IMPACT OF SEVERE MALE INFERTILITY ON CHROMOSOMAL STATUS OF EMBRYOS AND PREGNANCY OUTCOME IN YOUNGER WOMEN

Abstract

The relationship between severe male infertility and embryo aneuploidy has long been a subject of interest and there have been a limited number of studies. Our study used next generation sequencing (NGS), to evaluate the chromosomal status of blastocyst stage embryos and evaluated embryo morphokinetics and pregnancy outcomes in young women ( Severe male factor (SMF) is defined as sperm concentration below 5 million per ml. This covers a very wide range from 5 million down to non-obstructive azoospermia (NOA), in which sperm production is severely impaired. In our study, SMF cases were divided into the following 5 subgroups according to sperm concentration; 1) between five million and one million, 2) between one million and one hundred thousand, 3) less than one hundred thousand (cryptozoospermia), 4) Obstructive Azoospermia (OA) and 5) Non-obstructive Azoospermia (NOA). The control group was composed of males with normal sperm parameters (>39 million and >40% motile sperm in the ejaculate). 228 severe male infertility cases and 67 control cases with normal sperm parameters. In all groups female age was The PGT-A results showed that the overall aneuploidy rate of patients with SMF was 55.3% and the mosaicism rate was 13.2%. In the control group these figures were 55.8% and 6.7% respectively, a significantly higher mosaicism rate (p=0.001) was observed in the SMF group. Significantly higher chromosomal aneuploidy rates were found in couples with cryptozoospermia, in patients with OA and in patients with NOA compared to other male subgroups. Furthermore, embryo morphokinetic evaluation was carried out using time lapse imaging to investigate embryo development. NOA patients reached the first cleavage significantly later than the control group (27.78h vs. 26.55h, respectively; p=0.0347). There was also a difference between obstructive and non-obstructive azoospermia patients in the time to reach blastocyst, OA patients achieving a blastocyst significantly earlier than NOA (tB= 102.20h vs. tB=104.91h, respectively; p=0.0297). The cumulative live birth rates of SMF groups were compared. Significantly lower cumulative live birth rates were found in couples with cryptozoospermia (43.7%), in patients with OA (46%) and in patients with NOA (46.1%) compared to other SMF subgroups with five million and one million (58.1%) and between one million and one hundred thousand (71.4%) subgroups. In conclusion, the chromosomal status of embryos in severe male infertility cases with young female partners (