Impact of total motile sperm count on ICSI outcomes in male factor infertility: A retrospective cohort study

Total motile sperm count (TMSC) is one of the most commonly used indicators to assess semen quality in male infertility cases. However, its predictive value in intracytoplasmic sperm injection (ICSI) outcomes remains inconclusive. This study evaluates the impact of TMSC on ICSI outcomes in couples undergoing ICSI cycles for male factor infertility, where the female partner is a normoresponder. The data of patients (n = 293) who underwent ICSI between September 2007 and December 2021 due to male factor infertility, had normoresponder female partners, and had a postwash TMSC ≤ 5 × 106 on the day of ICSI were retrospectively analyzed. Patients were divided into 3 groups based on their TMSC values: Group 1 with TMSC < 1 × 106, Group 2 with 1 × 106 ≤ TMSC < 3 × 106, and Group 3 with 3 × 106 ≤ TMSC ≤ 5 × 106. The patients' total oocyte count, inseminated and fertilized oocyte counts, fertilization rate, number of embryos transferred, high-quality embryo formation on days 2 and 3, blastulation, embryo development arrest, and pregnancy rates were retrospectively compared. The average fertilization rate was calculated as 0.42 ± 0.22 in Group 1, 0.52 ± 0.25 in Group 2, and 0.56 ± 0.21 in Group 3, with statistically significant differences in fertilization rates (P < .001). The pregnancy rate was found to be 26.7% in Group 1, 34.0% in Group 2, and 40.0% in Group 3, with a statistically significant difference in pregnancy rates (P = .049). Embryo development arrest was 24.1% in Group 1, 14.4% in Group 2, and 10.0% in Group 3, with statistically significant differences (P = .025). Logistic regression identified fertilization rate as an independent predictor of clinical pregnancy (odds ratio = 1.020; 95% confidence interval: 1.008-1.032; P = .001), while day 3 embryo score showed borderline significance (P = .063). Although TMSC was not a statistically significant independent predictor (P = .053), it showed potential prognostic value. Significant differences were observed among TMSC groups in terms of fertilization and pregnancy rates. TMSC appears to influence fertilization and pregnancy success in ICSI cycles involving male factor infertility, and it is a useful tool for sperm evaluation.