Contribution of frozen embryo transfer cycles to ICSI clinical outcomes in male factor infertility - Lily Ng

 About a third of the infertility is attributed to unexplained or combined factors, while the remainder is split almost evenly between female and the male. The male factor infertility represents a challenge, particularly because there is a risk of impaired embryo development and therefore we still have to transfer multiple embryos at the cleavage stage. Day 5 or 6 embryo transfers are preferred due to more physiology, higher implantation rate and ability to test for euploidy using PGT-A. This study was done to find the benefit of adding frozen embryo transfer (FET) cycles to ICSI clinical outcomes in male factor infertility. Following fresh embryo transfer, sometimes few embryos are left over which can be cultured to day 5-6 and PGT-A on trophectoderm biopsy is done if requested by the patient. The study design includes transfer of fresh embryo, often more than one embryo, but it depends on the quality, excess embryos are left over that could go without or with PGT-A. These embryos are then cryopreserved to be used later in FET cycles, whether natural or programmed. 5358 couples were selected for this study who underwent ICSI with ejaculated spermatozoa. The results showed that with male factor infertility, cleavage stage ET is useful. The embryo implantation rate was 41% after transferring over 90,000 embryos. This led to 53% positive beta HCG and yielded 40% clinical pregnancies and 34% deliveries. The rates were all significantly higher in the FET cohort as they achieved 47% implantation rate, 52% clinical pregnancy and 45% delivery rate without PGT-A. However, with PGT-A, FET has an implantation rate of 58% and 60% achieved clinical pregnancy. The utilization of excess embryos is a valuable option. With the addition of PGT-A, higher success rates were observed, it caused  less distress for the couple and multiple gestation rates were reduced. The outcome of natural versus programmed FET is comparable. FET improves overall efficiency of ART while reducing embryos wastage.  

Poor semen parameters after embryo morphokinetic patterns during preimplantation development but do not compromise clinical outcomes - Marco Petrolo

This retrospective study with 616 embryos was done to assess the impact of the semen on morphokinetic parameters and impact of these discrepancies on clinical outcomes. The results showed that the use of altered sperm when using donor oocytes affects the developmental timings of the embryos, impacts PN and blastomeres’ size and decreases embryo utilization rate. The use of Testicular sperm extraction (TESE) sperm when using donor oocytes alters the developmental timings of embryos, impacts PN size, blastomeres’s size and embryo fragmentation and decreases both fertilization and utilization rates. Overall the use of TESE and altered sperm does not affect implantation and liver birth rate per transfer. These findings support the use of autologous sperm with donor oocytes, even in severe cases of male factor infertility, however the use of altered TESE sperm reduces the number of embryos per cycle. 

Sperm DNA fragmentation by Tunel influences live birth in egg recipients after euploid embryo transfer - Lozano FM

Sperm DNA integrity is important for optimal fertilization, implantation and pregnancy. Several studies have shown sperm DNA fragmentation(SDF)in infertile men correlates with adverse pregnancy outcomes. Ooplasmic sperm DNA fragmentation repair mechanisms may occur in female gametes, mainly in young women. The research on the impact of sperm DNA fragmentation on live birth rate is limited. Chromosomally normal embryos analyzed by PGT-A offers an opportunity to isolate male factor and evaluate its effect on pregnancy.The research of the male factor by TUNEL, together with the analysis of embryo by PGT-A, allows to know if ART outcomes are influenced by sperm DNA fragmentation. This retrospective study was done with 447 infertile couples and 467 PGT-Acycles in egg recipients. The results showed that 66.5% of male partners had normal semen parameters and 33.5% had altered semen quality. High sperm DNA fragmentation was seen in 8% of patients. The embryo aneuploidy rate was 32%. Miscarriage rate was significantly higher in the high SF group (12.5% vs 40%). Live birth rate was significantly lower in the high SDF group (32.6%  vs 13%). It was concluded that ART ART outcomes are affected by sperm DNA fragmentation on donor oocyte recipients. SDF increases miscarriage rate in egg recipients with PGT-A and LBR depends on sperm DNA damage in egg recipients after euploid embryo transfer. LBR decreased in patients with a high DFI after PGT-A. THis study confirms published studies showing that ART outcomes are affected by sperm DNA fragmentation. 

Human sperm selection using cumulus oophorus cells compared with conventional sperm preparation method on sperm quality and ICSI outcomes: A pilot study - G Ruvolo

 In Italy, about 85% of the ART cycles are ICSI, in which a single sperm is selected and injected. It would be useful to have a technique of selection of sperms with following characteristics: good motility, good morphology, euploid, chromatin integrity and acrosome reacted, routinely, the semen sample is processed to stimulate a physiological selective process in order to try to collect competent spermatozoa. The most used techniques of preparation of seminal samples for ART are simple washing, layer swim-up, discontinuous density gradients, magnetic activated cell sorting and microfluids. There is no integrated preparation technique that can guarantee sperm selection similar to physiology. The aim of this study was to compare the effect of sperm selection method using the cumulus oophorus cells with the conventional sperm preparation method on sperm motility and morphology and on the clinical and biological outcomes after ICSI, assuming that the interaction between spermatozoa and cumulus cells could act as natural and physiological method to select sperms with better morphology, motility with a complete acrosome reaction and possible euploid. This prospective study was done with 50 patients randomly selected attending ICSI. The patients were classified as group A when the sperms were selected using pellet swim-up and CC selection and as group B when it was used pellet swim-up treatment alone. The results showed the spermatozoa selected using cumulus oophorus cells showed higher rates of normal morphology, good motility compared with basal semen and the traditional pellet swim up protocol. In group A the clinical pregnancy and implantation rates seem to be higher than group B, but without statistical significance due to low sample size. This Procedure allows the selection of the spermatozoa through a more physiological selective process. Further studies are planned for analyzing the aneuploidies rates and the DFI of the treated spermatozoa. 

Can advanced sperm selection techniques improve blastocyst euploidy rate of abnormal sperm DNA fragmentation cases to the level of normal ones: Prospective randomized controlled trial - E Hasanen

The objective of this study was to evaluate the efficiency of sperm selection techniques using PGT-A in ICSI cases with abnormal sperm DNA fragmentation (SDF) and to compare PGT-A outcomes of PICSI and MACS ro a control group of normal SDF. This randomized controlled trial was done with 349 ICSI cases. The results showed the usage of advanced sperm selection techniques has shown comparable preimplantation and PGT-A results to that of normal SDF cases. There were no significant differences between PICSI and MACS when compared to normal SDF control. PICSI and MACS are efficient sperm selection techniques that eliminated the adverse effects of abnormal SDF on PGT-A outcomes.

39th annual meeting of European society of human reproduction and embryology (ESHRE), Copenhagen, 25-28 June, 2023