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Journal of Assisted Reproduction and Genetics

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Open Access 01-10-2018 | Assisted Reproduction Technologies

A treatment algorithm for couples with unexplained infertility based on sperm chromatin assessment

Authors: C. L. O’Neill, A. Parrella, D. Keating, S. Cheung, Z. Rosenwaks, G. D. Palermo

Published in: Journal of Assisted Reproduction and Genetics | Issue 10/2018

Abstract

Objective

To design a reproductive treatment algorithm based on the sperm DNA fragmentation (SDF) for couples with unexplained infertility following a poor intrauterine insemination (IUI) outcome.

Design

Couples that failed IUI with no apparent reproductive issue in both partners were allocated to diverse reproductive treatments on the basis of SDF.

Setting

Reproductive medical center in an academic setting.

Patient(s)

Over 4 years, couples with an unexpected poor IUI outcome and no apparent female or male partner reproductive issues were recruited.

Intervention(s)

IUI, IVF, and ICSI were performed in the standard fashion following sperm SDF assays.

Main outcomes measure(s)

Fertilization rate, implantation rate, pregnancy characteristics, and delivery rates.

Result(s)

A total of 354 couples with unexplained infertility and normal semen parameters underwent 1133 IUI cycles. Clinical pregnancy rate (CPR) with IUI at our center in an age-matched cohort is 23.9% while the study cohort had 1.8%. Following SDF assessment, couples with failed IUI attempts but normal SDF (SCSA 9.8 ± 4.6%; TUNEL 11.8 ± 6.2%) underwent IVF with a CPR of 12.7%; those with abnormal SDF underwent ICSI with ejaculated spermatozoa, resulting in a CPR of 18.7%. This group included couples with normal SDF that had failed IVF. Couples with abnormal SDF that failed ICSI with ejaculated spermatozoa achieved a CPR of 31.0% with surgically retrieved spermatozoa.

Conclusion(s)

Couples with unexplained infertility that present with unexpectedly poor IUI outcomes can be funneled into a treatment algorithm guided by the integrity of the sperm genome for higher chances of pregnancy using an alternate method of insemination.

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Title: A treatment algorithm for couples with unexplained infertility based on sperm chromatin assessment
Authors: C. L. O’Neill
A. Parrella
D. Keating
S. Cheung
Z. Rosenwaks
G. D. Palermo
Publication date: 01-10-2018
Publisher: Springer US
Published in: Journal of Assisted Reproduction and Genetics / Issue 10/2018
Print ISSN: 1058-0468
Electronic ISSN: 1573-7330
DOI: https://doi.org/10.1007/s10815-018-1270-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

A treatment algorithm for couples with unexplained infertility based on sperm chromatin assessment

Abstract

Objective

Design

Setting

Patient(s)

Intervention(s)

Main outcomes measure(s)

Result(s)

Conclusion(s)

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objective

Design

Setting

Patient(s)

Intervention(s)

Main outcomes measure(s)

Result(s)

Conclusion(s)

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