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Intervention improves assisted conception intracytoplasmic sperm injection outcomes for patients with high levels of sperm DNA fragmentation: a retrospective analysis
Author(s) -
Bradley C. K.,
McArthur S. J.,
Gee A. J.,
Weiss K. A.,
Schmidt U.,
Toogood L.
Publication year - 2016
Publication title -
andrology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.947
H-Index - 43
eISSN - 2047-2927
pISSN - 2047-2919
DOI - 10.1111/andr.12215
Subject(s) - intracytoplasmic sperm injection , sperm , dna fragmentation , testicular sperm extraction , live birth , andrology , assisted reproductive technology , blastocyst , pregnancy rate , human fertilization , medicine , gynecology , male infertility , infertility , embryo transfer , biology , pregnancy , embryo , embryogenesis , anatomy , genetics , apoptosis , programmed cell death
Summary Sperm 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.