PD25-01 DOES THE USE OF TESTICULAR SPERM IMPROVE OUTCOMES IN NON-AZOOSPERMIC COUPLES WITH PREVIOUS IN-VITRO FERTILIZATION (IVF) FAILURE USING EJACULATED SPERM?

INTRODUCTION AND OBJECTIVE: The use of testicular sperm for prior in-vitro fertilization (IVF) failure has been shown to have higher clinical pregnancy rates (CPR), live birth rates (LBR), and reduced spontaneous abortion (SAB) rates compared to ejaculated sperm (ES). However, some argue that this treatment is an invasive surgical procedure without clear benefit. This study evaluates the outcomes of IVF-intracytoplasmic sperm injection (ICSI) cycles using testicular sperm in non-azoospermic couples with prior IVF failure(s) using ES. METHODS: From 1/2015 to 10/2019, 116 non-azoospermic couples with 1 prior IVF cycle using ES underwent testicular sperm extraction (TESE) for IVF/ICSI. Failed cycles with ES were defined as those not progressing to clinical pregnancy. Outcomes using TESE sperm were compared to the mean values of couples' prior cycles using ES. Primary outcomes included clinical pregnancy rates (CPR) and live birth rates (LBR). Secondary outcomes included fertilization and blastocyst conversion. RESULTS: Among 116 couples, the average number of prior failed IVF cycles using ES was 2.3 (range: 1-8). A total of 140 IVF/ICSI cycles were performed using TESE sperm (116 fresh TESE sperm, 24 frozen/thawed TESE sperm). Of these, there were 71 fresh blastocyst transfers, 31 frozen blastocyst transfers (FET), and 38 cycles without transfer. There were also 9 FETs using supernumerary embryos, for a total of 111 embryo transfers. Compared to ES, IVF/ICSI using TESE sperm significantly improved blastocyst development (p[0.003), blastocyst conversion (p[0.003) and number of embryos available for vitrification (p[0.003). A subset of men (n[ 66) had a sperm DNA fragmentation (SDF) assessment of ES. Mean SDF was 45% (790%). Of these 66 men, 55 (83%) had an SDF >25%. The outcomes for patients with elevated SDF did not differ significantly from the overall cohort. CONCLUSIONS: In non-azoospermic couples with prior failed IVF cycles using ES, IVF/ICSI using TESE sperm may improve embryo development, CPR and LBR. Testicular sperm may avoid the adverse effects of elevated SDF from ES and improve pregnancy outcomes in some patients. Further randomized studies are needed to determine if such a benefit exists. Source of Funding: None