Second ejaculation produces good quality sperm and decreases the rate of unexpected ICSI cycle

Background: Second ejaculation can influence sperm quality which may define the first line treatment. The purpose of this study was to evaluate the effectiveness of a second ejaculation in decreasing the intracytoplasmic sperm injection (ICSI) rate in unexpected ICSI cycle. Methods: : A retrospective study of unexpected ICSI cycle and conventional in vitro fertilization IVF was conducted. The unexpected ICSI group was subdivided into the second ejaculation IVF and ICSI groups based on second ejaculation semen parameters after swim-up. To predict the influence of sperm protein between two ejaculation semen, the PXD010695 dataset and differentially expressed proteins (DEPs) were downloaded and subjected to bioinformatics analysis. Results: : Semen volume and sperm DNA fragmentation (SDF) were lower, whereas sperm concentration, total sperm count, progressive motility and total progressive motility sperm count after swim-up were higher during the second ejaculation. A lower rate of fertilization, a higher rate of good-quality embryos on day 3 and good-quality blastocyst were found in the second ejaculation IVF group. There was no significant difference among the groups in rate of rescue ICSI, oocytes utilization rate, clinical pregnancy, implantation, miscarriage, and live birth. Bioinformatics analysis indicated that the second ejaculation with downregulated proteins is related to a reduction in motility and forms a protein module with glutathione metabolism. Conclusion: For unexpected ICSI group, second ejaculation IVF produced good quality sperm and could be an economical and secure alternative to decrease the rate of unexpected ICSI.