The efficacy of ionomycin - induced artificial oocyte activation in preventing fertilization failure in an ICSI cycle: an eight - year retrospective study

Artificial oocyte activation (AOA) procedure may prevent the occurrence of fertilization failure following ICSI; however, the specific efficacy of AOA remains controversial. The study investigate the efficacy of AOA to prevent fertilization failure following ICSI and determine how different reasons for using AOA affect the results of AOA. This was a retrospective cohort study that enrolled 240 patients with previous fertilization failure following ICSI (ICSI-failure), severe teratozoospermia or using immotile post - thaw testicular sperm (sperm - immotile). Using sibling oocytes, half were subjected to AOA and half to conventional ICSI (c - ICSI). Based on fertilization outcomes, AOA cycles were classified into three types: AOA - effective, AOA - invalid, and AOA - unnecessary. Multinomial logistic regression was used to analyze the associations between AOA fertilization outcomes (AOA-invalid, AOA-effect, AOA-unnecessary) and indications for AOA use (previous ICSI-failure, severe teratozoospermia, sperm-immotile). For AOA-effect group, binary logistic regression was applied to assess the cumulative live birth rate (c-LBR). The AOA group had more normal fertilization cycles (197) than the c - ICSI group (68) (P<0.001). When comparing AOA-effect and AOA-invalid, Multinomial logistic regression revealed that ICSI-failure were more likely to result in an AOA-invalid outcome (p = 0.019). When comparing AOA-effect and AOA-unnecessary, severe teratozoospermia (p < 0.001) or sperm-immotile (p < 0.001) were more likely to result in an AOA-effect outcome. In the AOA-effect group, logistic regression showed ICSI-failure was positively related to c-LBR) (p = 0.039). Regarding fertilization, AOA may effectively treat patients with previous ICSI-failure, severe teratozoospermia, and sperm-immotile. However, considering the c-LBR, the efficacy of AOA is limited in the latter two groups. Therefore, patient information and consent are required for using AOA.