Use of the total motile sperm count to predict total fertilization failure in in vitro fertilization

Objective: To evaluate the capacity of baseline characteristics and total motile sperm count (TMC) to predict total fertilization failure (TFF) in patients undergoing IVF. Design: Retrospective cohort study. Setting: University hospital. Patient(s): Eight hundred ninety-two couples with a total of 1,569 consecutive IVF cycles. Intervention(s): Prewash and postwash TMC during fertility workup and at the time of ovum pickup (OPU). Main Outcome Measure(s): Analysis of logistic regression and the receiver operating characteristic curve were used to determine which variables could be used to predict TFF. Result(s): The area under the curve (AUC) for prewash TMC during fertility workup was 0.72, similar to a combination of pre- and postwash TMC. At the time of OPU, both pre- and postwash TMC had an AUC of 0.73. A model based on selected baseline characteristics (male age, number of IVF cycles, indication for IVF, and prewash TMC during fertility workup) had an AUC of 0.75. A model at the time of OPU, including the number of oocytes, had an AUC of 0.80. Conclusion(s): The use of both models, one before start of the IVF cycle and one at the time of OPU, allows an accurate prediction of the chance of TFF and is useful in counseling patients on whether to opt for IVF or ICSI.