Abstract

Objective: High sperm DNA fragmentation (SDF) results in fewer euploid embryos. Although sperm retrieved by testicular sperm extraction (TESE) has low SDF compared to the ejaculated sperm, there is little data comparing the prevalence of chromosomal abnormalities in the resulting embryos. The objective of this study was to compare rates of chromosomal abnormalities in blastocysts from sperm obtained either by TESE or ejaculate with high SDF. Methods: The blastocysts were generated by ICSI in both groups. The preimplantation genetic testing for aneuploidy (PGT-A) was performed by next-generation sequencing (NGS). This study utilized 2242 blastocysts from 400 couples; 200 couples in each group. The TESE-retrieved sperm and ejaculated sperm with high SDF had 1037 and 1205 blastocysts, respectively. The sperm DNA fragmentation was determined by the Halosperm G2 assay. The rates of euploid, aneuploid and mosaic embryos were compared by multivariate logistic regression and mixed-effects models that accounted for female age and ovarian reserve. Results: The TESE-derived sperm group had a significantly higher percentage of euploid blastocysts (67.8%) as compared to those derived from ejaculated sperm with high SDF (48.2%, p = 0.003). The multivariate logistic regression indicated that the sperm origin (TESE/ejaculate) was an independent predictor of euploid blastocysts [OR = 1.85; 95% CI = 1.05–3.26; p = 0.034]. The probability of having euploid blastocysts decreased by 6% for every 1% increase in the SDF. The increased age of the female was a major negative predictor [OR = 0.92 per year; 95% CI = 0.88–96; p = 0.001]. Conclusions: The TESE-derived sperm group had significantly higher euploid blastocysts as compared to the ejaculated sperm with high SDF group.

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