Prevalence, patterns and Treatment outcomes of abnormal semen parameters among infertile couples in Ethiopia: A Four-Year Retrospective study.
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Date
2026
Authors
Dr. Nuredin Awel
Journal Title
Journal ISSN
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Publisher
Addis Ababa Uinverstiy
Abstract
Background: Infertility is a substantial public health burden in sub-Saharan Africa, yet
evidence on assisted reproductive technology (ART) outcomes, particularly those related to male
factor infertility, remains limited in Ethiopia. Semen analysis is a cornerstone to male fertility
assessment; however, its prognostic significance for treatment success with intrauterine
insemination (IUI) or intracytoplasmic sperm injection (ICSI) in low-resource settings is not well
established. Despite expanding access to ART, data on the prevalence, patterns, and clinical
relevance of abnormal semen parameters in Ethiopia are scarce. This study provides the first
large-scale analysis of semen profiles and their association with ART outcomes among infertile
couples in Ethiopia.
Objective: This study aimed at describing the prevalence and patterns of abnormal semen
parameters and determining their association with fertility treatment outcomes between IUI and
ICSI among infertile couples undergoing first-cycle ART at two private fertility centers in Addis
Ababa, Ethiopia. between July 2021 and June 2025.
Methods: A four-year retrospective cross-sectional study was conducted among 1,242
consecutive infertile couples who underwent their first ART cycle (IUI or ICSI) between July
2021 and June 2025. Data were extracted from semen analysis records and treatment outcome
registries, with semen analysis standardized per WHO 2021 criteria. The primary outcome was
clinical pregnancy. Data were analyzed using SPSS version 26. Descriptive statistics were used
to assess prevalence and patterns of semen abnormalities. Associations between semen
parameters, reproductive characteristics, and clinical pregnancy were evaluated using chi-square
tests and multivariable binary logistic regression. Adjusted odds ratios (AORs) with 95%
confidence intervals (CIs) were reported, with statistical significance set at p < 0.05.
Results: The mean age of male partners was 40.07 ± 7.78 years, while female partners had a
mean age of 34.43 ± 11.69 years. Primary infertility accounted for 64.1% of couples where as
Secondary infertility comprised 35.9%. Abnormal semen parameters were highly prevalent,
observed in 55.6% (691/1242) of couples with a clinical pregnancy rate of (n=93, 13.5%). The
most common isolated abnormalities were suboptimal motility (n=404, 32.5%), suboptimal
count (n=347, 27.9%), and atypical morphology (n=221, 17.8%). Azoospermia (0 sperm/mL
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accounted for n=12, with a prevalence of 1.0% of all men. During the study period treatment
distribution was, 685 couples (55.2%) underwent IUI and 557 (44.8%) underwent IVF/ICSI,
with corresponding clinical pregnancy rates of 7.7% and 19.0% respectively, yielding an overall
clinical pregnancy rate of 12.8% (95% CI: 11.0–14.7%). In multivariable analysis, after
adjustment for covariates, abnormal semen parameters were not independently predictive of
clinical pregnancy. However, female age ≥35 years was associated with a 56% reduction in the
odds of pregnancy compared to age <30 (AOR = 0.44, 95% CI: 0.27–0.74, p = 0.002). IVF/ICSI
treatment conferred 3.65 times higher odds of success than IUI (AOR = 3.65, 95% CI: 2.31–
5.78, p < 0.001).
Conclusion: More than half of infertile men presenting to private fertility centers in Ethiopia
have at least one abnormal semen parameter. However, clinical pregnancy outcomes were
primarily influenced by female age and treatment modality rather than semen abnormalities per
se. The findings from this study suggest that semen analysis categories alone have limited
prognostic role for predicting ART success in this setting.
Recommendation: Rather than depending just on semen parameter classifications, clinical
counseling and treatment selection for IUI or ICSI should take a holistic, couple-centered
approach that gives priority to female age and the overall clinical context. Prospective research is
necessary to improve evidence-based classification of infertile couples receiving ART and to
better understand the prognostic role of semen abnormalities in ART outcomes.
Description
Keywords
Infertility, IUI, ICSI Clinical Pregnancy, Abnormal Semen Parameters, Assisted Reproductive Technologies, Ethiopia