P-179 Euploid blastocysts rate in pre-implantation genetic testing (PGT) cycles with high levels of sperm DNA fragmentation does not improve after Magnetic Activated Cell Sorting (MACS)

Abstract

Abstract Study question Is there any benefit when using MACS before PGT to increase the euploid blastocysts rate in patients with high sperm DNA fragmentation? Summary answer Euploid blastocysts rate was not improved after the use of MACS in PGT patients where the male partner has high DNA fragmentation. What is known already The presence of apoptotic markers in spermatozoa is highly correlated with the failure of assisted reproduction treatments. Under normal physiological conditions, apoptotic sperm cells with externalized phosphatidylserine (PS) residues on the plasma membrane can be recognized and efficiently eliminated in the female genital tract, preventing the fertilization of the oocyte by a spermatozoon with alterations in its DNA integrity. MACS eliminates apoptotic sperm with PS residues using magnetic microbeads conjugated with Annexin V. This technique reduces the proportion of sperm with high rates of sperm DNA fragmentation and can be used to maximize assisted reproduction technique (ART) outcomes. Study design, size, duration This retrospective cohort study included 54 PGT cycles with high sperm DNA fragmentation between March 2018 and November 2022. Among them, some cycles used MACS as a selection tool for non-apoptotic sperm. The control group consisted of cycles that did not perform MACS due to the patients' decision. We compared the euploid blastocysts, fertilisation and blastocysts formation rates. Participants/materials, setting, methods PGT cycles using their own oocytes and with high sperm DNA fragmentation were separated into two groups according to the use of MACS as a selection technique (n = 25) or not (n = 29). Both groups were comparable regarding patients' age, number of mature oocytes collected and cleavage embryo quality. Semen samples were considered with high sperm DNA fragmentation after a TUNEL test ≥ 20%. Data was compared through Chi-square test with significance set at P < 0.05. Main results and the role of chance The primary outcome was the euploid blastocysts rate, while secondary outcomes included fertilisation and blastocysts formation rate. No differences between MACS and control groups were observed regarding the euploid blastocyst rate [45.3% (34 euploid blastocysts/75 total blastocysts) vs. 43.4% (63/145)] or the blastocysts formation rate [43.6% (75 total blastocysts/172 normal fertilized oocytes) vs. 28.6% (18/63)]. Fertilization rate was better in the control group [72.9% (172 fertilized oocytes/236 inseminated oocytes) vs. 80.1% (145/181)], P < 0.05. Limitations, reasons for caution These results need confirmation with a bigger population size. As with any retrospective study, the potential for residual confounding factors exists. Even though no significant differences were observed in terms of blastocysts formation and euploidy, other parameters such as embryo quality or birth results should be evaluated in the future. Wider implications of the findings These data suggest that MACS in PGT cycles offers no clinical benefit to increase the euploid blastocyst rate. The use of add-ons must be well justified when introduced in the laboratories' everyday work. Trial registration number Not applicable