ArticleJournal of assisted reproduction and genetics2025
LOW FERTILIZATION: statistical definition and clinical relevance.
Article in Journal of assisted reproduction and genetics, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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7 authors.
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Abstract
purposeA reduced fertilization rate is a frustrating condition for patients and embryologists. This study aimed develop a statistical metric, LOW FERTILIZATION, to determine whether a distinct pathological entity underlies reduced fertilization or if it merely reflects statistical variability.
methodAn indirect argument inspired by proof by contradiction was developed using a statistical model based on two assumptions: (1) fertilization occurs with same probability (P) for all oocytes with P based on Istanbul Consensus benchmarks, (2) no underlying clinical condition affects the couple. With these assumptions, oocytes fertilization in a single cycle follows a binomial distribution, with LOW FERTILIZATION defined as outcome occurring with an expected probability below 5% under the null hypothesis. Afterwards, we applied findings to a real-world population evaluating the frequency of LOW FERTILIZATION, predictive factors, and recurrence risk.
resultsWe provided a table indicating the maximum number of fertilized oocytes to define low fertilization, alongside R code, to facilitate reproducibility. For real-world data in 2653 women, LOW FERTILIZATION was observed in 118 cases (4.5%, 95%CI: 3.7-5.3%), occurring in 3.6% of cIVF and 5.2% of ICSI cycles. Severe male factor infertility was associated with LOW FERTILIZATION in ICSI (adjusted OR = 2.60, 95% CI: 1.37-4.73). The adjusted OR of recurrence of LOW FERTILIZATION was 3.70 (95%CI: 1.40-8.71), rising to 7.26 (95%CI: 2.48-19.93) for couples undergoing ICSI in both cycles.
conclusionsThe LOW FERTILIZATION metric demonstrates a clinical condition, although relatively rare, associated with reduced fertilization. It also offers a valuable tool to guide future research investigating factors associated with this condition.
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