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Fertil Steril. 2017 Sep;108(3):468-482.e3. doi: 10.1016/j.fertnstert.2017.06.029.

Does the use of calcium ionophore during artificial oocyte activation demonstrate an effect on pregnancy rate? A meta-analysis.

Author information

1
Department of Obstetrics and Gynaecology, Hillingdon Hospital, Uxbridge, United Kingdom.
2
Division of Surgery and Cancer, Institute of Reproductive and Developmental Biology, Imperial College London, London, United Kingdom. Electronic address: srdjan.saso@imperial.ac.uk.
3
Division of Surgery and Cancer, Institute of Reproductive and Developmental Biology, Imperial College London, London, United Kingdom.
4
Department of Obstetrics and Gynaecology, Chelsea and Westminster Hospital, Imperial College London, London, United Kingdom.
5
Department of Cardiothoracic Surgery, National Heart and Lung Institute, Imperial College London, London, United Kingdom.
6
Centre for Reproductive and Genetic Health, London, United Kingdom.

Abstract

OBJECTIVE:

To study the effect, if any, of calcium ionophore as a method of artificial oocyte activation (AOA) on pregnancy outcomes and fertilization rates.

DESIGN:

Meta-analysis of randomized controlled trials, prospective observational and retrospective trials, case reports, and a case-control trial.

SETTING:

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.

KEYWORDS:

In vitro fertilization; artificial oocyte activation; calcium ionophore; live birth; pregnancy

[Indexed for MEDLINE]

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