Absolute asthenozoospermia and ICSI: what are the options?

Area of Science:

• Reproductive Medicine
• Andrology
• Infertility Research

Background:

• Complete asthenozoospermia affects 1 in 5000 men, presenting a poor prognosis for fertility, even with intracytoplasmic sperm injection (ICSI).
• Distinguishing between virtual and absolute asthenozoospermia is critical, as the former may contain motile sperm after processing, while the latter can stem from metabolic, structural, or idiopathic causes.
• Understanding the underlying cause of absolute asthenozoospermia is vital for potential treatment and improved management.

Purpose of the Study:

• To review the literature on the causes of absolute asthenozoospermia.
• To evaluate different techniques for improving intracytoplasmic sperm injection (ICSI) outcomes in patients with this condition.
• To propose a diagnostic and treatment algorithm for absolute asthenozoospermia.

Main Methods:

• Literature review of studies on the etiology of absolute asthenozoospermia.
• Analysis of various sperm preparation and selection techniques for ICSI.
• Development of a proposed diagnostic and treatment algorithm.

Main Results:

• Published results on fertilization, cleavage, and pregnancy rates after ICSI in absolute asthenozoospermia cases vary widely.
• Outcomes depend significantly on the sperm source and the specific immotile sperm selection technique used.
• The viability of spermatozoa in these cases can range from 0% to 100%.

Conclusions:

• Absolute asthenozoospermia is a major factor contributing to reduced fertilization and pregnancy rates post-ICSI.
• Various techniques exist to enhance ICSI success, but optimal methods for improving pregnancy outcomes remain undetermined.
• Further research is needed to establish the most effective strategies for managing couples with absolute asthenozoospermia.