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Solutions for Male Infertility at Barcelona Conference

September 27, 2018
Katie Visco

Early this July, the European Society of Human Reproduction and Embryology (ESHRE) held their annual meeting in Barcelona, Spain from July 1-4. This meeting is a global collaboration with 130 countries in attendance and a record number of 12,179 participants present. The ESHRE is an ambitious effort to constantly propel knowledge, research, and fertility practice forward to better understand the causes of, cures for, and nature of infertility.

Ovation Fertility, a national network of IVF labs of more than 50 scientists and doctors, presented abstracts and results by 14 scientists and reproductive endocrinologists. In particular, they studied how different sperm retrieval methods can affect the developing embryo in their presentation “Euploid Rate of Embryos Derived From Aspirated and Ejaculated Sperm.” Read further to learn about what Ovation Fertility is discovering in this area:

  • Background information on sperm retrieval methods
  • A summary of the study
  • What the study means for the future

Background Info

As noted in previous articles, male infertility is more common than most people think. In fact, it is estimated that one in 20 men have some kind of fertility problem, and most of the time, it is related to either sperm quality or quantity. In addition, two-thirds of infertile men have a problem making sperm in the testes.

This is all applicable to Ovation Fertility’s study, as it compared the embryos fertilized with sperm ejaculated, as usual, with embryos fertilized with sperm obtained through other methods to combat fertility problems. Two of the sperm retrieval methods Ovation Fertility studied were Percutaneous Epididymal Sperm Aspiration (PESA) and testicular sperm aspiration (TESE). Both methods are used for sperm intended for IVF.

baby in air
One in 20 men have a fertility problem, and two-thirds of these have difficulties producing viable sperm.

The Study

Ovation Fertility scientists examined the difference in the quality of embryos depending on the source of their sperm in this study. Men struggling with infertility due to azoospermia do not have sperm in the semen, so sperm needs to be retrieved from the testis or epididymis instead. This is where PESA and TESE come in--both are alternative methods of sperm retrieval. While PESA is usually used for men with obstructive azoospermia, TESE is used for nonobstructive azoospermia.

Ovation Fertility examined embryos fertilized with sperm obtained through PESA, TESE, and ejaculated sperm. Eggs were fertilized with the sperm through intracytoplasmic sperm injection (ICSI), and the resulting embryos were cultured for 7 days.

The study examined the quality of the embryos on days 5, 6, and 7 by using next-generation sequencing (NGS), a groundbreaking DNA sequencing technology. In total, 992 embryos were examined: 751 ejaculated sperm, 114 TESE, and 127 PESA sperm-sourced embryos. The study looked at euploid rates, the number of embryos that had the correct number of chromosomes (46) since euploid embryos are more likely to be implanted successfully, result in successful pregnancies, and have lower chances of miscarriage. Euploid rates were the highest for TESE sperm at 57%, then 50% for ejaculated sperm and 43% for PESA sperm.

DNA
‍Ovation Fertility used next-generation sequencing to examine the DNA of the embryos. (Photo: courtesy of Genetic Literacy Project)

What It Means

The similarities in the euploid rates in these different kinds of embryos is encouraging. Sperm acquired through non-natural methods such as TESE and PESA fared well compared to ejaculated sperm.

The study noted that “Ejaculated sperm euploid rate was not found to be significantly different between TESE and PESA” and that ultimately, the results showed that “Micro-surgical sperm aspiration procedures (PESA and TESE) followed by ICSI and PGS are all suitable approaches for treating azoospermia.”

This study, then, verifies, that PESA and TESE as sperm retrieval methods will bring similar results in the embryo as ejaculated sperm. It’s amazing how these procedures can create similar and even better results to a natural process.

child and father walking

However, since PESA embryos had the lowest euploid rate, the study noted that sperm extracted from the epididymis through PESA may have altered DNA that causes a higher chance of aneuploidy in the embryo. In response to this, the researchers noted, “Our findings suggest that sperm retrieved prior to further maturation in the epididymis, may be more effective to treat male patients with azoospermia.”

Overall, global meetings where the smartest reproductive endocrinologists and scientists share their knowledge and research will propel ART forward, especially considering the different cultural and social factors that influence attitudes towards ART. There are many of these conferences that focus on gynecology, obstetrics, infertility, and sexual health through the year.  Ovation Fertility in particular focuses “on reducing the cost of live birth through more efficient and effective fertility care.” Not only will these conference improve ART and reproductive knowledge, but knowing more about the chances of success with different methods will save money in the long run when deciding which method to use.

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