title: Sperm quality and paternal age: effect on blastocyst formation and pregnancy rates.
abstract: BACKGROUND
  Several studies suggest a decrease in sperm quality in men in the last decades. Therefore, the aim of this work was to assess the influence of male factors (sperm quality and paternal age) on the outcomes of conventional in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI).
  
  
  METHODS
  This retrospective study included all couples who underwent IVF or ICSI at Montpellier University Hospital, France, between 1 January 2010 and 31 December 2015. Exclusion criteria were cycles using surgically retrieved sperm or frozen sperm, with pre-implantation genetic diagnosis or using frozen oocytes. The primary outcomes were the blastulation rate (number of blastocysts obtained at day 5 or day 6/number of embryos in prolonged culture at day 3) and the clinical pregnancy rate. The secondary outcomes were the fertilization and early miscarriage rates.
  
  
  RESULTS
  In total, 859 IVF and 1632 ICSI cycles were included in this study. The fertilization rate after ICSI was affected by oligospermia. Moreover, in ICSI, severe oligospermia (lower than 0.2 million/ml) led to a reduction of the blastulation rate. Reduced rapid progressive motility affected particularly IVF, with a decrease of the fertilization rate and number of embryos at day 2 when progressive motility was lower than 32%. Paternal age also had a negative effect. Although it was difficult to eliminate the bias linked to the woman's age, pregnancy rate was reduced in IVF and ICSI when the father was older than 51 and the mother older than 37 years.
  
  
  CONCLUSIONS
  These results allow adjusting our strategies of fertilization technique and embryo transfer. In the case of severe oligospermia, transfer should be carried out at the cleaved embryo stage (day 2-3) due to the very low blastulation rate. When the man is older than 51 years, couples should be aware of the reduced success rate, especially if the woman is older than 37 years. Finally, promising research avenues should be explored, such as the quantification of free sperm DNA, to optimize the selection of male gametes.
authors.affiliation: ART/PGD Division, CHU Montpellier, Montpellier, F-34295 France.
authors.forename: Aurélie
authors.initials: A
authors.lastname: Chapuis
authors.affiliation: ART/PGD Division, CHU Montpellier, Montpellier, F-34295 France ; INSERM U1203, Montpellier, F-34295 France.
authors.forename: Anna
authors.initials: A
authors.lastname: Gala
authors.affiliation: ART/PGD Division, CHU Montpellier, Montpellier, F-34295 France ; INSERM U1203, Montpellier, F-34295 France.
authors.forename: Alice
authors.initials: A
authors.lastname: Ferrières-Hoa
authors.affiliation: ART/PGD Division, CHU Montpellier, Montpellier, F-34295 France ; INSERM U1203, Montpellier, F-34295 France ; Montpellier University, UFR of Medicine, Montpellier, France.
authors.forename: Tiffany
authors.initials: T
authors.lastname: Mullet
authors.affiliation: Gynaecology and Obstetric Department, CHU Montpellier, Montpellier, F-34295 France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Bringer-Deutsch
authors.affiliation: Gynaecology and Obstetric Department, CHU Montpellier, Montpellier, F-34295 France.
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Vintejoux
authors.affiliation: Gynaecology and Obstetric Department, CHU Montpellier, Montpellier, F-34295 France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Torre
authors.affiliation: ART/PGD Division, CHU Montpellier, Montpellier, F-34295 France ; INSERM U1203, Montpellier, F-34295 France ; Montpellier University, UFR of Medicine, Montpellier, France.
authors.forename: Samir
authors.initials: S
authors.lastname: Hamamah
keywords: Blastulation rate; Paternal age; Progressive motility; Rate of clinical pregnancy; Sperm concentration; Sperm quality