Selection of fertilization strategies for different sperm parameters in vitro fertilization

Lingling Qiu; Jinxiang Wu; Jing Chen; Hui Cao; Jingjing Cai; Xiaolan Huang; Ruiyun Wu; Yuanzhi Xie; Renata Finelli; Yali He; Suzhen Huang; Zhengyao Wang

doi:10.21037/atm-22-4308

Selection of fertilization strategies for different sperm parameters in vitro fertilization

Ann Transl Med. 2022 Sep;10(18):996. doi: 10.21037/atm-22-4308.

Authors

Lingling Qiu^#¹, Jinxiang Wu^#¹, Jing Chen¹, Hui Cao¹, Jingjing Cai¹, Xiaolan Huang¹, Ruiyun Wu¹, Yuanzhi Xie¹, Renata Finelli², Yali He¹, Suzhen Huang¹, Zhengyao Wang¹

Affiliations

¹ Department of Reproductive Medicine, the Second Affiliated Hospital of Fujian Medical University, Quanzhou, China.
² CREATE Fertility, London, UK.

^# Contributed equally.

Abstract

Background: Fertilization is a prerequisite for successful human reproduction. The choice of clinical fertilization strategy is crucial and directly affects clinical outcomes. This study analyzes the most appropriate assisted reproductive technology (ART) strategy based on sperm parameters.

Methods: Semen samples were divided into six groups based on semen progressive motility (PR) and semen density (SD): HMLD (high motility-low density) (PR ≥32% and sperm density <15×10⁶/mL, n=60), HMID (high motility-intermediate density) (PR ≥32% and 15×10⁶/mL ≤ SD <30×10⁶/mL, n=106), HMHD (high motility-high density) (PR ≥32% and SD ≥30×10⁶/mL, n=1,009), LMLD (low motility-low density) (PR <32% and SD <15×10⁶/mL, n=99), LMID (low motility-intermediate density) (PR <32% and 15×10⁶/mL ≤ SD <30×10⁶/mL, n=77), and LMHD (low motility-high density) (PR <32% and SD ≥30×10⁶/mL, n=164). We analyzed hyaluronic acid binding (HAB) assay and acrosin activity, along with fertilization, embryonic development, and pregnancy outcomes, to demonstrate the correlation of sperm parameters with fertilization function.

Results: In the PR <32% groups, the rate of intracytoplasmic sperm injection (ICSI) treatment decreased with increasing sperm concentration. Specifically, approximately 10% of in vitro fertilization (IVF) treatment cycles required a rescue ICSI when sperm PR was <32% accompanied by SD ≥15×10⁶/mL and PR ≥32% accompanied by SD <30×10⁶/mL, which was significantly higher than HMHD group, P<0.001. Sperm acrosin activity and HAB ability were significantly higher in the groups with good sperm parameters, P<0.05.

Conclusions: The findings of this study suggest, fertilization ability of sperm is closely related to sperm motility and density. In clinical practice, IVF strategies should be refined based on male sperm parameters.

Keywords: Fertilization strategies; in vitro fertilization (IVF); sperm density; sperm motility.