Ep 154: ‘Evaluating the Relationship Between Ejaculatory Abstinence and the Incidence of Embryo Mosaicism’ with Atoosa Ghofranian
Fertility Forward Episode 154:
Does ejaculatory abstinence really affect embryo mosaicism? Today on Fertility Forward, Fellow at RMA New York, Dr. Atoosa Ghofranian joins us to discuss her study titled: ‘Evaluating the Relationship Between Ejaculatory Abstinence and the Incidence of Embryo Mosaicism.’ Tuning in, you’ll hear about her inspiration behind the study, what mosaicism is, what her findings of the study were, why she thinks another study is needed, and more! We even discuss what we can learn from the concrete evidence this provided us. Finally, Atoosa tells us what she is grateful for today. Thanks for listening in!
Rena: Hi everyone. We are Rina and Dara and welcome to Fertility Forward. We are part of the wellness team at RMA of New York, a fertility clinic affiliated with Mount Sinai Hospital in New York City. Our Fertility Forward podcast brings together advice from medical professionals, mental health specialists, wellness experts, and patients because knowledge is power and you are your own best advocate.
Rena: I am so excited to welcome to Fertility Forward today, Atoosa Ghofranian from RMA New York, who is back for round two to tell us about her study for ASRM this year titled, Evaluating the Relationship between Ejaculatory Abstinence and the Incidents of Embryo Mosaicism. This sounds super interesting. I'm so curious to know about your study and what you found.
Dr. Ghofranian: Yeah, so I guess we'll start by talking about what brought this study about. So, mosaicism, to start, is when there is more than one chromosomely distinct cell line within an embryo. And this topic has gathered a lot of attention recently with advancements in diagnostic technology that have allowed for more precise identification of mosaic embryos. And there's been a couple previous studies that have suggested that the origins of mosaicism are attributed to events that are occurring post fertilization. But what that event IS is still unclear. There's only a couple studies to our knowledge that have specifically reported on the relationships between ejaculatory abstinence and DNA fragmentation and embryo ploidy, but they were limited in their sample size and methodology. So the goal of our study was to evaluate the relationship between the duration of ejaculatory abstinence, like you mentioned, and the incidence of embryo mosaicism.
Rena: Okay. So what did you find?
Dr. Ghofranian: Yeah, so we looked back at 2,385 IVF cycles from couples who underwent IVF with preimplantation genetic testing for aneuploidy across four IVF centers within the USF network over a four year period. And patients who had male factor infertility or any prior testicular pathology were excluded and we divided the patients into six groups depending on the days of ejaculatory abstinence that they had. So, zero to one days, 2, 3, 4, 5, and six to 10 and our primary outcome was the incidence of embryo mosaicism. So looking at the groups, they were all similar across their baseline demographics, like their age, race, BMI, their baseline ovarian reserve characteristics for the female partners were similar. Sperm concentration increased with increasing ejaculatory abstinence interval, which made sense, but sperm motility remained the same. And as far as the IVF outcomes, like the number of eggs retrieved maturity rate, fertilization rate, blastulation rate, everything was similar. But getting to sort of the meat of the study, there was no difference in the incidence of mosaic embryos across all of the groups. This remained relatively low between 4% to 7%. Interestingly, there was a difference in the number of euploid and aneuploid embryos. So with increasing duration of ejaculatory abstinence, there was an increase in euploid embryos and a decrease in aneuploid embryos. But then when looking at the statistical trend over time, there was no significant difference. So, in conclusion, while factors like sperm concentration might be influenced by ejaculatory abstinence, interval variations in ejaculatory abstinence don't appear to be associated with embryo ploidy status. So we can reassure couples that moderate differences in the ejaculatory abstinence of the partner prior to IVF are unlikely to be associated with their embryos PGT-A result.
Rena: Oh, interesting. Because I know a lot of people think that and they, they wonder that leading up to a cycle, you know, and should you abstain. So it sounds like you're totally debunking that myth.
Dr. Ghofranian: Yeah, so I mean there's definitely conflicting research and this is just adding to the literature. I think there definitely needs to be a sub-analysis of our study showing the relationship between ejaculatory abstinence and specifically the rate of euploid and aneuploid embryos. But definitely using technologies to trace what the actual origins of chromosomal anomalies specifically in mosaicism are will be super helpful.
Rena: Is that something that's coming down the pipeline, being able to do that?
Dr. Ghofranian: Yeah, definitely. I mean there's technologies combining copy number variation combined with SNIP analysis powered by artificial intelligence and that's all gonna improve accuracy and determining the genomic content of an embryo and what the actual incidents of mosaicism is as well as where it's coming from.
Rena: That's wild. So is, is that something that's gonna be able to be put to use soon, like now to use and…?
Dr. Ghofranian: Yeah, so the technologies are definitely out. I think they're still considered experimental. They're not being used routinely in practice, but hopefully with more data, more information, we can start to incorporate them into our practice.
Rena: That sounds like it will make a huge difference. Do you think then that the rate of mosaicism will decrease because of that?
Dr. Ghofranian: It's hard to say. I mean there's definitely some studies that are suggesting that every embryo is a little mosaic, so to speak, and the embryo has the ability to correct itself over time. And from the studies that we have transferring current mosaic embryos, there's variation in whether or not it's, it's more or less like a, they will implant or they won't and if they do implant they go on to be just a normal pregnancy. So it seems like they can correct themselves, but it's hard to say. I think it's something that's a topic that's still under investigation. Super interesting.
Rena: Yeah. So anything in terms of your study and and future indicators beyond what we just discussed - is there anything that you see that might be reassuring for patients to know?
Dr. Ghofranian: Yeah, I think ultimately they don't have to stress too much about the period of ejaculatory abstinence 'cause it hasn't been shown to make a huge difference. But as far as what the actual causes of mosaicism are, we still don't know.
Rena: Okay. So there at least there's some concrete evidence here that people can take away because I do know that that's a worry.
Dr. Ghofranian: Yeah, absolutely. I mean it doesn't seem moderate variations and ejaculatory abstinence it looks like between 1 to 10 days doesn't make a difference.
Rena: Okay. So that's super important for people to hear and to know and can hopefully relieve some anxiety or some stress intention that may be happening at home. Because I know, you know, of course in this process people wanna reach for something that feels like an action item to do because so much feels out of control.
Dr. Ghofranian: Right.
Rena: It sounds like this is something that they can eliminate.
Dr. Ghofranian: Yeah, absolutely. I think the World Health Organization right now recommends two to seven days of ejaculatory abstinence prior to any IVF or IUI cycles. But those recommendations aren't really based out of what the specific IVF outcomes are. It's based out of just a need for standardization comparing amongst males. So yeah, I think it's reassuring that they don't have to put too much pressure on themselves to have it in an abstinence interval of specific time.
Rena: Yeah, I think the more we know the better.
Dr. Ghofranian: Yeah, exactly.
Rena: So anything else? I know this was sort of short and sweet, but I think this was a, a really great piece of information to share with people. Anything else that you think might be relevant to share?
Dr. Ghofranian: I don't think so. I think that's pretty much it.
Rena: Okay. It was very short and sweet, but sometimes the best things come in small packages as they say
Dr. Ghofranian: Yeah, that's right. That's exactly right.
Rena: Okay. So the way we like to wrap these episodes is saying something we're grateful for. So something you're grateful for today.
Dr. Ghofranian: Oh my gosh. I recently am grateful for my fiance for dealing with the chaos of life outside of work while I deal with the chaos of work.
Rena: Love that. Well I hope he is listening. I hope he hears that
Dr. Ghofranian: Yeah, I'll make sure he listens.
Rena: I'll say I'm grateful for, for busyness. You know, I think we can get stressed and we feel overwhelmed and like there's so much to do. But I think the opposite end of that, you know, when the phone stops ringing or we don't have any tasks, that's a lot worse than being busy. So I'm grateful to be busy. I'm grateful for your time. I know it was super hard to schedule 'cause I know that you are one that's busy, but just a gratitude moment to say grateful for this work and being able to…
Dr. Ghofranian: Yeah, absolutely.
Rena: …sit here and and share this with people and being able to kind of fit everything in. So thank you so much.
Dr. Ghofranian: Yeah, no, thank you. I really appreciate your flexibility. Yeah, this is great. I'm excited to present it.
Rena: We're excited for you.
Dr. Ghofranian: Thanks.
Dara: Thank you so much for listening today. And always remember: practice gratitude, give a little love to someone else and yourself, and remember - you are not alone. Find us on Instagram @fertility_forward and if you're looking for more support, visit us at www.rmany.com and tune in next week for more Fertility Forward.