Department of Obstetrics and Gynaecology, Hillingdon Hospital, Uxbridge, United Kingdom.
Division of Surgery and Cancer, Institute of Reproductive and Developmental Biology, Imperial College London, London, United Kingdom.
Fertil Steril. 2017 Sep;108(3):468-482.e3. doi: 10.1016/j.fertnstert.2017.06.029.
To study the effect, if any, of calcium ionophore as a method of artificial oocyte activation (AOA) on pregnancy outcomes and fertilization rates.
Meta-analysis of randomized controlled trials, prospective observational and retrospective trials, case reports, and a case-control trial.
University-affiliated teaching hospital.
PATIENT(S): Infertile couples undergoing fertilization treatment.
INTERVENTION(S): Use of calcium ionophore during AOA.
MAIN OUTCOME MEASURE(S): Odds ratio (OR) as the summary statistic for binary variables was used. Both a fixed and random effects model were applied. Subgroup analysis using quantitative methodology (risk of bias, metaregression) and graphical comparison (funnel plot) assessed statistical heterogeneity.
RESULT(S): Fourteen studies were selected. AOA with calcium ionophore increased the overall clinical pregnancy rate (per ET; OR = 3.48; 95% confidence interval [CI], 1.65-7.37) and the live birth rate (OR = 3.33; 95% CI, 1.50-7.39). This effect of adding calcium ionophore was further demonstrated with fertilization, cleavage, blastocyst, and implantation rates. Subgroup analysis further supported our findings (studies where n > 10 in both arms; random and fixed effects models). A metaregression (beta = -.145) found that as the quality of the study increases, the effect of calcium ionophore is significantly more pronounced with regards to overall pregnancy rate.
CONCLUSION(S): AOA with calcium ionophore treatment after intracytoplasmic sperm injection (ICSI) results in a statistically significant improvement in fertilization, cleavage, blastulation, and implantation rates, as well as overall pregnancy and live-birth rates. The conclusion of this systematic review, demonstrating a strong effect of calcium ionophore use, is reassuring and promising, particularly for couples for whom ICSI alone yields poor fertilization rates.
研究钙离子载体作为一种人工卵子激活（AOA）方法对妊娠结局和受精率的影响。
随机对照试验、前瞻性观察性和回顾性试验、病例报告和病例对照试验的荟萃分析。
大学附属教学医院。
接受受精治疗的不孕夫妇。
在 AOA 中使用钙离子载体。
二分类变量的汇总统计量为比值比（OR）。应用固定效应模型和随机效应模型。使用定量方法（偏倚风险、元回归）和图形比较（漏斗图）进行亚组分析，评估统计异质性。
选择了 14 项研究。AOA 联合钙离子载体可提高整体临床妊娠率（每 ET；OR=3.48；95%置信区间[CI]，1.65-7.37）和活产率（OR=3.33；95% CI，1.50-7.39）。添加钙离子载体的这种作用进一步体现在受精、卵裂、囊胚和着床率上。亚组分析进一步支持了我们的发现（两组中 n>10 的研究；随机和固定效应模型）。元回归（beta=-0.145）发现，随着研究质量的提高，钙离子载体在整体妊娠率方面的效果明显更为显著。
ICSI 后 AOA 联合钙离子载体治疗可显著提高受精、卵裂、囊胚形成和着床率，以及整体妊娠率和活产率。本系统评价的结论表明钙离子载体的使用效果显著，这令人感到欣慰和充满希望，特别是对于 ICSI 本身受精率较差的夫妇。
