Predictive value of fresh and post-selection total motile sperm count on embryo quality and success rate of intracytoplasmic sperm injection in cycles with donated oocytes: a retrospective multi-center study.

PURPOSE: The study aims to evaluate whether fresh and post-selection total motile sperm count (TMSC) can be associated with embryo quality and cumulative live birth rate (CLBR) in intracytoplasmic sperm injection (ICSI) cycles. By focusing specifically on cycles using donated oocytes, the researchers aimed to minimize the confounding influence of female fertility factors. METHODS: This multicenter retrospective observational cohort study analyzed data from 862 couples undergoing ICSI with donated oocytes between January 2008 and December 2023 across 15 clinics in Spain. Patients were categorized into five distinct groups based on their fresh and post-selection TMSC values (ranging from less than 1 million to over 20 million). The primary outcome was CLBR, while secondary outcomes included fertilization rates, embryo quality, and pregnancy rates. RESULTS: While initial, unadjusted analyses showed some differences in fertilization rates and CLBR across the fresh TMSC groups, these associations lost statistical significance after adjusting for key confounding variables. Once adjustments were made for donor and male age, body mass index (BMI), sperm selection techniques, and WHO manual editions, neither fresh nor post-selection TMSC demonstrated any consistent, clinically meaningful relationship with fertilization, embryo quality, pregnancy outcomes, or CLBR. CONCLUSIONS: In ICSI cycles using donor eggs, neither fresh nor post-selection TMSC was independently associated with reproductive outcomes once confounding factors are accounted for. Consequently, clinicians should recognize the limited prognostic value of conventional semen parameters such as TMSC when counseling couples and assessing reproductive outcomes in donor-oocyte ICSI cycles.