JBRA Assisted Reproduction 2025;29(Suppl.2 SBRA 2025):10
Oral Presentation
29th Annual Congress of the SBRA. São Paulo/SP - Brazil, 2025
doi: 10.5935/1518-0557.20263525
O-10. Oocyte Quality Modulates the Impact of Paternal Age on ICSI Outcomes: Insights from an AI-Based Morphological Scoring System
Daniela Paes Almeida Braga1, Amanda Setti2, Maite del Collado1, Fjeldstad Jullin3, Natalie Mercuri3, Edson Borges Jr4
1 Science for Everymind - São Paulo - SP - Brasil
2 Instituto Sapientiae - São Paulo - SP - Brasil
3 Future Fertilitiy - Canada
4 Fertility - FertGroup - SÃO PAULO - SP - Brasil
Objective: The impact of paternal age on intracytoplasmic sperm injection (ICSI) outcomes has become increasingly relevant as men delay fatherhood in developed countries. While the effects of maternal age on assisted reproductive technology (ART) are well established, the independent influence of paternal age remains controversial. Oocytes possess comprehensive DNA repair machinery that becomes active after fertilization and relies on maternal factors stored during oocyte maturation. MAGENTA™ is an advanced artificial intelligence (AI) tool that evaluates images of mature denuded oocytes, providing analyses that correlate oocyte quality with subsequent embryo development. Therefore, MAGENTA™ may offer valuable insights into oocyte biology. Considering this, the objective of the present study was to evaluate whether oocyte age and quality, assessed by the AI-based MAGENTA™ system, can modulate the effect of paternal age on ICSI outcomes.
Methods: In this retrospective cohort study, images of 13,786 oocytes retrieved from 3,696 ICSI cycles performed between January 2020 and May 2024 were scored from 0 to 10 using the AI tool MAGENTA™. Oocytes were first stratified by paternal age into two groups: ≤39 years and >39 years. In the advanced paternal age group (>39 years), embryos were further stratified according to maternal age (≤37 vs. >37 years) and MAGENTA™ score (MS >6.4 vs. ≤6.4), resulting in four subgroups: Old_Male+ Young_Female + High_MS (n = 864), Old_Male + Young_Female + Low_MS (n = 831), Old_Male + Old_Female + High_MS (n = 1,988), and Old_Male + Old_Female + Low_MS (n = 2,538). The same stratification was applied to the younger paternal age group (≤39 years), yielding: Young_Male + Young_Female + High_MS (n = 2,742), Young_Male + Young_Female + Low_MS (n = 2,448), Young_Male + Old_Female + High_MS (n = 1,201), and Young_Male + Old_Female + Low_MS (n = 1,174). The effect of paternal age on laboratory outcomes—including fertilization, blastulation, and high-quality blastocyst rates, was evaluated across all groups. For clinical outcomes, pregnancy, implantation, and miscarriage rates were calculated as means per treatment cycle (i.e., one value per patient), and compared among groups.
Results: Fertilization, blastulation, and high-quality blastocyst rates differed significantly across groups defined by paternal age, maternal age, and MS (global p<0.001 for all laboratory outcomes). For fertilization, advanced paternal age negatively affected outcomes only when combined with low MS, regardless of maternal age. Fertilization rates were significantly lower (p<0.001) in the groups with older men (>39 years) and low MS, whether maternal age was ≤37 years (84.6%) or >37 years (83.9%), when compared with their high-MS counterparts (90.1% and 90.9%, respectively). For blastulation, the interaction between paternal age and maternal parameters was more pronounced. In the group with older paternal age, younger maternal age, and high MS, blastulation was significantly higher (61.0%) compared with the group with older paternal age, older maternal age, and low MS (37.6%; p<0.001). A similar pattern was observed for high-quality blastocyst rate: when paternal age was >39 years, maternal age was ≤37 years, and MS was high, high-quality blastocyst rate reached 48.7%, compared with 37.3% in cycles with both advanced maternal and paternal age and low MS (p<0.001). No significant impact of paternal age on clinical outcomes were notes.
Conclusion: This study demonstrates that the negative impact of advanced paternal age on ICSI outcomes is not uniform and is significantly modulated by maternal age and oocyte quality. High-quality oocytes, particularly from younger women, appear to attenuate or even neutralize the detrimental effects associated with paternal aging. The results offer clinically relevant insights that may support more individualized and informed counselling for couples undergoing ART.