RAISED SPERM DNA FRAGMENTATION – WILL INTERVENTION WITH SURGICAL RETRIEVAL OF TESTICULAR SPERMS OPTIMIZE REPRODUCTIVE AND PERI-NATAL OUTCOMES ?A DECADE’S OBSERVATIONAL STUDY FROM AN INDIAN CLINIC

Abstract

For Individuals with Raised Sperm DNA Fragmentation (SDF), will intervention with Surgical Retrieval of Sperms (SRS) from testes optimize Reproductive and Peri-Natal outcomes in Assisted Reproductive Techniques (ART) cycles. This is a retrospective study at our private IVF clinic from 2010 to 2019. SAMPLE SIZE: Couples with history of at least one failed IVF cycle were offered testing for SDF by SCSA method. SDF >30% was considered high and such couples were offered SRS from testes and testicular sperms were used for ICSI (n= 342). Couples were counselled about the risks, benefits and experimental nature of this intervention. Written consent was obtained from the couple and taken through an ART cycle with SRS from tests. Women underwent controlled ovarian stimulation and oocyte retrieval as per our clinic’s standard operating protocol (SOP). Fertilized oocytes were cultured till blastocyst stage and freeze all policy was adopted. Two blastocysts were transferred in a frozen embryo replacement cycle. INCLUSION CRITERIA: Individuals who had successful SRS with self-gamete cycles were included in this study. Exclusion CRITERIA: Donor gamete cycles and individuals who had failed SRS were excluded from this study. Primary Outcomes: Implantation rate (IR), Live birth rates (LBR) and Perinatal outcomes (Gestation Diabetes (GDM), Pregnancy Induced Hypertension (PIH), Intra Uterine Growth Restriction (IUGR), mean Pre-Term Birth rate (PTB), Birth weight (BW Normal - >2.5kgs), Low Birth weight (LBW – 1.5-2.5kgs), Very LBW (VLBW - <1.5kgs) Secondary Outcomes: Fertilization rate (FR); blastocyst rate (BR), Clinical pregnancy rate (CPR); Miscarriage rate (MR) and Multiple Pregnancy rate (MPR) Mean of the outcomes were as follows: FR - 93.35%, BR - 35%, IR - 40.34%, CPR - 56.90 %, MR was 12.03 %, MPR – 17.2% , LBR - 35.23, GDM – 6.06%, PIH – 6.82%, No IUGR reported in the study group. 17.4% had PTB. Mean BW was 2.5 kg. Out of this Normal BW was 55.6 %, LBW was 36.7 % and VLBW was 13.3 %. Use of SRS in couples with raised SDF seems to offer optimal reproductive and perinatal outcomes. Couples seeking ART with raised SDF, SRS can be offered as an active intervention. Testicular sperm for Raised SDF seem to offer beneficial reproductive and perinatal outcomes in ART cycles. TESA can be offered as an active intervention.