Presentation Authors: Alexandra Berger*, Valary Raup, Ramy Abou Ghadya, Anne Thomas, Martin Kathrins, Boston, MA
Introduction: An inability to obtain sperm for in-vitro fertilization (IVF) exposes the female partner to potentially avoidable risks and costs of ovulation induction and oocyte retrieval. We sought to investigate the incidence of failed fresh IVF cycles due to an inability to obtain sperm, as well as describe predictors for subsequent IVF cycles.
Methods: The Society for Assisted Reproductive Technology (SART) Clinical Outcome Report System database (2014-2016) was used to identify all fresh IVF cycles for which there was failure to obtain sperm. Patient linkage information was utilized to determine the outcomes of subsequent IVF cycles. Chi squared tests and logistic regression were used.
Results: 243,291 total fresh IVF cycles were identified, with 719 cycles (710 couples) listing "inability to obtain sperm" as reason for embryo non-transfer (0.3%). (Table 1) Male infertility was the reason for IVF in only 537 (75%) cycles. Ejaculation was the most common anticipated sperm source (414, 57%), followed by testicular biopsy (251, 35%) and epididymal aspirate (50, 7%). Most cycles resulted in retrieved oocytes (713, 99.2%), but oocytes were cryopreserved in only 627 (87.2%). 265 (37%) of couples underwent subsequent IVF cycles. On multivariable analysis, lack of cryopreservation of oocytes on initial cycle (OR 0.28, p=0.0001) and an initial diagnosis of male infertility (OR 0.53, p=0.014) were associated with failure to undergo subsequent cycles. Donor sperm was used in 52 (19%) second cycles. Of the couples who used partner sperm, method of sperm retrieval was largely conserved (181/213, 85%). Embryos were transferred in 186 (70%) of second cycles, with a clinical pregnancy rate of 34% (89/265) and live birth rate of 28% (73/265). Failed embryo transfers during second IVF cycle were due to repeat inability to obtain sperm (5, 6.4%), oocyte/embryologic reasons (52, 65.8%) and other (13, 16.5%).
Conclusions: Failure to obtain sperm during fresh IVF cycles is rare, occurring only 0.3% of the time (1 in 338 cycles). While uncommon, planning a fresh IVF cycle should be undertaken with caution in men with known male factor infertility, as these failed cycles expose the female partner to unnecessary medical risk and cost. Further studies are necessary to determine predictors of inability to obtain sperm for fresh IVF cycles.