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A treatment algorithm for couples with unexplained infertility based on sperm chromatin assessment
OBJECTIVE: To design a reproductive treatment algorithm based on the sperm DNA fragmentation (SDF) for couples with unexplained infertility following a poor intrauterine insemination (IUI) outcome. DESIGN: Couples that failed IUI with no apparent reproductive issue in both partners were allocated to...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer US
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6150896/ https://www.ncbi.nlm.nih.gov/pubmed/30056595 http://dx.doi.org/10.1007/s10815-018-1270-x |
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author | O’Neill, C. L. Parrella, A. Keating, D. Cheung, S. Rosenwaks, Z. Palermo, G. D. |
author_facet | O’Neill, C. L. Parrella, A. Keating, D. Cheung, S. Rosenwaks, Z. Palermo, G. D. |
author_sort | O’Neill, C. L. |
collection | PubMed |
description | OBJECTIVE: To design a reproductive treatment algorithm based on the sperm DNA fragmentation (SDF) for couples with unexplained infertility following a poor intrauterine insemination (IUI) outcome. DESIGN: Couples that failed IUI with no apparent reproductive issue in both partners were allocated to diverse reproductive treatments on the basis of SDF. SETTING: Reproductive medical center in an academic setting. PATIENT(S): Over 4 years, couples with an unexpected poor IUI outcome and no apparent female or male partner reproductive issues were recruited. INTERVENTION(S): IUI, IVF, and ICSI were performed in the standard fashion following sperm SDF assays. MAIN OUTCOMES MEASURE(S): Fertilization rate, implantation rate, pregnancy characteristics, and delivery rates. RESULT(S): A total of 354 couples with unexplained infertility and normal semen parameters underwent 1133 IUI cycles. Clinical pregnancy rate (CPR) with IUI at our center in an age-matched cohort is 23.9% while the study cohort had 1.8%. Following SDF assessment, couples with failed IUI attempts but normal SDF (SCSA 9.8 ± 4.6%; TUNEL 11.8 ± 6.2%) underwent IVF with a CPR of 12.7%; those with abnormal SDF underwent ICSI with ejaculated spermatozoa, resulting in a CPR of 18.7%. This group included couples with normal SDF that had failed IVF. Couples with abnormal SDF that failed ICSI with ejaculated spermatozoa achieved a CPR of 31.0% with surgically retrieved spermatozoa. CONCLUSION(S): Couples with unexplained infertility that present with unexpectedly poor IUI outcomes can be funneled into a treatment algorithm guided by the integrity of the sperm genome for higher chances of pregnancy using an alternate method of insemination. |
format | Online Article Text |
id | pubmed-6150896 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | Springer US |
record_format | MEDLINE/PubMed |
spelling | pubmed-61508962018-10-01 A treatment algorithm for couples with unexplained infertility based on sperm chromatin assessment O’Neill, C. L. Parrella, A. Keating, D. Cheung, S. Rosenwaks, Z. Palermo, G. D. J Assist Reprod Genet Assisted Reproduction Technologies OBJECTIVE: To design a reproductive treatment algorithm based on the sperm DNA fragmentation (SDF) for couples with unexplained infertility following a poor intrauterine insemination (IUI) outcome. DESIGN: Couples that failed IUI with no apparent reproductive issue in both partners were allocated to diverse reproductive treatments on the basis of SDF. SETTING: Reproductive medical center in an academic setting. PATIENT(S): Over 4 years, couples with an unexpected poor IUI outcome and no apparent female or male partner reproductive issues were recruited. INTERVENTION(S): IUI, IVF, and ICSI were performed in the standard fashion following sperm SDF assays. MAIN OUTCOMES MEASURE(S): Fertilization rate, implantation rate, pregnancy characteristics, and delivery rates. RESULT(S): A total of 354 couples with unexplained infertility and normal semen parameters underwent 1133 IUI cycles. Clinical pregnancy rate (CPR) with IUI at our center in an age-matched cohort is 23.9% while the study cohort had 1.8%. Following SDF assessment, couples with failed IUI attempts but normal SDF (SCSA 9.8 ± 4.6%; TUNEL 11.8 ± 6.2%) underwent IVF with a CPR of 12.7%; those with abnormal SDF underwent ICSI with ejaculated spermatozoa, resulting in a CPR of 18.7%. This group included couples with normal SDF that had failed IVF. Couples with abnormal SDF that failed ICSI with ejaculated spermatozoa achieved a CPR of 31.0% with surgically retrieved spermatozoa. CONCLUSION(S): Couples with unexplained infertility that present with unexpectedly poor IUI outcomes can be funneled into a treatment algorithm guided by the integrity of the sperm genome for higher chances of pregnancy using an alternate method of insemination. Springer US 2018-07-28 2018-10 /pmc/articles/PMC6150896/ /pubmed/30056595 http://dx.doi.org/10.1007/s10815-018-1270-x Text en © The Author(s) 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. |
spellingShingle | Assisted Reproduction Technologies O’Neill, C. L. Parrella, A. Keating, D. Cheung, S. Rosenwaks, Z. Palermo, G. D. A treatment algorithm for couples with unexplained infertility based on sperm chromatin assessment |
title | A treatment algorithm for couples with unexplained infertility based on sperm chromatin assessment |
title_full | A treatment algorithm for couples with unexplained infertility based on sperm chromatin assessment |
title_fullStr | A treatment algorithm for couples with unexplained infertility based on sperm chromatin assessment |
title_full_unstemmed | A treatment algorithm for couples with unexplained infertility based on sperm chromatin assessment |
title_short | A treatment algorithm for couples with unexplained infertility based on sperm chromatin assessment |
title_sort | treatment algorithm for couples with unexplained infertility based on sperm chromatin assessment |
topic | Assisted Reproduction Technologies |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6150896/ https://www.ncbi.nlm.nih.gov/pubmed/30056595 http://dx.doi.org/10.1007/s10815-018-1270-x |
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