A treatment algorithm for couples with unexplained infertility based on sperm chromatin assessment.

Area of Science:

• Reproductive Medicine
• Genetics
• Infertility Research

Background:

• Unexplained infertility affects numerous couples.
• Intrauterine insemination (IUI) often fails in these cases, necessitating alternative strategies.
• Sperm DNA fragmentation (SDF) is a potential marker for male reproductive health.

Purpose of the Study:

• To develop a reproductive treatment algorithm for unexplained infertility.
• The algorithm is based on sperm DNA fragmentation (SDF) levels.
• It aims to optimize outcomes after poor intrauterine insemination (IUI) results.

Main Methods:

• Couples with unexplained infertility and failed IUI underwent SDF testing (SCSA, TUNEL).
• Treatments (IUI, IVF, ICSI) were selected based on SDF results.
• Sperm DNA fragmentation assays were performed prior to interventions.

Main Results:

• IUI yielded a low clinical pregnancy rate (CPR) of 1.8% in the study cohort.
• Couples with normal SDF undergoing IVF had a 12.7% CPR.
• Abnormal SDF led to ICSI with ejaculated sperm (18.7% CPR) or surgically retrieved sperm (31.0% CPR).

Conclusions:

• An algorithm guided by sperm DNA fragmentation can improve pregnancy success.
• It offers a pathway for couples with unexplained infertility and poor IUI outcomes.
• Tailoring insemination methods based on SDF enhances reproductive treatment efficacy.