Employment of avanafil in a surrogacy program
Dimitriadis, F1; Zachariou, A2; Giakoumakis, I3; Dafnis, D3; Baltogiannis, D2; Karagiannis, A2; Tsounapi, P4; Giannakis, I2; Skouros, S2; Kaltsas, A2; Margariti, K2; Mamoulakis, CH5; Takenaka, A4; Sofikitis, N2
1: Aristotle University, Greece; 2: University of Ioannina,Greece; 3: Mediterranean Fertility Institute, Crete; 4: Tottori University, Japan; 5: University of Crete, Greece
Objective: Recent report have suggested a beneficial effect of sildenafil or vardenafil on semen quality (Curr Pharm Des. 2009;15:3506. Br J Urol Int 2010;106:1181). We evaluated the effect of avanafil administration on embryonic development and the pregnancy rate in a surrogate program. Considering that in a surrogacy parenthood program global legislation requires at least one of the intended parents to provide (in most cases the male partner) his/her own genetic material, it is imperative to discover new pharmaceutical agents to increase semen quality in order to achieve high pregnancy rates in the surrogate women.
Material and Methods: Twenty two couples (Group A) were selected. The female partner could not produce oocytes of appropriate quality for assisted reproductive technology (ART). Thus donor oocytes were used. Donor oocytes were collected and processed for ooplasmic injections of spermatozoa (ICSI techniques) recovered from the male partner. In the above selected couples all male participants were oligo-astheno-teratospermic and pregnancy was not achieved after transferring the generated blastocysts (using ART techniques) into the surrogate females. Subsequently each male participant received avanafil (25mg x 2 / day; taking into consideration the duration of the half-life of avanafil) for 90 days. Within a month, following the completion of the above 90-day-treatment by each man, all couples participated in a new ART program (new ICSI procedures).
Results: Within group A prior to avanafil treatment, 139 oocytes were injected and 12 blastocysts were developed. After avanafil treatment 154 oocytes were injected and 43 blastocysts were developed. The percentage of motile spermatozoa (%) and the percentage of developed blastocysts (%; after 106 hours of culture, post-ICSI) to the total number of injected oocytes was significantly larger after the treatment with avanafil compared to the respective values prior to the avanafil treatment (62±16 vs 19±8% motile sperms and 27% vs 8%, respectively). Six out of the 22 surrogate females achieved pregnancy after the 2nd ART procedure.
Conclusion: Our results suggest that avanafil treatment results in the generation of embryos (post-ICSI) with significantly higher potential for in vitro development up to the blastocyst stage probably due to amelioration of defects in genetic or epigenetic sperm factors.
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