AĞIR TERATOSPERMİYE BAĞLI ERKEK İNFERTİLİTESİNDE İNTRASİTOPLAZMİK SPERM ENJEKSİYONU-EMBRİYO TRANSFERİ SONRASI GEBELİK SONUÇLARININ DEĞERLENDİRİLMESİ

Year 2021, Volume: 22 Issue: 4, 246 - 252, 01.07.2021

Hatice Aktaş Bulat Aytek Şık Yılda Arzu Aba

https://doi.org/10.18229/kocatepetip.706091

Abstract

AMAÇ: Normal sperm morfolojisi %0 olan erkek infertilitesine sahip hastalarla normal sperm morfolojisi %1 - 4 olan erkek infertilitesine sahip hastaların, intrastoplazmik sperm enjeksiyonu (ICSI) - embriyo transferi (ET) sonrası gebelik sonuçları bakımından karşılaştırılması amaçlanmıştır.
GEREÇ VE YÖNTEM: Erkek infertilitesinde önemli bir yer tutan ağır teratozoosperminin ICSI sonuçları üzerine etkisi araştırılmıştır. Kruger strict kriterlerine göre spermiyogramda normal morfoloji oranı %0 olan hastalar ile %1 - 4 olan hasta hastalar, elde edilen MII oosit sayısı, fertilize oosit sayısı, transfer edilen embriyo sayısı, implante olan embriyo sayısı, fertilizasyon oranı ve klinik gebelik oranları bakımından karşılaştırıldı. Gruplar arası dengeyi sağlamak amacı ile 38 yaş üstü, düşük over rezervine sahip, polikistik over sendromu olan kadın hastalar ile azospermisi olan veya total immotil sperm tanısı almış erkek hastalar çalışmaya dahil edilmedi.
BULGULAR: İki hasta grubu arasında; ortalama yaş, ortalama infertilite süresi, ortalama vücut kitle indeksi, infertilite tipi, infertilite nedeni, sigara içiciliği, alkol kullanımı, erkek hastalarda geçirilmiş cerrahi, bazal hormon seviyeleri ve antral folikül sayısı bakımından istatistiksel olarak anlamlı bir fark yoktu (p>0,05). İki grupta elde edilen total oosit sayısı, MII oosit sayısı, fertilize oosit sayısı, fertilizasyon oranı ve transfer edilen embriyo sayısı açısından da istatistiksel olarak anlamlı derecede bir fark bulunamamıştır. Morfoloji %0 ve Morfoloji %1 - 4 gruplarının gebelik sonuçları arasında istatistiksel farklılık gözlenmemiştir (p=0,824), (p=0,854), (p=0.216), (p=0,812).
SONUÇ: Sperm morfolojisinin, ICSI-ET sikluslarında, fertilizasyon oranları, klinik gebelik oranları ve canlı doğum oranlarına etkisi gözlenmemiştir.

Keywords

İntrastoplazmik Sperm Enjeksiyonu, Sperm morfolojisi, Erkek İnfertilitesi

EVALUATION OF PREGNANCY RESULTS AFTER INTRACYTOPLASMIC SPERM INJECTION-EMBRYO TRANSFER IN MALE INFERTILITY DUE TO SEVERE TERATOZOOSPERMIA

Abstract

OBJECTIVE: It was aimed to compare the results of pregnancy after intracytoplasmic sperm injection (ICSI) embryo transfer of the patient group with male sperm infertility with 0% normal sperm morphology and 1 - 4% male sperm with normal sperm morphology.
MATERIAL AND METHODS: We investigated the effect of heavy teratozoospermia, which has an important place in male infertility, on ICSI results. According to Kruger strict criteria, patients with a normal morphology rate of 0% and patients with 1 - 4% in the spermiogram were compared in terms of the number of MII oocytes obtained, the number of fertilized oocytes, the number of embryos transferred, the number of implanted embryos, the fertilization rate and clinical pregnancy rates. We did not include female patients over 38 years of age, with low ovarian reserve, polycystic ovarian structure, and male patients with azoospermia or diagnosed with total immotile sperm in order to achieve a balance between the groups.
RESULTS: There were no statistically significant differences between the groups in terms of mean age, mean infertility duration, mean Body Mass Index (BMI), type of infertility, cause of infertility, smoking, alcohol use, previous surgery in male patients, basal hormone levels, and basal ovarian grade(p>0.05). When we compare the total oocyte count, MII oocyte count, fertilized oocyte count, fertilization rate, the number of embryos transferred in the two groups, there was no statistically significant difference between the pregnancy outcomes of morphology 0% and morphology 1-4% groups (p = 0.824), (p = 0.854), (p = 0.216), (p = 0.812).
CONCLUSIONS: No effect of sperm morphology on fertilization rates, clinical pregnancy rates, and live birth rates was observed in intracytoplasmic sperm injection-embryo transfer cycles (ICSI-ET).

Keywords

Intracytoplasmic Sperm Injection, Sperm Morphology, Male infertility

References

• 1. Miller JE, Smith TT. The effect of intracytoplasmic sperm injection and semen parameters on blastocyst development in vitro. Hum Reprod 2001;16:918–24.
• 2. Palermo GD, Cohen J, Alikani M, Adler A, Rosenwaks Z. Intracytoplasmic sperm injection: a novel treatment for all forms of male factor infertility. Fertil Steril 1995;63:1231–40.
• 3. Tesarik J, Mendoza C, Greco E. Paternal effects acting during the first cell cycle of human preimplantation development after ICSI. HumReprod 2002;17:184–9.
• 4. De Geyter C, Calhaz-Jorge C, Kupka MS, et al. European IVF-monitoring Consortium (EIM) for the European Society of Human Reproduction and Embryology (ESHRE). ART in Europe, 2014: results generated from European registries by ESHRE: the European IVF-monitoring Consortium (EIM) for the European Society of Human Reproduction and Embryology (ESHRE). Hum Reprod 2018;33(9): 1586–1601.
• 5. Practice Committee of American Society for Reproductive Medicine. Intracytoplasmic sperm injection (ICSI). Fertil Steril 2008;90(5):S187.
• 6. Matzuk MM, Lamb DJ. The biology of infertility: research advances and clinical challenges. Nat Med 2008;14:1197–213.
• 7. Verza S Jr, Esteves SC. Sperm defect severity rather than sperm source is associated with lower fertilization rates after intracytoplasmic sperm injection. Int Braz J Urol 2008;34:49–56.
• 8. Shoukir Y, Chardonnens D, Campana A, Sakkas D. Blastocyst development from supernumerary embryos after intracytoplasmic sperm injection: a paternal influence? Hum Reprod 1998;13:1632–7.
• 9. Sanchez R, Stalf T, Khanaga O, Turley H, Gips H, Schill WB. Sperm selection methods for intracytoplasmic sperm injection (ICSI) in andrological patients. J Assist Reprod Genet 1996;13:228–33.
• 10. Bukulmez O, Yucel A, Yarali H, Bildirici I, Gurgan T. The origin of spermatozoa does not affect intracytoplasmic sperm injection outcome. Eur J Obstet Gynecol Reprod Biol 2001;94:250–5.
• 11. Goker EN, Sendag F, Levi R, Sendag H, Tavmergen E. Comparison of the ICSI outcome of ejaculated sperm with normal, abnormal parameters and testicular sperm. Eur J Obstet Gynecol Reprod Biol 2002;104:129–36.
• 12. Practice Committee of the American Society for Reproductive, M. Diagnostic evaluation of the infertile female: A committee opinion. Fertility and Sterility, 2015;103(6): 44–50.
• 13. Castillo J, Estanyol JM, Ballescá JL, Oliva R. Human sperm chromatin epigenetic potential: genomics, proteomics, and male infertility. Asian J Androl. 2015;17:601-9.
• 14. Virtanen, HE, Jorgensen, N, Toppari, J. Semen quality in the 21(st) century. Nature Reviews Urology, 2017;14(2):120–130.
• 15. Bieniek, JM, Drabovich, AP, Lo, K C. Seminal biomarkers for the evaluation of male infertility. Asian Journal of Andrology 2016;18(3),426–433.
• 16. Bartolacci A, Pagliardini L, Makieva S, Salonia A, Papaleo E, Vigano P. Abnormal sperm concentration and motil‐ ity as well as advanced paternal age compromise early embry‐ onic development but not pregnancy outcomes: A retrospec‐ tive study of 1266 ICSI cycles. Journal of Assisted Reproduction and Genetics 2018;35(10):1897–1903.
• 17. Bulgurcuoğlu Kuran S, Altun A. Kaliteli spermin seçiminde güncel yöntemler Androloji Bul2015;17:206–13.
• 18. Antinori M, Licata E, Dani G, et al. Intracytoplasmic morphologically selected sperm injection: a prospective randomized trial. Reprod Biomed Online 2008;16:835–41.
• 19. Mauri AL, Petersen CG, Oliveira JB, Massaro FC, Baruffi RL, Franco JG Jr. Comparison of day 2 embryo quality after conventional ICSI versus intracytoplasmic morphologically selected sperm injection (IMSI) using sibling oocytes. Eur J Obstet Gynecol Reprod Biol 2010;150:42–6.
• 20. Hauser R, Bibi G, Yogev L, et al. Virtual azoospermia and cryptozoospermia--fresh/frozen testicular or ejaculate sperm for better IVF outcome? J Androl 2011;32(5):484-90.
• 21. Guo HB, Zhang YH, Zhang CL, et al. Outcomes of ICSI with sperm from different sources: a retrospective study of 431 cycles. Zhonghua Nan Ke Xue 2009; 15(10):925-8.
• 22. Dubey A, Dayal MB, Frankfurter D, et al. The infuence of sperm morphology on preimplantation genetic diagnosis cycles outcome. Fertil Steril 2008;89(6):1665–69.
• 23. Chemes HE, Sedo CA. Tales of the tail and sperm headaches: changing concepts on the prognostic significance of sperm pathologie saffectingthe head, neckand tail. Asian J Androl 2012;14(1): 14–23.
• 24. Kanto S, Sugawara J, Masuda H, Sasano H, Arai Y, Kyono K. Fresh motile testicular sperm retrieved from nonobstructive azoospermic patients has the same potential to achieve fertilization and pregnancy via ICSI as sperm retrieved from obstructive azoospermic patients. Fertil Steril 2008;90. 2010. e5-7.11.
• 25. Avendano C, Franchi A, Duran H, Oehninger S. DNA fragmentation of normal spermatozoa negatively impacts embryo quality and intracytoplasmic sperm injection outcome. Fertility and Sterility 2010;94(2): 549-57.
• 26. Pedrix A, Travers A, Chelli MH, et al. Assesment of acrosome and nuclear abnormalities in human spermatozoa with large vacuoles. Human Reproduction 2011; 26(1): 47-58.
• 27. Avendano C, Franchi A, Taylor S, Morshedi M, Bocca S, Oehninger S. Fragmentation of DNA in morphologically normal human spermatozoa. Fertility and Sterility 2009;91(4):1077-84.
• 28. Avendano C, Oehninger S. DNA Fragmentation in Morphologically Normal Spermatozoa: How Much Should We Be Concerned in the ICSI Era? Journal of Andrology 2011;32(4):356-63.
• 29. Franco JG, Mauri AL, Petersen CG, et al. Large nuclear vacuoles are indicative of abnormal chromatin packaging in human spermatozoa. International Journal of Andrology 2012;35(1):46-51.
• 30. Parmegiani L, Cognigni GE, Ciampaglia W, et al. Efficiency of hyaluronic acid (HA) sperm selection. J Assist Reprod Genet 2010;27:13-6.
• 31. Sharbatoghli M, Valojerdi MR, Amanlou M, Khosravi F, Jafar-abadi MA. Relationship of sperm DNA fragmentation, apoptosis and dysfunction of mitochondrial membrane potential with semen parameters and ART outcome after intracytoplasmic sperm injection. Arch Gynecol Obstet2012;286(5):1315-22.
• 32. Abu HA, Franken DR, Hoffman B, Henkel R. Accurate sperm morphology assessment predicts sperm function. Andrologia 2012;44:571-7.