Effects Of Donor Sperm On Perinatal And Neonatal Outcomes In Fresh Embryo Transfer Cycle

BackgroundMale factor infertility is one of the main causes of infertility,accounting for about 40%of infertile patients.When men’s fertility decreases due to factors such as less and weak abnormal sperm or erectile dysfunction,assisted reproductive technology-husband(ART-H)can be used for treatment.However,when men suffer from irreversible azoospermia,severe oligozoospermia,asthenospermia,abnormal spermatozoa and serious genetic diseases,the use of their own sperm can not achieve clinical pregnancy or will cause their offspring to suffer from serious genetic diseases,most patients will choose donor sperm for treatment Most infertile patients are worried about the success rate of sperm donor treatment and whether sperm donor will have adverse effects on their offspring.Although with the progress of assisted reproductive technology,the technology of sperm donor therapy is becoming more and more mature,the current research is still controversial about whether donor sperm will lead to adverse pregnancy outcomes.Moreover,most of the published articles are the comparison of pregnancy outcomes of artificial insemination between donor and partner sperm.There are few articles comparing in vitro fertilization/intracytoplasmic sperm injection(IVF/ICSI)between the two groups,and there is no systematic comparison of clinical pregnancy outcomes,perinatal outcomes and neonatal outcomes of infertile patients.PurposesThis paper explores whether the use of donor sperm for IVF/ICSI will increase adverse clinical pregnancy outcomes,perinatal outcomes,neonatal birth outcomes and incidence of birth defects.MethodsIn this single-center retrospective cohort study,we included 1559 infertile patients who received donor sperm at our hospital from 2015 to 2019.All patients required fresh embryo transfers and were first cycle transfers.Based on maternal age,body mass index,antral follicle count,years of infertility,basic follicle-stimulating hormone,basic luteinizing hormone,basic estradiol,male age,type of infertility(primary or secondary),cause of infertility(polycystic ovary syndrome,uterine infertility,endometriosis infertility,tubal infertility,unexplained infertility,multi factorial infertility,male infertility,and other causes),ovarian hyper-stimulation regimens(long regimen,short regimen,antagonist regimen,extra-long regimen,other regimens)for propensity score matching to match 4677 control subjects who received partner sperm treatment at a ratio of 1:3.Binary logistic regression analysis was performed to adjust for confounding factors.The clinical pregnancy outcomes,perinatal outcomes and neonatal outcomes were compared between the sperm donor group and the control group,respectively.ResultsThe embryo development of the donor sperm group was better than that of the husband sperm group.The number of high-quality embryos,the rate of high-quality embryos,the number of available embryos,the rate of available embryos,the rate of D3 high quality embryos transferred,and the rate of D5 high quality blastocyst transferred in the donor sperm group were higher than those of the husband sperm group,and P<0.05,with statistical differences.The clinical pregnancy rate(62.99%vs.59.65%;P=0.02)and live birth rates(54.65%vs.51.59%;P=0.036)of the donor sperm group were significantly higher than those in the husband sperm group.However,after adjusting for confounding factors,there was no statistical difference in the live birth rate between the two groups.The neonatal low birth weight rate(18.21%vs.21.39%;P=0.023)and the incidence of small for gestational age(SGA)in the sperm donor group(7.6%vs.11.97%;P<0.001)were lower than the donor sperm group.There were no statistically significant differences in the rates of biochemical pregnancy,ectopic pregnancy,early and late spontaneous abortion,mean birth weight,gestational age,large for gestational age(LGA)and neonatal defects between the two groups.To exclude the effect of multiple pregnancies,we also examined neonatal outcomes in singleton pregnancies separately.We found no significant differences between the two groups in the incidence of low birth weight,SGA,mean birth weight,gestational age,preterm birth,very preterm birth,LGA,high birth weight,and very low birth weight.(P>0.05).ConclusionCompared with husband sperm,donor sperm did not reduce the developmental capacity of embryos,did not reduce the live birth rate and clinical pregnancy rate,and did not increase the perinatal and neonatal adverse pregnancy outcomes.