الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
The fertilization failure in IVF can be dealt with using ICSI, but there is no treatment for fertilization failure in ICSI. Although the frequency of incidence of fertilization failure is low, if fertilization failure is encountered, medical treatment is usually stopped and serious psychological damage may occur to the patient, most of these being the result of impaired semen characteristics or a very low number of oocytes collected.
Oocyte activation is characterized by a dramatic rise in intracellular calcium concentration, which in mammals takes the form of calcium oscillations. The causative agent of these oscillations is proposed to be a recently described phosphoinositide-specific phospholipase C zeta, which is a soluble sperm factor delivered to the egg following membrane fusion.
The aime of this work was to evaluate the effect of artificial oocyte activation (AOA) using calcium ionophore (A23187) on the rate of fertilization and cleavage of embryos in surgically retrieved sperm of patients with non-obstructive azoospermia undergoing intracytoplasmic sperm injection (ICSI).
This study was conducted on 60 infertile couples undergoing ICSI cycles as a randomized controlled parallel groups experimental study, 60 ICSI cycles were divided into two groups: group A: includes 30 ICSI patients with surgically retrieved sperms of non-obstructive azoospermia treated with calcium ionophore (A23187) and group C/ control: includes 30 ICSI patients with surgically retrieved sperms of non-obstructive azoospermia, non-treated with calcium ionophore (A23187), after the approval from the Local Ethical Committee and informed consents from all the patients of the study.
Treatment was initiated in mid luteal phase using 0.1 mg subcutaneous GnRh agonist. Female aged from 20-38 years, had infertility more than 2 years due to non-obestructive aospermic husband. Poor responders, patients with PCOS, endometriosis and/or diabetes were excluded. Testicular spermatozoa were obtained via TESA, which was performed by longitudinally inserting a 21-gauge butterfly needle into the superior testicle pole while avoiding the epididymis.
Stimulation with 150-225 IU of gonadotropins was started day 2 of menses when down regulation of the pituitary was achieved as indicated by: endometrial lining of 5 mm or less, serum estradiol of 50pg/ml or less, vaginal ultrasound confirming the absence of ovarian cysts.
The oocytes were collected after 36 hours from HCG administration, were randomly allocated into two groups: group A (n=373) mature oocytes; immediately after injection, the injected oocytes were incubated in culture medium containing 5 μmol/l of the calcium ionophore (A23187) at 37°C and 6% CO2 for 30 min. group C (n=347) mature oocyte: control group were subjected to routine ICSI.
The results can be summarized as follows:
- There was no significant difference in the number of oocytes injected, and number of oocytes fertilized between the Ca ionophore treated group and control cycles.
- There was no significant difference in the fertilization and implantation rates between the Ca ionophore treated group and control cycles.
- There was no significant difference in the number of embryos and class A embryos in the two groups.
- There was highly significant difference regarding days of embryos transfer between the two groups.
- The pregnancy occurred in 17 (56.7%) of cycles in the ca ionophore treated group, and in 16 (53.3) in the control group. There was no significant difference in pregnancy rate between the two groups.
The present study concluded that, the ca ionophore do not significantly improve the fertilization, implantation rate or pregnancy rate. May be due to that, azoospermia represent a group of patients who does not seem to have functional disturbance in phospholipase C zeta. Also Ca ionophore did not improve the quality of embryos, and the number of embryos transferred had no relation to the pregnancy rate.