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Assisted oocyte activation is not beneficial for all patients with a suspected oocyte-related activation deficiency

Frauke Vanden Meerschaut UGent, Dimitra Nikiforaki UGent, STEFANIE DE GHESELLE UGent, VALERIE DULLAERTS UGent, Etienne Van den Abbeel UGent, Jan Gerris UGent, Björn Heindryckx UGent and Petra De Sutter UGent (2012) HUMAN REPRODUCTION. 27(7). p.1977-1984
abstract
Despite the success of ICSI, total fertilization failure (TFF) still occurs in 13 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 (osplit 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.
Please use this url to cite or link to this publication:
author
organization
year
type
journalArticle (original)
publication status
published
subject
keyword
FAILED FERTILIZATION, CA2+ OSCILLATIONS, SUCCESSFUL PREGNANCY, NORMOZOOSPERMIC PATIENT, ABNORMAL FERTILIZATION, MOUSE OOCYTES, CALCIUM IONOPHORE, PHOSPHOLIPASE-C-ZETA, IN-VITRO FERTILIZATION, INTRACYTOPLASMIC SPERM INJECTION, mouse oocyte activation test, ionophore, assisted oocyte activation, oocyte activation deficiency, failed fertilization
journal title
HUMAN REPRODUCTION
Hum. Reprod.
volume
27
issue
7
pages
1977 - 1984
Web of Science type
Article
Web of Science id
000305458800011
JCR category
OBSTETRICS & GYNECOLOGY
JCR impact factor
4.67 (2012)
JCR rank
3/77 (2012)
JCR quartile
1 (2012)
ISSN
0268-1161
DOI
10.1093/humrep/des097
language
English
UGent publication?
yes
classification
A1
copyright statement
I have transferred the copyright for this publication to the publisher
id
2980245
handle
http://hdl.handle.net/1854/LU-2980245
date created
2012-09-06 14:39:09
date last changed
2013-11-26 13:06:33
@article{2980245,
  abstract     = {Despite the success of ICSI, total fertilization failure (TFF) still occurs in 13 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 (osplit 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.},
  author       = {Vanden Meerschaut, Frauke and Nikiforaki, Dimitra and DE GHESELLE, STEFANIE and DULLAERTS, VALERIE and Van den Abbeel, Etienne and Gerris, Jan and Heindryckx, Bj{\"o}rn and De Sutter, Petra},
  issn         = {0268-1161},
  journal      = {HUMAN REPRODUCTION},
  keyword      = {FAILED FERTILIZATION,CA2+ OSCILLATIONS,SUCCESSFUL PREGNANCY,NORMOZOOSPERMIC PATIENT,ABNORMAL FERTILIZATION,MOUSE OOCYTES,CALCIUM IONOPHORE,PHOSPHOLIPASE-C-ZETA,IN-VITRO FERTILIZATION,INTRACYTOPLASMIC SPERM INJECTION,mouse oocyte activation test,ionophore,assisted oocyte activation,oocyte activation deficiency,failed fertilization},
  language     = {eng},
  number       = {7},
  pages        = {1977--1984},
  title        = {Assisted oocyte activation is not beneficial for all patients with a suspected oocyte-related activation deficiency},
  url          = {http://dx.doi.org/10.1093/humrep/des097},
  volume       = {27},
  year         = {2012},
}

Chicago
Vanden Meerschaut, Frauke, Dimitra Nikiforaki, STEFANIE DE GHESELLE, VALERIE DULLAERTS, Etienne Van den Abbeel, Jan Gerris, Björn Heindryckx, and Petra De Sutter. 2012. “Assisted Oocyte Activation Is Not Beneficial for All Patients with a Suspected Oocyte-related Activation Deficiency.” Human Reproduction 27 (7): 1977–1984.
APA
Vanden Meerschaut, F., Nikiforaki, D., DE GHESELLE, S., DULLAERTS, V., Van den Abbeel, E., Gerris, J., Heindryckx, B., et al. (2012). Assisted oocyte activation is not beneficial for all patients with a suspected oocyte-related activation deficiency. HUMAN REPRODUCTION, 27(7), 1977–1984.
Vancouver
1.
Vanden Meerschaut F, Nikiforaki D, DE GHESELLE S, DULLAERTS V, Van den Abbeel E, Gerris J, et al. Assisted oocyte activation is not beneficial for all patients with a suspected oocyte-related activation deficiency. HUMAN REPRODUCTION. 2012;27(7):1977–84.
MLA
Vanden Meerschaut, Frauke, Dimitra Nikiforaki, STEFANIE DE GHESELLE, et al. “Assisted Oocyte Activation Is Not Beneficial for All Patients with a Suspected Oocyte-related Activation Deficiency.” HUMAN REPRODUCTION 27.7 (2012): 1977–1984. Print.