O-298 Advanced paternal age men with raised sperm DFI – optimizing sperm selection to improve reproductive outcomes
Authors: Rayapati R.S , Mantravadi K.C , Gedela D.R 
Published: June 2022

Abstract

Study question
couples with men of Advanced Paternal Age who have raised Sperm DFI, history of previous IVF cycle failure, does sperm selection by MACS or MICROFLUIDICS or TESA optimize reproductive outcomes?

Summary answer
Men with APA and SDF could have altered reproductive outcomes. Optimizing sperm selection can improve reproductive outcomes. Study doesn't implicate the best sperm processing.

What is known already
It is evident that raised sperm DFI negatively affects the reproductive outcomes. Advancing age additionally is one of the factors for causing raised sperm DFI and altered reproductive outcomes. Hence in this study we intend to evaluate the efficacy of sperm selection by MACS, MF or TESA to obtain good quality sperms +and optimize reproductive outcomes.

Study design, size, duration
Retrospective study during 2014 – 2021.Couples with men of APA (&gt;45yrs) & raised DFI (&gt;25%) underwent IVF, sperm selection done with MACS (n = 24), MF (n = 30), TESA group (n = 30) considered in study group. APA men with raised sperm DFI and no intervention for sperm selection were considered as control group (n = 31). Women age &lt;37 years with one failed IVF cycle in the past considered for this study. Cycles where PGT done were excluded from study.

Participants/materials, setting, methods
All women underwent controlled ovarian stimulation (COS) and OPU as per clinics SOP. Male partners underwent either fresh TESA/MACS/MF for sperm preparation.ICSI was the method of insemination in both groups. They were subjected to extended blastocyst culture and vitrified. Later in a Frozen Embryo Replacement (FET) cycle, two blastocysts with 100% survival were transferred.Implantation Rate (IR), Miscarriage Rate (MR), Multiple Pregnancy Rate (MPR) and Live Birth Rate (LBR) were compared between study and control group.

Main results and the role of chance
The reproductive outcomes for study group i.e, MACS, MF and TESA Vs Control group were as follows: MACS group - IR 53%, MR of 16%, MPR 24% and LBR - 55% MF group - IR 65%, MR of 6% MPR 25% and LBR of 66% TESA group - IR 50%, MR of 16% MPR 24% and LBR of 59% CONTROL GROUP - IR 40%, MR of 8%, MPR 17% and LBR of 42%
According to our study, reproductive outcomes of all the study groups (MACS, MF & TESA) showed comaprable reproductive outcomes.
Of all the interventions used in study group, MF sperm sorting seem to have offered the best reproductive outcomes. However, considering the LBR which was comparable between all groups this study doesn’t prove superiority of one sperm processing method over another.
Control group showed the least IR and LBR, emphasising the role of advanced sperm selection technique in men with APA and raised sperm DFI to otpimize reproductive outcomes.

Limitations, reasons for caution
Small sample size with retrospective data. Role of PGT-A in such group of men to optimize reproductive outcomes needs further research.

Wider implications of the findings
Shortening the time to preganacy is one of the endeavours in Infertility treaments, offering a suitable sperm processing method to optimize reproductive outcome can be a favourable add on, in Assited reproductive Treatment cycles.

Trial registration number
N/A