Intervention improves assisted conception intracytoplasmic sperm injection outcomes for patients with high levels of sperm DNA fragmentation: a retrospective analysis

Abstract

SUMMARYSperm DNA fragmentation (SDF) is used in assisted reproductive technology (ART) programs as an indicator for sperm quality, although there is still a lack of consensus as to its clinical utility. In this retrospective study, we examined intracytoplasmic sperm injection (ICSI) outcomes of 1924 infertile patients who underwent SDF analysis using the sperm chromatin integrity test. ART patients were classified as having low [DNA fragmentation index (DFI) <29%] or high SDF (DFI ≥29%) and by whether or not an intervention [physiological intracytoplasmic sperm injection (PICSI), intracytoplasmic morphologically selected sperm injection (IMSI), testicular sperm extraction (TESE)/testicular sperm aspiration (TESA), frequent ejaculation] was performed. High SDF patients who did not have an intervention had a lower fertilization rate and poorer clinical outcomes from blastocyst transfers as compared with low SDF patients; the fertilization rate was 66.0% vs. 70.2% (p = 0.042), single embryo transfer (SET) fetal heart pregnancy rate was 28.5% vs. 45.2% (p = 0.042), and SET live birth rate was 24.9% vs. 40.6% (p = 0.060), respectively. Furthermore, high SDF patients who had an intervention had significantly improved blastocyst transfer outcomes, similar to those of low SDF patients; the SET live birth rate for high SDF intervention patients was 43.8% as compared with 24.9% for high SDF no intervention patients (p = 0.037) and 40.6% for low SDF patients (p = 0.446). Analysis of the three main intervention subgroups for high SDF patients revealed that TESE/TESA patients had the highest SET live birth rate; in comparison with 24.2% for high SDF patients who did not have an intervention, PICSI patients had 38.3% (p = 0.151), IMSI patients had 28.7% (p = 0.680), and TESE/TESA patients had 49.8% (p = 0.020). Our data suggest that SDF results indicate ICSI outcomes and that patients who have high SDF benefit from an intervention.

Impact of multiple blastocyst biopsy and vitrification-warming procedures on pregnancy outcomes

“…Ovarian stimulation, oocyte collection, and fertilization with sperm were performed as described previously (6,14). Embryo culture to the blastocyst stage was performed in groups of up to five embryos as described previously (6) with either in-house manufactured sequential media identical in formulation to Sydney IVF embryo culture medium suite (Cook Medical) or Gems sequential embryo culture media (Genea Biomedx).…”

DNA fragmentation in spermatozoa: a historical review

“…compared fertilization rates after physiological ICSI (PICS), IMSI and extraction of testicular sperm, respectively. They found that the use of testicular sperm significantly increased the fertilization rate, pregnancy rate and live birth rate after ICSI for patients with increased DNA fragmentation (Bradley et al ., ).…”

Noninvasive imaging systems for gametes and embryo selection in IVF programs: a review

“…They concluded that IMSI had no convincing improvement in clinical outcomes. They also reported that fertilization and blastocyst formation rates were not increased after IMSI than conventional ICSI (Bradley et al ., ).…”