Asian Pacific Journal of Reproduction
Successful rescue activation of unfertilized oocytes with calcium ionophore (A23187) ina case of recurrent ICSI fertilization failure: A case report
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Abstract:
Rationale: This case report describes a couple with recurrent fertilization failure despite undergoing multiple cycles of intracytoplasmic sperm injection (ICSI). The principal clinical concern was suspected oocyte activation deficiency (OAD), in which fertilization is impeded due to the oocyte’s inability to initiate embryogenesis, commonly attributed to inadequate intracellular calcium (Ca2+) release following sperm injection. Patient concerns: The couple repeatedly experienced complete or near-complete fertilization failure in previous ICSI cycles, raising suspicion of an underlying oocyte activation defect. Diagnosis: Based on the repeated absence of fertilization post- ICSI and clinical history, a diagnosis of suspected OAD leading to recurrent ICSI fertilization failure was considered. Interventions: Artificial oocyte activation (AOA) using the calcium ionophore A23187 was performed. After ICSI, unfertilized oocytes were exposed to the ionophore to induce Ca2+ influx, simulating physiological calcium oscillations essential for oocyte activation. The efficacy of intervention was evaluated through subsequent embryonic development, morphological grading, and chromosomal integrity. Outcomes: Following AOA treatment, successful oocyte activation occurred, resulting in the formation of high-grade embryos with normal developmental progression. Chromosomal analysis revealed no detectable abnormalities, indicating genomic stability. Lessons: Calcium ionophore–mediated AOA may serve as an effective adjunct in cases of recurrent ICSI failure attributed to OAD. This case highlights the importance of individualized therapeutic strategies in assisted reproduction; however, further research is needed to refine protocols, validate broader clinical efficacy, and assess long-term safety, including potential epigenetic risks.
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