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Volume 22, Issue 6 (November 2020) 22, 623–628; 10.4103/aja.aja_146_19

Comparison of ART outcomes in men with altered mRNA protamine 1/protamine 2 ratio undergoing intracytoplasmic sperm injection with ejaculated and testicular spermatozoa

Jonás Sarasa1, María Enciso1, Laura García2, Andrea Leza2, Klaus Steger3, Jon Aizpurua2

1 iGLS, Alicante 03540, Spain
2 IVF-Spain, Alicante 03540, Spain
3 Department of Urology, Pediatric Urology and Andrology, Molecular Andrology, Justus-Liebig-University Giessen, Giessen 35385, Germany

Correspondence: Dr. J Sarasa (j.sarasa@igls.net)

Date of Submission 08-May-2019 Date of Acceptance 25-Nov-2019 Date of Web Publication 24-Mar-2020


Assisted reproductive technologies involving the use of spermatozoa and eggs for in vitro fertilization (IVF) have come as the solution for many infertile couples to become parents. However, in some cases, the use of ejaculated spermatozoa delivers poor IVF performance. Some studies have suggested the use of testicular spermatozoa in severe male infertility cases, but no guidelines regarding their utilization are currently available. In the present study, we found the mRNA protamine 1/protamine 2 (P1/P2) ratio to be a valuable biomarker of poor sperm function that could be used as a diagnostic key for the identification of cases that would benefit from the use of testicular spermatozoa. A total of 23 couples undergoing egg donation cycles with at least one previous cycle failure were studied. All couples underwent two consecutive intracytoplasmic sperm injection (ICSI) cycles with either ejaculated or testicular spermatozoa (TESA). The sperm mRNA P1/P2 ratio, fertilization rate, blastocyst rate, and pregnancy and live birth rate were compared. Results showed improved ICSI and clinical outcomes in cycles with testicular spermatozoa in men with altered mRNA P1/P2 ratios. TESA cycles presented significantly higher rates of fertilization (mean ± standard deviation: 76.1% ± 15.1% vs 65.5% ± 18.8%), blastocyst formation (55.0% ± 20.3% vs 30.8% ± 23.8%), and good morphological quality blastocyst (28.9% ± 22.9% vs 13.5% ± 17.9%) and also improvements on pregnancy (60.9% vs 0%) and healthy birth rates (56.5% vs 0%) than EJACULATE cycles. The results described here suggest that in patients with previous IVF/ICSI failures and aberrant mRNA protamine ratios, the use of testicular spermatozoa may be a good alternative to improve clinical outcomes.

Keywords: DNA damage; male infertility; mRNA protamine ratio; sperm chromatin; testicular spermatozoa

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