Testicular sperm for ICSI in men with high DFI - Can it be made a Recommendation?
Ponnusamy, AK1; Vasan, SS2; Manoharan, M3
1: Alphalife Urology & Andology Center, Namakkal, India; 2: Manipal Fertility Center, Bangalore, India; 3: Kurinji Hospital, Salem, India
Introduction: Despite clear break through in the field of ART we are still unable to pull up the pregnancy rates beyond 35-40%.What is it that we are MISSING??? Sperm DNA fragmentation has emerged as an important biomarker for assessing male fertility potential. Many studies have postulated that one of the mechanisms involved in sperm DNA fragmentation is ROS-induced DNA damage during co-migration of mature sperm with ROS-producing immature sperm through the seminiferous tubules and epididymis.This can be bypassed by testicular sperm aspiration.
Materials and methods: Retrospective, observational, cohort study conducted at Manipal Fertility center from June 2015 till December 2016. Group A : Ejaculate-ICSI n=37 Group B : Testicular-ICSI n=39 Inclusion criteria Infertility duration >1 year, Couples undergoing IVF-ICSI, No abnormality noted in the medical history, physical examination and endocrine proﬁle, Persistent high SDF levels (>30%) in two semen specimens, SDF performed using the SCSA flowcytometry analysis, No evidence of subclinical genital infections and/or leukocytospermia ,Women with average to good quality oocytes on retrieval Exclusion criteria Severe male factor infertility (severe oligoasthenoteratozoospermia, <5 million/mL; and azoospermia) Women with history of poor response to ovarian stimulation, including those ﬁtting the Bologna criteria for expected poor responders Patients in whom oocyte or sperm donation was used, Any uterine pathology like Fibroid uterus, Adenomyosis which could impact implantation
Results: The two groups were homogeneous regarding to age,endocrine profile, infertility duration and the proportion of females with an associated infertility problem No difference in no of oocytes retrieved in the two groups. Fertilization rate was lower in the Testicular -ICSI group (64.6%) compared to Ejaculate- ICSI group (73.6%), however not statistically significant. Pregnancy rates were higher in the Testicular- ICSI group 48.7% vs Ejaculate ICSI 38.7% Miscarriage rates were remarkably low in Testicular-ICSI group than the Ejaculate ICSI group(15.7%vs 35.7%) It was noted that the pregnancy rates in men with DFI in the range of 30-40 was not different. (53.3% in Ejaculate and 46.1% in Testicular group) A significantly higher pregnancy rate was observed in the Testicular group when the ranges of DFI was higher than 40 Interestingly it was observed that in patients with DFI more than 50 pregnancy almost never occured with ejaculate sperms and better pregnancy rates were observed with Testicular sperms.
Conclusion: DNA fragmentation index is an important biomarker for assesing male fertility potential and should be made a part of routine evaluation.Testicular sperm is associated with improved ICSI outcomes in men with high DFI.DFI cut off for Labelling a patient with high DFI needs reconsideration.
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