Calcium ionophore improves embryonic development and pregnancy outcomes in patients with previous developmental problems in ICSI cycles

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

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.

Artificial oocyte activation technology as adjuvant therapy for primary ciliary dyskinesia: a report of eight cases and literature review

OBJECTIVE

To explore the clinical application effect and feasibility of intracytoplasmic sperm injection (ICSI) combined with artificial oocyte activation (AOA) technology in the treatment of male infertility caused by primary ciliary dyskinesia (PCD).

CASES REPORT

Between April 2022 and April 2024, our hospital's reproductive center treated a total of eight patients diagnosed with PCD and concurrent male infertility. Among them, six patients were treated with ICSI in conjunction with AOA as an adjuvant therapy, with their oocytes being subjected to ionomycin treatment for a duration of 15 min post-ICSI. One patient underwent ICSI alone, while another patient chose to use donor sperm. Ultimately, we assessed the fertilization rates and transferable embryo rates of all patients. The statistical results showed that the six patients who received ICSI combined with AOA achieved an average fertilization rate of 77.9% and a transferable embryo rate of 66.7%. Four of these patients achieved clinical pregnancy and live birth after embryo transfer. In contrast, the patient who received only ICSI had a fertilization rate of 51.7% and a transferable embryo rate of 20%.

CONCLUSIONS

AOA can be used as an adjuvant treatment in ICSI cycles for patients with PCD accompanied by male infertility. It not only increases the fertilization rate but also potentially improves embryo quality, thereby enhancing the transferable embryo rate.

Assessing the impact of calcium ionophore on pregnancy outcomes in artificial oocyte activation cycles: a 10-year update of systematic review and meta-analysis

PURPOSE

The objective is to evaluate the effectiveness and safety of calcium ionophore as an artificial oocyte activation (AOA) method on pregnancy outcomes in different groups of intracytoplasmic sperm injection (ICSI) patients, providing potential evidence to establish consensus on the indications of AOA.

METHODS

A systematic comprehensive search was performed in Medline, Embase, the Cochrane Library, and Google Scholar databases. Studies published from January 2014 to June 2024 were searched for analysis. All studies that compared ICSI with AOA-ICSI in routine indications composing impaired fertilization or embryo developmental arrest in previous cycles, or male-factor infertility were included.

RESULTS

Twelve studies were included in the meta-analysis. AOA-ICSI was associated with the increase in the overall fertilization rate (OR 1.99, 95% CI 1.16-3.41) and live birth rate (OR 4.58, 95% CI 1.52-13.80). All secondary outcomes including cleavage, blastocyst, high-quality embryo, implantation, biochemical pregnancy, clinical pregnancy presented superiority or equivalence in AOA-ICSI. And the use of calcium ionophore did not increase the miscarriage rate (OR 0.43, 95% CI 0.08-2.43). In subgroup analysis, AOA-ICSI exhibited a more significant effect on patients with indications of no or low fertilization. However, in patients with non-fertilization factors, no statistically significant improvements were observed in all outcomes.

CONCLUSION

Calcium ionophore is an effective artificial oocyte activation approach to improving pregnancy outcomes after ICSI, particularly in cases with indications of fertilization factors, providing further support for the application of AOA in specific populations. Further validation is needed to comprehensively establish the safety of AOA.

TRIAL REGISTRATION

PROSPERO registration number CRD42024551481.

Minerals and the Menstrual Cycle: Impacts on Ovulation and Endometrial Health

The role of minerals in female fertility, particularly in relation to the menstrual cycle, presents a complex area of study that underscores the interplay between nutrition and reproductive health. This narrative review aims to elucidate the impacts of minerals on key aspects of the reproductive system: hormonal regulation, ovarian function and ovulation, endometrial health, and oxidative stress. Despite the attention given to specific micronutrients in relation to reproductive disorders, there is a noticeable absence of a comprehensive review focusing on the impact of minerals throughout the menstrual cycle on female fertility. This narrative review aims to address this gap by examining the influence of minerals on reproductive health. Each mineral's contribution is explored in detail to provide a clearer picture of its importance in supporting female fertility. This comprehensive analysis not only enhances our knowledge of reproductive health but also offers clinicians valuable insights into potential therapeutic strategies and the recommended intake of minerals to promote female reproductive well-being, considering the menstrual cycle. This review stands as the first to offer such a detailed examination of minerals in the context of the menstrual cycle, aiming to elevate the understanding of their critical role in female fertility and reproductive health.