TESE-Derived Sperm Create Significantly More Euploid Embryos as Compared to the Ejaculated Sperm with High DNA Fragmentation

Objective: High sperm DNA fragmentation (SDF) results in more aneuploid embryos. Although sperm retrieved by testicular sperm extraction (TESE) has low SDF as 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 embryos generated by TESE or ejaculated sperm with increased SDF. Methods: The blastocysts were generated by ICSI. The preimplantation genetic testing for aneuploidy (PGT-A) was achieved by next-generation sequencing (NGS). This study utilized 400 embryos; 200 in each group. The sperm DNA fragmentation was determined by 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 embryos showed significantly higher percentage of euploid embryos (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 source (TESE / ejaculate) was an independent predictor of euploid embryos [OR = 1.85; 95% CI = 1.05 - 3.26; p = 0.034]. The probability of having euploid embryos decreased by 6% for every 1% increase in the SDF. The increased age of female was a major negative predictor [OR = 0.92 per year; 95% CI = 0.88 - 96; p = 0.001]. Conclusion: TESE-derived sperm with low SDF resulted in significantly higher euploid embryos as compared to the ejaculated sperm with increased SDF.