Pregnancy outcomes in infertile couples undergoing IVF/ICSI-ET with a diagnosis of male factor infertility

Objective: The aim of this study is to investigate the effects of male factor infertility on fertilization, embryo formation, pregnancy outcomes, obstetric outcomes, and neonatal results in infertile couples undergoing IVF/ICSI-ET. Materials and Methods: A total of 465 patients with male infertility and unexplained infertility who applied to the Reproductive Endocrinology and Infertility Department of the Department of Obstetrics and Gynecology of Çukurova University Faculty of Medicine between 2019 and 2023 were included in the study and evaluated retrospectively. The patients were examined in 5 groups. Group 1 included 233 normospermic patients with unexplained infertility, group 2 included 56 patients with mild oligospermia, group 3 included 51 patients with severe oligospermia, group 4 included 73 patients with cryptozoopermia, and group 5 included 52 patients with azoospermia who underwent TESE. Results: Of the patients included in the study, 406 (87.3%) underwent ICSI, 37 (8%) underwent DET, and 22 (4.7%) underwent TESE and therefore the cycle was cancelled. Primary infertility was found to be statistically higher in the azoospermic group and secondary infertility was found to be statistically higher in the normospermic group (p<0.001). The duration of infertility was found to be longer in the normospermic and slightly oligospermic groups and in the azoospermic groups (p=0.002). The number of fertilized oocytes was found to be statistically higher in the normospermic and severe oligospermic groups compared to the azoospermic group (p<0.001). The number of embryos formed was found to be statistically significantly higher in the normospermic and severe oligospermic groups compared to the cryptozoospermic group (p<0.001). Embryo transfer was performed in a total of 377 patients (81.1%). Fresh embryo transfer (FET) was performed in 344 (90.2%) of these patients and frozen embryo transfer (FET) was performed in 37 (9.8%). Beta-hCG positivity was observed in 129 (34.2%) of those who underwent embryo transfer. Chemical pregnancy was seen in 14 (3%) of these, gestational sac formation in 15 (3.2%), clinical pregnancy in 99 (21.3%) and no pregnancy occurred in 337 (72.5%). In 41 (36%) of pregnancy, pregnancy resulted in abortion, while the pregnancy of 73 (64%) continued or live birth. Statistically significant total motile sperm count was found to be higher in patients who became pregnant (p=0.002). No statistically significant difference was found between male age, treatment protocol, embryo transfer day, chemical pregnancy, abortion, GS formation, clinical pregnancy, abortion and ongoing pregnancy or live birth between the groups. No significant difference was found between male age and pregnancy. A total of 90 newborns were included in the study. In the unexplained infertility group, statistically significant neonatal APGAR scores were lower and NICU admission was higher. Conclusion: Male factor negatively affects the number of fertilized oocytes and the number of embryos formed. In addition, as TMSS increases, the pregnancy rate increases. Numerous randomized controlled studies are needed to better understand the effects of male factor on fertilization, embryo formation, implantation, pregnancy, obstetric, perinatal and neonatal outcomes. Keywords: Male infertility, ICSI, fertilization, embryo, pregnancy