DECODING TOTAL FERTILIZATION FAILURE IN INTRACYTOPLASMIC SPERM INJECTION CYCLES: A COMPARATIVE ANALYSIS OF SPERM AND OOCYTE PARAMETERS

Abstract

Objective

This study aimed to identify parameters associated with total fertilization failure in ICSI cycles. Specifically, we investigated which male and female factors contribute to total fertilization failure. Additionally, we sought to identify patient populations at risk for total fertilization failure to develop preventive strategies for future cases.

Materials and Methods

This retrospective study was conducted at the Bursa Uludağ University ART Center between 2011 and 2024. ICSI was performed on all retrieved oocytes. The study group included patients who had at least three oocytes retrieved and experienced total fertilization failure(n=98). The control group comprised patients with a fertilization rate above 80%(n=937). Comparative evaluations were made between the two groups regarding patients' baseline characteristics, basal hormonal parameters, ovarian stimulation profiles, semen parameters, and oocyte quality scores. Additionally, ovarian response was assessed using the Follicular Output Rate(FORT) and Follicle-to-Oocyte Index(FOI) in both groups. Logistic regression analysis was performed to examine the relationship between significant variables and fertilization failure.

Results

Baseline parameters between the study and control groups were statistically similar, indicating no significant differences in initial characteristics except for infertility duration(p=0.002) and etiology(p<0.001). Semen analysis, however, revealed that the study group had significantly lower sperm concentration(p=0.002) and motility(p<0.001) compared to the control group, while sperm morphology(p=0.492) percentages were similar between the groups. The rate of azoospermia was also higher in the fertilization failure group. Concerning oocyte parameters, the study group showed a significantly lower FOI(p=0.007) compared to the control group, while oocyte maturation rates(p=0.166) were similar between the groups. Despite these differences, oocyte quality scores were comparable(p=0.272).

Discussion

Our study highlights that total fertilization failure in ICSI cycles is significantly associated with lower sperm concentration, reduced motility, and azoospermia. Despite similar baseline parameters and oocyte quality scores between the study and control groups, the study group experienced no successful fertilization. These findings suggest that sperm factors are more crucial than oocyte quality in predicting fertilization success.

Conclusion

In conclusion, semen parameters, including lower sperm concentration and reduced motility, are key factors associated with total fertilization failure in ICSI cycles. These parameters should be closely monitored to identify patients at higher risk for total fertilization failure. Addressing these factors may improve fertilization outcomes and guide the development of targeted interventions to reduce total fertilization failure rates in future cycles.