To compare the effectiveness of calcium ionophore–induced artificial oocyte activation (AOA) and piezoelectric stimulation in improving fertilization, embryo quality, and pregnancy outcomes in ICSI cycles of severe male factor infertility. A prospective controlled study was conducted at the Istanbul University IVF Center between December 2023 and June 2025. Data collection and follow-up for all pregnancy outcomes, including live birth, were completed before July 2025. The study included 150 couples with severe male factor infertility divided into three groups: (i) Control (conventional ICSI, n = 50), (ii) ICSI + Calcium ionophore (n = 50), and (iii) ICSI + Piezoelectric (n = 50). Severe male factor infertility was defined according to WHO (2021) criteria. Oocytes were fertilized and cultured under standardized conditions. Embryo morphology was assessed on Day 3 according to the Istanbul Consensus (2011) criteria and on Day 5 using the Gardner and Schoolcraft grading system. Statistical comparisons were performed using ANOVA, Kruskal–Wallis, and chi-square tests, with p < 0.05 considered significant. The primary outcome measure was the fertilization rate, while embryo quality and clinical outcomes were evaluated as secondary outcomes. Fertilization rates were significantly higher in the ICSI+Piezoelectric group compared with both the control and ICSI+Calcıum ionophore groups (p < 0.0001). The proportion of good-quality (Grade I) embryos was also greater in the ICSI+Piezoelectric group (38.2%) than in the control (28.3%) and ICSI+Calcıum ionophore (29.5%) groups (p < 0.05). No statistically significant differences were observed in pregnancy outcomes, including implantation, clinical pregnancy, ongoing pregnancy, or live birth rates; however, a non-significant trend toward higher ongoing pregnancy rates was noted in the ICSI+Calcıum ionophore group. Piezoelectric activation was associated with higher fertilization rates and improved early embryo morphology; however, these improvements did not translate into statistically significant differences in clinical pregnancy or live birth outcomes.
Akpınar et al. (Mon,) studied this question.