Defining Predictive Factors for Total Fertilization Failure and Embryo Development Arrest in Intracytoplasmic Sperm Injection Cycles

Purpose Total fertilization failure (TFF) and embryo development arrest (EDA) remain challenging outcomes in intracytoplasmic sperm injection (ICSI) cycles. This study aimed to identify predictive factors associated with TFF and EDA in ICSI treatments. Methods This retrospective study analyzed 1846 ICSI cycles performed between January 2016 and December 2019 at a tertiary assisted reproduction center. Patients were categorized into successful fertilization and unsuccessful fertilization groups (TFF and EDA). Demographic characteristics, ovarian reserve markers, stimulation parameters, semen characteristics, and embryological outcomes were compared. Univariate and multivariate logistic regression analyses were performed to determine independent predictors of fertilization success. Receiver operating characteristic (ROC) analysis was used to evaluate prognostic factors. Results Successful fertilization was achieved in 76.5% of cycles, while TFF and EDA occurred in 6.6% and 16.9%, respectively. Female age, basal FSH level, serum AMH level, antral follicle count, estradiol level on oocyte pick-up day, number of retrieved oocytes, and number of metaphase II oocytes were significantly associated with fertilization outcomes. In multivariate analysis, only the number of two-pronuclear (2PN) embryos was identified as an independent predictor of successful fertilization (OR = 12.016, 95% CI: 7.529–19.176, p < 0.001). ROC analysis demonstrated that a 2PN cut-off value of 2.5 predicted fertilization success with 75% sensitivity and 78% specificity (AUC = 0.845). Conclusion The number of 2PN embryos is the strongest independent prognostic factor for fertilization success in ICSI cycles. Identifying patients at risk for TFF and EDA may help optimize treatment strategies and improve clinical outcomes