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Does omitting teratospermia as a selection criterion for ICSI change pregnancy rates?

  • Assisted Reproduction Technologies
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Abstract

Purpose

There is controversy whether teratospermia is associated with poorer IVF outcomes and if ICSI may overcome this deficit. The debate likely lies in study heterogeneity, poor adjustment for confounders, and inter-observer variation in sperm morphology assessment. Given the current literature, a shift in practice was implemented at our center in February 2017, whereby teratospermia was no longer a criterion for ICSI. We hypothesized that, despite decreasing ICSI rates, we would see no change in ART outcomes.

Methods

A retrospective study was performed including 1821 couples undergoing IVF/ICSI at a single center from January 2016 to December 2018, divided into cohorts before and after the practice change. The primary outcome of clinical pregnancy and secondary outcomes of fertilization, fertilization failure, good quality blastocyst formation, embryo utilization, positive hCG, and miscarriage rates was compared, adjusting for potential confounders. Subgroup analysis was performed evaluating teratospermia as the only reason for a male factor infertility diagnosis.

Results

Despite a decrease in ICSI rate of 30.3%, we found no significant difference in clinical intrauterine pregnancy rate, with an adjusted relative risk of 0.93 (0.81, 1.07, P = 0.3008). There were no significant differences in other secondary outcomes after multivariate adjustment. Subgroup analysis for those with male factor infertility due to teratospermia showed no difference in outcomes.

Conclusion

This study concurs with the recent data suggesting that employing ICSI solely for teratospermia is unnecessary. This may allow clinics to decrease ICSI rates without sacrificing success rates, leading to lower cost and risk associated with treatment.

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Funding

This study was funded by the Ottawa Fertility Centre research fund.

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, University of Ottawa, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada

    Bonnie Woolnough, Doron Shmorgun, Marie-Claude Leveille & Jenna Gale

  2. Ottawa Fertility Centre, 100-955 Green Valley Crescent, Ottawa, ON, K2C 3V4, Canada

    Bonnie Woolnough, Doron Shmorgun, Marie-Claude Leveille & Jenna Gale

  3. Ottawa Hospital Research Institute, 1053 Carling Ave, Ottawa, Ontario, K1Y 4E9, Canada

    Marie-Claude Leveille, Elham Sabri & Jenna Gale

Authors
  1. Bonnie Woolnough
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  2. Doron Shmorgun
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  3. Marie-Claude Leveille
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  4. Elham Sabri
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  5. Jenna Gale
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Bonnie Woolnough, Jenna Gale, and Elham Sabri. The first draft of the manuscript was written by Bonnie Woolnough, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Bonnie Woolnough.

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Conflict of interest

Doron Shmorgun is a partner with the Ottawa Fertility Centre. Marie-Claude Leveille is an employee of the Ottawa Fertility Centre, and Jenna Gale is an associate physician at the Ottawa Fertility Centre. Bonnie Woolnough has no conflict of interest to declare. Elham Sabri has no conflict of interest to declare.

Ethics approval

This research study was conducted retrospectively from data obtained for clinical purposes for quality assurance. The Ottawa Health Science Network Research Ethics Board found the study to be exempt from requiring ethics review.

Research data repository: Synapse: DOI: https://doi.org/10.7303/syn21535256

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Woolnough, B., Shmorgun, D., Leveille, MC. et al. Does omitting teratospermia as a selection criterion for ICSI change pregnancy rates?. J Assist Reprod Genet 37, 1895–1901 (2020). https://doi.org/10.1007/s10815-020-01827-1

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  • DOI: https://doi.org/10.1007/s10815-020-01827-1

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