Assessing the treatment of male infertility through principal component analysis: a retrospective study

To determine whether routine fertility treatments reorganize the systemic architecture of semen parameters in infertile men, rather than producing isolated parameter improvements. We specifically investigated whether morphology becomes more functionally integrated with motility and other core fertility indicators following treatment.

Paired pre and posttreatment semen samples from 112 infertile men attending Faruk Medical City, Kurdistan Region of Iraq (2015-2024), were analyzed. Data included age, liquification time, abstinence days, white blood cells, semen volume, sperm concentration, total sperm number, progressive motility, normal morphology, and sperm defects. Non-normal data were transformed, and Spearman's correlations and Principal Component Analysis (PCA) were used to characterize systemic relationships before and after treatment.

Semen parameter relationships showed reorganization following treatment, rather than isolated gains. Core indicators (concentration, sperm number, motility) maintained structural stability (Principal Component (PC)1 variance: 34%→35%), while morphology became more integrated with other parameters. Correlations between morphology and concentration increased 51% (rs = 0.327→0.494) and with motility 32% (rs = 0.453→0.597). PCA confirmed this reorganization, with PC2 transitioning from a 'structural defect' component toward a pattern consistent with a 'functional integration' axis coupling morphology and motility. Age-stratified analysis revealed stronger morphology-motility coordination in younger men, whereas older men showed persistent viscosity and defect issues. Leukocyte-defect correlations weakened, a pattern consistent with reduced inflammatory contributions to sperm abnormalities.

Fertility treatments were associated with systemic reorganization of semen parameter networks, with morphology emerging as a central biomarker of functional recovery. These findings support a shift from single-parameter monitoring toward multivariate, systems-based approaches and highlight the value of age-stratified treatment strategies and anti-inflammatory interventions in optimizing outcomes.