P-1001: Poor sperm count or motility predicts Kruger morphology but not sufficiently to forgo morphology testing

Abstract

A large body of literature demonstrates that sperm from men with extremely poor morphologies using Kruger’s Strict Criteria (< 4% normal) fertilize poorly. These couples benefit significantly from intracytoplasmic sperm injection. Semen analyses performed at general laboratories frequently do not include a strict Kruger morphology assessment. These studies either include no morphology assessment, or use the older WHO criteria for morphology. Clinicians are often asked to use these analyses for clinical decisions, to avoid repeat semen analysis. We therefore wanted to determine the ability of other semen analysis parameters-specifically count and/or motility- to predict normal or abnormal morphology on the strict Kruger morphology scale. Retrospective review of all semen analyses from January 1, 2002 to December 31, 2005 at University Reproductive Associates. Semen analyses were collected from our Andrology laboratory database. The study was approved by the IRB of New Jersey Medical School in Newark, New Jersey. All complete semen analyses were considered. Only the first semen analysis was included for each man (n=1384). All analyses included measurements of count (million/cc), motility (%), and strict Kruger morphology (% normal). Predictive values were calculated to determine if an abnormal sperm count or motility predicted abnormal sperm morphology. Each semen analysis was evaluated and classified by count, motility, and strict Kruger morphology. A significant association exists between Count/Motility and Morphology (P << .005, Chi squared = 221.6 with 1 degree of freedom). The positive predictive value of an abnormal count or motility for a low Kruger morphology was 60% and the negative predictive value was 80%. However, 40% of the specimens with poor count and/or motility had normal morphology greater than or equal to 5%. Twenty percent of the specimens with normal count and motility had normal morphology less than or equal to 4%. The sensitivity was 60% and the specificity was 80%.Tabled 1 Abnormal sperm count and motility were reasonable predictors of abnormal morphology. However, 20% of samples which were normal for both count and motility would go undetected despite their extremely poor Kruger morphology. As sperm morphology is an independently important predictor of sperm fertilization potential, the Kruger morphology remains an important component of the complete semen analysis.