P-122 The impact of severe male factor on morphokinetic embryo development in low-prognosis patients according to the POSEIDON criteria: an analysis of 10366 injected oocytes
Authors: Setti A , Braga D , Guilherme P , Gallo de Sá P , Caldas M , Iaconelli Junior A , Borges E 
Published: July 2024

Abstract

Study question
Does severe male factor infertility (SMF) impact embryo morphokinetic behavior in low-prognosis women as stratified by the Patient-Oriented Strategies Encompassing IndividualizeD Oocyte Number (POSEIDON) criteria?

Summary answer
Embryos from SMF patients showed lower KIDScore ranking than those from non-SMF (nSMF) patients, which may justify the reduced clinical outcomes contrasted to Control group.

What is known already
It has been reported that 37.1% of poor responder patients (POR) have infertile male partners. While the maternal influence has been well-investigated, the role of seminal quality on reproductive outcomes in POR remains questionable. Embryo monitoring with timelapse imaging (TLI) may be a valuable approach to evaluate whether sperm quality relates to association between POSEIDON classification and the competences of developing embryos. The aim of this study was to investigate whether SMF impacts embryo quality and morphokinetic behavior in the four groups of low-prognosis women as stratified by the POSEIDON criteria.

Study design, size, duration
This historical cohort-study was performed in a private university–affiliated IVF center, between Mar/2019 and Apr/2022. Kinetic data were analyzed in 10366 embryos cultured in a TLI incubator until day five, derived from 2272 patients undergoing ICSI. Patients were split into eight groups according to the POSEIDON criteria and the presence or absence of SMF (&lt;5 × 106 sperms/mL). Embryo morphokinetics were compared among the groups (post hoc achieved power &gt; 90%).

Participants/materials, setting, methods
Injected oocytes were cultured in the EmbryoScope+ incubator, which recorded the following kinetic markers: timing to pronuclei appearance and fading (tPNa and tPNf), two (t2), three (t3), four (t4), five (t5), six (t6), seven (t7), and eight cells (t8), morulae (tM), start of blastulation (tSB) and blastulation (tB). Durations of second and third cell cycles (cc2 and cc3) and timing to complete synchronous divisions s1, s2, and s3 were calculated. The KIDScore ranking was recorded.

Main results and the role of chance
POSEIDON group 1 embryos showed significantly slower tPNa, tPNf, t2, t3, t4, t6, and t7 compared to those from Control group. POSEIDON group 2 embryos showed significantly slower tPNa, t4, t6, t7, t8, and tM compared to those from Control group. Embryos in POSEIDON 2 SMF subgroup took longer than those in POSEIDON 2 nSMF subgroup, and those in both Control subgroups, to achieve tPNf, t2, t3, t5, tSB. POSEIDON group 3 embryos showed significantly slower t8, and cc2 compared to those from Control group. POSEIDON group 4 embryos showed significantly slower tPNf, t2, t3, t4, t5, t6, t7, t8, s2, and s3 compared to those from Control group. For POSEIDON groups 1, 2 and 4, and Control group, the KIDScore ranking was significantly different between SMF and nSFM subgroups. KIDScore ranking was significantly different across all the subgroups in POSEIDON 3. Irrespective of sperm quality, implantation and miscarriage rates were significantly improved in Control subgroups compared to POSEIDON 2 subgroups, there were trends toward improved clinical outcomes in Control subgroups compared to POSEIDON 3 subgroups, and pregnancy, implantation and miscarriage rates were significantly improved in Control subgroups compared to POSEIDON 4 subgroups.

Limitations, reasons for caution
The use of historical cohort groups is a drawback. Despite the eligibility criteria for inclusion in the analysis, potential differences in the baseline characteristics cannot be ruled out.

Wider implications of the findings
The results presented contribute to the understating of the relationship between sperm quality and embryo morphokinetic behavior in POSEIDON patients. Embryo quality, as assessed by TLI-imaging, and clinical outcomes were significantly lower in POSEIDON SMF patients, suggesting that both oocyte (quantity and quality) and sperm are determinant of embryo development.

Trial registration number
N/A