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Calcium chloride dihydrate supplementation at ICSI improves fertilization and pregnancy rates in patients with previous low fertilization: a retrospective paired treatment cycle study

  • Assisted Reproduction Technologies
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Abstract

Purpose

To determine if 5mM calcium chloride dihydrate supplementation of the Polyvinylpyrrolidone (PVP) media at the time of ICSI (ICSI-Ca) improves fertilization, utilization, and clinical pregnancy rates compared to ICSI alone, particularly in patients with a history of low fertilization (< 50%).

Methods

Retrospective study between 2016 and 2021 at Monash IVF Victoria on a paired cohort of patients (n = 178 patients) where an ICSI cycle was analyzed coupled with the subsequent ICSI-Ca cycle. The paired cohort was further subdivided into a low-fertilization cohort (< 50% fertilization on previous cycles: n = 66 patients) compared to the remaining patients with fertilization ≥ 50% (n = 122). Exclusion criteria included donor cycles, PGT patients, surgical sperm retrieval, women ≥ 45 years old, patients with > 6 cycles, and patients with ≤ 5 inseminated oocytes.

Results

Calcium supplementation significantly increased both fertilization (28.8% ICSI vs 49.7% ICSI-Ca, P < 0.0001) and clinical pregnancy rate (4.9% ICSI vs 25.0% ICSI-Ca: P < 0.05) in the low-fertilization cohort but not in the normal-fertilization cohort. Interestingly, utilization rate significantly increased in the normal-fertilization cohort (32.6% ICSI vs ICSI-Ca: 44.9%, P < 0.01) but not in the low-fertilization cohort, although the number of embryos utilized per patient after ICSI-Ca increased in both groups.

Conclusion

Calcium supplementation does not appear to be a detrimental addition to ICSI and may improve IVF outcomes, particularly for patients with a history of low fertilization. Further investigations including prospective case-matched studies or a RCT are required to confirm these findings.

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Funding

This study is funded by Monash IVF Group, Victoria.

Author information

Author notes

  1. Mark P Green and Deirdre Zander-Fox contributed equally to this manuscript

Authors and Affiliations

  1. Monash IVF, Epworth Hawthorn, Hawthorn, Melbourne, VIC, 3122, Australia

    Sophie Popkiss, Fabrizzio Horta, Beverley Vollenhoven, Mark P. Green & Deirdre Zander-Fox

  2. Department of Obstetrics and Gynaecology, School of Clinical Science, Monash University, Melbourne, Australia

    Fabrizzio Horta & Beverley Vollenhoven

  3. Monash Health, Melbourne, Australia

    Beverley Vollenhoven

  4. School of BioSciences, University of Melbourne, Melbourne, Australia

    Mark P. Green

  5. University of Adelaide, Adelaide, Australia

    Deirdre Zander-Fox

  6. University of South Australia, Adelaide, Australia

    Deirdre Zander-Fox

  7. Department of Science, Monash University, Melbourne, Australia

    Deirdre Zander-Fox

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  1. Sophie Popkiss
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Contributions

SP, FH, MG, and DZ designed the study. SP conducted all statistical analyses, interpreted results, and drafted the article. All authors (SP, FH, BV, MG, and DZ) interpreted results, reviewed the manuscript and provided substantial advice through the data analysis work, and contributed intellectually to the writing or revising of the manuscript and approval of the final version.

Corresponding author

Correspondence to Sophie Popkiss.

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Ethics approval for the study was obtained under Monash Health Ethics Number: 15172 M.

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The authors declare no competing interests.

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Popkiss, S., Horta, F., Vollenhoven, B. et al. Calcium chloride dihydrate supplementation at ICSI improves fertilization and pregnancy rates in patients with previous low fertilization: a retrospective paired treatment cycle study. J Assist Reprod Genet 39, 1055–1064 (2022). https://doi.org/10.1007/s10815-022-02407-1

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