The following is a summary of the “Artificial oocyte activation with ionomycin compared with A23187 among patients at risk of failed or impaired fertilization,” published in the January 2023 issue of Reproductive Biomedicine Online by Jia, et al.

About 157 couples with a history of TFF (0%), low fertilization (30%), or severe oligo-astheno-teratozoospermia (OAT) in the male partner were included in this single-center, retrospective cohort study that spanned 7 years. Using either 10 mol/l ionomycin or commercial A23187, 171 cycles of ICSI-AOA were performed on couples. Clinical and embryological outcomes were compared.

Around 3 subgroups had significantly higher fertilization rates in the ionomycin group than in the A23187 group: TFF (46.9% versus 28.4%, P = 0.002), low fertilization (67.7% versus 49.2%, P<0.001), and severe OAT (66.4% versus 31.6%). When comparing AOA with ionomycin to A23187, the day 3 cleavage rate was higher for the low fertilization group (P = 0.009) but not for the TFF or severe OAT groups (both P > 0.05). 

There was no statistically significant difference (P > 0.05) in the rates of clinical pregnancy, implantation, and live birth, cumulative live births, or the rates of good-quality embryos on day 3, or in the rates of good-quality embryos on day 5. With 64 successful deliveries, 72 healthy infants entered the world. Compared to commercial A23187, AOA with 10 mol/l ionomycin may be more effective in enhancing oocyte activation in patients at risk of failed or impaired fertilization. This is especially true in cases where the defect is related to the sperm.