P-024 Is it worth proceeding with testicular sperm extraction (TESE), or should one go directly for sperm donation (SD)?
Year: 2025
Type: conference-abstract
Abstract: Study question How much does the severe male factor affect IVF outcomes? Summary answer Across different maternal ages, the male factor affected only the fertilization rate but did not influence the ploidy status of the embryo. What is known already The severe male factor includes a condition of a serious OligoAstenoTeratozoospermia (OAT) or azoospermia and affects about 10%–15% of couples worldwide. The most severe form of male infertility is Non-Obstructive Azoospermia (NOA), characterized by the absent or severely impaired sperm production in the testes. This group of IVF patients require testicular sperm extraction (TESE) in order to conceive with their own gametes. However, it is well known that ejaculated and testicular sperm differ in the sperm degree of nuclear maturation, thus, this could affect the fertilization rate and the embryo development in NOA patients. Study design, size, duration This retrospective study included 1.374 ICSI/PGT-A cycles, performed in Villa Mafalda Reproductive Department from 2020 to 2024. These cycles were divided into three groups based on maternal age: ≤ 34 years old (n = 281); 35-37 years old (n = 258); ≥ 38 years old (n = 835). A total of 3.381 day5/6/7 blastocysts underwent to trophectoderm biopsy and analyzed by the Next Generation Sequencing (NGS). Finally, 536 Single Embryo Transfer (SET) were performed using frozen euploid blastocysts. Participants/materials, setting, methods Each maternal group was additionally divided according to the sperm source in: Normo (≤ 34 n = 168; 35-37 n = 160; ≥ 38 n = 607); NOA (≤ 34 n = 14; 35-37 n = 28; ≥ 38 n = 33); OAT (≤ 34 n = 99; 35-37 n = 70; ≥ 38 n = 195) and SD (≤ 34 n = 14; 35-37 n = 9; ≥ 38 n = 27). For each subgroups, the Fertilization rate (Fr), the Euploid Blastocysts rate (EBr), the Ongoing Pregnancy/Live Birth rate (OP/LBr) and the Miscarriage rate (Mr) were analyzed. Main results and the role of chance A pairwise comparison between groups was performed by Chi-square analysis and p < 0.05 was considered statistically significant. As expected, for each maternal age group, the fertilization rate (Fr) was higher (p < 0.001) in the Normo subgroup compared to both the OAT and the NOA subgroups. The data were as follows: ≤ 34 years old (Normo 81.62%, OAT 69.61%, NOA 63.43%); 35-37 years old (Normo 74.97%, OAT 64.60%, NOA 51.11%); ≥ 38 years old (Normo 70.67%, OAT 65.50%, NOA 53.77%). Furthermore, within the NOA subgroups, the younger patients (≤ 34 years old) exhibited a significantly higher Fr compared to the older ones (p < 0.03), suggesting a higher oocyte competence to repair sperm DNA damage in younger patients. Unexpectedly, the EBr, OP/LBr, and Mr were comparable across the same maternal age groups, regardless of the sperm source, implying that maternal age remains the main limiting factor in determining blastocyst ploidy. Finally, to assess the competence of testicular spermatozoa to support the development of healthy embryos, the EBr was compared between NOA and SD cycles across different maternal ages. No significant differences were found, demonstrating once again, that the sperm source did not affect the embryo ploidy status. Limitations, reasons for caution Data should be evaluated carefully due to the retrospective nature of the single center study. Moreover, increasing the sample size of the NOA and the SD subgroups could help to sustain the statistical power of the observations. Wider implications of the findings The oocyte’s competence to repair sperm DNA damage and sustain fertilization decreases with maternal age. However, across different maternal ages, no differences in EBr were found regardless of the sperm source, including SD. Hence, even in the presence of severe male factor infertility, SD should not be the first option. Trial registration number No
Source: Human Reproduction
Language: English
Subfield: Reproductive Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W4411728126