After nearly two decades of trying to start a family, a couple has successfully conceived with the help of a groundbreaking AI-guided sperm recovery method developed at the Columbia University Fertility Center. The case, detailed in a research letter published in The Lancet, marks the first reported successful pregnancy using the innovative STAR (Sperm Tracking and Recovery) technology. Male infertility accounts for about 40% of all infertility cases, and among those, 10% to 15% of men face azoospermia—a condition where ejaculate contains little or no sperm. In such cases, traditional sperm retrieval methods often fail, leaving many couples with few options for biological parenthood. Zev Williams, senior author of the study and Director of the Columbia University Fertility Center, explained the challenge: “A semen sample can appear normal under the naked eye, but under the microscope, it may be nothing more than a sea of cellular debris with no visible sperm.” For many men with azoospermia, the only option has been surgical sperm extraction, a procedure that carries risks such as vascular damage, inflammation, and temporary drops in testosterone. Existing methods rely on skilled technicians manually examining processed samples—a time-consuming and costly process that can further damage fragile sperm cells. “The field has long struggled to find a better way to identify and retrieve viable sperm in men with extremely low sperm counts,” Williams said. To address this, Williams assembled a multidisciplinary team of experts in advanced imaging, microfluidics, and reproductive endocrinology. The result was STAR, a system that combines high-resolution imaging, artificial intelligence, and microfluidic technology to detect and isolate rare sperm cells. The process begins with a high-powered imaging system scanning a semen sample, capturing over 8 million images in under an hour. AI algorithms analyze these images in real time to identify sperm cells amid the debris. Once detected, a microfluidic chip with microscopic hair-like channels directs the sperm-containing fraction of the sample to a robotic arm, which gently extracts the sperm within milliseconds—preserving its viability. In the first clinical application, a patient who had been trying to conceive for nearly 20 years underwent the procedure. Despite multiple failed IVF attempts, manual sperm searches, and two prior surgical extractions, the STAR system successfully identified two viable sperm cells from a 3.5 mL sample in just two hours. These sperm were used to create two embryos, one of which led to a successful pregnancy. “With just one healthy sperm, you can create an embryo,” Williams said, emphasizing the transformative potential of the technology. While the study is based on a single case, it demonstrates the feasibility of overcoming longstanding barriers in treating azoospermia. Larger clinical trials are now underway to assess the effectiveness of STAR across broader patient populations. If proven scalable, the technology could offer new hope to countless couples facing male-factor infertility.