{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,5]],"date-time":"2026-09-05T09:13:22Z","timestamp":1788599602494,"version":"build-2803163510"},"reference-count":22,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","license":[{"start":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T00:00:00Z","timestamp":1778803200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:p>\n                    Multiple morphological abnormalities of the sperm flagella (MMAF) compromise intracytoplasmic sperm injection (ICSI) outcomes. Testicular sperm aspiration (TESA) may be beneficial, but its impact on early embryonic development and pregnancy in MMAF remains uncertain. This study evaluated the effect of TESA on fertilization, cleavage, on-time Day-3 embryo development, and clinical pregnancy and explored modification by female age and MMAF genotype. In this retrospective cohort, 196 MMAF patients undergoing ICSI (January 2019\u2013December 2024) without female-factor infertility were analyzed: TESA group (\n                    <jats:italic toggle=\"yes\">n<\/jats:italic>\n                    = 65) versus non-TESA group (\n                    <jats:italic toggle=\"yes\">n<\/jats:italic>\n                    = 131). Only fresh embryo transfer cycles were included. Outcomes were fertilization, cleavage, on-time Day-3 embryo development, and pregnancy. Multivariable regression was complemented by inverse probability of treatment weighting, propensity score matching, and stratified analyses by female age and genotype. Robustness was examined using bootstrap resampling and outlier-sensitivity analyses. Notably, TESA was associated with higher fertilization rates (adjusted coefficient: +5.63%,\n                    <jats:italic toggle=\"yes\">P<\/jats:italic>\n                    = 0.022; inverse probability of treatment weighting average treatment effect [IPTW-ATE]: +5.9%,\n                    <jats:italic toggle=\"yes\">P<\/jats:italic>\n                    = 0.022; Cohen\u2019s d: 0.371). Cleavage gains were smaller (IPTW-ATE: +3.8%,\n                    <jats:italic toggle=\"yes\">P<\/jats:italic>\n                    = 0.013; Cohen\u2019s d: 0.246) and method-sensitive. No significant differences were found for on-time Day-3 development or pregnancy; power was limited for these endpoints. TESA mostly improved fertilization in women aged 30\u201335 years (IPTW-ATE: +9.5%,\n                    <jats:italic toggle=\"yes\">P<\/jats:italic>\n                    = 0.017) and cleavage in genotype-negative patients (IPTW-ATE: +10.1%,\n                    <jats:italic toggle=\"yes\">P<\/jats:italic>\n                    = 0.012). Propensity models showed good balance (area under the receiver operating characteristic curve: 0.638, and standardized differences &lt;0.1); power was adequate for fertilization (0.825). Overall, TESA is associated with higher fertilization rates in MMAF-ICSI, with modest and method-sensitive evidence for cleavage, supporting selective use. Prospective, multi-center validation is needed. Limited downstream effects suggest a role primarily at early stages.\n                  <\/jats:p>","DOI":"10.4103\/aja2025113","type":"journal-article","created":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T19:00:39Z","timestamp":1778871639000},"page":"634-640","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Testicular sperm aspiration enhances fertilization rates in MMAF patients undergoing ICSI: a retrospective cohort study"],"prefix":"10.4103","volume":"28","author":[{"given":"Lei-Xi","family":"Peng","sequence":"first","affiliation":[{"name":"Reproduction Medical Center of West China Second University Hospital, Key Laboratory of Obstetric, Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, Sichuan University, Chengdu 610041, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Long-Long","family":"Fu","sequence":"additional","affiliation":[{"name":"Reproductive Health Research Centre\/Human Sperm Bank, NHC Key Laboratory of Frontiers and Technologies in Reproductive Health, National Research Institute for Family Planning, Beijing 100081, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jin-Hong","family":"Li","sequence":"additional","affiliation":[{"name":"Reproduction Medical Center of West China Second University Hospital, Key Laboratory of Obstetric, Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, Sichuan University, Chengdu 610041, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lang","family":"Qin","sequence":"additional","affiliation":[{"name":"Reproduction Medical Center of West China Second University Hospital, Key Laboratory of Obstetric, Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, Sichuan University, Chengdu 610041, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiao-Yong","family":"Qiao","sequence":"additional","affiliation":[{"name":"Reproduction Medical Center of West China Second University Hospital, Key Laboratory of Obstetric, Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, Sichuan University, Chengdu 610041, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Bai","sequence":"additional","affiliation":[{"name":"Reproduction Medical Center of West China Second University Hospital, Key Laboratory of Obstetric, Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, Sichuan University, Chengdu 610041, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wen-Hong","family":"Lu","sequence":"additional","affiliation":[{"name":"Reproductive Health Research Centre\/Human Sperm Bank, NHC Key Laboratory of Frontiers and Technologies in Reproductive Health, National Research Institute for Family Planning, Beijing 100081, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi-Hong","family":"Yang","sequence":"additional","affiliation":[{"name":"Reproduction Medical Center of West China Second University Hospital, Key Laboratory of Obstetric, Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, Sichuan University, Chengdu 610041, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,5,15]]},"reference":[{"key":"R1-20260905","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1093\/humupd\/dmv020","article-title":"Teratozoospermia: spotlight on the main genetic actors in the human","volume":"21","author":"Coutton","year":"2015","journal-title":"Hum Reprod Update"},{"key":"R2-20260905","doi-asserted-by":"crossref","first-page":"236","DOI":"10.4103\/aja.aja_53_19","article-title":"Insight on 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