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New Orleans-Having severe teratospermia does not affect pregnancy outcomes when using in vitro fertilization with intracytoplasmic sperm injection, according to a large retrospective review presented at the American Society for Reproductive Medicine annual meeting by investigators from Weill Medical College of Cornell University, New York.
"This is the first study to evaluate ICSI outcomes with profound teratospermia while controlling for infertility due to female factors," reported first author Maria F. Costantini-Ferrando, MD, PhD, and colleagues. "Our findings suggest there may be no need for donor sperm as a first-line therapy."
The study was a retrospective chart review of 206 couples, 103 with and 103 without a sperm morphology of 0% (based on Kruger's criteria, 0% indicated profound teratospermia and differentiated this group from those with sperm morphology ≥1%). Subjects were consecutively treated between May 1997 and November 2004. All subjects underwent IVF with ICSI. Each egg donor donated to only two couples: one with and one without a sperm morphology of 0%. Analyses were performed while controlling for egg donor factors.
No significant differences in terms of pregnancy, spontaneous abortion, or delivery rates were found between couples with and without profound teratospermia. There were 63 pregnancies in the 0% group and 65 in the ≥1% group; 51 IUPs in the 0% group and 57 in the ≥1% group; 11 spontaneous abortions in the 0% group and 9 in the ≥1% group; and 40 deliveries in the 0% group and 48 in the ≥1% group.
The researchers pointed out that the good pregnancy rates achieved in their sample are helpful when counseling men with profound teratospermia.
The findings also have other implications, according to the investigators. They suggest there may be limited predictive value of Kruger's strict criteria in the case of profound teratospermia with ICSI. Since pregnancy losses between the groups were equal, there is also the suggestion that teratospermia might reflect the inability of the sperm to penetrate the egg, rather than indicate an increase in chromosomal abnormalities of the male gamete, they said.
ASRM attendee Harris M. Nagler, MD, professor and chairman of urology at Beth Israel Medical Center, New York, observed, "Prior to our use of ICSI, when we co-incubated the sperm and egg, these results would be surprising. But since ICSI bypasses the selection criteria and fertilization process, it mainly confirms our current clinical impression. In general, we have not precluded using IVF and ICSI in people with profound teratospermia, and I think this is a nice series that confirms our impressions and shows this is the appropriate way to manage these patients."