The impact of fresh versus cryopreserved testicular sperm on in-vitro fertilization outcomes in couples with elevated sperm DNA fragmentation: a retrospective cohort study.
Dana R Siegel, Laura K Kaizer, Mary D Sammel, Cassandra Roeca
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引用次数: 0
Abstract
Background: Elevated sperm DNA fragmentation (SDF) is associated with male factor infertility, recurrent pregnancy loss, and poor reproductive outcomes. An option for management includes the utilization of testicular sperm; however, the comparative reproductive efficacy of fresh versus cryopreserved testicular sperm men with elevated SDF remains unclear. Therefore, the objective of this study was to identify differences in reproductive outcomes between fresh and cryopreserved testicular sperm in patients with elevated SDF who are undergoing intracytoplasmic sperm injection (ICSI) after testicular sperm extraction (TESE).
Methods: This was a retrospective cohort study of a multi-site fertility network of patients with elevated SDF who underwent TESE and subsequent ICSI using either fresh or cryopreserved testicular sperm.
Results: A total of 60 men with elevated SDF underwent TESE and subsequent IVF with ICSI. 66.7% (n = 40) used fresh testicular sperm while the remaining 33.3% (n = 20) used cryopreserved testicular sperm following TESE. There were no significant differences in patient demographics or SDF (median 46.5 (IQR: 34.0, 59.0) vs. 48.0 (IQR: 38.0, 64.0), p = 0.525) between those that used fresh or cryopreserved testicular sperm. Among all initiated treatment cycles, there was no statistically significant difference in cumulative live birth (42.5% vs. 25.0%, p = 0.656), clinical pregnancy (55.0% vs. 35.0% p = 0.144) or miscarriage rates (10% vs. 5.0%, p = 0.185) between fresh and cryopreserved testicular sperm. Similarly, there were no significant differences in fertilization (median 48.8 (IQR 33.5, 61.3) vs. 43.7 (IQR:32.8, 63.1), p = 0.937) or blastocyst conversion (median 16.7 (IQR: 0.0, 40.0) vs. 26.1 (IQR: 16.7, 52.8), p = 0.106).
Conclusion: Live birth, clinical pregnancy, miscarriage, fertilization and blastocyst yield were not significantly different when using fresh or cryopreserved testicular sperm in couples undergoing TESE for elevated SDF. Although this is the largest study examining these clinical outcomes to date, our study may have low statistical power and additional prospective studies with larger sample sizes are needed.
背景：精子DNA片段化（SDF）升高与男性因素不育、复发性流产和不良生殖结局有关。一种治疗方法包括利用睾丸精子；然而，SDF升高的新鲜睾丸精子与冷冻睾丸精子的生殖功效比较尚不清楚。因此，本研究的目的是确定SDF升高的患者在睾丸精子提取（TESE）后接受卵胞浆内单精子注射（ICSI）后新鲜和冷冻保存睾丸精子的生殖结局差异。方法：这是一项针对SDF升高患者的多位点生育网络的回顾性队列研究，这些患者使用新鲜或冷冻保存的睾丸精子进行TESE和随后的ICSI。结果：共有60名SDF升高的男性接受了TESE和随后的ICSI体外受精。66.7% （n = 40）使用新鲜睾丸精子，其余33.3% （n = 20）使用低温保存睾丸精子。使用新鲜或冷冻睾丸精子的患者人口统计学或SDF（中位数46.5 （IQR: 34.0, 59.0）比48.0 (IQR: 38.0, 64.0), p = 0.525）无显著差异。在所有开始的治疗周期中，新鲜和冷冻睾丸精子的累积活产率（42.5% vs. 25.0%, p = 0.656）、临床妊娠率（55.0% vs. 35.0% p = 0.144）和流产率（10% vs. 5.0%, p = 0.185）差异无统计学意义。同样，受精(中位数48.8 （IQR: 33.5, 61.3) vs. 43.7 (IQR:32.8, 63.1), p = 0.937）或囊胚转化(中位数16.7 （IQR: 0.0, 40.0) vs. 26.1 (IQR: 16.7, 52.8), p = 0.106）无显著差异。结论：因SDF升高而接受TESE的夫妇使用新鲜或冷冻睾丸精子时，活产、临床妊娠、流产、受精和囊胚产量均无显著差异。虽然这是迄今为止检验这些临床结果的最大规模的研究，但我们的研究可能具有较低的统计效力，需要更多样本量更大的前瞻性研究。
期刊介绍：
Reproductive Biology and Endocrinology publishes and disseminates high-quality results from excellent research in the reproductive sciences.
The journal publishes on topics covering gametogenesis, fertilization, early embryonic development, embryo-uterus interaction, reproductive development, pregnancy, uterine biology, endocrinology of reproduction, control of reproduction, reproductive immunology, neuroendocrinology, and veterinary and human reproductive medicine, including all vertebrate species.
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