{"title":"Impact of artificial oocyte activation with calcium ionophore on ICSI outcomes using surgically retrieved spermatozoa: A comprehensive analysis.","authors":"Adva Aizer, Meirav Noach-Hirsh, Chen Shimon, Olga Dratviman-Storobinsky, Lilach Haham Marom, Ettie Maman, Raoul Orvieto","doi":"10.1111/andr.70047","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Intracytoplasmic sperm injection (ICSI) is an effective technique for addressing male infertility. However, fertilization challenges persist, particularly with spermatozoa obtained through testicular sperm procedures.</p><p><strong>Objectives: </strong>This study evaluates the impact of artificial oocyte activation (AOA) on ICSI outcomes using surgically retrieved spermatozoa (motile, immotile, fresh, and frozen), including results from vitrified-warmed embryo transfers and investigating potential improvements in clinical outcomes.</p><p><strong>Materials and methods: </strong>A retrospective analysis was conducted on 73 testicular sperm extraction (TESE)-ICSI cycles involving 57 patients. Outcomes were compared between AOA and non-AOA groups using a sibling oocyte model.</p><p><strong>Results: </strong>Fertilization rates were similar between AOA and non-AOA groups (53.2% vs. 52.3%). However, AOA showed a non-significant increase in TQE rates (64.4% vs. 54.7%, p = 0.067). Cumulative live-birth rates were comparable between AOA (19.3%) and non-AOA (21.6%) groups (p = 0.77). Notably, AOA significantly enhanced TQE rates when used with fresh spermatozoa (65.9% vs. 49.4%, p = 0.026) and non-progressive/immotile spermatozoa (72.7% vs. 51.1%, p = 0.031), yet had minimal effect with motile spermatozoa. There were no significant differences in embryo development timings between the groups. Obstetric and neonatal outcomes were comparable in-between groups, supporting the safety of AOA in this setting.</p><p><strong>Discussion: </strong>AOA appears to positively influence ICSI outcomes when using fresh and non-progressive/immotile spermatozoa. While the overall morphokinetics of embryo development were not affected, the improvement in TQE rates highlights AOA's potential in enhancing embryo quality. The consistent trends toward higher clinical pregnancy and live-birth rates further support its clinical utility.</p><p><strong>Conclusion: </strong>The study demonstrates that AOA significantly improves TQE rates, without negatively impacting overall morphokinetics or obstetric and neonatal outcomes. While the results suggest AOA's potential for specific subsets of male factor infertility cases, further research is needed to confirm its long-term safety and efficacy before broader clinical applications.</p>","PeriodicalId":7898,"journal":{"name":"Andrology","volume":" ","pages":""},"PeriodicalIF":3.2000,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Andrology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1111/andr.70047","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ANDROLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Intracytoplasmic sperm injection (ICSI) is an effective technique for addressing male infertility. However, fertilization challenges persist, particularly with spermatozoa obtained through testicular sperm procedures.
Objectives: This study evaluates the impact of artificial oocyte activation (AOA) on ICSI outcomes using surgically retrieved spermatozoa (motile, immotile, fresh, and frozen), including results from vitrified-warmed embryo transfers and investigating potential improvements in clinical outcomes.
Materials and methods: A retrospective analysis was conducted on 73 testicular sperm extraction (TESE)-ICSI cycles involving 57 patients. Outcomes were compared between AOA and non-AOA groups using a sibling oocyte model.
Results: Fertilization rates were similar between AOA and non-AOA groups (53.2% vs. 52.3%). However, AOA showed a non-significant increase in TQE rates (64.4% vs. 54.7%, p = 0.067). Cumulative live-birth rates were comparable between AOA (19.3%) and non-AOA (21.6%) groups (p = 0.77). Notably, AOA significantly enhanced TQE rates when used with fresh spermatozoa (65.9% vs. 49.4%, p = 0.026) and non-progressive/immotile spermatozoa (72.7% vs. 51.1%, p = 0.031), yet had minimal effect with motile spermatozoa. There were no significant differences in embryo development timings between the groups. Obstetric and neonatal outcomes were comparable in-between groups, supporting the safety of AOA in this setting.
Discussion: AOA appears to positively influence ICSI outcomes when using fresh and non-progressive/immotile spermatozoa. While the overall morphokinetics of embryo development were not affected, the improvement in TQE rates highlights AOA's potential in enhancing embryo quality. The consistent trends toward higher clinical pregnancy and live-birth rates further support its clinical utility.
Conclusion: The study demonstrates that AOA significantly improves TQE rates, without negatively impacting overall morphokinetics or obstetric and neonatal outcomes. While the results suggest AOA's potential for specific subsets of male factor infertility cases, further research is needed to confirm its long-term safety and efficacy before broader clinical applications.
背景：胞浆内单精子注射（ICSI）是治疗男性不育症的有效方法。然而，受精的挑战仍然存在，特别是通过睾丸精子手术获得的精子。目的：本研究评估人工卵母细胞激活（AOA）对手术取出精子（活动的、不活动的、新鲜的和冷冻的）ICSI结果的影响，包括玻璃化加热胚胎移植的结果，并研究临床结果的潜在改善。材料与方法：回顾性分析57例患者的73例睾丸精子抽取(TESE)-ICSI周期。采用同胞卵母细胞模型比较AOA组和非AOA组的结果。结果：AOA组与非AOA组受精率相近，分别为53.2%和52.3%。然而，AOA组TQE发生率无显著升高（64.4% vs. 54.7%, p = 0.067）。AOA组（19.3%）和非AOA组（21.6%）的累计活产率具有可比性（p = 0.77）。值得注意的是，AOA显著提高了新鲜精子（65.9% vs. 49.4%, p = 0.026）和非进展/不运动精子（72.7% vs. 51.1%, p = 0.031）的TQE率，但对运动精子的影响很小。各组间胚胎发育时间无显著差异。两组间的产科和新生儿结局具有可比性，支持在这种情况下AOA的安全性。讨论：当使用新鲜和非进行性/不动精子时，AOA似乎对ICSI结果有积极影响。虽然胚胎发育的整体形态动力学没有受到影响，但TQE率的提高凸显了AOA在提高胚胎质量方面的潜力。较高的临床妊娠率和活产率的持续趋势进一步支持其临床应用。结论：研究表明，AOA可显著提高TQE率，对整体形态动力学或产科和新生儿结局没有负面影响。虽然结果表明AOA在男性因素不育病例的特定亚群中具有潜力，但在更广泛的临床应用之前，需要进一步的研究来确认其长期安全性和有效性。
期刊介绍：
Andrology is the study of the male reproductive system and other male gender related health issues. Andrology deals with basic and clinical aspects of the male reproductive system (gonads, endocrine and accessory organs) in all species, including the diagnosis and treatment of medical problems associated with sexual development, infertility, sexual dysfunction, sex hormone action and other urological problems. In medicine, Andrology as a specialty is a recent development, as it had previously been considered a subspecialty of urology or endocrinology
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