Double Ionophore Activation (DIA) technique in cases of severe male factor: Case Series

Background: Sperm binding or injection into human oocytes induces calcium oscillations resulting in oocyte activation, fertilization, and subsequent embryonic development. In severe male factor, sperm may fail to activate oocytes with subsequent ICSI failure. Artificial oocyte activation with calcium ionophore can induce calcium influx with improved oocyte activation and development.Objective: The current case series evaluated a unique technique of double ionophore activation (DIA) in severe male factor without previous ICSI failure.Materials and Methods: Case series of 17 infertile couples with severe male factors undergoing ICSI. The injected oocytes were incubated in calcium ionophore twice with this new protocol for artificial oocyte activation.Results: Fertilization, cleavage, and blastocyst rates were 71.4%, 100%, and 73.3% respectively. The pregnancy rate for fresh transfer was 9/13 (69.2%) and the pregnancy rate for FET was 4/6 (66.7%).Conclusion: DIA protocol may improve oocyte activation in severe male factor and a well-designed prospective study is needed.