Efficacy of assisted oocyte activation in improving the reproductive outcome in conventional IVF cases with recurrent developmental problems

Background Assisted oocyte activation (AOA) is employed to enhance fertilization rates following fertilization failure after intracytoplasmic sperm injection (ICSI). Several studies have also demonstrated that AOA may play a role in embryo development. Poor embryo quality remains one of the major challenges for patients with recurrent developmental problems. We aimed to investigate whether ICSI followed by assisted oocyte activation (ICSI-AOA) can improve embryo quality in conventional in vitro fertilization (C-IVF) cases with recurrent developmental problems. Methods This retrospective cohort single-center study compared ICSI-AOA cycles with previous C-IVF cycles in couples who had nearly normal fertilization rates (≥ 40%) but impaired embryonic development (at most one D3 good quality embryo for all previous cycles) in at least two prior IVF cycles. A total of 24 couples experiencing embryo developmental issues were included in this study from January 2019 to December 2022. Results After ICSI-AOA, the D3 good quality embryo rate was significantly improved compared with previous C-IVF cycles (19.30 versus 4.04%; p  < 0.001). We observed that the mean number of D3 embryo blastomere was significantly increased after ICSI-AOA compared with previous C-IVF cycles (7.85 versus 6.94; p  = 0.002). No significant difference was observed in the D3 embryo fragmentation rate between previous C-IVF and subsequent ICSI-AOA cycles (14% versus 13%, p  = 0.088). The ICSI-AOA cycles showed significantly higher pregnancy (41.67 versus 19.23%, p  = 0.039) and live birth (29.17 versus 3.85%, p  = 0.002) rates compared with previous C-IVF treatment. Conclusion Our data suggest that ICSI-AOA may be beneficial to some patients with recurrent developmental problems in C-IVF treatment.