Impact of Seminal Properties, Incubator Type, and Sperm DNA Fragmentation on Pregnancy Outcomes in ICSI and IMSI Techniques: A Retrospective Cohort Study

Background: The selection of the optimal Assisted reproductive technology (ART) technique is challenging in cases with low-quality sperm. Objective: this research was designed to assess the impact of seminal properties, incubator type, and sperm DNA fragmentation on pregnancy outcomes in intracytoplasmic sperm injection (ICSI) and intracytoplasmic morphologically selected sperm injection (IMSI) techniques.Materials and Methods: This retrospective cohort research involved 140 couples with males who had high sperm DNA fragmentation, at least one previous failure of implantation or previous miscarriages after ICSI, and women 40 years or younger at least 8 months of marriage without normal pregnancy who were enrolled in the ICSI or IMSI program. Participants were divided into ICSI (n=100) and IMSI (n=40) groups, further categorized by incubator type (humidified vs. dry) and SDF percentage (<20 vs. >20).Results: there is no significant difference in sperm DNA fragmentation between ICSI and IMSI groups. The ICSI group had higher sperm concentration and motility, while the IMSI group had higher abnormal forms and lower acrosomal index. IMSI group had higher positive clinical pregnancies and cumulative fetal heart development. Cumulative fetal hearts were higher in humidified incubators. Higher sperm DNA fragmentation was associated with lower total motility and was a significant predictor of lower cumulative clinical results in ART at a cutoff value of 4.5%.Conclusion: IMSI is effective in achieving positive clinical pregnancies and cumulative fetal heart development, particularly in cases with high sperm DNA fragmentation. Humidified incubators further enhanced outcomes. High sperm DNA fragmentation significantly predicted lower ART success