Predictive value of seminal oxidation-reduction potential (ORP) analysis for reproductive outcomes of intracytoplasmic sperm injection (ICSI) cycles

Ralf Henkel, Aqeel Morris, Paraskevi Vogiatzi, Ramadan Saleh, Hassan Sallam, Florence Boitrelle, Nicolas Garrido, Mohamed Arafa, Murat Gül, Amarnath Rambhatla, Israel Maldonado Rosas, Ashok Agarwal, Kristian Leisegang, Thomas Ignatius Siebert
Reproductive BioMedicine Online Available online 25 May 2022. 2022 doi:


Research question: Has seminal oxidation-reduction potential (ORP) clinical relevance for reproductive outcome. Design: In this prospective observational study a total of 144 couples who had an ICSI cycle between June 2018 and December 2020 were included. The study included patients undergoing fresh ICSI cycles with autologous gametes. Cycles that had day-3 embryo transfers and cryopreservation cycles were excluded. There was no restriction to patients with severe male infertility; couples with unexplained infertility and couples with unexplained male infertility were included, those with azoospermia were excluded. Semen analysis, seminal ORP, sperm DNA fragmentation and reproductive outcomes (fertilisation, blastocyst development, pregnancy and live birth) were determined. Results: Seminal ORP correlated significantly negatively with fertilisation rate (r=-0.267; P=0.0012), blastocyst development rate (r=-0.389; P<0.0001), implantation (r=-0.281; P=0.0010), pregnancy (r=-0.293; P=0.0006) and live birth (r=-0.359; P<0.0001). ROC curve analysis showed significant predictive power for ORP for fertilisation (≥80%; AUC=0.652; P=0.0012), blastocyst development rate (≥60%; AUC=0.762; P<0.0001), implantation (AUC=0.658; P=0.0015), pregnancy (AUC=0.673; P=0.0004) and live birth (AUC=0.728; P<0.0001). Comparable results were obtained for SDF (fertilisation: AUC: 0.678; blastocyst development: AUC: 0.780; implantation: AUC: 0.649; pregnancy: AUC: 0.664; live birth: AUC: 0.723). Normal sperm morphology showed for all reproductive outcome parameters the lowest predictive power. With male age as confounding factor, ORP (cut-off value of 0.51 mV/106 sperm/mL) has significant (P<0.04667) effects on odds ratios for all reproductive outcome parameters. Multivariate logistic regression to investigate potential seminal and female confounding factors revealed that seminal ORP significantly (P<0.0039; P<0.0130) affects reproductive outcome. Conclusion: Seminal ORP as determined by means of the MiOXSYS system is relevant for good fertilisation, blastocyst development, implantation, clinical pregnancy and live birth.