Abstract
To study how the choice of the first assisted reproductive technology treatment type affects the cumulative live birth rate (CLBR) in couples with high sperm DNA fragmentation index (DFI). Longitudinal cohort study. University-affiliated fertility clinic. A total of 2,713 infertile couples who underwent assisted reproductive technology treatment between 2007 and 2017 were included in the study. All invitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) treatments (up to three fresh treatments and all associated frozen-thawed embryo transfers) offered to the couples by the public health care system were included, in total 5,422 cycles. None. The primary outcome was the CLBR. The secondary outcomes were the fertilization rate and the miscarriage rate. The IVF and ICSI groups were defined according to the method applied in the first treatment cycle. In the IVF group, the CLBR values were higher for couples with normal DFI compared with those for couples with high DFI (≥20%) (48.1% vs. 41.6% for conservative CLBR estimate and 55.6% vs. 51.4% for optimal CLBR estimate after adjustment for female age, respectively). No DFI-dependent difference was seen in the ICSI group. Our results demonstrated that a high DFI predicts a statistically significantly lower CLBR if IVF and not ICSI is applied in the first cycle of assisted reproduction.
Highlights
We reported that—for first assisted reproductive technology (ART) treatment cycles— the odds ratio (OR) of live birth was approximately 0.6 if the DNA fragmentation index (DFI), as assessed by the sperm chromatin structure assay (SCSA), was >20% compared with treatments with a DFI of %20% [20]
One of the obstacles to making cost-benefit analyses in relation to applying DFI measurements as a standard procedure is that the available data are based on single cycles, not taking into consideration the complexity of ART procedures with multiple cycles and mixing of in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) as well as fresh and frozen embryo transfers offered to a couple
Couples with infertility, defined as at least one year of unsuccessful attempts to achieve pregnancy, who had undergone IVF/ICSI at Reproductive Medicine Centre (RMC), Malmo€, between 2007 and 2017 and had at least one DFI value for an ejaculate used for IVF/ICSI treatment were asked to participate in the study
Summary
To study how the choice of the first assisted reproductive technology treatment type affects the cumulative live birth rate (CLBR) in couples with high sperm DNA fragmentation index (DFI). All in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) treatments (up to three fresh treatments and all associated frozen-thawed embryo transfers) offered to the couples by the public health care system were included, in total 5,422 cycles. One of the obstacles to making cost-benefit analyses in relation to applying DFI measurements as a standard procedure is that the available data are based on single cycles, not taking into consideration the complexity of ART procedures with multiple cycles and mixing of IVF and ICSI as well as fresh and frozen embryo transfers offered to a couple. The criterion for performing standard IVF in the first cycle was the yield of R5 Â 106 spermatozoa after gradient centrifugation of the ejaculate
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