Research question

Do donor spermatozoa improve IVF outcomes after first oocyte donation failure?

Design

Retrospective, multicentre study including couples undergoing oocyte donation cycles using autologous or donor spermatozoa after a failed first attempt. Male partners were further characterized as normozoospermic or oligoasthenoteratospermic, i.e. fewer than 5 million motile progressive spermatozoa in the ejaculate. The main outcomes measured were live birth rate (LBR) per embryo transfer, LBR per number of embryos transferred, and cumulative LBR (CLBR) considering oocytes consumed in the previous donation cycles.

Results

Analysis comprised 6065 cycles of oocyte donation failure; among these, subgroup analyses by sperm quality comprised 4113 cycles with severe male factor and 1150 cycles with suboptimal/normal spermatozoa. Sperm replacement in the first cycle after failure increased LBR per embryo transfer (OR 2.21, 95% CI 1.7–2.8, P < 0.001) and per number of embryos transferred (OR 2.46, 95% CI 1.9–3.1, P < 0.001) for normospermic and oligoasthenoteratospermic men. Replacement by the third cycle after failure was less beneficial (LBR per embryo transfer: OR 1.35, 95% CI 0.9–2.1, P = 0.16; LBR per embryos transferred: OR 1.33, 95% CI 0.9–2.0, P = 0.186). Kaplan–Meier curves of CLBR per oocyte fertilized with autologous or donor spermatozoa were statistically different (P < 0.001) and demonstrate how each additional oocyte may affect success based on sperm source (donor/autologous).

Conclusions

Donor spermatozoa improved outcomes when used after an initial failed oocyte donation cycle. The CLBR curves can be used to determine the cumulative chances of live birth using either autologous or donor spermatozoa, providing guidance on when to replace spermatozoa.

中文翻译：

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捐卵失败后，捐献精子会改善生殖结果吗？每个供体卵母细胞消耗的累积活产率的回顾性分析

研究问题

第一次捐卵失败后，捐献精子是否会改善试管婴儿的结果？

设计

回顾性多中心研究包括在首次尝试失败后使用自体或供体精子进行卵母细胞捐赠周期的夫妇。男性伴侣被进一步表征为正常精子症或少弱精子症，即射精中少于 500 万个活动性进行性精子。测量的主要结果是每次胚胎移植的活产率 (LBR)、每移植胚胎数的 LBR 以及考虑到先前捐赠周期中消耗的卵母细胞的累积 LBR (CLBR)。

结果

分析包括 6065 个卵母细胞捐赠失败周期；其中，按精子质量进行的亚组分析包括 4113 个具有严重男性因素的周期和 1150 个具有次优/正常精子的周期。失败后第一个周期的精子置换增加了每次胚胎移植的 LBR (OR 2.21, 95% CI 1.7-2.8, P  < 0.001) 和每移植胚胎数 (OR 2.46, 95% CI 1.9-3.1, P  < 0.001)正常精子和少弱精子症男性。失败后第三个周期的更换不太有益（每次胚胎移植的 LBR：OR 1.35，95% CI 0.9-2.1，P  = 0.16；每个移植胚胎的 LBR：OR 1.33，95 % CI 0.9-2.0，P = 0.186）。每个用自体或供体精子受精的卵母细胞 CLBR 的 Kaplan-Meier 曲线在统计学上是不同的（P  < 0.001），并证明每个额外的卵母细胞如何影响基于精子来源（供体/自体）的成功。

结论

在最初失败的卵母细胞捐赠周期后使用供体精子可改善结果。CLBR 曲线可用于确定使用自体精子或供体精子的累积活产机会，为何时更换精子提供指导。