Assessing the impact of calcium ionophore on pregnancy outcomes in artificial oocyte activation cycles: a 10-year update of systematic review and meta-analysis

source extracted confidence: high 2026-04-09
#humans #pregnancy #female #sperm-injections-intracytoplasmic #calcium-ionophores

Assessing the impact of calcium ionophore on pregnancy outcomes in artificial oocyte activation cycles: a 10-year update of systematic review and meta-analysis

Zhang et al., 2025 | J Assist Reprod Genet | Meta Analysis

Citation

Zhang Jingqi, Sui Yilun, ... Fu Jing. Assessing the impact of calcium ionophore on pregnancy outcomes in artificial oocyte activation cycles: a 10-year update of systematic review and meta-analysis. J Assist Reprod Genet. 2025-Jan;42(1):165-183. doi:10.1007/s10815-024-03319-y

Abstract

PURPOSE: The objective is to evaluate the effectiveness and safety of calcium ionophore as an artificial oocyte activation (AOA) method on pregnancy outcomes in different groups of intracytoplasmic sperm injection (ICSI) patients, providing potential evidence to establish consensus on the indications of AOA. METHODS: A systematic comprehensive search was performed in Medline, Embase, the Cochrane Library, and Google Scholar databases. Studies published from January 2014 to June 2024 were searched for analysis. All studies that compared ICSI with AOA-ICSI in routine indications composing impaired fertilization or embryo developmental arrest in previous cycles, or male-factor infertility were included. RESULTS: Twelve studies were included in the meta-analysis. AOA-ICSI was associated with the increase in the overall fertilization rate (OR 1.99, 95% CI 1.16-3.41) and live birth rate (OR 4.58, 95% CI 1.52-13.80). All secondary outcomes including cleavage, blastocyst, high-quality embryo, implantation, biochemical pregnancy, clinical pregnancy presented superiority or equivalence in AOA-ICSI. And the use of calcium ionophore did not increase the miscarriage rate (OR 0.43, 95% CI 0.08-2.43). In subgroup analysis, AOA-ICSI exhibited a more significant effect on patients with indications of no or low fertilization. However, in patients with non-fertilization factors, no statistically significant improvements were observed in all outcomes. CONCLUSION: Calcium ionophore is an effective artificial oocyte activation approach to improving pregnancy outcomes after ICSI, particularly in cases with indications of fertilization factors, providing further support for the application of AOA in specific populations. Further validation is needed to comprehensively establish the safety of AOA. TRIAL REGISTRATION: PROSPERO registration number CRD42024551481.

Key Findings

Twelve studies were included in the meta-analysis. AOA-ICSI was associated with the increase in the overall fertilization rate (OR 1.99, 95% CI 1.16-3.41) and live birth rate (OR 4.58, 95% CI 1.52-13.80). All secondary outcomes including cleavage, blastocyst, high-quality embryo, implantation, biochemical pregnancy, clinical pregnancy presented superiority or equivalence in AOA-ICSI. And the use of calcium ionophore did not increase the miscarriage rate (OR 0.43, 95% CI 0.08-2.43). In subgroup a

Outcomes Measured

  • Requires manual extraction

Population

Field Value
Population indications of no or
Sample Size See abstract
Age Range See abstract
Condition See abstract

MeSH Terms

  • Humans
  • Pregnancy
  • Female
  • Sperm Injections, Intracytoplasmic
  • Calcium Ionophores
  • Oocytes
  • Pregnancy Rate
  • Pregnancy Outcome
  • Fertilization in Vitro
  • Male
  • Live Birth
  • Embryo Transfer

Evidence Classification

  • Level: Meta Analysis
  • Publication Types: Journal Article, Systematic Review, Meta-Analysis
  • Vertical: calcium

Provenance

Source extracted via PubMed E-utilities API on 2026-04-09