Skip to main content

Sperm count affects cumulative birth rate of assisted reproduction cycles in relation to ovarian response



To explore the possible influence of sperm quality, as assessed by prewash total sperm count (TSC), on cumulative success rates in assisted reproduction cycles.


Retrospective study carried out in private IVF centre. Seven hundred sixty-five couples undergoing complete ICSI cycles, i.e. whose all embryos were transferred or disposed of. Couples were characterised by male infertility and female age younger than 36 years. Couples with a combination of female and male infertility factors were excluded. The primary outcome measure was cumulative live birth rate. Secondary outcomes were cumulative pregnancy and miscarriage rates. No specific interventions were made.


Higher TSC values have a positive impact on cumulative success rates in cycles characterised by few retrieved oocytes (1 to 5), while does not influence the outcome of cycles with a normal (6 to 10) or high (> 10) number of retrieved oocytes.


The study highlights the importance of sperm quality for the efficacy of assisted reproduction treatments. This influence may remain relatively cryptic in association with normal or high ovarian response, but emerge decisively in cases of reduced ovarian response, suggesting a relationship between ovarian response and oocyte ability to compensate for paternal-derived deficiencies.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3


  1. Fragouli E, Alfarawati S, Spath K, Jaroudi S, Sarasa J, Enciso M, et al. The origin and impact of embryonic aneuploidy. Hum Genet. 2013;132:1001–13.

    Article  Google Scholar 

  2. Nagaoka SI, Hodges CA, Albertini DF, Hunt PA. Oocyte-specific differences in cell-cycle control create an innate susceptibility to meiotic errors. Curr Biol. 2011;21:651–7.

    Article  CAS  Google Scholar 

  3. Patrizio P, Bianchi V, Lalioti MD, Gerasimova T, Sakkas D. High rate of biological loss in assisted reproduction: it is in the seed, not in the soil. Reprod BioMed Online. 2007;14:92–5.

    Article  CAS  Google Scholar 

  4. Barratt CL, Kay V, Oxenham SK. The human spermatozoon - a stripped down but refined machine. J Biol. 2009;8:63.

    Article  CAS  Google Scholar 

  5. Jodar M. Sperm and seminal plasma RNAs: what roles do they play beyond fertilization? Reproduction. 2019;158(4):R113–23.

    Article  PubMed  CAS  Google Scholar 

  6. Palermo G, Joris H, Devroey P, Van SAC. Pregnancies after intracytoplasmic injection of single spermatozoon into an oocyte. Lancet. 1992;340:17–8.

    Article  CAS  Google Scholar 

  7. Van PA, Proctor ML, Johnson NP, Philipson G. Techniques for surgical retrieval of sperm prior to intra-cytoplasmic sperm injection (ICSI) for azoospermia. Cochrane Database Syst Rev. 2008:CD002807.

  8. CDC. Assisted Reproductive Technologies 2016. 2018.

  9. Germond M, Urner F, Chanson A, Primi MP, Wirthner D, Senn A. What is the most relevant standard of success in assisted reproduction? The cumulated singleton/twin delivery rates per oocyte pick-up: the CUSIDERA and CUTWIDERA. Hum Reprod. 2004;19:2442–4.

    Article  Google Scholar 

  10. Garrido N, Bellver J, Remohí J, Simón C, Pellicer A. Cumulative live-birth rates per total number of embryos needed to reach newborn in consecutive in vitro fertilization (IVF) cycles: a new approach to measuring the likelihood of IVF success. Fertil Steril. 2011;96:40–6.

    Article  Google Scholar 

  11. Zacà C, Bazzocchi A, Pennetta F, Bonu MA, Coticchio G, Borini A. Cumulative live birth rate in freeze-all cycles is comparable to that of a conventional embryo transfer policy at the cleavage stage but superior at the blastocyst stage. Fertil Steril. 2018;110:703–9.

    Article  Google Scholar 

  12. Zacà C, Spadoni V, Patria G, Cattoli MC, Bonu MAB, Borini A. How do live birth and cumulative live birth rate in IVF cycles change with the number of oocytes retrieved? EC Gynecol. 2017;3:391–401.

    Google Scholar 

  13. World Health Organization. WHO laboratory manual for the examination and processing of human semen. 2010.

  14. Tarozzi N, Nadalini M, Bizzaro D, Serrao L, Fava L, Scaravelli G, et al. Sperm-hyaluronan-binding assay: clinical value in conventional IVF under Italian law. Reprod BioMed Online. 2009;19(Suppl 3):35–43.

    Article  Google Scholar 

  15. Tarozzi N, Nadalini M, Lagalla C, Coticchio G, Zacà C, Borini A. Male factor infertility impacts the rate of mosaic blastocysts in cycles of preimplantation genetic testing for aneuploidy. J Assist Reprod Genet. 2019;36:2047–55.

    Article  Google Scholar 

  16. Borini A, Bonu MA, Coticchio G, Bianchi V, Cattoli M, Flamigni C. Pregnancies and births after oocyte cryopreservation. Fertil Steril. 2004;82:601–5.

    Article  Google Scholar 

  17. Borini A, Gambardella A, Bonu MA, Dal PL, Sciajno R, Bianchi L, et al. Comparison of IVF and ICSI when only few oocytes are available for insemination. Reprod BioMed Online. 2009;19:270–5.

    Article  Google Scholar 

  18. Borini A, Bafaro MG, Bianchi L, Violini F, Bonu MA, Flamigni C. Oocyte donation programme: results obtained with intracytoplasmic sperm injection in cases of severe male factor infertility or previous failed fertilization. Hum Reprod. 1996;11:548–50.

    Article  CAS  Google Scholar 

  19. Cobo A, Bellver J, Domingo J, Pérez S, Crespo J, Pellicer A, et al. New options in assisted reproduction technology: the Cryotop method of oocyte vitrification. Reprod BioMed Online. 2008;17:68–72.

    Article  Google Scholar 

  20. Levine H, Jørgensen N, Martino-Andrade A, Mendiola J, Weksler-Derri D, Mindlis I, et al. Temporal trends in sperm count: a systematic review and meta-regression analysis. Hum Reprod Update. 2017;23:646–59.

    Article  Google Scholar 

  21. Wang C, Swerdloff RS. Limitations of semen analysis as a test of male fertility and anticipated needs from newer tests. Fertil Steril. 2014;102:1502–7.

    Article  Google Scholar 

  22. Schlegel PN. Nonobstructive azoospermia: a revolutionary surgical approach and results. Semin Reprod Med. 2009;27:165–70.

    Article  Google Scholar 

  23. Rumbold AR, Sevoyan A, Oswald TK, Fernandez RC, Davies MJ, Moore VM. Impact of male factor infertility on offspring health and development. Fertil Steril. 2019;111:1047–53.

    Article  Google Scholar 

  24. Yuan M, Huang L, Leung WT, Wang M, Meng Y, Huang Z, et al. Sperm DNA fragmentation valued by SCSA and its correlation with conventional sperm parameters in male partner of recurrent spontaneous abortion couple. Biosci Trends. 2019;13:152–9.

    Article  CAS  Google Scholar 

  25. Deng C, Li T, Xie Y, Guo Y, Yang QY, Liang X, et al. Sperm DNA fragmentation index influences assisted reproductive technology outcome: a systematic review and meta-analysis combined with a retrospective cohort study. Andrologia. 2019;51:e13263.

    Article  CAS  Google Scholar 

  26. Kamkar N, Ramezanali F, Sabbaghian M. The relationship between sperm DNA fragmentation, free radicals and antioxidant capacity with idiopathic repeated pregnancy loss. Reprod Biol. 2018;18:330–5.

    Article  Google Scholar 

  27. Tarozzi N, Nadalini M, Stronati A, Bizzaro D, Dal PL, Coticchio G, et al. Anomalies in sperm chromatin packaging: implications for assisted reproduction techniques. Reprod BioMed Online. 2009;18:486–95.

    Article  Google Scholar 

  28. Borini A, Tarozzi N, Bizzaro D, Bonu MA, Fava L, Flamigni C, et al. Sperm DNA fragmentation: paternal effect on early post-implantation embryo development in ART. Hum Reprod. 2006;21:2876–81.

    Article  CAS  Google Scholar 

  29. Garolla A, Cosci I, Bertoldo A, Sartini B, Boudjema E, Foresta C. DNA double strand breaks in human spermatozoa can be predictive for assisted reproductive outcome. Reprod BioMed Online. 2015;31:100–7.

    Article  CAS  Google Scholar 

  30. Evgeni E, Lymberopoulos G, Touloupidis S, Asimakopoulos B. Sperm nuclear DNA fragmentation and its association with semen quality in Greek men. Andrologia. 2015;47:1166–74.

    Article  CAS  Google Scholar 

  31. Evgeni E, Lymberopoulos G, Gazouli M, Asimakopoulos B. Conventional semen parameters and DNA fragmentation in relation to fertility status in a Greek population. Eur J Obstet Gynecol Reprod Biol. 2015;188:17–23.

    Article  CAS  Google Scholar 

  32. Jaroudi S, Kakourou G, Cawood S, Doshi A, Ranieri DM, Serhal P, et al. Expression profiling of DNA repair genes in human oocytes and blastocysts using microarrays. Hum Reprod. 2009;24:2649–55.

    Article  CAS  Google Scholar 

  33. Menezo YJ, Russo G, Tosti E, El MS, Benkhalifa M. Expression profile of genes coding for DNA repair in human oocytes using pangenomic microarrays, with a special focus on ROS linked decays. J Assist Reprod Genet. 2007;24:513–20.

    Article  Google Scholar 

  34. Barragán M, Pons J, Ferrer-Vaquer A, Cornet-Bartolomé D, Schweitzer A, Hubbard J, et al. The transcriptome of human oocytes is related to age and ovarian reserve. Mol Hum Reprod. 2017;23:535–48.

    Article  CAS  Google Scholar 

  35. Stringer JM, Winship A, Liew SH, Hutt K. The capacity of oocytes for DNA repair. Cell Mol Life Sci. 2018;75:2777–92.

    Article  CAS  Google Scholar 

Download references


The study was self-funded by - Family and Fertility Center.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Giovanni Coticchio.

Ethics declarations

Approval for the study was obtained from the local Institutional Review Board. Informed consent was obtained from selected patients.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary materials


Supplementary Table 1 Post hoc analysis among groups on CPR, miscarriage rate and CLBR Supplementary Table 2 Outcome rates of cycles classified according to TSC and subanalysed based on number of retrieved oocytes. a: P < 0.0001, b: P = 0.0085, c: P = 0.0045, d: P = 0.012, e: P = 0.0019, f: P = 0.0121 (DOCX 21.4 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Zacà, C., Coticchio, G., Tarozzi, N. et al. Sperm count affects cumulative birth rate of assisted reproduction cycles in relation to ovarian response. J Assist Reprod Genet 37, 1653–1659 (2020).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


  • Sperm count
  • Ovarian stimulation
  • Assisted reproduction
  • Pregnancy
  • Live birth