The impact of severe oligozoospermia on morphokinetic embryo development in low-prognosis patients according to the Patient-Oriented Strategies Encompassing IndividualizeD Oocyte Number criteria: an analysis of 10,366 injected oocytes

Abstract

ObjectiveTo study whether severe male factor infertility (SMF), reflected by oligozoospermia, impacts embryo morphokinetic behavior in low-prognosis women as stratified by the Patient-Oriented Strategies Encompassing IndividualizeD Oocyte Number (POSEIDON) criteria. DesignCohort study SettingPrivate university–affiliated IVF center. Patients10366 injected oocytes from 2272 women undergoing ICSI cycles between March 2019 and April 2022. Intervention(s)Patients were split into eight groups according to the POSEIDON criteria (1 to 4) and the presence or absence of SMF. A Control group of normo-responder patients was included. Kinetic markers from the point of insemination were recorded in the EmbryoScope incubator. Main Outcome Measure(s)Morphokinetic milestones and ICSI clinical outcomes. ResultsEmbryos from patients in the POSEIDON group 1 showed significantly slower tPNa, tPNf, t2, t3, t4, t6, and t7 compared to those from Control group. KIDScore ranking was significantly different between SMF and non-SMF (nSFM) subgroups in both POSEIDON 1 and Control groups. Embryos from patients in the POSEIDON group 2 showed significantly slower tPNa, t4, t6, t7, t8, and tM compared to those from Control group. Embryos in POSEIDON 2 SMF subgroup took longer than those in POSEIDON 2 nSMF subgroup, and those in both Control subgroups, to achieve tPNf, t2, t3, t5, tS. KIDScore ranking was significantly different between SMF and nSMF subgroups in both POSEIDON 2 and Control groups. Embryos from patients in the POSEIDON group 3 showed significantly slower t8, and cc2 compared to those from Control group. KIDScore ranking was significantly different across the subgroups. Embryos derived from patients in the POSEIDON group 4 showed significantly slower tPNf, t2, t3, t4, t5, t6, t7, t8, s2, and s3 compared to those from Control group. KIDScore ranking was significantly different between SMF and nSMF subgroups in both POSEIDON 4 and Control groups. Irrespective of sperm quality, clinical outcomes were significantly improved in Control subgroups compared to POSEIDON 2 and 4 subgroups. ConclusionsEmbryos in the SFM groups presented a lower KIDScore ranking than those derived from the nSMF groups in both POSEIDON 1-4 and Control groups, suggesting that cumulative differences result in worse morphokinetic development when the algorithm is used.