Evaluating the Effectiveness of Assisted Oocyte Activation in ICSI: Pairwise Meta-Analyses and Systematic Evidence Evaluation

Abstract

Background

Artificial oocyte activation (AOA) is used to improve fertilisation rates in intracytoplasmic sperm injection (ICSI) cycles.

Objectives

To assess the effectiveness of AOA on fertilisation, embryo development, and clinical outcomes, including live birth.

Search Strategy

We searched PubMed, Cochrane, and Scopus from January 1990 to March 2024 using terms related to ‘artificial oocyte activation’ and ‘ICSI.’

Selection Criteria

Study designs included randomised trials (RCTs), quasi-experimental, cohort, and case–control studies that evaluated AOA's effects on ICSI outcomes, provided quantitative data and were published in English.

Data Collection and Analysis

Reviewers independently performed data extraction using a standardised form. Study quality was appraised using Joanna Briggs Institute (JBI) Checklists. Meta-analyses employed a random-effects model, and evidence was classified using a comprehensive numerical framework.

Main Results

We included 45 studies covering 56 787 mature oocytes, 7463 women for clinical pregnancies, and 7063 women for live births. AOA showed potential in increasing fertilisation rates in patients with a history of low or absent fertilisation but did not enhance embryo development or clinical outcomes. This effect diminished when excluding low-quality studies or focusing solely on RCTs. In other patient groups, AOA showed limited or nonsignificant benefits.

Conclusions

Applying comprehensive evidence assessment, AOA showed potential in improving fertilisation rates in patients with fertilisation problems but no benefits for embryo development or live birth rates. This underscores the critical importance of rigorous evidence credibility in informing clinical practice in assisted conception.