ICSI in cases of sperm DNA damage: beneficial effect of oral antioxidant treatment.
BACKGROUND
Most studies examining the use of ICSI for cases of elevated sperm DNA fragmentation report poor pregnancy and implantation rates. ICSI with testicular sperm samples has recently been suggested for these cases. Here we test a less invasive approach based on oral antioxidant treatment prior to ICSI with ejaculated spermatozoa.


METHODS
Thirty-eight men with an elevated (> or =15%) percentage of DNA-fragmented spermatozoa in the ejaculate were treated with antioxidants (1 g vitamin C and 1 g vitamin E daily) for 2 months after one failed ICSI attempt. In 29 (76%) of these cases this treatment led to a decrease in the percentage of DNA-fragmented spermatozoa, and a second ICSI attempt was performed. Outcomes of the two attempts were compared.


RESULTS
No differences in fertilization and cleavage rates or in embryo morphology were found between the ICSI attempts performed before and after the antioxidant treatment. However, a marked improvement of clinical pregnancy (48.2% versus 6.9%) and implantation (19.6% versus 2.2%) rates was observed after the antioxidant treatment as compared with the pretreatment ICSI outcomes.


CONCLUSIONS
Oral antioxidant treatment appears to improve ICSI outcomes in those patiens with sperm DNA damage, in whom this treatment reduces the percentage of damaged spermatozoa.
Greco
Ermanno
E
Centre for Reproductive Medicine, European Hospital, Rome, Italy.
Romano
Stefania
S
Iacobelli
Marcello
M
Ferrero
Susanna
S
Baroni
Elena
E
Minasi
Maria Giulia
MG
Ubaldi
Filippo
F
Rienzi
Laura
L
Tesarik
Jan
J
D000328:Adult; D000975:Antioxidants / Q000008:administration & dosage*; D001205:Ascorbic Acid / Q000008:administration & dosage*; D053938:DNA Fragmentation / Q000187:drug effects*; D005260:Female; D006801:Humans; D020287:In Situ Nick-End Labeling; D015994:Incidence; D007248:Infertility, Male / Q000188:drug therapy* / Q000453:epidemiology; D008297:Male; D011247:Pregnancy; D011256:Pregnancy Outcome; D020554:Sperm Injections, Intracytoplasmic; D013094:Spermatozoa / Q000187:drug effects / Q000473:pathology*; D014810:Vitamin E / Q000008:administration & dosage
D000975:Antioxidants; D014810:Vitamin E; D001205:Ascorbic Acid