Comparative ICSI Outcomes in Idiopathic Male Factor and Unexplained Infertility: A Retrospective Cohort Study

Abstract

Objective: To compare ICSI outcomes in couples with idiopathic male factor sub-fertility versus unexplained sub-fertility.

Methods: This retrospective cohort study was conducted at Al-Kafeel IVF Centre, Karbala, Iraq, and included 98 couples who underwent ICSI between February 2023 and January 2024. Of these, 62 had idiopathic male factor sub-fertility and 36 had unexplained sub-fertility. All underwent conventional ICSI. Outcomes assessed were fertilisation rate, cleavage rate, total embryos, good-quality embryos, and biochemical pregnancy confirmed by positive β-hCG.

Results: Fertilisation rates were 73.2% ± 25.6 (idiopathic) vs 79.5% ± 22.9 (unexplained), p = 0.39; cleavage rates 95.2% ± 18.1 vs 97.8% ± 5.0, p = 0.56. Total embryos (mean ± SD) were lower in the idiopathic group (3.9 ± 2.6) than in the unexplained group (7.2 ± 4.7), p = 0.003; good-quality embryos 3.5 ± 2.4 vs 6.6 ± 4.1, p = 0.002. Biochemical pregnancy occurred in 32/62 (51.6%) idiopathic versus 14/36 (38.9%) unexplained. Unadjusted odds ratio for pregnancy (idiopathic vs unexplained) = 1.68 (95% CI 0.73–3.86), Fisher’s exact p = 0.29. After adjustment for maternal age, BMI, total oocytes and number of embryos transferred (multivariable logistic regression), the group effect was [report aOR here once analysis is run].

Conclusions: Idiopathic male factor sub-fertility is associated with lower embryo yield and fewer good-quality embryos after ICSI, but biochemical pregnancy rates did not differ significantly. Future studies should adjust for embryo transfer policy and include live birth outcomes.