Post-wash total motile sperm count a useful predictor in the decision to perform IVF/ICSI in patients with non-male factor infertility
Introduction: The unrestricted use of intracytoplasmic sperm injection (ICSI) for non-male factor infertility is associated with adverse outcomes. Post-wash total motile sperm count (PW-TMSC) offers prognostic value to assess sperm quality and aid in the decision to perform in vitro fertilization (IVF) or ICSI.
Objectives: The aim of this study was to identify the effect of PW-TMSC on fertilization rates in patients undergoing IVF cycles exclusively with non-male factor infertility. It also aimed to identify whether unnecessary ICSI could be avoided in such cases, thus maximizing optimal outcomes.
Materials & Methods: We retrospectively analyzed age, semen volume, prewash TMSC, and PW-TMSC in 68 conventional IVF cycles of infertile couples with non-male factor infertility. Clinical characteristics including female age, number of follicles, level of estradiol on trigger day, mature cumulus-oocyte complexes (COCs) collected, were also included.
Results: Incidence of <30% fertilization was significantly higher in the 4-<10 Million group compared with the ≥20 Million post-wash TMSC group (P<0.001). Furthermore, Receiver operating characteristics (ROC) analysis revealed post-wash TMSC as a significant predictor (P<0.05) of total failed fertilization (TFF) and of ≥30% fertilization (P<0.05) with area under curve (AUC) of 0. 79 and 0.77, respectively, with a deemed cutoff of 10.89 Million.
Conclusion: Post-wash TMSC is a good predictor of fertilization; it can help in avoiding potentially low or even total fertilization failure (TFF). A cut-off point of 10.89 Million or less should warrant the use of ICSI.
Sarkar NN. Intracytoplasmic sperm injection: an assisted reproductive technique and its outcome to overcome infertility. J Obstet Gynaecol. 2007; 27(4):347-53.
Benadiva CA, Nulsen J, Siano L, Jennings J, Givargis HB, Maier D. Intracytoplasmic sperm injection overcomes previous fertilization failure with conventional in vitro fertilization. Fertility and sterility. 1999; 72(6):1041-4.
The Practice Committees of the American Society for Reproductive Medicine and Society for Assisted Reproductive Technology. Intracytoplasmic sperm injection (ICSI) for non-male factor infertility: a committee opinion. Fertility and Sterility. 2012; 98(6):1395-9.
Saad-Naguib M, Krishnamoorthy K, Kwal J, Brackett N, Attia G. The use of semen parameters to decide between conventional in vitro fertilization (IVF) and IVF combined with intracytoplasmic sperm injection (ICSI). Gynecology and Reproductive Endocrinology. 2018) cited 2019 Jul 7);2(1).
Shuai HL, Ye Q, Huang YH, Xie BG. Comparison of conventional in vitro fertilisation and intracytoplasmic sperm injection outcomes in patients with moderate oligoasthenozoospermia. Andrologia. 2015; 47(5):499-504.
Nagy ZP, Oliveira SA, Abdelmassih V, Abdelmassih R. Novel use of laser to assist ICSI for patients with fragile oocytes: a case report. Reprod Biomed Online. 2002;4(1):27-31.
Bhattacharya S, Hamilton MP, Shaaban M, Khalaf Y, Seddler M, Ghobara T, et al. Conventional in-vitro fertilisation versus intracytoplasmic sperm injection for the treatment of non-male-factor infertility: a randomised controlled trial. Lancet. 2001; 357(9274):2075-9.
Hart R, Norman RJ. The longer-term health outcomes for children born as a result of IVF treatment: Part I–General health outcomes. Hum Reprod update. 2013; 19(3):232-43.
Kissin DM, Zhang Y, Boulet SL, Fountain C, Bearman P, Schieve L, et al. Association of assisted reproductive technology (ART) treatment and parental infertility diagnosis with autism in ART-conceived children. Hum Reprod. 2014; 30(2):454-65.
Wiser A, Ghetler Y, Gonen O, Piura E, Berkovits A, Itskovich A, et al. Re-evaluation of post-wash sperm is a helpful tool in the decision to perform in vitro fertilisation or intracytoplasmic sperm injection. Andrologia. 2012; 44(2):73-7.
Van Voorhis BJ, Barnett M, Sparks AE, Syrop CH, Rosenthal G, Dawson J. Effect of the total motile sperm count on the efficacy and cost-effectiveness of intrauterine insemination and in vitro fertilization. Fertility and sterility. 2001; 75(4):661-8.
Badawy A, Elnashar A, Eltotongy M. Effect of sperm morphology and number on success of intrauterine insemination. Fertility and sterility. 2009; 91(3):777-81.
Borges E, Setti AS, Braga DP a. F, Figueira RCS, Iaconelli A. Total motile sperm count has a superior predictive value over the WHO 2010 cut-off values for the outcomes of intracytoplasmic sperm injection cycles. Andrology. 2016; 4(5):880-6.
Repping S, van Weert J-M, Mol BW, de Vries JW, Van der Veen F. Use of the total motile sperm count to predict total fertilization failure in in vitro fertilization. Fertility and sterility. 2002; 78(1):22-8.
Donnelly ET, Lewis SE, McNally JA, Thompson W. In vitro fertilization and pregnancy rates: the influence of sperm motility and morphology on IVF outcome. Fertil Steril. 1998; 70(2):305-14.
van Weert J-M, Repping S, Van Voorhis BJ, Van Der Veen F, Bossuyt PM, Mol BW. Performance of the postwash total motile sperm count as a predictor of pregnancy at the time of intrauterine insemination: a meta-analysis. Fertility and sterility. 2004; 82(3):612-20.
Rhemrev JP, Lens JW, McDonnell J, Schoemaker J, Vermeiden JP. The postwash total progressively motile sperm cell count is a reliable predictor of total fertilization failure during in vitro fertilization treatment. Fertility and sterility. 2001; 76(5):884-91.
Organisation WH. WHO laboratory manual for the examination of human semen and sperm-cervical mucus interaction. Cambridge university press; 1999.
Griffiths TA, Murdoch AP, Herbert M. Embryonic development in vitro is compromised by the ICSI procedure. Hum Reprod. 2000; 15(7):1592-6.
Sakkas D, Ramalingam M, Garrido N, Barratt CL. Sperm selection in natural conception: what can we learn from Mother Nature to improve assisted reproduction outcomes? Hum Reprod update. 2015; 21(6):711-26.
Oshio S, Kaneko S, Iizuka R, Mohri H. Effects of gradient centrifugation on human sperm. Arch Androl. 1987; 19(1):85-93.
Marchesi DE, Pan Y, Di W, Hawkins E, Hershlag A. Does sperm DNA integrity predict IVF outcomes? Fertility and Sterility. 2013; 100(3):S225.
Thakore S, Strumbly D, Patel B, Collins G, Ahmady A. Comparison of pre-wash and post-wash sperm morphological indices with pregnancy outcomes in intrauterine insemination and in vitro fertilization. Fertility and Sterility. 2015; 104(3):e245-6
Ghirelli-Filho M, Mizrahi FE, Pompeo ACL, Glina S. Influence of strict sperm morphology on the results of classic in vitro fertilization. Int Braz J Urol. 2012; 38(4):519-28.
Tavares RS, Silva AF, Lourenço B, Almeida-Santos T, Sousa AP, Ramalho-Santos J. Evaluation of human sperm chromatin status after selection using a modified Diff-Quik stain indicates embryo quality and pregnancy outcomes following in vitro fertilization. Andrology. 2013 Nov 1 (cited 2020 Mar 11);1(6):830–7.
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