Artificial Oocyte Activation (AOA)

AOA is an advanced laboratory technique used during In-vitro Fertilisation (IVF) to assist the egg in completing the activation process after fertilisation.

During natural fertilisation, when a sperm enters the egg, it triggers a series of calcium signals inside the egg. These signals “activate” the egg, allowing it to begin dividing and developing into an embryo.

However, in some couples undergoing Intra-Cytoplasmic Sperm Injection (ICSI), this activation process may not occur properly, even when the sperm has been successfully injected into the egg. As a result, fertilisation may fail.

At Sunfert, we may perform AOA immediately after ICSI using specialised laboratory techniques. This helps stimulate the egg to complete the activation process and improves the likelihood of successful fertilisation in carefully selected cases.

Our fertility specialists and embryologists will evaluate each case before recommending AOA.

AOA may be beneficial for couples who have experienced fertilisation difficulties during previous IVF treatments.

At Sunfert, we may consider AOA for patients who have:

• previous fertilisation failure after ICSI
• very low fertilisation rates in previous IVF cycles
• severe male factor infertility
• sperm-related activation defects
• certain rare egg activation disorders

In these cases, AOA may help trigger the biological signals required for the egg to begin embryo development.

However, it is important to note that AOA is not necessary for most IVF patients. Our fertility specialists and embryologists will recommend it only when there is evidence that it may improve the chances of fertilisation.

The patient may be recommended for AOA if previous IVF treatments have shown problems related to egg activation or fertilisation.

Our fertility specialists may discuss about AOA if patient have experienced:

• total fertilisation failure in a previous IVF or ICSI cycle
• repeated low fertilisation rates despite good-quality eggs and sperm
• history of unsuccessful ICSI cycles
• suspected sperm-related activation problems

Before recommending AOA, our clinical team will carefully review:

• previous IVF cycle outcomes
• egg and sperm quality
• laboratory fertilisation results
• patient’s overall fertility history

This personalised assessment helps ensure that any additional technique used during IVF is clinically justified and beneficial for the patient.

At Sunfert, AOA can be done within 3 steps:

Step 1: Fertility Evaluation

During a fertility assessment, we conduct a comprehensive evaluation for both partners to identify potential factors affecting fertility and guide a personalised treatment plan.

• Both Spouses: Review of medical history, reproductive history, and previous fertility treatment outcomes.
• Female Spouse: Hormonal profile testing, ovarian reserve assessment, and evaluation of the pelvic organs (uterus, ovaries, cervix, fallopian tubes).
• Male Spouse: Semen analysis to assess sperm quality and reproductive potential.

Step 2: Ovulation Stimulation

Hormonal medications will be given by our doctors which used to stimulate the ovaries to produce multiple eggs.

This stage usually starts at Day 2 or Day 3 of the patient’s menstrual cycle and typically lasts about 10 to 12 days depending on the treatment protocol the patient undergoes.

Step 3: Oocyte Pick-Up (OPU)

Also known as egg retrieval, this is a minimally invasive procedure in which our fertility specialist collects eggs from the patient’s ovaries. The procedure typically takes about 20 to 30 minutes to complete.

During OPU, patients are given light anaesthesia or monitored sedation by an anaesthetist, ensuring that they remain comfortable and pain-free throughout the procedure.

Before concluding the procedure, our fertility specialist will carefully examine the vaginal puncture site to ensure there is no bleeding.

After OPU, patients are observed for 1 to 2 hours in our day ward before being discharged home. 

Most patients experience only mild bloating, cramping, or minimal bleeding, and many are able to return to their normal routine the next day.

Step 4: Sperm Selection

For every egg, our embryologist selects a single healthy sperm with optimal morphology and motility.
 

Step 5: Intra-Cytoplasmic Sperm Injection (ICSI)

Inject the selected sperm carefully into the egg cytoplasm with a specialised microinjection tool.
 

Step 6: Artificial Oocyte Activation 

Immediately after ICSI, the eggs will be cultured for 15 minutes in a culture medium containing calcium ionophore.

15 minutes later, our embryologist will rinse the eggs to remove the calcium ionophore and place the eggs into fresh culture media drops for routine culture.

Step 7: Fertilisation Evaluation

Our embryologist will perform a fertilisation assessment 16 to 18 hours after the ICSI procedure to check if the egg has been successfully fertilised.

Step 8: Embryo Culture

The fertilised eggs are carefully monitored in our laboratory as they develop into embryos.
 

Step 9: Embryo Transfer or Freezing

Healthy embryos may then be transferred to the uterus or frozen for future use.

If you are facing fertility challenges, start with a consultation with our specialists. We will guide you through your fertility journey with expertise and compassionate care. 

Make an appointment with our Fertility Specialist today and take the next step toward your parenthood goals.

Question #1: Does AOA increase IVF success rates?

• AOA may improve fertilisation rates for patients who have experienced fertilisation failure or suspected egg activation problems. However, it is recommended only for selected cases where it is clinically appropriate.

Question #2: Is AOA performed for every IVF patient?

• No. Most IVF patients do not require Artificial Oocyte Activation.
• At Sunfert, we recommend AOA only when there is evidence that it may help improve fertilisation outcomes.

Question #3: Is Artificial Oocyte Activation safe for the eggs?

• AOA has been used in assisted reproductive technology for many years and is considered safe when performed by experienced and well-trained embryologists in specialised IVF laboratories.

Question #4: Is AOA done before or after ICSI?

• AOA is performed immediately after ICSI, once the sperm has been injected into the egg.

Question #5: Will AOA guarantee fertilisation?

• No fertility treatment can guarantee fertilisation or pregnancy. However, AOA may improve the chances of successful fertilisation for certain patients with specific fertilisation challenges.