EVALUATING THE EFFICIENCY OF PHYSIOLOGICAL ICSI (PICSI) IN PATIENTS WITH DIFFERENT LEVELS OF ABNORMAL SPERM DNA FRAGMENTATION

Abstract

To evaluate the efficiency of sperm selection by PICSI on males with different levels of abnormal sperm DNA fragmentation (SDF). A retrospective cohort study included 630 couples undergoing ICSI from October 2016 to October 2019. Cases were divided according to their SDF levels into: (Mild: 20.4-25%, Moderate: 25.1-30%, and Severe: >30%) and normal SDF (<20% control) groups. The study included females ≤37 years old, with a minimum of 5 mature oocytes injected and had a fresh blastocyst transfer. All males SDF levels were assessed prior to their ICSI cycles using the terminal deoxynucleotidyl transferase biotin-dUTP nick end labeling (TUNEL) assay. Comparisons included pre-implantation embryo development, pregnancy, and live birth rates. The Chi square test was used for the qualitative parameters and Kruskal Walis test for non-parametric quantitative parameters (SPSS version 23). We found no significant differences between the control and high SDF groups in: type of infertility, female age, male age, count, motility, abnormal morphology, smoking status, abstinence days, No. of retrieved oocytes, and No. of mature oocytes. The outcomes of ICSI versus PICSI for the different study groups are shown in Table 1.Tabled 1Study outcomesNormal SDF n=291PICSIp-valuesMild n=147Moderate n=93Severe n=99Cleavage rate (%)75.6±18.275.3±16.677±17.978.8±14.80.6Blastocyst rate (%)64.7±19.663.2±2067.1±17.764.8±18.10.82Good quality Blastocyst rate (%)37.2±23.838±27.233±22.833.8±25.10.27Fair quality Blastocyst rate (%)17±17.115.2±18.215.2±15.618.4±17.30.5Vitrified Blastocysts3.36±3.53.37±3.52.64±2.22.67±2.70.65Implantation rate (%)44.5±43.241.5±40.738.4±44.434.4±39.20.09Clinical pregnancy rate (%)*64.461.355.760.20.53Ongoing pregnancy rate (%)*54.645.245.252.30.22Miscarriage rate (%)*14.523.515.68.20.11Live birth rate (%)*53.64343.951.20.16Data are mean (SD), otherwise stated. n refers to the number of cycles. PICSI = physiological intracytoplasmic sperm injection. SDF = Sperm DNA fragmentation. * Data are percentages only. P values <0.05 are considered significant. Open table in a new tab PICSI can perform with the same efficiency at all levels of abnormal SDF, improving their reproductive outcomes to the level of the control group. A prospective randomized trial with a control of abnormal SDF is planned as a future study to confirm these findings.