Use Of Testicular Sperm/ICSI Yields High Pregnancy Rates In Couples Who Failed Multiple IVF Cycles Due To High Levels Of Sperm DNA Fragmentation
Philip Werthman, Robert Boostanfar, Wendy Chang, Corinne Chung, Hal Danzer, Tina Koopersmith, Guy Ringler, Mousa Shamonki, Mark Surrey, Michael Vermish, and John Wilcox
Presented at the Pacific Coast Reproductive Society Annual Meeting April 2010
INTRODUCTION AND OBJECTIVES: Sperm DNA damage (fragmentation) is a known cause of male infertility and has been shown to negatively impact pregnancy outcomes in couples undergoing In-Vitro Fertilization (IVF) with Intracytoplasmic Sperm Injection (ICSI). Previous studies have shown that sperm DNA damage may occur after the sperm have exited the testicle and levels of DNA fragmentation are lower in testicular sperm than in ejaculated sperm. The object of this study was to evaluate the results of IVF/ICSI using testicular sperm in couples that failed to achieve pregnancy on prior IVF cycles and had high levels of sperm damage as a cause of their infertility.
METHODS: We retrospectively reviewed the charts of 24 consecutive patients who underwent testicular sperm extraction for use with ICSI between January 1, 2008 and August 1, 2008. All patients had sperm present in the ejaculate that tested with a high DNA Fragmentation Index (DFI) as measured by Sperm Chromatin Structure Assay (SCSA). All patients had failed to achieve pregnancy during prior IVF cycles using ejaculated sperm. In an effort to improve the chances of conception, couples elected to have sperm harvested directly from the testicle and used for IVF/ICSI. Ovarian hyperstimulation was performed by one of 10 different reproductive endocrinologists at 5 different ART laboratories in the Los Angeles area. Testicular sperm extraction was performed by a single surgeon (PW) on the day of oocyte retrieval or one-day prior.
RESULTS: All men had at least one abnormal semen parameter and a high DFI (?30%) ranging from 32 to 82% with a mean of 51.6%. The etiology of sperm damage included varicocele, pyospermia, infection, partial obstruction, cryptorchidism, steroid abuse and idiopathic. Average age of female partner was 36.4 years with a range between 32-46 years. Two couples used an egg donor and the wives’ ages were excluded from the aforementioned calculation. All couples had undergone between 1 and 7 prior ICSI attempts with a mean of 3 failed cycles. A pregnancy rate of 62.5% was achieved when testicular sperm were used. An 83% pregnancy rate was achieved when the DFI was over 65%. A 75% pregnancy rate was achieved in couples that underwent 4 or more prior failed IVF cycles.
CONCLUSIONS: These data show that use of testicular sperm/ICSI provides an efficient treatment option for couples that fail multiple IVF cycles because of high levels of sperm DNA fragmentation. Neither the degree of sperm DNA damage or the number of prior failed IVF cycles appeared to affect the ability to achieve pregnancy when testicular sperm were used.