Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan.
Department of Obstetrics and Gynecology, Saitama Medical University, Saitama, Japan.
Front Endocrinol (Lausanne). 2023 Mar 9;14:1131808. doi: 10.3389/fendo.2023.1131808. eCollection 2023.
This large multi-center retrospective study examined whether artificial oocyte activation (AOA) using Ca ionophore following ICSI improves the live birth rate for couples with previous ICSI cycles of unexplained low fertilization rate. In this large-scale multi-center retrospective study conducted in Japan, data were collected from Keio University and 17 collaborating institutions of the Japanese Institution for Standardizing Assisted Reproductive Technology. Between January 2015 and December 2019, 198 couples were included in this study. Oocytes for both the intervention and control groups were procured from the same pool of couples. Oocytes obtained from ICSI cycles with no or low fertilization rate (<50%) with unknown causes were included in the control (conventional ICSI) group while oocytes procured from ICSI cycles followed by performing AOA were assigned to the intervention (ICSI-AOA) group. Those fertilized with surgically retrieved sperm were excluded. ICSI-AOA efficacy and safety were evaluated by comparing these two groups. Live birth rate was the primary outcome. The ICSI-AOA group (2,920 oocytes) showed a significantly higher live birth per embryo transfer rate (18.0% [57/316]) compared to that of the conventional ICSI group with no or low fertilization rate (1,973 oocytes; 4.7% [4/85]) (odds ratio 4.5, 95% confidence interval 1.6-12.6; P<0.05). A higher live birth rate was observed in younger patients without a history of oocyte retrieval. Miscarriage, preterm delivery, and fetal congenital malformation rates were similar between the two groups. ICSI-AOA may reduce fertilization failure without increasing risks during the perinatal period. AOA may be offered to couples with an ICSI fertilization rate < 50%.
这项大型多中心回顾性研究旨在探讨卵母细胞胞质内钙离子刺激（ICSI-AOA）是否可以提高不明原因低受精率患者的活产率。在这项在日本进行的大规模多中心回顾性研究中，数据来自庆应义塾大学和日本辅助生殖技术标准化机构的 17 个合作机构。2015 年 1 月至 2019 年 12 月，共有 198 对夫妇纳入本研究。干预组和对照组的卵母细胞均来自同一对夫妇的卵母细胞池。将不明原因的 ICSI 周期中受精率<50%（低受精率）的卵母细胞纳入对照组（常规 ICSI），而将 ICSI 周期后进行 AOA 的卵母细胞纳入干预组（ICSI-AOA）。排除那些用手术获得精子受精的卵母细胞。通过比较这两组，评估 ICSI-AOA 的疗效和安全性。活产率是主要结局。与低受精率组（1,973 个卵母细胞；4.7%[4/85]）相比，ICSI-AOA 组（2,920 个卵母细胞）的活产率明显更高（18.0%[57/316]）（比值比 4.5，95%置信区间 1.6-12.6；P<0.05）。在无卵母细胞采集史的年轻患者中，活产率更高。两组的流产、早产和胎儿先天性畸形率相似。ICSI-AOA 可能降低受精失败的风险，而不会增加围产期的风险。对于 ICSI 受精率<50%的夫妇，可考虑提供 AOA。
