Predictive value of sperm DFI, ROS, and MMP for In Vitro fertilization pregnancy outcomes in asthenozoospermic patients

Objective: fertilization (IVF) pregnancy outcomes. Methods: This retrospective cohort study included 320 men with asthenozoospermic patients and 100 with normal semen parameters, assessed between January 2023 and June 2024. Of these, 143 couples undergoing IVF-embryo transfer were analyzed for outcomes. Semen samples were evaluated for conventional parameters, DFI, ROS, and MMP. Patients were stratified by DFI and MMP thresholds, and a combined DFI/MMP group was analyzed. Fertilization rate, cleavage rate, high-quality embryo rate, blastocyst formation rate, clinical pregnancy rate, miscarriage rate, and live birth rates were recorded. Multivariate logistic regression and receiver operating characteristic (ROC) curve analyses were performed. Results: Asthenozoospermic patients showed significantly higher DFI and ROS, and lower MMP compared to controls, with these parameters correlating to asthenozoospermia severity. DFI and MMP were identified as independent predictors of clinical pregnancy rate via multivariate logistic regression. The high DFI group had significantly lower fertilization, pregnancy, and live birth rates than the low DFI group, while the high MMP group demonstrated superior outcomes across all metrics compared to the low MMP group. The low DFI/high MMP group achieved the best results, exhibiting significantly higher fertilization, pregnancy, and live birth rates than the high DFI/low MMP group. ROC curve analysis indicated that the combination of DFI and MMP provided greater predictive power for clinical pregnancy (AUC = 0.771) than DFI (AUC = 0.643) or MMP (AUC = 0.651) alone. Conclusion: Sperm DFI and MMP are confirmed as independent and clinically significant predictors of clinical pregnancy in asthenozoospermic patients undergoing IVF treatment. The combined assessment of DFI and MMP offers superior predictive utility for IVF pregnancy outcomes compared to the assessment of either marker alone. These findings underscore the critical role of these sperm quality parameters in assessing reproductive potential and suggest significant clinical utility for guiding patient management and optimizing treatment strategies in assisted reproductive technologies.