A major obstacle to achieving pregnancy in assisted reproductive technology is high sperm DNA fragmentation (SDF) which results in embryos with chromosomal abnormalities. 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 either by TESE or ejaculated sperm with increased SDF. A prospective cohort study on 400 embryos was carried out. The preimplantation genetic testing for aneuploidy (PGT-A) was achieved by next-generation sequencing (NGS). The sperm DNA fragmentation was measured by Halosperm G2 assay. Embryos were cultured to the blastocyst stage. The trophectoderm biopsies were performed on day-5. 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.
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]. The results of this study showed that extraction of testicular sperm presented statistically significant benefit in the creation of euploid embryos over ejaculated sperm with high SDF. These results warrant the use of TESE as a clinical treatment in high SDF cases to increase the success of IVF and decrease embryo wastage.