Asian Journal of Andrology, Journal Year: 2024, Volume and Issue: unknown

Published: Sept. 3, 2024

High levels of sperm DNA fragmentation (SDF) are associated with reduced assisted reproductive technology (ART) outcomes. Currently, SDF is not included in routine clinical assessment male partners infertile couples, but the 6th edition World Health Organization (WHO) manual for semen analysis chapter on extended examinations. evaluation may be indicated several conditions that have been shown to affect and increase fragmentation. In cases high levels, clinician will attempt correct any reversible factors treat patients empirically antioxidants. If persist despite empirical treatment, intracytoplasmic injection (ICSI) indicated. During ICSI, embryologists can employ advanced selection procedures, reduce proportion spermatozoa fragmentation, although no procedure ensure only non-DNA-fragmented selected. consists single- or double-strand breaks backbone nucleic acid. It occur because activation apoptotic pathway, derangement process chromatin maturation during spermatogenesis, due an oxidative insult transit genital tract after spermiation.1–3 elevated men3 adverse outcomes many studies.4 Considering cannot distinguish between fertile men (with some exceptions), WHO Laboratory Examination Processing Human Semen5 section examination. measured by methods.5 Among most popular assays, it important those evaluate susceptibility damage (sperm dispersion [SCD] structure assay [SCSA]), from occurrence real (terminal deoxynucleotidyl transferase dUTP nick end labeling [TUNEL] Comet). For these methods, suggested laboratories should establish their own thresholds.5 This poses problems standardization assays.5 Published original research recent meta-analyses according method used measuring suggest TUNEL Comet assays are, general, better predictors such as fertilization rates, embryo quality, implantation miscarriage, live birth.6–8 WHEN TO ORDER AN TEST? among diagnostic tests infertility where a possible risk factor present. Several reported SDF.9,10 These include varicoceles, leukocytospermia, recurrent pregnancy loss, intrauterine insemination (IUI), vitro (IVF) ICSI failure, obesity, age (Table 1). Although there substantial evidence suggesting poorer ART outcomes, all societies' guidelines recommend men.3 lack gold standard technique, variable cut-off studies equivocal bias couple low-quality study design SDF. noted spermatozoon fragmented motile, viable, functional, oocyte ability repair damaged fertilization.11 However, impaired aged women ovarian pathologies affecting function.11 Indeed, when donor oocytes young healthy employed ART, correlation found outcomes.12 Therefore, also evaluated couples unexplained miscarriages, quality compromised.Table 1: Main indications based current literatureHOW DEAL WITH ELEVATED SDF? Clinicians approach utilizing following strategies: (1) offer treatment patient decrease (2) proceed using low selected techniques (e.g., Z microfluidic sorting; Figure The option offered depends female advisable without further delay.Figure Sperm preparation demonstrated lower levels. SDF: fragmentation; MACS: magnetic cell IMSI: morphological injection; PICSI: physiological HA: hyaluronic acid.The first line lifestyle changes which short abstinence, adequate rest, proper diet, weight reduction applicable, cessation smoking.13,14 Known correctable clinically significant varicoceles infections treated. Another strategy antioxidants, considering stress cause damage.1 Some positive effect antioxidants SDF;1,3 however, few them randomized controlled trials (RCT), systematic review selecting three eligible RCT did find SDF.15 With regard apoptosis involved induction SDF, follicle-stimulating hormone (FSH), reduces testis apoptosis, has hypogonadal FSH levels.16 According results survey promoted Global Andrology Forum,17 almost 80% clinicians modifications, while about 77% would prescribe empiric Only minority shorter abstinence (38%) use (about 21%). techniques, potential options, birefringent assessment, (PICSI) acid, (IMSI), others,18,19 select healthier (Figure 1 shows techniques). easy embryologist determine suitable, effective, least time-consuming available techniques. Most, if all, SDF,18 none assures expected still methods assess destroying it; hence, unable utilize testing ideal sperm. addition, whether leads improved remains controversial20 multifactorial causes infertility. A significantly increases rate euploidy (from 25.3% 42.9%, P < 0.001) previous outcomes.21 Microfluidic proposed more efficient compared other sperm-sorting sorting (MACS) acid selection.22 employing microfluidics show favorable high-quality needed confirm practice. Ideally, robust point-of-care viable allow ejaculate produced immediate fertility avoid inconsistencies each ejaculate. Evidence testicular-extracted ones, data fully support this conclusion.23 explained hypothesis suffer reactive oxygen species (ROS) along seminal pathways.2 Elevated frequently detected elderly subjects scrotum, seminiferous tubules poorly protected microtraumas, various factors.24 Thus, man ages over years, accessory gland inflammation. studies, level, confirmed higher cumulative birth could achieved ejaculated elevated. cases, worthwhile perform testicular extraction (TESE) ICSI.25,26 CLINICAL CASES To illustrate index improve here, we discuss 3 who were going through treatments. scenarios demonstrate assessing abovementioned IVF treatments result chances pregnancy. case under Ethical Committee Canton Ticino, Bellinzona, Switzerland (Approval No. 2020-01580 CE 3689), permits scientific publications. Case 40-year-old heavy smoker, married 36-year-old woman, difficulty conceiving 5 years. Fertility revealed moderate–severe oligoasthenoteratozoospermia (OATS) only. experienced miscarriage 2019 partner underwent varicocele 2020. four unsuccessful IUIs 2021 2022. Twelve mature (MII) injected, 6 fertilized, resulting obtained blastocysts cryopreserved. single blastocyst transfers, they failed conceive. Andrological consultation was performed man, normal genitalia profile. April 2023, new moderate OATS, abnormal (SCD: 35%; aniline blue staining: 37%). month, MACS, resulted pretreatment SCD 40% posttreatment 7%). cycle, MII MACS-selected spermatozoa, attainment blastocysts. transfer one delivery newborn 11, 2024. Four remained 2 couple, both being 36 years old, came conceive 3.5 comprehensive andrological had severe FSH, luteinizing (LH), total testosterone karyotype, genetic testing, whereas showed anti-Müllerian (AMH) 0.97 ng ml−1 (usually above ml−1) 11.0 mUI ml−1. 2021, cycles Unfortunately, March revealing volume ml OATS concentration 1.6 × 106 (normal level: >15 motility 4% ≥40%), morphology 1% ≥4%). note sample very viability (20%) 69%; acridine orange test: 45%; 32%). semen, amenable strategies, TESE right arranged concurrently his wife's cycle. 9 fresh spermatozoa. cycle followed August 2023. second November 2023 failed. third cryopreserved transferred February 2024, ongoing currently at 12th week gestation. Five vials remain 33 presented 22 months duration. obese (130 kg 186 cm height), apparently good health, slight gynecomastia. Normal testes, epididymis, vasa examination varicocele. Hormone profile normal. woman gynecologically normal, apart AMH 0.80 ml−1). Semen analyses concentration: 0.2 ×106–3.0 ml−1; motility: 18% slow progressive). Routine An performed; retrieved fertilization. same submitted test 70% taking urofollitropin 150 IU times per week, human chorionic gonadotropin (hCG) 2000 twice trying lose he sought medical consultation. May invited provide two ejaculates h. 5.6 OATs leukocytospermia: 0.8 12% progressive; 1%; leukocytes 6.8 evidenced 52% similar abnormalities before: 2.2 ml; 1.3 3% rapid progressive 20% 6.4 43% Leukocytospermia considered symptoms signs July simultaneously partner's pickup, microsurgical (micro-TESE) yielded recovery number quality. Nine injected oocytes, fertilized cryopreserved; remaining (6 vials). September 35 weeks. KEY POINTS impact Its help process. technique nor acceptable established. success ICSI. COMMENTS demanding women, its successful outcome including viability. additional criterion welcome, limitations. Since 2018, European Academy (EAA) Guidelines "suggest addition integrity (if laboratory experience) get information couple's chance spontaneous reproduction."25 Similarly, manual,5 evaluations certain circumstances. Better-quality unlikely future, difficulties enrollment prospective trials. prudent apply sound judgment existing referring ICSI.25 preliminary conjunction protocols, take-home-baby IVF. AUTHOR CONTRIBUTIONS EB GMC wrote manuscript. ZWH, BB, BF, SR reviewed edited ZWH contributed creation 1. AA coordinated work authors checked final version. All read approved COMPETING INTERESTS declare competing interests.

Language: Английский