Assisted oocyte activation significantly increases fertilization and pregnancy outcome in patients with low and total failed fertilization after intracytoplasmic sperm injection: a 17-year retrospective study

Assisted oocyte activation overcame low or total failed fertilization after intracytoplasmic sperm injection in 122 couples diagnosed with oocyte activation deficiencies and resulted in 60 healthy live births.

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Volume 112, Issue 2, Pages 266–274


Davina Bonte, M.Sc., Minerva Ferrer-Buitrago, Ph.D., Lien Dhaenens, M.D., Mina Popovic, M.Sc., Vanessa Thys, B.Sc., Ilse De Croo, M.Sc., Stefanie De Gheselle, M.Sc., Nathalie Steyaert, B.Sc., Annekatrien Boel, Ph.D., Frauke Vanden Meerschaut, M.D., Ph.D., Petra De Sutter, M.D., Ph.D., Björn Heindryckx, Ph.D.



To investigate the extent to which assisted oocyte activation (AOA) improves clinical outcomes in patients diagnosed with oocyte activation deficiencies (OADs).


Retrospective cohort study comparing AOA cycles and previous intracytoplasmic sperm injection (ICSI) cycles in couples experiencing low or total failed fertilization after ICSI. Importantly, the sperm-related oocyte-activating capacity was examined in all patients before AOA with the use of the mouse oocyte activation test (MOAT).


Infertility center at a university hospital.


A total of 122 couples with a history of low or total failed fertilization after ICSI.


ICSI, MOAT, AOA, and embryo transfer.

Main Outcome Measure(s)

Fertilization, pregnancy, and live birth rates.


MOAT revealed 19 patients with a sperm-related OAD (MOAT group 1), 56 patients with a diminished sperm-related oocyte-activating capacity (MOAT group 2), and 47 patients with a suspected oocyte-related OAD (MOAT group 3). AOA (191 cycles) significantly improved fertilization, pregnancy, and live birth rates in all MOAT groups compared with previous ICSI attempts (243 cycles). Fertilization rates after AOA were significantly different among MOAT groups 1 (70.1%), 2 (63.0%), and 3 (57.3%). Between MOAT group 1 and 3, significant differences in pregnancy (49.0% vs. 29.4%) and live birth (41.2% vs. 22.1%) rates were observed. In total, 225 embryo transfers resulted in 60 healthy live births following AOA.


Patients undergoing diagnostic testing before AOA show a significant improvement in clinical outcomes compared with previous cycles. Our findings highlight that AOA should be reserved for patients with clear OADs.

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Fertility and Sterility

Editorial Office, American Society for Reproductive Medicine

Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders.