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Abstract
Objective
To treat couples with total fertilization failure (TFF) due to a combined oocyte- and sperm-related oocyte activation deficiency by optimizing oocyte response to chemical activation with calcium ionophore.
Design
Case report
Setting
Tertiary Hospital
Patients
Two couples with history of TFF after ICSI
Intervention (s)
To overcome oocyte-related OAD, extended in vivo/in vitro oocyte maturation was carried to enhance ooplasmic maturity; to address sperm-related OAD, AGT was performed to trigger oocyte activation.
Main outcome measures
Treatment cycle outcomes for the 2 couples undergoing ICSI with EOM and AGT.
Results
We identified 2 couples with TFF after ICSI due to combined factor of OAD confirmed by PLCζ expression and genomic assessment. Initial AGT treatment alone failed to enhance fertilization, suggesting superimposed oocyte dysmaturity prohibiting oocytes from responding to chemical stimuli. To address this complex form of OAD, in couple 1, 27 oocytes out of 34 retrieved presented normal metaphase II spindles after EOM; ICSI with AGT yielded a fertilization rate of 63.0% (17/27). All 17 zygotes were cryopreserved initially. Two embryos were thawed and transferred, yielding a monochorionic diamniotic twin pregnancy. Couple 2 underwent 3 ICSI cycles with EOM and AGT; 91.4% (32/35) of oocytes displayed normal metaphase II spindle and achieved an overall fertilization rate of 43.8% (14/32). A total of 12 blastocysts were cryopreserved. A single 46XY blastocyst was thawed and transferred, resulting in a singleton pregnancy.
Conclusion
Our study has demonstrated the usefulness of EOM by targeting spindle presence to enhance chemical responses to AGT.
Article info
Publication history
Accepted:
December 21,
2022
Received in revised form:
December 20,
2022
Received:
September 1,
2022
Publication stage
In Press Accepted ManuscriptIdentification
Copyright
© 2022 The Authors. Published by Elsevier Inc. on behalf of American Society for Reproductive Medicine.
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