Severity of oligo‐asteno‐teratozoospermia no longer determines overall success rate in male subfertility

In this longitudinal multicentre cohort study, the overall ongoing pregnancy rateafter current evidence-based managementin male subfertility was studied. All subfertile couples who visited the fertility clinicfor the first time between 2002 and 2006, and had male subfertility as a single diagnosis (n = 762 of 2476 couples), were included in this study. Couples were groupedby the severity of male factor. GroupI (n = 541) had a total motile sperm count (TMSC) 1-20 × 10(6) . GroupII (n = 161) had a TMSC <1 × 10(6) . GroupIII (n = 60) had azoospermia. The overall ongoing pregnancy ratewas 65.5% (500/762). The overall ongoing pregnancy ratesin groupI (69.3%) and groupII (61.5%) were comparable (p = 0.06). However, groupI and groupII conceived significantly more frequently than groupIII (43.3%) ( groupI vs. groupIII p < 0.001 and groupII vs. groupIII p = 0.02, respectively). Moreover, the spontaneous ongoing pregnancy ratein groupI was 35.3%, in groupII 22.4% and in groupIII, 1.7% ( groupI vs. groupII p = 0.002; groupI vs. groupIII p < 0.001; groupII vs. groupIII p < 0.001). Thus, despite a significant difference in spontaneous ongoing pregnancy rates, except for azoospermia, the overall ongoing pregnancy rates, regardless of the severity of the male factor, were comparable. Couples with poorer sperm parameters, however, have to undergo more invasive treatment to reach the same goal.