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Use of Phospholipase C Zeta Analysis to Identify Candidates for Artificial Oocyte Activation: a Case Series of Clinical Pregnancies and a Proposed Algorithm for Patient Management

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Journal Fertil Steril
Date 2020 Jul 6
PMID 32622408
Citations 15
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Abstract

Objective: To investigate the applicability of phospholipase C zeta (PLCζ) analysis in assisting the clinical decision-making process when considering artificial oocyte activation (AOA) for infertile males in assisted reproductive technology.

Design: Fifty-six males (43 infertile/13 fertile) were screened using our PLCζ assay.

Setting: Fertility unit/university laboratory.

Patient(s): Infertile males with abnormal sperm morphology or total fertilization failure, low fertilization rate (<50%), or repeated fertilization failure in assisted reproductive technology.

Intervention(s): We analyzed PLCζ levels in sperm from fertile and infertile males. Eligible patients subsequently underwent intracytoplasmic sperm injection (ICSI)/artificial oocyte activation (AOA) with calcimycin (GM508).

Main Outcome Measure(s): PLCζ localization and level and the proportion of sperm expressing PLCζ. Thresholds of PLCζ deficiency, fertilization rates, pregnancy rates, and live birth rates of AOA and non-AOA cycles.

Result(s): Compared with 13 fertile controls, 34 of the 43 infertile males had significantly lower levels of PLCζ and/or a significantly lower proportion of sperm exhibiting PLCζ. Of these 34 patients, 15 showed a significant PLCζ reduction in both parameters, which we termed "PLCζ deficiency." Five PLCζ-deficient patients opted for AOA; all five achieved fertilization, and four achieved clinical pregnancies and live births. The fertilization rate improved significantly from 18.6% (ICSI) to 56.8% (ICSI/AOA). The clinical pregnancy rate and live birth rate with AOA were both 40% per initiated cycle. Youden index analysis revealed that the cutoffs below which infertile males were likely to benefit from AOA were 71% for the proportion of sperm expressing PLCζ and 15.57 arbitrary units for mean PLCζ level.

Conclusion(s): PLCζ analysis is a useful diagnostic tool to determine patient eligibility for subsequent AOA treatment.

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Phospholipase C zeta: a hidden face of sperm for oocyte activation and early embryonic development.

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Phospholipase C Zeta in Human Spermatozoa: A Systematic Review on Current Development and Clinical Application.

Parrella A, Medrano L, Aizpurua J, Gomez-Torres M Int J Mol Sci. 2024; 25(2).

PMID: 38279344 PMC: 10815952. DOI: 10.3390/ijms25021344.