Kepler University, Department of Gynecology, Obstetrics, and Gynecological Endocrinology, Krankenhausstrasse 26-30, Linz Upper Austria, Austria.
University of Graz, Department of Mathematics and Scientific Computing, Heinrichstrasse 36, Graz Styria 8010, Austria; FH Joanneum-University of Applied Science, Institute of Electronic Engineering, Alte Poststrassee 147, Graz Styria, Austria.
Reprod Biomed Online. 2022 May;44(5):829-837. doi: 10.1016/j.rbmo.2021.11.008. Epub 2021 Nov 18.
Does a double ionophore application improve the outcome of cycles in which single ionophore application was unsuccessful?
This retrospective intervention study (duration 4.5 years) included 79 patients with suspected chronic failed oocyte activation (<30% fertilizations) and/or poor embryo development (developmental arrest, 24 h developmental delay, blastulation rate <15%) in both preceding cycles, the first without ionophore and the second with single ionophore treatment. Within the study period, all patients with failed ionophore treatments (single applications of ready-to-use calcimycin for 15 min) were offered an adapted protocol in the subsequent cycle (study cycle) in which the same ionophore was applied twice (separated by 30 min). Tests for paired data (control and study cycle) were used to reduce the effect of confounders.
The overall fertilization rate did not differ between the study and control cycles. Cleavage (P = 0.020) and blastocyst formation (P = 0.018) rates improved significantly in the study cycles. Implantation (P = 0.001), biochemical (P < 0.001) and clinical pregnancy (P < 0.001) rates were also significantly higher in the study cycles. The study cycles resulted in 29 live births and all 32 babies born were healthy.
This study suggests that double ionophore application may improve blastocyst formation and clinical pregnancy rates in cases of failed single ionophore treatment, irrespective of whether the ionophore was used to overcome fertilization failure or poor embryo development. Fertilization rate was only increased in cases with a history of fertilization failure. Because single ionophore treatment was used in only one previous cycle it cannot be ruled out that some improvement in clinical outcomes would also have been achieved by using single instead of double ionophore treatment again in the subsequent attempt.
双离子载体应用是否能改善单次离子载体应用不成功的周期结局？
这是一项回顾性干预研究（持续 4.5 年），纳入了 79 例前两个周期疑似慢性卵母细胞激活失败（<30%受精）和/或胚胎发育不良（发育阻滞、24 小时发育延迟、囊胚形成率<15%）的患者，第一个周期未使用离子载体，第二个周期使用了单次离子载体治疗。在研究期间，所有离子载体治疗失败的患者（单次使用即用型钙调蛋白 15 分钟）在下一个周期（研究周期）中都接受了改良方案，即在同一周期中应用两次（间隔 30 分钟）。采用配对数据检验（对照周期和研究周期）来减少混杂因素的影响。
研究周期和对照周期的总体受精率无差异。但研究周期的卵裂（P=0.020）和囊胚形成（P=0.018）率显著提高。研究周期的种植率（P=0.001）、生化妊娠率（P<0.001）和临床妊娠率（P<0.001）也显著升高。研究周期共获得 29 例活产，32 例出生婴儿均健康。
本研究表明，对于单次离子载体治疗失败的病例，双离子载体应用可能改善囊胚形成和临床妊娠率，无论离子载体是用于克服受精失败还是胚胎发育不良。只有在受精失败史的情况下，受精率才会提高。由于单次离子载体治疗仅在前一个周期使用，因此不能排除在随后的尝试中再次使用单次而非双离子载体治疗也会获得一些临床结局的改善。
