P-231 Embryo morphokinetics in male factor infertility
Authors: Aladham M 
Published: June 2022

Abstract

Study question
Are embryo morphokinetics and division pattern susceptible to sperm origin?

Summary answer
Surgical retrieved sperm and Oligo-astheno-teratozoospermia have significant effect on morphokinetics and pattern of embryo development in IVF.

What is known already
Among couples seeking primary infertility treatment, approximately one third of them have male factor indication. Intracytoplasmic sperm injection (ICSI) has changed their prognosis to achieve successful pregnancy. Recently, there are many conflicting studies on the relation of sperm origin, embryo development and clinical outcome after fertilization burrier is passed by ICSI. Implementation of time-lapse monitoring system (TLM) allows us to analyze embryo development under stable conditions, and identify morphological, temporal, spatial parameters and cell cycle endpoints at which embryos with sperm of different origin exhibit distinct kinetics. The magnitude of variable morphokinetics in anticipating pregnancy outcome is not yet determined.

Study design, size, duration
This is a prospective cohort study that included 195 ICSI cycles stratified into three groups of different sperm origin (abnormal sperm (OAT), surgical sperm(SRS) and normosperm (CS)). Each group included around 400 zygotes for patients seeking IVF treatment in Fakih IVF/Dubai between December 2019 and December 2021 in Dubai / UAE. The mean age of patients is (22-40 years female/ 22-45 years male). Normospermia subset was limited to couples seeking gender selection and tubal factor.

Participants/materials, setting, methods
Embryo morphokinetics (time to polar body (tPB) until time to blastocyst (tB)) and cell cycle durations were analyzed. Embryos were examined for irregular cleavage phenotypes. The prevalence of each category of out of-range morphokinetics and abnormal cleavage among the different groups was compared. The portion of embryos displaying optimal ranges for the indicated morphokinetics was explored focusing on cell cycle duration. Finally, multi-variables influencing morphokinetics parameters were controlled. Chi2 test was performed in SPSS, P-value&lt;0.05.

Main results and the role of chance
Embryos derived from SRS were later to reach tPNf and t2(26.66±9.16 and 29.03±8.52) than embryos derived from CS (25.15±4.20 and 27.84±4.98) and OAT (25.71±6.20 and 28.67±7.22). P &lt; 0.05. Embryos derived from SRS reached t5(47.94±11.02) faster than both embryos derived from CS (49.61±8.89) and OAT (49.26±9.47). Embryos derived from SRS reached t6(51.64±10.44) faster than embryos from CS (53.10±8.96). P value=0.0. Embryos derived from SRS and OAT reached tSB (95.34±9.01 and 94.92 ±10.04) and tB(103.68±8.53 and 102.08±10.32) significantly later than embryos derived from CS (91.16±5.65 and 96.34±7.70). No correlation was found between sperm origin and irregular embryo phenotypes except for blastomere asymmetry and incomplete morulation. P = 0.0004. SRS and OAT had higher incidence of blastomere asymmetry at 2-, 3- and 4cell stage than CS. P = &lt;0.05. For incomplete morulation, CS group had higher incidence of 1-3 fragments at morula stage(71.3%) than SRS and OAT (57.4% and 49%). However, OAT had higher incidence of 3-5 fragments at morula stage(35.9%) than SRS (224.1%) and CS (18.8%). Significantly, SRS displayed higher proportion of embryos out of range for most of the measured morphokinetics. P &lt; 0.05. Accordingly, less proportion of embryos in SRS and OAT fall within optimal range for cell cycle duration P &lt; 0.0. Antral follicle count, number of collected oocytes and male’s age had significantly affected morphokinetics and cleavage abnormality.

Limitations, reasons for caution
Selection of sperm by ICSI due to male- and severe male factor infertility may result in selecting live sperm with the best available normal morphology which may not reflect DNA fragmentation status of the overall sample where damage of DNA is more significant and lead to bias the results.

Wider implications of the findings
Embryo development potential with different sperm origin was compared based normal optimum morphokinetics or not. Further follow up study to investigate clinical outcome of implantation and clinical pregnancy rate, miscarriage rate and live birth rate is needed.

Trial registration number
DSREC-11/2021_07