Abstract
ObjectiveTo design a reproductive treatment algorithm based on the sperm DNA fragmentation (SDF) for couples with unexplained infertility following a poor intrauterine insemination (IUI) outcome.DesignCouples that failed IUI with no apparent reproductive issue in both partners were allocated to diverse reproductive treatments on the basis of SDF.SettingReproductive medical center in an academic setting.Patient(s)Over 4 years, couples with an unexpected poor IUI outcome and no apparent female or male partner reproductive issues were recruited.Intervention(s)IUI, IVF, and ICSI were performed in the standard fashion following sperm SDF assays.Main outcomes measure(s)Fertilization rate, implantation rate, pregnancy characteristics, and delivery rates.Result(s)A total of 354 couples with unexplained infertility and normal semen parameters underwent 1133 IUI cycles. Clinical pregnancy rate (CPR) with IUI at our center in an age-matched cohort is 23.9% while the study cohort had 1.8%. Following SDF assessment, couples with failed IUI attempts but normal SDF (SCSA 9.8 ± 4.6%; TUNEL 11.8 ± 6.2%) underwent IVF with a CPR of 12.7%; those with abnormal SDF underwent ICSI with ejaculated spermatozoa, resulting in a CPR of 18.7%. This group included couples with normal SDF that had failed IVF. Couples with abnormal SDF that failed ICSI with ejaculated spermatozoa achieved a CPR of 31.0% with surgically retrieved spermatozoa.Conclusion(s)Couples with unexplained infertility that present with unexpectedly poor IUI outcomes can be funneled into a treatment algorithm guided by the integrity of the sperm genome for higher chances of pregnancy using an alternate method of insemination.
Highlights
Infertility is seen in 15% of couples of reproductive age
A recent systematic review on the treatment of couples with unexplained infertility concluded that the accrued data was not compelling enough to point to any specific treatment modality to significantly increase their chances of pregnancy but suggested that these couples should be individually assessed and treatment should be based on their unique reproductive profile [2]
The combined intrauterine insemination (IUI) cycles of these patients resulted in a clinical pregnancy rate of 2.9% (Fig. 1; Table 2)
Summary
Infertility is seen in 15% of couples of reproductive age Of those that seek treatment, roughly 60% can be identified as having a male and/or female factor affecting their reproductive ability [1]. In the event that couples fail to achieve a pregnancy despite a young female partner displaying a normal ovulation profile with patent tubes and a male partner with adequate semen parameters, the diagnosis of unexplained infertility is applied. This situation is observed in up to 30% of couples unable to reproduce [2]. A plausible option would be to proceed with in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI), which would possibly unveil any issue with oocyte maturity or fertilization competence
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