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Fertility Treatment for Sperm DNA Fragmentation
A sperm DNA fragmentation assessment can help determine appropriate fertility treatment in infertile men with normal semen parameters who have a failed IUI cycle. A recent study by Weill Cornell Medical College analyzed the efficiency of different fertility treatment methods by comparing pregnancy rates between normal and abnormal sperm DNA fragmentation cohorts in relation to IUI, IVF and IVF with ICSI. The researchers determined, “For men with compromised sperm DNA fragmentation in their ejaculate, ICSI confirms to be the best insemination method with ejaculated sperm. For men who have compromised sperm nuclear DNA that failed ICSI, a testicular sampling yielded superior clinical outcome.”
A sperm chromatin DNA fragmentation assesses the integrity of the nucleus of the sperm, explains Dr. Gianpiero Palermo, Director of Assisted Fertilization and Andrology at the Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine at Cornell, one of the world's largest ICSI programs. “The claim is that when the chromatin is highly fragmented in the sperm, the embryo does not implant or implants poorly."
Patients who had a failed IUI cycle had DNA fragmentation testing. If the results were normal, the sperm was determined to be normal, and the patient’s next treatment was IVF. If pregnancy didn’t result from IVF, the next treatment was IVF with ICSI.
“The theory is that with ICSI, because we select the most motile spermatozoa, they have more integrity. When a sperm stops moving, the membrane is damaged and the chromatin is more damaged. That’s the rationale,” Palermo says.
If pregnancy did not result following ICSI, the male underwent a testicular biopsy to retrieve sperm from the testicle. In theory the sperm from the testicle should be less traumatized then sperm that goes through the male reproductive tract, he says. This provides a higher pregnancy rate.
The outcomes of the study, and the algorithm developed can help determine the best route to pregnancy when the male has sperm DNA fragmentation. “With a patient with sperm DNA fragmentation, we know [standard] IVF will be risky, it will waste money, time and emotion for the patient,” Palermo says.