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Significant differences in efficiency between two commonly used ionophore solutions for assisted oocyte activation (AOA): a prospective comparison of ionomycin and A23187

  • Assisted Reproduction Technologies
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Abstract

Purpose

Despite the success of ICSI in treating severe male factor infertile patients, total fertilization failure (FF) still occurs in around 1–3% of ICSI cycles. To overcome FF, the use of calcium ionophores has been proposed to induce oocyte activation and restore fertilization rates. However, assisted oocyte activation (AOA) protocols and ionophores vary between laboratories, and the morphokinetic development underlying AOA remains understudied.

Methods

A prospective single-center cohort study involving 81 in vitro matured metaphase-II oocytes from 66 oocyte donation cycles artificially activated by A23187 (GM508 CultActive, Gynemed) (n=42) or ionomycin (n=39). Parthenogenesis was induced, and morphokinetic parameters (tPNa, tPNf, t2-t8, tSB, and tB) were compared between the 2 study groups and a control group comprising 39 2PN-zygotes from standard ICSI cycles.

Results

Ionomycin treatment resulted in higher activation rates compared to A23187 (38.5% vs 23.8%, p=0.15). Importantly, none of the A23187-activated parthenotes formed blastocysts. When evaluating the morphokinetic dynamics between the two ionophores, we found that tPNa and tPNf were significantly delayed in the group treated by A23187 (11.84 vs 5.31, p=0.002 and 50.15 vs 29.69, p=0.005, respectively). t2 was significantly delayed in A23187-activated parthenotes when compared to the double heterologous control embryo group. In contrast, the morphokinetic development of ionomycin-activated parthenotes was comparable to control embryos (p>0.05).

Conclusion

Our results suggest that A23187 leads to lower oocyte activation rates and profoundly affects morphokinetic timings and preimplantation development in parthenotes. Despite our limited sample size and low parthenote competence, standardization and further optimization of AOA protocols may allow wider use and improved outcomes for FF cycles.

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Anonymized data will be shared on reasonable request to the corresponding author.

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Acknowledgements

We thank all the donors at Clinica Eugin who participated in this study.

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Authors and Affiliations

  1. Clínica EUGIN, C/ Balmes 236, 08006, Barcelona, Spain

    A. Quintana-Vehí, M. Martínez, M. J. Zamora & I. Miguel-Escalada

  2. Eugin Group, 08006, Barcelona, Spain

    A. Rodríguez, R. Vassena & M. Popovic

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  1. A. Quintana-Vehí
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  2. M. Martínez
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  3. M. J. Zamora
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  4. A. Rodríguez
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  5. R. Vassena
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  6. I. Miguel-Escalada
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  7. M. Popovic
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Contributions

AQ-V: involved in study design, experimental methods, data analysis, statistical analysis and manuscript preparation. MM involved in study design, experimental methods and manuscript preparation. IM-E: involved in statistical analysis and manuscript preparation. MJZ, AR, RV, and MP involved in study implementation and supervision, expert knowledge, and manuscript preparation. All authors read and approved the final manuscript.

Corresponding author

Correspondence to I. Miguel-Escalada.

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Ethics approval

Permission to conduct the study was granted by the Ethics Committee for Clinical Research of Clinica Eugin (CEIm Eugin, protocol code: IONOTIME). All patients obtained and signed a written informed consent form. All procedures were performed in accordance with the ethical standards of the institutional research committees and with the 1964 Helsinki Declaration, as revised in 2013.

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Written informed consent was obtained from all individual participants included in the study.

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The authors declare no competing interests.

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Quintana-Vehí, A., Martínez, M., Zamora, M.J. et al. Significant differences in efficiency between two commonly used ionophore solutions for assisted oocyte activation (AOA): a prospective comparison of ionomycin and A23187. J Assist Reprod Genet 40, 1661–1668 (2023). https://doi.org/10.1007/s10815-023-02833-9

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  • DOI: https://doi.org/10.1007/s10815-023-02833-9

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