According to the WHO, infertility affects 15% of reproductive age couples worldwide. Among the assisted reproductive technologies available for patients with infertility, intracytoplasmic sperm injection (ICSI) has become one of the most widely employed and is now thought to be the most common method for oocyte insemination outside of the human body.

ICSI entails the selection of an individual sperm cell and its injection directly into an oocyte. Usually, an embryologist performs the selection of the individual sperm cell to inject by subjectively observing the morphology and progression of the candidate spermatozoon. Subjectivity and time constrains, however, suggest the best possible candidate might not always be selected. Further optimization of ICSI technology remains a significant goal, yet the majority of approaches proposed in the literature have returned mixed results. The deployment of an artificial intelligence (AI) software capable of detecting and non-invasively predicting the value of individual spermatozoa in real time could significantly improve ICSI.

SiD (IVF 2.0 Ltd, London, UK) is a software designed to identify, evaluate, and assist in the spermatozoon selection process ahead of ICSI. SID uses a mathematical model to evaluate individual spermatozoa in real-time according to their motility patterns (for instance velocity, linearity, straightness) and their morphology. The software has been developed by making use of retrospective data analysis, but its prospective evaluation is still pending.

With the above in mind, this study intends to address the following question: can the use of a software assistant for the selection of individual sperm cells for injection (SiD), improve ICSI outcomes (oocyte fertilization, embryo development and quality, embryo ploidy, pregnancy, and live birth)? Patients with a clinical indication for undergoing ICSI will be prospectively enrolled into the study. Following ovarian stimulation, the oocytes retrieved from each patient will be randomly split into two groups and inseminated by ICSI using sperm selected either subjectively by an embryologist (control group) or by the software assistant SiD (experimental group). Embryos will be allowed to develop for up to six days and until blastocyst formation assessments are completed. Embryos might be subjected to cytogenetic screening or used for embryo transfer according to patient needs. The recorded outcomes will be anonymized prior to statistical analysis.

Inclusion Criteria:

• Participant's age between 18 and 40 years of age.
• Informed consent signed by the patient before treatment.
• IVF treatments with medical or embryology indication to perform ICSI.
• Cycles with at least 2 oocytes in Metaphase II.
• Fresh ejaculated motile sperm.
• Fresh oocytes.
• Selection of sperm using a 7% or 10% PVP solution.
• Presence of motile sperm at the time of sperm selection for ICSI.
• Videos recorded with a total magnification of 200x.

Exclusion Criteria:

• Patients diagnosed with recurrent pregnancy loss.
• Spermatozoa extracted by testicular biopsy.
• Frozen/thawed spermatozoa.
• Frozen/thawed oocytes in any case.
• That the recommendations for use of SiD have not been fully followed.
• Poor quality of saved ICSI video.
• Inability to reliably trace sperm-oocyte-embryo throughout the process.
• Oocytes that are not in Metaphase II.
• Patients with immotile sperm