This retrospective cohort study of 2051 consecutive fresh non-donor intracytoplasmic sperm injection (ICSI) cycles investigated whether time from oocyte retrieval to denudation, precisely measured and recorded by an operator-independent automated radiofrequency-based system, affected cycle outcome. ICSI cycles were divided into two groups: group I (denudation within <2 h of oocyte retrieval, n = 1118) and group II (denudation 2-5 h after oocyte retrieval, n = 933). Univariate analysis by two-sample t-test or Mann-Whitney test was used, as appropriate. Both groups were comparable with regards to mean number of oocytes retrieved and fertilized normally after ICSI. The mean number of embryos transferred and surplus embryos cryopreserved at the blastocyst stage were similar. There was no significant difference in fertilization, embryo implantation, pregnancy, clinical pregnancy or live birth rates between the groups. Analysis of group I ICSI outcome after subdivision into immediate (up to 30 min) and early (31-119 min) denudation showed no statistically significant differences between the two subgroups. In conclusion, early oocyte denudation within <2 h after retrieval does not appear to compromise ICSI cycle outcome, permitting more efficiency and flexibility in scheduling laboratory workload. As this was a retrospective observational study, further prospective studies are required to confirm the findings.

No abstract

No abstract

concentration that would allow a couple to access previously unavailable reproductive options. The tiers used for upgrading were: 1-5 million/cc (ICSI/IVF), 5-15 million/cc (IUI) and >15 million/cc (natural conception). AI models were trained and tested using R to predict which patients were likely to upgrade after surgery. The model sorted men into categories that defined how likely they were to upgrade after surgery (likely, equivocal, and unlikely).RESULTS: Data from 240 men were included from both centers. Average age was 36 years. The majority of men had grade 2 left varicocele, and (when present) a grade 1 right varicocele. A total of 47% of men experienced an upgrade in sperm concentration following surgery, 47% did not change, and 6% downgraded. The data from Miami were used to create a random forest model for predicting upgrade in sperm concentration. The most informative parameters were preoperative FSH, sperm concentration and surgical laterality. On external validation using Toronto data, the model accurately predicted upgrade in 87% of men deemed likely to improve, and in 49% and 36% of men who were equivocal and unlikely to improve, respectively. Overall, the model performed well on external validation with an AUC of 0.72 and good calibration (Figure 1).CONCLUSIONS: A machine learning model performed well in predicting clinically meaningful post-varicocelectomy semen upgrade using pre-operative hormonal, clinical, and semen analysis data. To our knowledge, this is the first prediction model to show the utility of hormonal data, as well as the first to use AI to predict upgrading. This model can be used by clinicians in pre-operative counseling of their patients.