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Abstract Study question Can sperm selection techniques improve the reproductive outcomes of ICSI patients, particularly in males with high teratozoospermia index (TZI) and sperm DNA fragmentation (SDF)? Summary answer Sperm selection techniques significantly increase fertilization and blastocyst development rates in males with high TZI and SDF, achieving a euploidy rate comparable to normal cases. What is known already Abnormal sperm morphology negative effects begin at the fertilization and reach the blastocyst quality and euploidy status. Men with abnormal teratozoospermic index (TZI) exhibit high levels of chromosomal abnormalities and sperm DNA fragmentation (SDF). SDF adversely affects pre and post-implantation embryo development events. Blastocyst aneuploidy isn’t solely due to the oocyte; but also, sperm contribution should be taken into consideration. Previous studies reported that advanced sperm selection techniques (PICSI and MACS) can efficiently enhance reproductive outcomes in abnormal SDF ICSI cases. The efficiency of these techniques in improving ICSI outcomes of patients with high TZI plus SDF remains unexplored. Study design, size, duration A prospective randomized controlled trial included a total of 264 couples, divided into three groups: (1) Control-1 group: males having normal TZI and no sperm selection techniques were used (n = 111), (2) Control-2 group (NO-SS): males having high TZI and no sperm selection techniques were used (n = 63), and (3) Sperm selection (SS) group: males having high TZI and SDF, and sperm selection techniques were used (n = 90). The study started from January till October 2023. Participants/materials, setting, methods Eligibility: females had ≥5MII oocytes, males had abnormal (1.8) TZI, and all blastocysts (≥4BB) had trophoectoderm biopsy. Cases were randomized on the ICSI day to (control-2) and (SS) groups, along with (control-1) with normal TZI for comparison. Females were categorized into 2 subgroups (35, and ≥35 years). SS techniques included physiological ICSI and magnetic-activated cell sorting. PGT-A was done using Illumina platform (Miseq). Statistical analysis (SPSS) of pre-implantation embryo development and PGT-A results was done. Main results and the role of chance We found no significant differences between the female, male ages and number of mature oocytes between the studied groups. Limitations, reasons for caution The results included all pre-implantation embryo parameters but, subsequent post-implantation events like implantation, pregnancy, and miscarriage rates will add more data about the competency of the resulting embryos. A Small sample size of females aged from 36 to 40 years old. Wider implications of the findings Sperm selection techniques appear to be efficient in improving fertilization, blastocyst development rates, and euploidy rates in males with high TZI and sperm DNA fragmentation, suggesting potential benefits for couples undergoing infertility treatment. Trial registration number NCT06231589
Nasreldin et al. (Mon,) studied this question.