Embryo competence and above all, live birth and offspring fitness.

Future progress may depend on identifying which sperm traits and their underlying genetic architecture are linked to embryo competence #ESHREjc

Interventions like varicocele repair, or antioxidant therapy shows improvements in semen parameters often, but translation into higher live birth rates remains inconsistent and context-dependent.

Both may offer benefit in selected populations, but evidence remains inconsistent. As suggested by the current study and others, morphology may not be the most biologically informative trait when selecting sperm.

Even when ICSI is ultimately used, earlier male evaluation can still influence management by identifying modifiable factors (e.g. varicocele, endocrine imbalance, lifestyle exposures), informing timing of treatment, and guiding decisions on sperm source (ejaculated vs testicular).

These are heterogeneous conditions. Grouping them together may obscure distinct mechanisms, ranging from meiotic defects to post-testicular damage. More granular phenotyping could reveal subgroups with very different reproductive risks and treatment responses. #ESHREjc

Live birth rate reflects success at the endpoint, but time-to-live-birth reflects the journey. Time-to-live-birth might be more meaningful because it captures the number of cycles, emotional burden, and financial cost required to achieve a successful outcome.

Clinical guidelines could place greater emphasis on early and comprehensive male evaluation alongside female assessment. This would help ensure that male factor is identified earlier, supporting more targeted and efficient treatment strategies. #ESHREjc

An additional challenge is that men are rarely routinely screened, and many only present after prolonged unsuccessful attempts to conceive. This delays identification of severe male factor even further, reducing the window for early intervention and increasing time-to-live-birth. #ESHREjc

The clinical endpoint should not only be live birth, but also time-to-live-birth. Severe male factor may not change neonatal outcomes, but it may significantly impact the number of cycles required. #ESHREjc

Agree that counselling is key, but this also highlights a diagnostic gap. Better stratification could improve both patient expectations and treatment efficiency. #ESHREjc

If neonatal outcomes are comparable among live births, the key biological bottleneck likely lies before implantation. #ESHREjc

Delighted to contribute to this discussion. Male fertility has remained underfunded and under-researched for decades, even though male factors contribute to around half of infertility cases. It is time to give male reproductive health the scientific attention it deserves. #ESHREjc

Never?

🙋🏼‍♂️🙋🏼‍♂️🙋🏼‍♂️ @JanStukenborg we are ready for the next expedition. Do your magic!