CONSORT flow diagram.
ANEUPLOIDY
Male partners were first screened by a semen analysis. We also carried out a genetic assessment on spermatozoa from the raw ejaculates by fluorescent in situ hybridization (FISH) to determine the proportion of X- and Y-bearing spermatozoa prior to sperm processing. Standard sperm processing was performed for the control group, consisting of 1,212 couples undergoing ICSI with PGT-A solely for aneuploidy. For 105 consenting couples, sperm specimens were enriched for their desired sex. The processed specimens were subsequently used in their ICSI cycles with PGT-A, and a small portion was retained for a blinded assessment by FISH. The proportion of X- to Y-bearing spermatozoa, as well as ICSI and PGT-A outcomes, were compared between the two cohorts. Our main outcome measures included the proportion of spermatozoa and embryos enriched for female and male sex, as well as embryo euploidy rates and ICSI clinical outcomes.