IMPORTANCE OF POSTPRANDIAL GLYCEMIA (PPG) IN ART: A NOVEL THERAPY WITH SITAGLIPTIN FOR ART REPEATERS INCREASES PREGNANCY RATE BY DECREASING PPG AND ADVANCED GLYCATION ENDPRODUCTS

OBJECTIVE: Time-lapse technology was used to examine the developmental kinetics of embryos obtained by ICSI performed either with ejaculated normal semen or with surgically retrieved spermatozoa. We aimed to study possible differences in cellular divisions which may be due to different maturative stages of injected sperm. DESIGN: During spermiogenesis, the transit of spermatozoa in the epididymal tract favors nuclear maturation and DNA packaging through protamine dephosphorilation and the formation of molecular bridges. It has been suggested that the timing of embryo developmental stages after ICSI insemination may be affected by the origin of sperm. In this retrospective observational study (Sep 2012-Nov 2013), time-lapse technology allowed to observe embryos obtained by ICSI either with testicular sperm (TS-group: 25 cycles, female mean age1⁄436.29 4.29) or with normal (WHO, 2010) ejaculated sperm (ES-group: 32 cycles, mean age1⁄436.63 4.92). MATERIALS AND METHODS: In each group, 224 oocytes were injected. Development up to day-3 was studied: second polar body extrusion, 2PN appearance-fading, 2-8-cell divisions and intervals between divisions. Data are reported as average Delta-t expressed in hours ( SD) from ICSI insemination. RESULTS: Respectively in TS-group and ES-group, 2PNwere 118 (52.7%) and 176 (78.6%) (p<0.0001); developmental kinetics was studied on surviving 2PNembryos: 85 and 144. Significant differences appeared in the duration of 4cell stages (10.03 5.51 inTS,N1⁄459; 11.72 3.94 in ES,N1⁄4100; p1⁄40.026), in the time-lapse between 5 and 6 cells (4.57 4.76 in TS, N1⁄446; 2.77 4.24 in ES, N1⁄469; p1⁄40.035) and in the overall time to develop from 5 to 8 cells (11.97 8.19 in TS, N1⁄438; 8.45 6.99 in ES, N1⁄480; p1⁄40.017). CONCLUSION: The source of spermatozoa interferes with fertilization potential. A significative difference appeared in the duration of later cleavage stages: in embryos deriving from testicular sperm, the duration of the 4-cell stage was shorter. Conversely, the time-lapse from 5 to 6 cells and the overall time-lapse between 5 and 8 cells was longer in embryos from testicular sperm as compared to normal ejaculated sperm. Understanding the dynamics of embryo development in relation to the type of sperm injected may help defining parameters for increasing ICSI outcomes and could provide valuable insights for improving clinical results.