Application of a ready to use calcium ionophore increases rates of fertilization and pregnancy in severe male factor infertility

Capsule:
Patients with severe male factor infertility treated with a ready-to-use ionophore achieve high fertilization and pregnancy rates.

Authors:
Thomas Ebner, Ph.D., Maria Köster, Ph.D., Omar Shebl, M.D., Marianne Moser, Ph.D., Hans Van der Ven, M.D., Gernot Tews, M.D., Markus Montag, Ph.D.

Volume 98, Issue 6, Pages 1432-1437, December 2012

Abstract:

Study objective:
To analyze whether a ready-to-use calcium ionophore improves outcome from fertilization to life birth in patients with severe male factor infertility.

Design:
Artificial oocyte activation was offered to all such patients in a 20-month period.

Setting:
Specialized in vitro fertilization (IVF) centers in Austria and Germany.

Patients:
Twenty-nine azoospermic and 37 cryptozoospermic patients participated.

Interventions:
Mature oocytes treated with a ready-to-use Ca2+-ionophore (GM508 Cult-Active) immediately after intracytoplasmic sperm injection (ICSI).

Main outcome measure(s):
Rates of fertilization, implantation, clinical pregnancy, and live birth.

Results:
Patients had had 88 previous cycles without artificial activation that resulted in a fertilization rate of 34.7%, 79 transfers (89.8%), and 5 pregnancies, which all spontaneously aborted except one. After artificial oocyte activation, the fertilization rate was 56.9%. In terms of fertilization rate, both azoospermic (64.4%) and cryptozoospermic (48.4%) men statistically significantly benefited from use of the ionophore. In 73 transfer cycles, positive β-human chorionic gonadotropin levels were observed in 34 cases (46.6%) and 29 cycles (39.7%) that ended with a clinical pregnancy. The corresponding implantation rate was 33.3%. Four spontaneous abortions occurred (11.8%), and 32 healthy children were born.

Conclusions:
This is the first prospective multicenter study on artificial oocyte activation in severe male factor infertility. Present data indicate that a ready-to-use calcium ionophore can yield high fertilization and pregnancy rates for this particular subgroup. In addition to fertilization failure after ICSI, severe male factor infertility is an additional area for application of artificial oocyte activation.

  • Jim Hotaling

    This article suggests that a ready to use calcium ionophore can significantly improve preganancy outcomes in couples with male factor infertility. However, over 75% of the men in this study had obstructive azoospermia. I would be very interested to see the results stratified by obstructive vs. non-obstructive azoospermia.

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