A treatment approach for couples with disrupted sperm DNA integrity and recurrent ART failure

Abstract

ObjectiveTo test a novel method to select spermatozoa with high chromatin integrity.DesignSpecimens with high sperm chromatin fragmentation (SCF) were selected by density gradient selection (DGS) and microfluidic sperm sorting (MSS).SettingAcademic medical center.Patient(s)Ejaculates from consenting men were processed by DGS/MSS. Couples underwent ICSI cycles with spermatozoa processed by DGS/MSS. Clinical outcomes were evaluated after embryo transfer.Intervention(s)SCF was measured by TUNEL. ICSI with spermatozoa selected by DGS and MSS was performed.Main outcome measure(s)Fertilization, embryo implantation, and pregnancy outcomes were compared between DGS and MSS.Result(s)A total of 23 men had an average SCF of 20.7 ± 10%. After DGS and MSS, the SCF was 12.5 ± 5% and 1.8 ± 1%, respectively. In couples who underwent ICSI, the average SCF was 28.8 ± 9%, which fell to 21.0 ± 9% after DGS and 1.3 ± 0.7% after MSS. Four couples underwent 11 ICSI cycles with DGS and achieved one (25%) pregnancy that resulted in pregnancy loss. In four subsequent ICSI cycles with MSS, an ongoing clinical pregnancy rate of 50% was achieved. Five additional couples underwent 12 cycles of ICSI with DGS. After preimplantation genetic testing for aneuploidy, 30.3% of the embryos were euploid. One pregnancy was achieved, resulting in pregnancy loss. With MSS, 31.5% of the embryos were euploid and 4 couples obtained a pregnancy. Finally, sixteen couples underwent 20 ICSI cycles solely with MSS at our center. Of these couples, 8 had failed 13 ICSI cycles with DGS elsewhere. These couples achieved an overall implantation of 34.5% (10/29) and a pregnancy rate of 58.8% (10/17).Conclusion(s)Microfluidic selection yielded spermatozoa with optimal genomic integrity and improved chances of obtaining a euploid conceptus.

Thoughts on the popularity of ICSI

“…A more sophisticated alternative sperm selection method was proposed, aiming to select ejaculated spermatozoa with the highest genomic integrity and competence, such as testicular sperm extraction. By using microfluidic techniques together with ICSI, a higher rate of euploid conceptuses was achieved even in patients who had not been able to obtain suitable embryos to transfer in their historical cycles [ 92 ].…”

The Use of Testicular Sperm for Intracytoplasmic Sperm Injection in Patients with High Sperm DNA Damage: A Systematic Review

“…The control of exogenous factors such medication use, obesity and smoking combined with an increase of ejaculation frequency and use of appropriate antioxidants can help reduce DNA fragmentation and may decrease the need for invasive procedures. The use of adequate sperm selection methods may also provide sperm with lower SDF levels [ 27 28 ].…”

Reproductive Chances of Men with Azoospermia Due to Spermatogenic Dysfunction

“…Additional work on novel techniques is underway that will further optimize the sperm chosen for oocyte injection. One promising technique is microfluidic sorting of sperm, which allows for analysis of sperm count, motility, and morphology on a microscopic level, allowing for the identification and selection of sperm with the best qualities [ 137 , 138 ]. Studies examining microfluidics-sorted sperm have demonstrated improved ICSI and clinical outcomes compared to sperm selected by conventional methods [ 138 , 139 ].…”