PURPOSE There is controversy whether teratospermia is associated with poorer IVF outcomes and if ICSI may overcome this deficit. The debate likely lies in study heterogeneity, poor adjustment for confounders, and inter-observer variation in sperm morphology assessment. Given the current literature, a shift in practice was implemented at our center in February 2017, whereby teratospermia was no longer a criterion for ICSI. We hypothesized that, despite decreasing ICSI rates, we would see no change in ART outcomes. METHODS A retrospective study was performed including 1821 couples undergoing IVF/ICSI at a single center from January 2016 to December 2018, divided into cohorts before and after the practice change. The primary outcome of clinical pregnancy and secondary outcomes of fertilization, fertilization failure, good quality blastocyst formation, embryo utilization, positive hCG, and miscarriage rates was compared, adjusting for potential confounders. Subgroup analysis was performed evaluating teratospermia as the only reason for a male factor infertility diagnosis. RESULTS Despite a decrease in ICSI rate of 30.3%, we found no significant difference in clinical intrauterine pregnancy rate, with an adjusted relative risk of 0.93 (0.81, 1.07, P = 0.3008). There were no significant differences in other secondary outcomes after multivariate adjustment. Subgroup analysis for those with male factor infertility due to teratospermia showed no difference in outcomes. CONCLUSION This study concurs with the recent data suggesting that employing ICSI solely for teratospermia is unnecessary. This may allow clinics to decrease ICSI rates without sacrificing success rates, leading to lower cost and risk associated with treatment.

中文翻译：

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忽略畸形精子症作为 ICSI 的选择标准会改变妊娠率吗？

目的 畸形精子症是否与较差的 IVF 结果相关以及 ICSI 是否可以克服这种缺陷存在争议。争论可能在于研究的异质性、混杂因素的不良调整以及精子形态评估的观察者间差异。鉴于目前的文献，我们中心于 2017 年 2 月实施了实践转变，由此畸形精子症不再是 ICSI 的标准。我们假设，尽管 ICSI 率下降，但我们不会看到 ART 结果发生变化。方法 回顾性研究 2016 年 1 月至 2018 年 12 月在单中心接受 IVF/ICSI 的 1821 对夫妇，分为实践改变前后的队列。临床妊娠的主要结局和受精、受精失败的次要结局，比较了高质量的囊胚形成、胚胎利用、hCG 阳性和流产率，调整了潜在的混杂因素。进行了亚组分析，评估畸形精子症是男性因素不育诊断的唯一原因。结果 尽管 ICSI 率下降了 30.3%，但我们发现临床宫内妊娠率没有显着差异，调整后的相对风险为 0.93（0.81、1.07，P = 0.3008）。多变量调整后，其他次要结局没有显着差异。因畸形精子症导致男性因素不育的亚组分析显示结果没有差异。结论 本研究与最近的数据一致，表明仅将 ICSI 用于畸形精子症是不必要的。