IMPACT STATEMENT: We consider this research question to be valuable and a decreased ability to repair DNA strand breaks.
nd breaks. However, the impact
cause it could reveal relationships between lifestyle factors and diet and
sperm quality.
P-596 6:30 AM Wednesday, October 20, 2021
IS THERE A ROLE FOR USE OF SURGICALLY
RETRIEVED TESTICULAR SPERMS IN INDIVIDUALS
WITH CRYPTOZOOSPERMIA? Krishna Mantravadi, Sr.
MBBS, PGDHOM, Masters in clinical embryology,
Durga Gedela Rao, Sr. MRCOG Oasis fertility, Hyderabad, India.
Cryptozoospermia men have very low sperm count and motility and this
could be detrimental for Assisted Reproductive Outcomes (ART) outcomes.
Use of testicular sperm (TESA) to optimize ART outcomes has been pro-
posed in the past. Superiority of TESA sperm over ejaculated sperm is still
a matter of debate.
OBJECTIVE: In Individuals with cryptozoospermia and undergoing ART,
will surgically retrieved testicular sperm optimize reproductive outcomes?
MATERIALS AND METHODS: This was a retrospective study of cou-
ples seeking ART cycles with cryptozoospermia at our private fertility clinic
between Jan 2013 to Dec 2019. Cryptozoosermia men underwent ICSI either
with ejaculate sperm (n¼38) or with sperm retrieved from TESA (n¼45).
This retrospective data analysis of cryptozoospermia ART cycles was done
from general population. All couples with cryptozoospermia underwent ICSI
either with ejaculated sperm or sperm retrieved using TESA. Offering TESA
to crytozoospermia individuals was a departmental policy and necessary con-
sents were obtained with prior counselling. Only couples who had a success-
ful frozen embryo transfer with one or two blastocysts, created from
autologous gametes were considered for this study. Live birth rate (LBR)
and Miscarriage Rate (MR) were the primary outcomes.
RESULTS: Reproductive Outcomes of TESA Vs Ejaculated sperm were:
Clinical Pregnancy rate (CPR) – 19/45 (42%) Vs 20/38 (53%)
(OR 0.66 CI- 0.28 to 1.57) (P¼0.34)
Implantation rate - 22/80 (28%) Vs 19/74 (26%)
(OR 1.09 CI - 0.54 to 2.25) (P ¼ 0.80)
Miscarriage per ET - 2/45 (4.4%) Vs 2/38 (5.3%)
(OR 0.84 CI - 0.11 to 6.2) (P¼0.86)
LBR - 17/45 (38%) Vs 18/38 (47%)
(OR -0.67 CI 0.28 to 1.62) (P¼0.38)
Though statistically not significant Ejaculate sperm group couples seem to
have better LBR than TESA group.
Data from this study doesn’t seem to show superiority of one intervention
over the other.
Considering the invasiveness of TESA procedure and lesser LBR (which
was statistically not significant) in TESA group, there seems a need for a
RCT to look for role of TESA for cryptozoospermia men as an active inter-
vention to optimize reproductive outcomes.
CONCLUSIONS: Use of Testicular Sperm Aspiration (TESA) to optimize
reproductive outcomes for cryptozoospermia men doesn’t seem to be a supe-
rior intervention over ejaculated sperm.
IMPACT STATEMENT: Use of surgically retrieved sperm for cryptozoo-
spermia men to optimize reproductive outcomes still needs further research.
References: NA
SUPPORT: NO FUNDING RECEIVED
P-597 6:30 AM Wednesday, October 20, 2021
ADVANCED PATERNAL AGE AND SPERM DNA FRAG-
MENTATION: A SYSTEMATIC REVIEW. Daniel
Gonzalez, B.S.,1 Jesse Ory, MD,2 Ruben Blachman-Braun,
M.D., M.Sc.,1 Sirpi Nackeeran, BA,1 Jordan C. Best, B.S.,3
Ranjith Ramasamy, M.D1 1University of Miami Miller School of Medicine,
Miami, FL; 2University of Miami, Miami, FL; 3Nova Southeastern Univer-
sity College of Osteopathic Medicine, Davie, FL.
OBJECTIVE: The average age at which couples first reproduce has
increased significantly in recent decades, with the mean age now at around
30 years in many countries. Increased life expectancy, modern societal ex-
pectations pressures, and advanced age of marriage has resulted in the ten-
dency for couples to delay parenthood. While increasing maternal age is
well established as a risk factor for adverse reproductive outcome and
offspring fitness, the influence of paternal age on sperm parameters and
fecundity is unclear. Male ageing is often associated with defective sperm
DNA remodeling mechanisms that result in poorly packaged chromatin
FERTILITY & STERILITYÒ
of advanced paternal age on DNA fragmentation remains inconclusive.
The aim of the present systematic review was to investigate the impact of
advancing paternal age (APA) on DNA fragmentation.
MATERIALS AND METHODS: We conducted a thorough search of
listed publications in Scopus, PubMed, and EMBASE, in accordance with
the PRISMA guidelines.
RESULTS: We identified 3,120 articles, of which nineteen were selected
for qualitative analysis, resulting in a sample of 40,668 men. Of the 19 arti-
cles evaluating the impact of APA on DFI% (DNA fragmentation Index)
included, 4 were on Normozoospermic and subfertile men, 3 on normozoo-
spermic, Oligoasthenoteratozoospermic and Teratozoospermic, 6 on fertile
and infertile men, 4 on just infertile men, and 2 evaluated a general popula-
tion. Seventeen of the ninrnteen studies demonstrated APA’s effect and
impact on DFI%.
CONCLUSIONS: Although there was no universal definition for APA, the
present review suggests that older age is associated with increased DFI. In
elderly men with normal semen parameters, further studies should be per-
formed to assess the clinical implications of DFI, as a conventional semen
analysis can often fail to detect an etiology for infertility. As sperm quality
is a pivotal factor in fertility potential and ART outcomes, physicians should
consider assessing DNA fragmentation in men around the age of 40 years
IMPACT STATEMENT: Analyzing DNA fragmentation in men around
the age of 40 years can provide an additional tool to set expectations and
counsel couples seeking fertility.
P-598 6:30 AM Wednesday, October 20, 2021
LOW PERCENTAGE MOTILITY WHEN SPERM CON-
CENTRATION IS NORMAL DOES NOT APPEAR TO
BE A CAUSE OF UNEXPLAINED FAILURE TO HAVE
A LIVE DELIVERY DESPITE IN VITRO FERTILIZA-
TION (IVF). Jerome H. Check, M.D., Ph.D.,1 Carrie K. Wilson, B.A.,2
Donna Summers, M.S.,2 Diane L. Check, BS, MT,2 Danya Horwath,
M.S., T.S.2 1Cooper Medical School of Rowan University, Camden, NJ;
2
Cooper Institute for Reproductive Hormonal Disorders, P.C., Mt. Laurel,
NJ.
OBJECTIVE: Some data suggest that sperm with very low motile density
can lead to a trend for a lower chance of a live delivery following in vitro
fertilization (IVF) with intracytoplasmic sperm injection (ICSI) even despite
the transfer of embryos with apparent normal morphology. The purpose of
the present study was to see if low % motility in the presence of normal sperm
concentration can also be a subtle cause of unexplained infertility.
MATERIALS AND METHODS: Couples were identified who were
sharing donor oocytes when both male partners had normal concentrations
of their sperm (R20x106/mL) but where one had motility <30% and the
other R50%. Subsequent fertilization rates, embryo quality, as evidence
by number of blastomeres on day 3 transfer, and pregnancy rates were deter-
mined. ICSI was used or not according to the discretion of the physician.
RESULTS:
Pregnancy rates based on % motility for shared oocyte cycles when
sperm concentration R20 mill/mL
Motility <30% R50%
# cycles 37 37
% fertilized 70.5% 70.1%
% 6-8 cell day 3 60.6% 70.7%
% clinical pregnancy/transfer 58.3% 68.0%
% miscarriage/clinical pregnancy live 0.0% 35.3%
% delivered 58.3% 44.0%
% implantation 31.3% 40.0%
There were no statistical differences or trends that would suggest that low
% motile sperm, despite normal sperm concentration, leads to embryos with
a lower chance to achieve a live delivery. With no trends seen at all, the study
will not be continued.
CONCLUSIONS: Based on other studies, there is a suggestion that sperm
from men with very low motile density, used for IVF-ET, the embryos
formed, though appearing to be morphologically normal, may be the cause
of lower live delivered pregnancy rates. This raised the question as to the pos-
sibility that sperm with very low MD may be more likely to have
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