Effect Of Different Sperm Sources And Relevant Operation Time On ICSI Outcomes

Objective: To compare the reproductive outcomes between testicular and ejaculated sperm in intracytoplasmic sperm injection(ICSI)cycles and to evaluate the outcomes of denudation and injection timing with the use of testicular(Testi-ICSI)versus ejaculated(Ejac-ICSI)sperm.Methods: This is a single-center retrospective analysis of 370 patients,415 ICSI cycles performed in the Fourth Hospital of Hebei Medical University from February 2016 to July 2020.The patients were divided into two groups according to sperm sources: semen group and TESA group.According to the denudation timing and injection timing,patients were grouping with:(i).T1(ovum pick-up to denudation time interval): T1A1(≤3h)and T1B1(>3h),(ii).T2(denudation to injection time interval): T2A2(≤2h)and T2B2(>2h),(iii).T3(ovum pick-up to injection time interval): T3A3(≤5h)and T3B3(>5h).Results: 1.The 2PN fertilization rate,cleavage rate and good quality embryo rate of semen group were significantly higher than those in TESA group(P<0.05).There were no significant differences in total fertilization rate,blastocyst rate,utilizable blastocyst rate,implantation rate,clinical pregnancy rate,live birth rate and abortion rate between semen group and TESA group(P>0.05).2.There were positive correlations between T1 and 2PN fertilization rate,total fertilization rate(P<0.05)and there were no correlations between T1 and cleavage rate,good quality embryo rate,blastocyst rate,utilizable blastocyst rate(P>0.05).There was negative correlation between T2 and blastocyst rate(P<0.05)and there were no correlations between T2 and 2PN fertilization rate,total fertilization rate,cleavage rate,good quality embryo rate,utilizable blastocyst rate(P>0.05).There was positive correlation between T3 and total fertilization rate(P<0.05)and there were no correlations between T3 and 2PN fertilization rate,cleavage rate,good quality embryo rate,blastocyst rate,utilizable blastocyst rate(P>0.05).3.In semen group: The 2PN fertilization rate,total fertilization rate and blastocyst rate of T1B1 were significantly higher than those in T1A1(P<0.05).There were no significant differences in cleavage rate,good quality embryo rate,blastocyst rate,utilizable blastocyst rate,implantation rate,clinical pregnancy rate,live birth rate and abortion rate between T1A1 and T1B1(P>0.05).The utilizable blastocyst rate of T2B2 was significantly higher than that in T2A2(P<0.05).There were no significant differences in 2PN fertilization rate,total fertilization rate,cleavage rate,good quality embryo rate,blastocyst rate,implantation rate,clinical pregnancy rate,live birth rate and abortion rate between T2A2 and T2B2(P>0.05).The 2PN fertilization rate and total fertilization rate of T3B3 was significantly higher than those in T3A3(P<0.05),but the good quality embryo rate of T3A3 was significantly higher than that in T3B3(P<0.05).There were no significant differences in cleavage rate,blastocyst rate,implantation rate,clinical pregnancy rate,live birth rate and abortion rate between T3A3 and T3B3(P>0.05).4.In TESA group,the 2PN fertilization rate,total fertilization rate,clinical pregnancy rate and live birth rate of T1B1 were significantly higher than those in T1A1(P<0.05).There were no significant differences in cleavage rate,good quality embryo rate,blastocyst rate,utilizable blastocyst rate,implantation rate and abortion rate between T1A1 and T1B1(P>0.05).There were no significant differences in 2PN fertilization rate,total fertilization rate,cleavage rate,good quality embryo rate,blastocyst rate,utilizable blastocyst rate,implantation rate,clinical pregnancy rate,live birth rate and abortion rate between T2A2 and T2B2(P>0.05).The abortion rate of T3B3 was significantly lower than that in T3A3(P<0.05).There were no significant differences in 2PN fertilization rate,total fertilization rate,cleavage rate,good quality embryo rate,blastocyst rate,utilizable blastocyst rate,implantation rate,clinical pregnancy rate and live birth rate between T3A3 and T3B3(P>0.05).Conclusions:1.The laboratory outcomes in semen group are better than those in TESA group,whereas there are no differences between two groups in the clinical outcomes.2.Prolonging oocyte culture time at least 3 hours before denudation can increase the fertilization rate.3.In semen group,prolonging oocyte culture time more than 2 hours after denudation can a decrease the blastocyst rate.4.Performing injection within 5 hours after OPU has a positive effect on the laboratory outcomes.