Total Progressively Motile Sperm Cell Count as a Predictor of Fertilization Failure

Objectives: This study aimed to investigate the differences in clinical parameters between cycles with normal in vitro fertilization (IVF) fertilization rates and those with low fertilization rates requiring rescue intracytoplasmic sperm injection (R-ICSI). Methods: A retrospective analysis was conducted on clinical data from 606 IVF cycles and 97 R-ICSI cycles from January 2019 to August 2024. Non-parametric tests, logistic regression analysis, and ROC curves were employed to analyze the relationship between the data and identify the most influential indicators of fertilization failure. Results: Significant differences were observed between the two groups in female age, male age, female BMI, type of infertility, years of infertility, sperm concentration, number of forward motile spermatozoa, PR, IM, DFI, and acrosomal enzyme activity (P < 0.05). Following R-ICSI, the normal fertilization rate increased from 17.16% (150/874) to 61.78% (540/874), significantly different from the 67.08% (3715/5538) observed in the IVF group (P < 0.05). The area under the curve (AUC) for female BMI, DFI, and total progressively motile sperm cell count (TPMC) were 0.575, 0.617, and 0.703, respectively, with Youden indices of 0.13, 0.21, and 0.31. Conclusions: The results suggest that TPMC is the most effective predictor of fertilization failure.