Fertility and Sterility: Effect of the male factor on the clinical outcome of intracytoplasmic sperm injection combined with preimplantation aneuploidy testing: observational longitudinal cohort study of 1,219 consecutive cycles
Mazzilli R., Cimadomo D., Vaiarelli A., Capalbo A., Dovere L., Alviggi E., Dusi L., Foresta C., Lombardo F., Lenzi A., Tournaye H., Alviggi C., Rienzi L., Ubaldi F .M.
Fertil Steril. 2017 Dec;108(6):961-972.e3. doi: 10.1016/j.fertnstert.2017.08.033. Epub 2017 Oct 3
OBJECTIVE: To evaluate the impact of the male factor on the outcomes of intracytoplasmic sperm injection (ICSI) cycles combined with preimplantation genetic testing for aneuploidies (PGT-A).
DESIGN: Observational longitudinal cohort study.
SETTING: Private in vitro fertilization (IVF) center.
PATIENT(S): A total of 1,219 oocyte retrievals divided into five study groups according to sperm parameters: normozoospermia (N), moderate male factor (MMF), severe oligoasthenoteratozoospermia (OAT-S), obstructive azoospermia (OA), and nonobstructive azoospermia (NOA).
INTERVENTION(S): ICSI with ejaculated/surgically retrieved sperm, blastocyst culture, trophectoderm-based quantitative polymerase chain reaction PGT-A, and frozen-warmed euploid embryo transfer (ET).
MAIN OUTCOMES MEASURE(S): The primary outcome measures were fertilization, blastocyst development, and euploidy rates; the secondary outcome measures were live birth and miscarriage rates. Perinatal and obstetrical outcomes were monitored as well.
RESULT(S): A total of 9,042 metaphase II oocytes were inseminated. The fertilization rate was significantly reduced in MMF, OAT-S, OA, and NOA compared with N (74.8%, 68.7%, 67.3%, and 53.1% vs. 77.2%). The blastocyst rate per fertilized oocyte was significantly reduced in MMF and NOA compared with N (48.6% and 40.6% vs. 49.3%). The timing of blastocyst development also was affected in OA and NOA. Logistic regression analysis adjusted for confounders highlighted NOA as a negative predictor of obtaining an euploid blastocyst per OPU (odds ratio 0.5). When the analysis was performed per obtained blastocyst, however, no correlation between male factor and euploidy rate was observed. Embryo transfers also resulted in similar live birth and miscarriage rates. No impact of sperm factor on obstetrical/perinatal outcomes was observed.
CONCLUSION(S): Severe male factor impairs early embryonic competence in terms of fertilization rate and developmental potential. However, the euploidy rate and implantation potential of the obtained blastocysts are independent from sperm quality.
KEYWORDS: Preimplantation genetic testing; aneuploidy; azoospermia; euploid blastocyst; male factor