| Sumario: | <p><strong>Objective</strong></p>
<p>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.</p>
<p><strong>Design</strong></p>
<p>Fifty-six males (43 infertile/13 fertile) were screened using our PLCζ assay.</p>
<p><strong>Setting</strong></p>
<p>Fertility unit/university laboratory.</p>
<p><strong>Patient(s)</strong></p>
<p>Infertile males with abnormal sperm morphology or total fertilization failure, low fertilization rate (<50%), or repeated fertilization failure in assisted reproductive technology.</p>
<p><strong>Intervention(s)</strong></p>
<p>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).</p>
<p><strong>Main Outcome Measure(s)</strong></p>
<p>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.</p>
<p><strong>Result(s)</strong></p>
<p>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.</p>
<p><strong>Conclusion(s)</strong></p>
<p>PLCζ analysis is a useful diagnostic tool to determine patient eligibility for subsequent AOA treatment.</p>
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