Does Physiological Intracytoplasmic Sperm Injection Improve Outcome in Men with Abnormal Semen Parameters: A Retrospective Cohort Study

Background: As the male factor in infertility is on rising trend, we need a promising tool for sperm selection to improve the embryo development. Aim: The present study compares the embryological and clinical parameters between physiological intracytoplasmic sperm injection (PICSI) and conventional intracytoplasmic sperm injection (ICSI) in abnormal semen parameters. Settings and Design: This was a retrospective cohort study. Materials and Methods: This study was conducted over the duration of 9 months from April to December 2023. One hundred and four patients, who matched the inclusion and exclusion criteria, were enrolled in the study. The adjusted blastulation rate was evaluated as the primary outcome, and the secondary outcomes studied were fertilisation rate, good-quality cleavage stage embryo rate, clinical pregnancy and miscarriage rate. Statistical Analysis Used: The outcome measures were calculated using independent Student’s t-test, and P < 0.5 was considered statistically significant. Results: The 104 enrolled patients were divided into two groups. In the study population (n = 51), PICSI was used for sperm selection and the controls (n = 53) used conventional ICSI. The adjusted blastulation rate was statistically significant higher in the PICSI group (43.7%) as compared to the controls (34.2%) (P = 0.022). The fertilisation and cleavage rates were not statistically different amongst the groups. The pregnancy rate (37.2% vs. 32%, P = 0.027) and miscarriage rate (5.3% vs. 11.7%, P = 0.005) were statistically better in the PICSI group. Conclusion: PICSI may improve treatment outcomes in couples undergoing assisted reproduction for male factor infertility. However, larger randomised controlled trials are needed for validating the current study findings.