Abstract
Sperm morphology is the best predictor of fertilization potential, and the critical predictive information for supporting assisted reproductive methods selection. Given its important predictive value and the declining reality of semen quality in recent years, the threshold of normal sperm morphology rate (NSMR) is being constantly corrected and controversial, from the 4th edition (14%) to the 5th version (4%). We retrospectively analyzed 4756 cases of infertility patients treated with conventional-IVF(c-IVF) or ICSI, which were divided into three groups according to NSMR: ≥14%, 4%–14% and <4%. Here, we demonstrate that, with decrease in NSMR(≥14%, 4%–14%, <4%), in the c-IVF group, the rate of fertilization, normal fertilization, high-quality embryo, multi-pregnancy and birth weight of twins gradually decreased significantly (P<0.05), while the miscarriage rate was significantly increased (p<0.01) and implantation rate, clinical pregnancy rate, ectopic pregnancy rate, preterm birth rate, live birth rate, sex ratio, and birth weight(Singleton) showed no significant change. In the ICSI group, with decrease in NSMR (≥14%, 4%–14%, <4%), high-quality embryo rate, multi-pregnancy rate and birth weight of twins were gradually decreased significantly (p<0.05), while other parameters had no significant difference. Considering the clinical assisted methods selection, in the NFMR ≥14% group, normal fertilization rate of c-IVF was significantly higher than the ICSI group (P<0.05), in the 4%–14% group, birth weight (twins) of c-IVF were significantly higher than the ICSI group, in the <4% group, miscarriage of IVF was significantly higher than the ICSI group. Therefore, we conclude that NSMR is positively related to embryo reproductive potential, and when NSMR<4% (5th edition), ICSI should be considered first, while the NSMR≥4%, c-IVF assisted reproduction might be preferred.
Highlights
Fifteen percent of couples are subfertile, and in one-half of these cases subfertility can be attributed to the male partner [1,2]
No single semen parameter definitely predicts the potential of an individual couple to achieve success with assisted reproduction [3], the percentage of sperm with normal morphology is positively correlated with IVF fertilization and pregnancy rates [4,5]
In order to further probe the effect of human normal sperm morphology rate, 4765 pairs of infertile couples (3922 pairs receiving conventional IVF (c-IVF), and 843 receiving ICSI) were enrolled at the Tangdu Reproductive Medical Center between January 2011 and March 2013
Summary
Fifteen percent of couples are subfertile, and in one-half of these cases subfertility can be attributed to the male partner [1,2]. No single semen parameter definitely predicts the potential of an individual couple to achieve success with assisted reproduction [3], the percentage of sperm with normal morphology is positively correlated with IVF fertilization and pregnancy rates [4,5]. Given the important predictive value of sperm morphology and the the decline in semen quality reported in recent years, WHO’s definition of teratozoospermia is frequently corrected. The reference value for normal sperm morphology rate (NSMR) proposed was ,30% in 1992, ,14% in 1999 and ,4% in 2010. Due to these substantial increases in the reference values, the appropriate threshold to apply is uncertain [8]
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