Comparison of Icsi with Fresh and Frozen Ejaculated Sperm in Donor Oocyte Recipient Cycles Utilizing Sibling Oocytes

Bardos, J. D.; Kodama, S.; Kwal, J. M.; Jahandideh, S.; Hill, M. J.; DeCherney, A. H.; Devine, K.; Levy, M.

Objective: Use of frozen sperm in non-male factor infertility is often needed in donor cycles. Most studies to date examining outcomes of fresh vs frozen sperm are unable to control for oocyte quality. Studies examining sibling oocytes represent a unique model to control for oocyte quality. A recent small study using this model found worse outcomes in the frozen group. We sought to evaluate, in a large cohort, if fresh and frozen ejaculated sperm are associated with similar pregnancy outcomes by analyzing paired donor egg recipient (DER) cycles. Materials and Methods: Retrospective cohort study from 2016-2019 at a large fertility center. Patients who underwent DER cycles where oocytes were split between two couples and one couple used fresh sperm and the other used frozen sperm were included. All patients with uterine factor, male factor or surgically obtained sperm were excluded. Primary outcome was Ongoing pregnancy/Live birth rate (OPR). Secondary outcome included clinical pregnancy rate (CPR) and miscarriage rate. GEE analysis was performed to control for confounding factors and donors providing oocytes to both study cohorts. Results: 1255 donor oocytes cycles were screened. A total of 205 unique oocytes donors were identified with oocytes inseminated with discrepant sperm in different recipient cycles. There were 698 recipient transfer cycles, 405 fresh and 293 frozen. Cohorts were similar in baseline characteristics (table 1). There were no differences in OPR/LBR with fresh vs frozen sperm (53.6% vs 55.6%, p=0.7) or clinical pregnancies (66.4% vs 63.5%, p=0.4). Spontaneous miscarriage (<20 weeks) was significantly higher in the fresh cohort (12.3% vs 6.1%, p=0.01). Conclusions: In this large study uniquely controlling for oocyte quality, there are no differences in live birth rate when fresh or frozen sperm was utilized on the same donor oocytes. This type of comparison is important as it helps control as much as possible the oocyte, thus isolating the discrepant sperm state as a determinant of outcome. There was a significant increase in miscarriage rate when fresh sperm was used. Impact Statement: In this large study comparing paired sibling donor oocytes, no difference in live birth rate was seen when couples utilized fresh or frozen sperm. This is particularly important in large donor or international programs especially during the COVID19 pandemic in which it may be difficult for the partner to be present, and a frozen sample may be needed. [Formula presented]