Disorders of spermatogenesis and the effectiveness of assisted reproductive technology programs: a literature review

Disorders of spermatogenesis represent a significant yet insufficiently studied factor that influences the outcomes of assisted reproductive technology (ART) programs and the incidence of early reproductive loss. The aim of this review was to systematize current evidence on the relationship between routine and advanced parameters used for the assessment of spermatogenesis and embryo quality, ART effectiveness, and the risk of implantation failure. The results of large retrospective and prospective studies, as well as systematic reviews and meta-analyses, addressing the role of sperm concentration, motility, morphology, and sperm DNA fragmentation in determining embryological and clinical outcomes of ART have been analyzed. It has been shown that conventional semen parameters have limited prognostic value, whereas sperm DNA fragmentation is associated with reduced clinical pregnancy rates and an increased risk of miscarriage. Special attention is given to modern methods for assessing sperm DNA integrity and their diagnostic capabilities. The review also discusses the impact of oxidative stress and the role of antioxidant therapy in the context of male preconception preparation prior to ART programs. The review highlights the importance of a comprehensive evaluation of male reproductive function and a personalized approach to patient management in order to improve ART outcomes and reduce the risk of early reproductive loss.