Exploring the related factors of fertilization failure in in-vitro fertilization-embryo transfer

To investigate the influencing factors of fertilization failure in in vitro fertilization-embryo transfer (IVF-ET), so as to conduct clinical predictions and reduce the fertilization failure rate.

A retrospective study was conducted on 1,818 IVF-ET cycles with natural sperm-egg fusion performed in the Department of Reproductive Medicine at the Maternity & Child Care Center of Qinhuangdao from January 2022 to December 2024. These cycles were divided into two groups: the experimental group (218 cycles) with fertilization failure-related adverse outcomes and the control group (1,600 cycles) with normal fertilization. Univariate analysis was first applied to compare general characteristics, endocrine parameters, gonadotropin-related indices, oocyte and sperm parameters, and infertility causes between the two groups. Subsequently, factors with a statistical difference (P < 0.05) in the univariate analysis were enrolled in a multivariate logistic regression model to identify independent influencing factors of fertilization failure.

Univariate analysis showed that infertility duration, primary infertility, non-tubal infertility factors, serum estradiol (E2) and luteinizing hormone (LH) levels on the day of human chorionic gonadotropin (HCG) administration, total oocyte yield, sperm motility, normal sperm morphology rate, and post-processing sperm concentration were all associated with IVF fertilization failure. Multivariate logistic regression analysis further identified primary infertility, non-tubal infertility factors, and elevated LH levels on the day of HCG administration as independent risk factors for fertilization failure.

Clinical attention should be prioritized for female patients with primary infertility caused by non-tubal factors and elevated LH levels on the day of HCG administration, as these factors independently increase the risk of fertilization failure; targeted clinical interventions for such cases may help reduce the incidence of fertilization failure in IVF-ET cycles.