Shorter ejaculatory abstinence interval and maternal endometrium exposure to seminal plasma as tools to improve pregnancy rate in patients undergoing intracytoplasmic sperm injection cycles

Abstract Study question To evaluate the effectiveness of using Microfluidic Sperm Sorting (MFSS) technique and Physiological Intracytoplasmic Sperm Injection (PICSI) technique in patient with high DNA fragmentation index (DFI) sperm samples. Summary answer Sperm selected by microfluidic sorting are associated with significant increase in day 3 grade A embryo development rate, clinical pregnancy rate over PICSI. What is known already DNA damage is unrecognisable in living sperm prior to insemination and an increased sperm DNA fragmentation index has been associated with lower fertilization rates, impaired embryo development and reduced pregnancy rates. Standard semen processing techniques are associated with centrifugation, which may induce reactive oxygen species and DNA damage. In strategies to minimize sperm DNA fragmentation, Physiological ICSI can relatively reduce sperm DNA fragmentation by 67.9% (Parmegiani et al., 2010) while new technique Microfluidic sperm sorter technique also demonstrate sperm selection with significantly reduced DNA damage. Study design, size, duration A prospective randomised study was conducted from 1st August 2019 to 31st December 2020. Two hundred patients were randomised by computer generated list and divided into 2 groups. Group A (n = 100) , in which sperm were processed by microfluidic sperm sorter (MFSS) while in group B (n = 100), sperm were selected by Physiological Intracytoplasmic Sperm Injection (PICSI) technique and morphologically normal motile sperm were injected by Intracytoplasmic sperm injection (ICSI) technique in all mature oocytes. Participants/materials, setting, methods The study period included all normozoospermic patients with high DNA fragmentation index (>25% ) while oligospermic, asthenozoospermic samples, patients with poor ovarian reserve and advanced age were excluded from the study. All A grade embryos were vitrified and transferred in frozen embryo replacement cycle. Both groups were compared on the basis of fertilisation rate, day 3 grade A embryo development rate , clinical pregnancy rate and miscarriage rate. Main results and the role of chance Cycle characteristics (female age, length of stimulation, gonadotrophin dose, number of oocytes and number of transferred embryos) were similar in both groups. Between the 2 groups, There was a significant increase observed in day 3 grade A embryo development rate (60% vs. 42%, p–0.016) and clinical pregnancy rate (62% vs. 46%, p–0.049), while no statistical significant difference observed in fertilisation rate (82% vs. 78%, p–0.80) and miscarriage rate ( 12% vs. 11%, p- 1). Limitations, reasons for caution: Larger randomised control studies are needed to strengthen these results. Wider implications of the findings: We have demonstrated that sperm sorted by microfluidic helps in selection of sperm with better DNA integrity over Physiological ICSI. Using it in routine practice can help in reducing the negative effect of reactive oxygen species and thus improve pregnancy rate and live birth rate. Trial registration number MCDH/2019/31

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R-128. Identification of laboratory factors contributing to a 50% pregnancy rate in intracytoplasmic sperm injection cycles

Human Reproduction ◽

10.1093/humrep/14.suppl_3.336 ◽

1999 ◽

Vol 14 (Suppl_3) ◽

pp. 336-336

Author(s):

Z.R. Nagy ◽

L. Rienzi ◽

F. Ubaldi ◽

F. Morgia ◽

M. Iacobelli ◽

...

Keyword(s):

Pregnancy Rate ◽

Intracytoplasmic Sperm Injection

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Higher clinical pregnancy rate with in-vitro fertilization versus intracytoplasmic sperm injection in treatment of non-male factor infertility: Systematic review and meta-analysis

Journal of Gynecology Obstetrics and Human Reproduction ◽

10.1016/j.jogoh.2020.101706 ◽

2020 ◽

Vol 49 (6) ◽

pp. 101706 ◽

Cited By ~ 2

Author(s):

Ahmed M. Abbas ◽

Reda S. Hussein ◽

Mohamed A. Elsenity ◽

Ihab I. Samaha ◽

Karim A. El Etriby ◽

...

Keyword(s):

Systematic Review ◽

In Vitro Fertilization ◽

Pregnancy Rate ◽

Intracytoplasmic Sperm Injection ◽

Meta Analysis ◽

Clinical Pregnancy ◽

Male Factor Infertility ◽

Male Factor ◽

Vitro Fertilization

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Lower sperm aneuploidy rate is associated with a higher pregnancy rate in unselected patients undergoing intracytoplasmic sperm injection

Fertility and Sterility ◽

10.1016/s0015-0282(02)03543-4 ◽

2002 ◽

Vol 78 ◽

pp. S62

Author(s):

Aldo E Calogero ◽

Nunziatina Burrello ◽

Caterina Grazioso ◽

Adele De Palma ◽

Carlo Torrisi ◽

...

Keyword(s):

Pregnancy Rate ◽

Intracytoplasmic Sperm Injection ◽

Aneuploidy Rate ◽

Sperm Aneuploidy

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Resuspending ram spermatozoa in seminal plasma after cryopreservation does not improve pregnancy rate in cervically inseminated ewes

Theriogenology ◽

10.1016/j.theriogenology.2007.01.012 ◽

2007 ◽

Vol 67 (7) ◽

pp. 1262-1268 ◽

Cited By ~ 27

Author(s):

C.M. O’Meara ◽

A. Donovan ◽

J.P. Hanrahan ◽

P. Duffy ◽

S. Fair ◽

...

Keyword(s):

Pregnancy Rate ◽

Seminal Plasma

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Fertilizing capacity of epididymal and testicular sperm using intracytoplasmic sperm injection (ICSI)

Reproduction Fertility and Development ◽

10.1071/rd9950281 ◽

1995 ◽

Vol 7 (2) ◽

pp. 281 ◽

Cited By ~ 37

Author(s):

SJ Silber ◽

P Devroey ◽

H Tournaye ◽

Steirteghem AC Van

Keyword(s):

Pregnancy Rate ◽

Intracytoplasmic Sperm Injection ◽

Pregnancy Rates ◽

Obstructive Azoospermia ◽

Motile Sperm ◽

Epididymal Sperm ◽

Testicular Sperm ◽

Cleavage Rate

For men with uncorrectable obstructive azoospermia, their only hope of fathering a child is microsurgical epididymal sperm aspiration (MESA) combined with in vitro fertilization (IVF). In 1988, proximal epididymal sperm were demonstrated to have better motility than senescent sperm in the distal epididymis, and it was thought that retrieval of motile sperm from the proximal epididymis would yield reliable fertilization and pregnancy rates after conventional IVF. However, the results to date have been poor, and although a minority of patients achieved good fertilization rates with IVF, the vast majority (81%) had consistently poor or no fertilization and the pregnancy rate averaged only 9%. Recently, intracytoplasmic sperm injection (ICSI) has been successfully used to achieve fertilization and pregnancies for patients with extreme oligoasthenozoospermia. ICSI has therefore been applied to cases of obstructive azoospermia and, in this report, 67 MESA-IVF cases are compared with 72 MESA-ICSI cases. The principle that motile sperm from the proximal segments of the epididymis should be used for ICSI was followed, although in the most severe cases in which there was an absence of the epididymis (or absence of sperm in the epididymis), testicular sperm were obtained from macerated testicular biopsies. These sperm only exhibited a weak, twitching motion. In 72 consecutive MESA cases, ICSI resulted in fertilization and normal embryos for transfer in 90% of the cases, with an overall fertilization rate of 46%, a cleavage rate of 68%, and ongoing or delivered pregnancy rates of 46% per transfer and 42% per cycle. The pregnancy and take-home baby rates increased from 9% and 4.5% with IVF to 53% and 42% with ICSI. There were no differences between the results for fresh epididymal, frozen epididymal or testicular sperm, and the number of eggs collected did not affect the outcome. The results were also unaffected by the aetiology of the obstruction such as congenital absence of the vas deferens or failed vasoepididymostomy. The only significant factor which affected the pregnancy rate was female age. It is concluded that although complex mechanisms involving epididymal transport may be beneficial for conventional fertilization of human oocytes (in vivo or in vitro), none of these mechanisms are required for fertilization after ICSI. Given the excellent results with epididymal and testicular sperm, ICSI is obligatory for all future MESA patients. Finally, the use of ICSI with testicular sperm from men with non-obstructive azoospermia is also discussed.

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