Background: Sperm morphology is a key factor influencing fertilization and embryo development in assisted reproductive technology (ART). However, the predictive value of sperm deformity indices and selection techniques remains debated. This study evaluated the impact of teratozoospermia on fertilization, blastocyst formation, and embryo quality, comparing conventional and microfluidic sperm selection methods. Methods: A retrospective analysis was conducted on ART cycles involving patients with teratozoospermia. Sperm selection was performed using density gradient centrifugation (DGC) or microfluidic sperm sorting (MFSS). The correlations between the Sperm Deformity Index (SDI), Multiple Anomalies Index (MAI), and Teratozoopermia Index (TZI) with fertilization rates, blastocyst formation, and embryo quality were assessed. Statistical analysis included correlation tests, receiver operating characteristic (ROC) curves, and independent samples t-tests. Results: Patients with severe teratozoospermia exhibited lower fertilization rates (p < 0.01) and reduced blastocyst formation (p = 0.02). The SDI and MAI showed moderate negative correlations with fertilization (r = −0.15 and r = −0.25, respectively) and blastocyst development (r = −0.20 and r = −0.30, respectively), while the TZI had only weak associations (r = −0.10 and r = −0.15, respectively). ROC analysis demonstrated that the SDI and MAI were moderate predictors of embryo viability (AUC = 0.70 and 0.75, respectively). Patients who underwent microfluidic sperm selection had higher fertilization rates (p = 0.03) and improved blastocyst quality (p = 0.04) than those processed with DGC. Conclusions: Severe teratozoospermia negatively affects fertilization and blastocyst formation, with the SDI and MAI showing moderate predictive value for embryo development. The use of microfluidic sperm selection significantly improved embryo quality, supporting its clinical relevance in ART.

Background and Objectives: Aneuploidy is the leading cause of implantation failure and miscarriage, with prevalence increasing with maternal age. Embryos classified as chaotic, characterized by the presence of five or more chromosomal abnormalities, and those with complex aneuploidies, defined by two to four abnormalities, represent a controversial category in preimplantation genetic testing for aneuploidy (PGT-A), as the potential for misclassification remains a significant concern. Materials and Methods: We performed a retrospective study at the Calla IVF Center, Oradea, analyzing 230 blastocysts grouped by maternal age (25–30, 31–35, 36–40, and 41–50 years). A trophoblast biopsy was performed on days 5–7, and the samples were analyzed by next-generation sequencing (NGS). Embryos were classified as euploid, aneuploid, mosaic, or chaotic. The 19 embryos initially diagnosed as chaotic were thawed and subjected to re-biopsy. Statistical analysis included descriptive statistics (chi-square tests and ANOVA) and multivariable regression models, with p < 0.05 as the criterion for statistical significance. Results: Aneuploidy increased with maternal age, from 29.6% in women aged 25–30 years to 68.7% in those aged 41–50 (p = 0.002). Poor-quality blastocysts exhibited higher aneuploidy rates (72.4%) than good-quality embryos (34.6%; p = 0.004). Chaotic embryos comprised 8.3% of the cohort. Upon re-biopsy, none were confirmed as euploid; all remained abnormal and were reassigned to aneuploid, mosaic, or persistently chaotic categories. This finding suggests that apparent euploid results reported elsewhere may reflect technical variability and sampling limitations in PGT-A rather than accurate chromosomal normalization. Conclusions: The prevalence of aneuploid embryos showed a progressive increase with advancing maternal age. Chaotic embryos are heterogeneous, and re-biopsy may help refine the interpretation of complex PGT-A profiles, supporting its role as a diagnostic and quality control tool rather than a strategy to identify euploid embryos. Our study offers novel insights through age-stratified analysis, the integration of morphology with genetics in a Romanian IVF cohort, and a detailed evaluation of chaotic embryos, providing clinical recommendations for patient counseling and embryo selection.

Background and Objectives: Sperm DNA fragmentation (SDF) has emerged as an important marker of male reproductive potential; however, its relationship with sperm kinematic performance remains incompletely understood. While conventional semen analysis primarily evaluates sperm concentration and motility, computer-assisted semen analysis (CASA) enables a more detailed assessment of sperm motility parameters, including velocity, path length, and directionality. Materials and Methods: This observational study included 183 semen samples, stratified by SDF levels into control (1–15%), mild (15.01–25%), moderate (25.01–50%), and severe (>50%) fragmentation groups. Sperm kinematic parameters were assessed using CASA, including curvilinear velocity (VCL), straight-line velocity (VSL), average path velocity (VAP), linearity (LIN), straightness (STR), and wobble (WOB). Group comparisons were performed using ANOVA or Kruskal–Wallis tests, correlation analyses were conducted using Spearman’s rank coefficient, and multivariable linear regression models were applied to evaluate the independent effect of SDF after adjustment for sperm concentration and progressive motility. Results: Parameters reflecting directional motility and movement efficiency differed significantly across increasing SDF categories. VSL, LIN, STR, and WOB showed a progressive decline with higher levels of DNA fragmentation, whereas VCL and VAP did not demonstrate a proportional decrease across groups. Correlation analysis revealed significant negative associations between SDF and VSL (ρ = −0.367, p < 0.001), VAP (ρ = −0.323, p < 0.001), and VCL (ρ = −0.202, p = 0.006), while correlations with LIN, STR, and WOB were negative but not statistically significant. Multivariable regression analysis confirmed SDF as an independent negative predictor of VSL and VAP after adjustment for conventional semen parameters, whereas the association with VCL was no longer significant. Conclusions: Increased sperm DNA fragmentation is associated with impaired sperm motility efficiency and directionality, rather than a uniform reduction in motility. These findings highlight the functional relevance of sperm DNA integrity in shaping sperm kinematic performance and support the complementary use of SDF assessment and CASA parameters in evaluating male fertility.