Microdissection testicular sperm extraction is the preferred method for sperm retrieval in men with non-obstructive azoospermia. However, the effects of sperm retrieval quantity and freezing on intracytoplasmic sperm injection outcomes remain incompletely understood. To evaluate the impact of sperm quantity and freezing status on fertilization and cumulative live birth rate following intracytoplasmic sperm injection using microdissection testicular sperm extraction spermatozoa in non-obstructive azoospermia patients. We retrospectively analyzed 1394 microdissection testicular sperm extraction-intracytoplasmic sperm injection cycles performed between 2017 and 2022 at a single tertiary center. Sperm retrieval yield was stratified into three groups: sufficient sperm count (>10 spermatozoa/100 fields), low sperm count (6-10/100), and extremely low sperm count (1-5/100). Fertilization rate (two pronuclei) and cumulative live birth rate were compared across sperm retrieval yield and freezing subgroups. Multivariable regression and interaction models assessed the independent and combined effects of sperm quantity and freezing status. Fertilization and cumulative live birth rate declined significantly with reduced sperm counts (two pronuclei: 53.6%→32.2%; cumulative live birth rate: 49.8%→21.8%; p<0.001). Frozen spermatozoa yielded comparable outcomes to fresh spermatozoa overall, but in the extremely low sperm count group, frozen spermatozoa were associated with a significantly lower cumulative live birth rate than fresh spermatozoa (12.3% vs. 29.3%; p=0.015). Interaction analysis confirmed this adverse effect (OR=0.39; 95% CI 0.16-0.95; p=0.038). No significant freezing effect was observed in the other groups. Sperm retrieval quantity is an important predictor of intracytoplasmic sperm injection success in men with non-obstructive azoospermia. Freezing generally does not affect outcomes, but may significantly reduce live birth rates when sperm availability is extremely limited. Prioritizing the use of fresh spermatozoa in such cases may improve clinical outcomes.

Genetic variants in the dynein axonemal heavy chain 17 (DNAH17) have been implicated in multiple morphological abnormalities of the sperm flagella (MMAF) and asthenoteratozoospermia (ATZS). The aim of this study is to identify novel DNAH17 variants associated with MMAF and ATZS and to evaluate the impact of these variants on sperm motility, sperm morphology, the ultrastructure of sperm flagella, and the outcomes of intracytoplasmic sperm injection (ICSI). In the present study, we identified one novel homozygous and three compound heterozygous DNAH17 variants in one consanguineous and three nonconsanguineous families. Semen analysis revealed significant reductions in sperm motility and notable morphological changes. Transmission electron microscopy (TEM) revealed the absence of outer dynein arms (ODAs), loss of peripheral doublet microtubules (DMTs) 4-7, and multiple mitochondrial sheath (MS) abnormalities in the sperm flagella. Functional analyses indicated that these variants disrupted the expression and localization of the DNAH17 protein in the sperm flagella. Tandem mass tagging proteomics and immunofluorescence demonstrated a significant reduction in the expression of proteins associated with the assembly of ODA-associated proteins into the axoneme from individuals with DNAH17 variants. Notably, successful pregnancies were achieved through ICSI combined with assisted oocyte activation (AOA) treatment in the female partner of these probands. This study identified seven novel homozygous or compound heterozygous DNAH17 variants in both consanguineous and nonconsanguineous families, highlighting their detrimental effects on sperm motility, morphology, and flagellar ultrastructure. These findings provide valuable insights for the genetic diagnosis of MMAF and may enhance future genetic counseling strategies.

ABSTRACTPurposeDensity gradient centrifugation (DGC) enriches motile sperm but may increase sperm DNA fragmentation (SDF), whereas microfluidic sperm sorting devices, such as ZyMōt and CA0, enable centrifugation‐free selection with lower SDF. Direct comparisons are limited, and their relative clinical efficacy remains unclear. We compared sperm parameters and SDF after DGC, ZyMōt, and CA0 to evaluate sperm selection performance and assessed the clinical utility of ZyMōt and CA0 based on intracytoplasmic sperm injection (ICSI) outcomes.MethodsSeventeen semen samples were aliquoted into three groups and processed using DGC, ZyMōt, or CA0. Sperm parameters and SDF were evaluated before and after selection. ICSI was performed using ZyMōt or CA0‐selected sperm, inseminating 108 oocytes with ZyMōt and 64 with CA0, followed by the comparative analysis of embryo development.ResultsZyMōt‐selected sperm exhibited higher motility, average path velocity, and amplitude of lateral head displacement than DGC (p < 0.01); CA0‐selected sperm showed higher linearity and wobble. ZyMōt achieved higher rates of fertilization, blastocyst formation, and good‐quality blastocysts, and a lower percentage of poor‐quality cleavage‐stage embryos than CA0 (all p < 0.05).ConclusionsZyMōt demonstrated superior sperm quality compared with DGC and CA0, and favorable ICSI outcomes further support its potential clinical applicability.Trial RegistrationThe study (H2023‐230) was registered in the Japan Registry of Clinical Trials (jRCT) Clinical Trials Registry in Japan (jRCT1040230045)

Background/Objectives: Male infertility contributes to nearly half of global infertility cases, yet conventional semen analysis is insufficient to predict assisted reproductive technology (ART) outcomes such as intracytoplasmic sperm injection (ICSI). Sperm DNA fragmentation (SDF) is a promising biomarker of genomic integrity, but clinical implementation remains hindered by methodological heterogeneity. This study compared two SDF assays—TUNEL and Acridine Orange (AO)—regarding their correlations with semen parameters and ICSI outcomes. Methods: Sixty men undergoing ICSI were prospectively enrolled. SDF was analyzed using two flow cytometric assays: TUNEL (detecting DNA strand breaks) and AO (assessing chromatin instability). Semen quality and ICSI outcomes (fertilization, cleavage, blastulation, and embryo utilization rates) were evaluated. Statistical analyses included Spearman’s rank correlation and Mann–Whitney tests. Results: Median SDF levels were significantly higher by TUNEL than AO (17.2% vs. 10.15%; p = 0.0065). Inter-assay correlation was weak (r = 0.299, p = 0.01). AO-derived SDF correlated positively with age (r = 0.311, p = 0.02), while TUNEL showed no such trend. Neither assay correlated significantly with semen parameters or ICSI outcomes, although AO tended to associate with lower motility and slightly reduced top-quality embryo rates. Conclusions: TUNEL and AO capture distinct facets of sperm DNA damage. Their limited correlation and lack of predictive value for ICSI outcomes highlight the need for assay-specific interpretation and standardization. Integration of SDF with additional biomarkers and oocyte factors may enhance its clinical utility.

The mammalian spermatozoon neck is a unique structure that functions during spermatid differentiation and spermatozoa swimming, and its contents are critical for post-fertilization embryogenesis. Mutations in proteins localizing to the neck connecting piece (the modified pericentriolar material) result in acephalic spermatozoa. In contrast, mutations in proteins localizing to the centriole often produce abnormal tail morphology. Acephalic spermatozoa can be categorized based on the exact location of the neck breakpoint. Here, we classify 24 proteins known to cause acephaly in human and mice spermatozoa into five different acephalic types, depending on where the breakpoint occurs. We also discuss other proteins found in the spermatozoonneck, which may result in spermatozoa acephaly. The relationship between the exact location of the neck's break and intracytoplasmic sperm injection (ICSI) outcomes is explored in the context of the spermatozoon centrosome's role. We conclude that to understand this relationship, future research should investigate DNA, phospholipase C zeta, and centriole functionality, in addition to the location of the acephalic breakpoint in the patient's sperm.

Despite advances in assisted reproductive technologies, predicting outcomes of in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) remains difficult. Hormonal status, oocyte maturity, and ovarian reserve contribute to treatment variability. This study examined correlations among demographic, endocrine, and embryological parameters in women undergoing IVF and ICSI whose partners had normal semen profiles, and evaluated the effect of follicle-stimulating hormone (FSH) levels on outcomes. A retrospective analysis was performed on 488 women aged 18 to 45 years who underwent IVF and ICSI between 2022 and 2024. Data included age, body mass index (BMI), infertility duration, and levels of FSH, luteinizing hormone, anti-Müllerian hormone (AMH), thyroid-stimulating hormone, and fasting blood sugar. Embryological variables were oocyte yield, maturity stages (germinal vesicle, metaphase I, and metaphase II [MII]), and embryo count. Pearson correlations and the Kruskal-Wallis test were used to compare groups stratified by FSH (<10, 10-20, >20 mIU/mL). BMI and infertility duration showed weak correlations with embryological outcomes. AMH correlated positively with embryo count (r=0.29, p<0.01). MII oocytes correlated strongly with oocyte yield (r=0.90, p<0.01) and moderately with embryo count (r=0.46, p<0.01). Women with FSH <10 mIU/mL had significantly higher oocyte yield, MII oocyte numbers, and embryo counts than those with FSH ≥10 mIU/mL (p<0.001). Lower FSH and higher AMH are associated with better oocyte maturity and embryo yield. These markers may support individualized stimulation strategies to improve IVF and ICSI outcomes.

This study aimed to evaluate the impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and inactivated virus vaccination on intracytoplasmic sperm injection (ICSI) outcomes in infertile couples. A retrospective case-control study was conducted at the Royan Institute from August 2020 to March 2022. The study included 90 couples in the COVID-19 infection phase and 31 in the vaccination phase. A total of 30 infected but unvaccinated couples were compared to a control group of 60 couples with no COVID-19 infection or vaccination history. Additionally, 31 couples underwent treatment before and after receiving the Sinopharm inactivated vaccine. Key variables analysed included sperm parameters (concentration, motility, progressive motility and morphology), ovarian parameters (antral follicle count, oocyte retrieval), embryological outcomes and pregnancy outcomes. SARS-CoV-2 infection significantly reduced sperm motility (P = 0.02) and progressive motility (P = 0.01) compared to controls. Sperm concentration and morphology showed non-significant declines. Post-vaccination analysis revealed similar but statistically insignificant changes in sperm parameters. Ovarian stimulation parameters and embryological outcomes remained unaffected by both infection and vaccination. Although biochemical, clinical pregnancy and live birth rates were lower among the infected group, these differences did not reach statistical significance (p = 0.16, 0.08 and 0.09). SARS-CoV-2 infection has been associated with impaired sperm progressive motility, which may negatively influence ICSI outcomes. In contrast, vaccination with an inactivated virus does not appear to impact fertility outcomes. These findings provide crucial guidance for physicians and infertile couples managing treatments during and after the pandemic, suggesting the need for extended recovery periods before ART procedures following COVID-19 infection.

The role of myomectomy for intramural (IM) fibroids prior to artificial reproductive technique (ART) cycles is still debatable. This study assesses evidence regarding the effect of myomectomy for IM fibroids on invitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) cycle outcomes. Online search of databases from June 1949 to February 2024 were performed. A literature search was performed using Ovid MEDLINE, EMBASE, and Cochrane Library databases. Medical subject headings and keywords were used to generate a subset of citations for myomectomy, fibroid, leiomyoma, assisted conception, ICSI, IVF, ART, and pregnancy outcomes. The PRISMA checklist was completed. RefWorks was used for reference management. Eligible studies were identified by two independent reviewers. Rayyan was used for data screening. RevMan v5 software was used for data screening, extraction, and synthesis. All women undergoing IVF/ICSI cycles with fresh or frozen embryo transfer with IM uterine fibroids were included. A total of 1572 studies were identified, with 423 assessed for eligibility, 118 duplicates removed, and 58 meeting the inclusion criteria. Seven studies were included in the systematic review. A total of 1644 women reported on in these seven studies. Results show a 63% higher chance of an ongoing pregnancy rate/live birth rate in those who underwent myomectomy compared to those who did not have myomectomy, prior to IVF (Relative Risk (RR)1.64 (1.15-2.33); P ≤ 0.01). This systematic review of non-RCTs has shown beneficial effects, although there is significant variation in reporting fibroids by International Federation of Gynecology and Obstetrics classification and on reporting of the outcomes; hence, further well-designed studies are required. Individualized patient care for the decision to undergo a myomectomy prior to IVF/ICSI should be considered.

In assisted reproductive technology, spermatozoa must be separated from seminal fluid to achieve optimal fertilization capacity. Conventional separation techniques frequently result in elevated reactive oxygen species production and iatrogenic injury due to repeated cell centrifugation. The aim of this systematic review and meta-analysis was to evaluate the effects of free centrifuge sorting (FCS) techniques on intracytoplasmic sperm injection (ICSI) outcomes. A comprehensive literature search was conducted using PubMed, Scopus, Web of Science, and Cochrane databases. The meta-analysis adhered to the Preferred Reporting Items for Systematic reviews and Meta-Analyses Protocols (PRISMA-P) guidelines. All eligible studies were selected using the population, intervention, comparison/comparator, outcomes, and study design (PICOS) methodology. The primary outcomes assessed were fertilization rate (FR), the high-quality embryo rate, implantation rate (IR), and clinical pregnancy rate (CPR). The study is registered in PROSPERO under registration number CRD42023415532. After screening 306 records for eligibility, three studies were ultimately included in the analysis. Our results demonstrate that following ICSI, a very brief period of abstinence significantly increased IR and CPR. However, no significant differences were observed for FR. The FCS technique yielded spermatozoa of superior biological quality following removal of seminal samples, and this purified sperm population improved reproductive outcomes in ICSI programs.

Association of bisphenol A exposure with in vitro fertilization outcomes: A meta-analysis and systematic review.

To prevent the occurrence of a luteinizing hormone surge during assisted reproductive technology cycles, clinicians commonly utilize gonadotropin-releasing hormone (GnRH) analogues or progestin. However, there is a paucity of data directly comparing the reliability and efficacy of these strategies. This retrospective study compares ovarian stimulation outcomes in intracytoplasmic sperm injection (ICSI) cycles using either a progestin-primed ovarian stimulation (PPOS) protocol or a GnRH antagonist protocol for controlled ovarian hyperstimulation, conducted between January 2022 and November 2023. A total of 385 patients were analyzed, with 150 receiving the PPOS protocol and 235 receiving the GnRH antagonist protocol. There were no significant differences in oocyte yield, embryo quality, fertilization rates, or pregnancy outcomes between the two groups. Multiple regression analysis revealed that the type of stimulation protocol was not associated with live birth rates (LBR). However, longer infertility duration (p = 0.011) and diminished ovarian reserve (p < 0.001) were linked to lower LBR. Conversely, a higher number of good-quality embryos (p = 0.003), increased blastocyst formation rates (p = 0.003), and two-embryo transfers (p = 0.003) were associated with improved LBR. These findings suggest that the PPOS protocol is an effective approach for ovarian stimulation in ICSI cycles, demonstrating comparable outcomes to GnRH antagonists across multiple outcome measures.

Total motile sperm count (TMSC) is one of the most commonly used indicators to assess semen quality in male infertility cases. However, its predictive value in intracytoplasmic sperm injection (ICSI) outcomes remains inconclusive. This study evaluates the impact of TMSC on ICSI outcomes in couples undergoing ICSI cycles for male factor infertility, where the female partner is a normoresponder. The data of patients (n = 293) who underwent ICSI between September 2007 and December 2021 due to male factor infertility, had normoresponder female partners, and had a postwash TMSC ≤ 5 × 106 on the day of ICSI were retrospectively analyzed. Patients were divided into 3 groups based on their TMSC values: Group 1 with TMSC < 1 × 106, Group 2 with 1 × 106 ≤ TMSC < 3 × 106, and Group 3 with 3 × 106 ≤ TMSC ≤ 5 × 106. The patients’ total oocyte count, inseminated and fertilized oocyte counts, fertilization rate, number of embryos transferred, high-quality embryo formation on days 2 and 3, blastulation, embryo development arrest, and pregnancy rates were retrospectively compared. The average fertilization rate was calculated as 0.42 ± 0.22 in Group 1, 0.52 ± 0.25 in Group 2, and 0.56 ± 0.21 in Group 3, with statistically significant differences in fertilization rates (P < .001). The pregnancy rate was found to be 26.7% in Group 1, 34.0% in Group 2, and 40.0% in Group 3, with a statistically significant difference in pregnancy rates (P = .049). Embryo development arrest was 24.1% in Group 1, 14.4% in Group 2, and 10.0% in Group 3, with statistically significant differences (P = .025). Logistic regression identified fertilization rate as an independent predictor of clinical pregnancy (odds ratio = 1.020; 95% confidence interval: 1.008–1.032; P = .001), while day 3 embryo score showed borderline significance (P = .063). Although TMSC was not a statistically significant independent predictor (P = .053), it showed potential prognostic value. Significant differences were observed among TMSC groups in terms of fertilization and pregnancy rates. TMSC appears to influence fertilization and pregnancy success in ICSI cycles involving male factor infertility, and it is a useful tool for sperm evaluation.

This study aimed to evaluate reproductive outcomes according to the timing of testicular sperm retrieval. The study included 282 infertile couples divided into three groups: group A (freeze-thawed testicular sperm extraction [TESE] sperm, n=233), group B (fresh TESE sperm collected 1 day before ovum pickup, n=22), and group C (fresh TESE sperm collected on the same day as ovum pickup, n=27). The indications for TESE were surgically uncorrectable azoospermia or ejaculation failure, often accompanied by medical comorbidities such as diabetes mellitus and spinal cord injury. The outcome parameters assessed were fertilization rates, embryo quality, and clinical pregnancy rates. The mean paternal age was 36.8±5.7 years, and the mean maternal age was 32.6±3.5 years. The mean duration of infertility was 2.9±1.8 years. The fertilization rates were 70.7%, 78.9%, and 73.0% for groups A, B, and C, respectively (p=0.047). The percentages of good-quality embryos were 68.2%, 65.3%, and 48.4%, respectively (p=0.007); specifically, the percentage of good-quality embryos was significantly lower in group C compared with the other two groups. Clinical pregnancy rates per transfer were similar at 51.1%, 50.0%, and 48.1% (p=0.958), with no differences observed in miscarriage rates. Testicular sperm retrieval can be safely performed 1 day before ovum pickup, resulting in favorable fertility outcomes.

BackgroundSperm immobilization is an important step in intracytoplasmic sperm injection (ICSI) as it is necessary for oocyte activation by the spermatozoa. Several techniques are available for sperm immobilization. However, the effects of sperm mobilization techniques on intracytoplasmic sperm injection outcomes have not been established as most of the reports of studies on sperm immobilization techniques are inconsistent. This study aimed to evaluate a mild aggressive mechanical sperm immobilization technique: micro-rubbing, and investigate the effectiveness of micro-rubbing sperm immobilization in ICSI.MethodsMatched retrospective cohort study of patients who underwent intracytoplasmic sperm injection between April 2018 and June 2023 were enrolled. Non-preimplantation preimplantation genetic testing (non-PGT) and preimplantation genetic testing for aneuploidy (PGT-A) cycles were categorised into two groups based on sperm immobilization method: micro-rubbing and single-touch. Each couple was matched with separate control patients treated by the same operator for ICSI and oocyte denudation, maternal age, duration of infertility, primary or secondary infertility, sperm source, embryo condition, and endometrial thickness on the day of embryo transfer. Main Outcome Measures included: fertilization, oocyte utilization, and blastocyst chromosomal aneuploidy rates.ResultsOverall, 2967 ICSI cycles were evaluated, of which 330 and 318 cycles performed using micro-rubbing sperm immobilization in non-PGT and PGT-A groups, respectively. Compared with the ICSI cycles performed using single-touch sperm immobilization, micro-rubbing sperm immobilization cycles have significantly higher fertilization (non-PGT: 85.28% vs. 76.06%, P < 0.001; PGT-A: 85.26% vs. 75.45%, P < 0.001), day-3 embryo utilization per 2 pronucleus, and embryo utilization rate on day 3 per oocyte injected (non-PGT: 64.13% vs. 50.24%, P < 0.001; PGT-A:63.43% vs. 48.79%, P < 0.001). There were no statistically significant differences in embryo cleavage, top-quality embryos on day 3, blastocyst formation, blastocyst chromosomal aneuploidy, implantation, pregnancy, live birth, or miscarriage rates between both groups. ConclusionsMicro-rubbing sperm immobilization appears to be effective, with a statistically significant improvement in fertilization and embryo utilization rate on day 3 per oocyte injected. However, it does not seem to affect clinical pregnancy or live birth rates per transfer.Supplementary InformationThe online version contains supplementary material available at 10.1186/s13048-025-01829-6.

To identify novel CCDC188 variants in acephalic spermatozoa syndrome (ASS) patients and investigated the potential effect on theoutcome of intracytoplasmic sperm injection (ICSI). Sixteen patients diagnosed as ASS by morphological analysis were recruited in the first half of 2023. Whole exome sequencing (WES) and Sanger sequencing were performed to identify thegenetic cause and define the hereditary mode, using genomic DNA extracted from peripheral blood. Morphological characteristics of sperm were revealed by hematoxylin and eosin (H&E) staining and transmission electron microscopy (TEM). Pathogenicity of variants was evaluated in silico, and further confirmed in vitro and vivo by western blotting (WB), reverse transcript-polymerase chain reaction (RT-PCR), quantitative real-time PCR (qPCR), and immunofluorescence (IF). ICSI was performed with a standard operation procedure as the treatment strategy. Two novel variants in CCDC188 (NM_001365892.2: c.481C > T[p.Gln161*] and c.1022 + 1G > A[p. K325Afs*110]) were identified in two unrelated infertile men. Morphological analysis displayed the typical ASS phenotype of patients' sperm. The depletion of CCDC188 protein was observed accompanied with SUN5 and PMFBP1 in patients' sperm. Notably, a poor ICSI outcome occurred after a sperm head and a detached tail from one patient were simultaneously microinjected, caused by fertilization failure and abnormal embryo development. Our results broadened the variant spectrum of CCDC188. We firstly reported a poor outcome of one proband after ICSI treatment, which suggested the role played by CCDC188 in male infertility might involve not only spermatogenesis but also fertilization and early embryonic development.

Background: Tuberculosis is a communicable disease that is a major cause of ill health and one of the leading causes of death worldwide. Latent tuberculosis infection (LTBI) widely exists in people all over the world, especially in patients with unexplained infertility, and the relationship between latent tuberculosis infection and ovarian reserve, as well as pregnancy outcomes of in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI), remains poorly understood.Methods: A single-center, retrospective cohort study was conducted at the Reproductive Medicine and Genetics Centre, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, between January 2018 and December 2020. The study aimed to investigate whether LTBI affects ovarian reserve and pregnancy outcomes in infertile women undergoing assisted reproductive technology. The primary outcomes were ovarian reserve and cumulative live birth rate per IVF/ICSI cycle, while secondary outcomes included pregnancy outcomes and maternal and neonatal complications.Results: A total of 11523 assisted reproductive technology cycles were ultimately included in the comparison of ovarian reserves, and 9141 IVF/ICSI cycles were ultimately included in the comparison of clinical outcomes between the LTBI and control groups. The data revealed that women with LTBI had significantly lower anti-Müllerian hormone (4.61 ± 3.99 ng/mL vs. 4.88 ± 4.22 ng/mL, P=0.035, β=-0.23, 95% CI -0.43 to -0.04) and antral follicle counts [11.00 (8.00, 17.00) vs. 12.00 (8.00, 19.00), P=0.048, β=-0.26, 95% CI -0.53 to -0.01]. The conservative and optimistic cumulative live birth rates (61.42% vs. 61.94%, adjusted OR: 0.95, 95% CI: 0.82-1.10; 72.65% vs. 73.25%, adjusted OR: 0.94, 95% CI: 0.78-1.14), the live birth rates after fresh embryo transfer (39.28% vs. 40.83%, adjusted OR: 0.97, 95% CI: 0.82-1.14) and other secondary outcomes in the LTBI group were comparable to those in the control group after excluding factors such as age, ovarian reserve, and the number of oocytes retrieved.Conclusions: LTBI may affect the ovarian reserve but not directly affect the pregnancy outcomes of IVF/ICSI in infertile women.

Assessment of Biotin (vitamin H) supplementation to sperm preparation medium on outcomes of intracytoplasmic sperm injection (ICSI).

AimTo compare intracytoplasmic sperm injection (ICSI) outcomes between oligoasthenoteratozoospermic (OAT) men with recurrent assisted reproductive technology (ART) failures who underwent ICSI using sperm from the ejaculate on the day of a planned microdissection testicular sperm extraction (m-TESE) vs sperm obtained via m-TESE.MethodsWe reviewed the outcomes of men who underwent ICSI using either ejaculate or m-TESE due to OAT and recurrent ART failure at the Department of Reproductive Endocrinology, Gülhane Training and Research Hospital, between November 2016 and January 2024. The study enrolled 172 men: 66 men in the ejaculate group and 106 in the m-TESE group. All patients had fewer sperm parameters in two subsequent semen analyses.ResultsThe groups did not significantly differ in terms of female (P = 0.631) or male (P = 0.655) age. Sperm was obtained from 76/106 men in the m-TESE group (69.81%). The embryo transfer rate on day three was significantly higher in the m-TESE group (32.2% vs 8.3%; P = 0.003), whereas, on day five, it was significantly higher in the ejaculate group (61.7% vs 37.9%; P = 0.015). The ejaculate group had significantly higher overall pregnancy rates (59.1% vs 33%; P = 0.001) and overall live birth rates (37.9% vs 22.6%; P = 0.031).ConclusionIn recurrent ICSI failure, the reproductive success of ejaculate was higher than that of m-TESE. If it contains motile spermatozoa, the ejaculate before m-TESE could be considered even in severe OAT patients with two or more ART/ICSI failures.

People with spinal cord injury (SCI) may suffer from anejaculation due to functional obstructive azoospermia (OA). Testicular sperm extraction (TESE) may successfully overcome this problem, even if the optimal timing is controversial. The primary aim of this study was to report our experience with TESE in SCI, focusing on the effect of time since SCI event on the TESE outcomes. We included all consecutive people with SCI and functional OA undergoing TESE between January 2011 and December 2021 in four Italian tertiary referral centers. We recorded TESE sample parameters, sperm retrieval rate (SRR) and intracytoplasmic sperm injection (ICSI) outcomes. Logistic regression analysis was performed to assess whether time since SCI was significantly associated with these outcomes. The time since SCI was considered in three different ways: 1) continuously; 2) ≤9 years vs >9 years; 3) ≤5 years, >5 and ≤10 years, >10 years. We included 32 patients with tetraplegia and 75 with paraplegia, undergoing 107 TESE procedures. The median age at surgery and time since SCI were 33 years (IQR 29-38) and 9 years (IQR 3-14), respectively. The SRR was 81.3%. Thirty-three out of 87 patients underwent ICSI, achieving pregnancy in 63.6% after one cycle. The final live birth rate was 90.5%. Logistic regression analyses outlined that the SRR was not affected by considered variables, including time since SCI, considered both continuously and categorically. Our SRR did not prove to be negatively affected by all considered variables, especially by the time since SCI. Clinicians should not deter SCI patients with functional OA from undergoing TESE after a long time since SCI.

Recent progress in assisted reproductive medicine has introduced novel therapeutic possibilities for couples experiencing various reproductive challenges or subfertility. A critical concern in this field is the diminished ovarian response to hormonal treatments preceding ovum pickup, necessitating personalised and optimised protocols to enhance ovarian response across different age groups. Furthermore, a common male factor in IVF couples, oligozoospermia, characterised by a low sperm count, significantly impacts the success rates of assisted reproductive technologies, posing an increasing challenge for in vitro fertilisation clinics. Lifestyle choices, dietary habits, and overall health behaviours have also demonstrably affected fertility outcomes in the 21st century. This original article aims to highlight the synergistic importance of both partners’ health, specifically addressing poor ovarian response and oligozoospermia, in achieving successful conception. Our study analysed intracytoplasmic sperm injection outcomes in couples affected by both aforementioned conditions and proposed an optimal management strategy. This study shows that oligozoospermia significantly reduced ICSI fertilisation and cleavage rates. Poor ovarian responders experienced more cancelled cycles due to fewer embryos. While blastocyst rates relative to zygotes were comparable, overall success was lower in groups with male factor infertility and poor ovarian response, necessitating personalised treatment approaches.