SDD/SDFA Testing in infertile men who have failed IUI – predictor of successful IVF outcomes?

Abstract

Infertility evaluation focuses on female factors prior to initiating advanced reproductive techniques. A cursory evaluation of the male includes a semen analysis to ensure sufficient sperm for intra-uterine insemination (IUI). Once IUI fails, further testing of the male ensues, often with normal results but persistent failures of ART. We sought to determine the utility of sperm DNA decondensation (SDD) and fragmentation analysis (SDFA) to predict the success of in vitro fertilization (IVF). Retrospective review of 42 patients in accord with institutional review policies. We evaluated the records of 42 men who failed at least two IUI cycles previously and who presented for a male infertility evaluation. Data examined included patient and partner ages, conventional semen analysis parameters, Testosterone, FSH, LH and genetic evaluation results. SDD and SDFA results and IVF outcomes were also queried. Eleven men had abnormal results for both the SDD and SDFA tests, 14 had an abnormality of only one test and 17 men had normal tests (Table 1). Mean values are presented for hormonal tests and medians for semen analysis data in Table 1. Among men where both tests were abnormal, the median number of IVF cycles was two, and four men were unable to achieve pregnancies despite two, three and four (two men) IVF cycles. With one abnormal test, the median number of cycles was also two, and only two men were unable to achieve pregnancies despite one and two cycles respectively. Finally, men with two normal tests had a median of one IVF cycle. Thus far, three men each of whom has undergone one cycle have not had achieved pregnancies. Table 1Baseline and Demographic InformationBoth Tests AbnormalOne Test AbnormalBoth Tests NormalPatient Age36.236.635.8Partner Age34.833.934.6Testosterone ng/dL403.7411.1400.9FSH (IU/dL)5.64.84.3LH (IU/dL)4.03.74.0Sperm Conc (million/mL)47.525.568.5Motility (%)4266.558Morphology (Kruger)2.04.04.5% unable to conceive with IVF36% (4/11)14% (2/14)18% (3/17) Open table in a new tab SDD and SDFA testing in men with adequate sperm parameters to undergo IUI may be useful in predicting IVF outcomes. Among men with abnormal SDD and SDFA tests, more cycles of IVF were required to achieve pregnancy. Furthermore, a higher proportion of men with both tests abnormal were unable to achieve pregnancies. SDD/SDFA testing may be useful tools to help advise couples of their success rates with IVF after failing IUI.