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Volume 23, Issue 4 (July 2021) 23, 376–385; 10.4103/aja.aja_84_20

Abnormal fertilization in ICSI and its association with abnormal semen parameters: a retrospective observational study on 1855 cases

Konstantinos Pantos1, Konstantinos Sfakianoudis1, Evangelos Maziotis2, Anna Rapani2, Eleni Karantzali2, Artemis Gounari-Papaioannou2, Terpsithea Vaxevanoglou1, Michael Koutsilieris2, Mara Simopoulou2

1 Centre for Human Reproduction, Genesis Athens Clinic, 14-16 Papanikoli, Chalandri, Athens 11527, Greece
2 Department of Physiology, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias, Athens 11527, Greece

Correspondence: Dr. M Simopoulou (marasimopoulou@hotmail.com)

Date of Submission 24-Feb-2020 Date of Acceptance 28-Oct-2020 Date of Web Publication 22-Jan-2021


Intracytoplasmic sperm injection (ICSI) efficiently addresses male factor infertility. However, the occurrence of abnormal fertilization, mainly characterized by abnormal pronuclei (PN) patterns, merits investigation. To investigate abnormal fertilization patterns following ICSI and identify their respective associations with abnormal parameters in semen analysis (SA), a retrospective observational study including 1855 cycles was performed. Male infertility diagnosis relied on the 2010 WHO criteria. The population was divided into groups based on their SA results. The presence of 2PNs and extrusion of the second polar body (PB) indicated normal fertilization. A Kruskal–Wallis test along with a Wilcoxon post hoc evaluation and Bonferroni correction was employed for comparison among the groups. For the pregnancy rate, logistic regression was employed. No correlation was established between the SA abnormalities and the 1PN or 3PN formation rates. The highest and lowest 0PN rates were reported for the oligoasthenoteratozoospermic and normal groups, respectively. The lowest cleavage formation rates were identified in the oligoasthenozoospermic and oligoasthenoteratozoospermic groups. The aforementioned groups along with the oligoteratozoospermic group similarly presented the lowest blastocyst formation rates. For the clinical pregnancy rate, no statistically significant difference was observed. In conclusion, the incidence of two or more abnormal SA parameters – with the common denominator being oligozoospermia – may jeopardize normal fertilization, cleavage, and blastocyst rates. Once the developmental milestone of achieving blastocyst stage status was achieved, only oligoasthenozoospermia and oligoasthenoteratozoospermia were associated with lower rates. Interestingly, following adjustment for the number of blastocysts, no statistically significant differences were observed.

Keywords: assisted reproduction techniques; fertilization; intracytoplasmic sperm injection; oligoasthenoteratozoospermia; pronuclei; semen analysis

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