P-160 Repeated treatment with the same sperm donor during the second cycle does not improve pregnancy rate, live birth rate nor risk of miscarriage
Authors: Ekwurtzel E , De Sousa-Soares S , Stenfelt C , Ahlström A , Vinnars M  T 
Published: July 2024

Abstract

Study question
Can repeated treatment with the same sperm donor in intrauterine insemination (IUI) and IVF/ICSI in the second cycle improve the outcome?

Summary answer
Pregnancy rate, live birth and miscarriage were not affected by repeated treatment with the same sperm donor in the second cycle with IUI or IVF/ICSI.

What is known already
Women with a longer exposure to paternal antigens have a higher chance of successful placentation and the use of donated gametes increases the risk for disorders related to placental insufficiency. Local exposure to seminal fluid has been shown to improve pregnancy rate. However, it is unknown how repeated exposure to the same donor, as opposed to changing donor, affects the outcome and currently there is no evidence suggesting that one method is superior to the other.

Study design, size, duration
This is a retrospective cohort study from three IVF clinics in Sweden including 868 women who have undergone reproductive treatments with donated sperms between 2014 and 2022. The outcomes pregnancy rate, live birth rate and risk of miscarriage were compared between women who had used the same donor in the second treatment cycle with women who were treated with a new donor.

Participants/materials, setting, methods
631 nulliparous women undergoing IUI or IVF/ICSI with donated sperm using the same donor during two consecutive treatment cycles were compared to 237 nulliparous women who had changed donor between the treatments. All medical indications for treatment were included in the study. Oocyte donation cycles and frozen embryo transfer cycles were excluded. Statistical analyses were performed using logistic regression, adjusting for year of treatment, maternal age, treatment method and clinic.

Main results and the role of chance
No differences in pregnancy rate nor live birth rate were found when comparing repeated treatments with the same donor with change of donor in IUI or IVF/ICSI (odds ratio (OR); 0.95, 95% CI 0.67-1.34, p = 0.77; OR 1.30, 95% CI 0.86-1.95, p = 0.21 respectively). A significant difference was found in miscarriage (OR 0.38, 95% CI 0.18-0.79, p = 0.01). However, after adjusting for year of treatment, maternal age, treatment method and clinic, no significant differences were found in any of the outcomes: pregnancy rate (adjusted OR (aOR) 0.94, 95% CI 0.65-1.38, p = 0.77), live birth rate (aOR 1.21, 95% CI 0.78-1.88, p = 0.40) nor miscarriage (aOR 0.44, 95% CI 0.19-1.03, p = 0.06).

Limitations, reasons for caution
In addition to the retrospective study design, the restricted number of patients is a limitation. The possibility of undocumented confounders that could impact the results is also a reason for caution. Furthermore, as only two subsequent treatments were studied, any effect of longer exposure could not be evaluated.

Wider implications of the findings
Our results could not show that using the same sperm donor repeatedly is superior to changing donor regarding pregnancy, live birth or miscarriage. Further research on additional exposure to the same donor as well as outcomes specific to placental insufficiency is needed to address the issue further.

Trial registration number
NA