Choosing fertilization method by analyzing sperm morphology or by performing swim-up preparation

Area of Science:

• Reproductive Medicine
• Infertility Treatment
• Sperm Analysis

Background:

• Sperm morphology analysis is subjective and can lead to overuse of intracytoplasmic sperm injection (ICSI).
• Conventional in vitro fertilization (IVF) and ICSI are common assisted reproductive technologies.
• Objective methods are needed to guide the selection between IVF and ICSI.

Purpose of the Study:

• To evaluate if sperm yield after swim-up preparation is a better predictor than morphology for choosing between IVF and ICSI.
• To reduce the number of costly and invasive ICSI procedures.

Main Methods:

• Retrospective analysis of 53 split cycles with poor sperm morphology.
• Prospective evaluation of 357 cycles using sperm count post-swim-up to guide fertilization method selection.
• Conventional IVF was used when ≤1 million sperm were available after swim-up.

Main Results:

• No significant difference in fertilization rates between IVF and ICSI in the retrospective part.
• Total fertilization failure (TFF) occurred in 4 IVF cycles but none in ICSI cycles (retrospective).
• In the prospective part, TFF was 8.9% in the poor morphology group versus 1.3% in the good morphology group, representing 1% of all cycles.

Conclusions:

• The swim-up yield strategy reduced ICSI treatments by 10%, decreasing costs and workload.
• The strategy may increase total fertilization failure rates, but the reduction in ICSI cycles is substantial.
• Sperm yield after swim-up is a viable alternative to morphology for selecting fertilization methods.