data show that ICSI-AOA is very efficient in patients with a suspected oocyte-related activation deficiency and previous TFF after conventional ICSI. In contrast, when there was a history of LF in another centre, one should be careful and test the efficiency of ICSI-AOA on half of the sibling oocytes, because ICSI-AOA is not always beneficial for patients with previous LF and a suspected oocyte-related activation deficiency. For these patients, a split ICSI-AOA cycle using sibling oocytes can help to distinguish between a molecular oocyte-related activation deficiency and a previous technical or other biological failure. Moreover, this split ICSI-AOA strategy enables us to set the appropriate strategy for future treatment cycles. Further research with larger groups of patients is now required.
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ABSTRACT: Intracytoplasmic sperm injection (ICSI) is a very efficient technique used in couples diagnosed with severe sperm abnormalities. Fortunately, in only a minority of the couples ICSI does not lead to normal fertilization, which means that, in those couples, no (or very few) embryos will be available for transfer. Failure of fertilization following conventional ICSI can be related to the oocyte or the spermatozoon. Only a few diagnostic tests are currently available to assess the reason for ICSI fertilization failure. The most often advised treatment is assisted oocyte activation (AOA), a highly specialized fertilization technique that can be added to conventional ICSI to overcome fertilization failure in those couples. Since the late 1990s, many centres have been performing AOA in this rare group of patients, with restoration of fertilization and pregnancy rates in many couples. However, until adequate scientific evidence is provided regarding its safety and efficacy, AOA cannot yet be considered an established treatment. This review tackles the mechanism of human oocyte activation and the relatively rare phenomenon of fertilization failure after ICSI. Next, we describe the current diagnostic approaches and focus on the application, efficiency and safety of AOA in human assisted reproduction.Reproductive biomedicine online 01/2014; · 2.68 Impact Factor
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ABSTRACT: Background The effect of assisted reproduction technology (ART) on language development is still unclear. Moreover, different techniques are introduced at rapid pace and are not always accompanied by extensive follow-up programmes.AimsTo investigate the language development of 3–10-year-old children born following ART using intracytoplasmic sperm injection (ICSI) combined with assisted oocyte activation (AOA), which is a highly specialized technique applied in cases with a history of fertilization failure following conventional ICSI. Secondly, a comparison is made between the language development of singletons and twins.Methods & ProceduresTwenty children, six boys and 14 girls, born following ICSI combined with AOA and older than 3 years were included in the study. The mean age of the children was 5;4 years (range = 3;1–10;4 years; SD = 1;8 years). Expressive and receptive language development were assessed using the Clinical Evaluation of Language Fundamentals (CELF-IV-NL) for children older than 5 years and the Reynell Developmental Language Scales (RTOS) for children younger than or equal to 5 years.Outcomes & ResultsThe mean total score for language ability (in percentiles) was 56.8 (SD = 33.6), which corresponds to normal language skills. Significantly higher scores were found for AOA singletons compared with twins. For the general language, none of the children scored within the clinical zone for language disability corresponding with a percentile lower than 5.Conclusion & ImplicationsThis study presents the first data concerning language outcome in 3–10-year-old children born following AOA. General language scores of the AOA children in this study are located within the normal ranges. The language development of singletons was significantly better compared with twins. Although the results are reassuring for language development, in future long-term follow-up studies in this population are necessary.International Journal of Language & Communication Disorders 05/2014; · 1.44 Impact Factor
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ABSTRACT: To assess the Ca(2+)-releasing ability of sperm involved in partial hydatidiform moles.Fertility and sterility. 06/2014;