Value Of Sperm Morphology Research Articles

Predictive Value of Teratospermia During Initial Sperm Analysis on the Success of Intrauterine Insemination Cycles

ObjectiveTo evaluate the predictive value of sperm morphology, specifically teratospermia, seen during initial semen analysis on the success of intrauterine insemination (IUI) cycles and pregnancy outcomes. MethodsA retrospective cohort analysis on patients undergoing IUI at a large US fertility network. Baseline demographic characteristics, primary infertility diagnoses, and pregnancy outcomes were recorded. A total of 27,925 IUI cycles in 16,169 unique patients were analyzed. IUI cycles were grouped by a sperm morphology of 1% (n=3,799), 2% (n=5,506), 3% (n=4,857), or 4% or greater (n=13,763). The outcome measures were pregnancy rate (positive pregnancy test), clinical pregnancy rate (ultrasound confirmation of a gestational sac with a yolk sac around 5-6 weeks), live birth rate, and miscarriage rate. ResultsSperm morphology is a significant predictor of pregnancy rate (p= <0.001), clinical pregnancy rate (p=0.011), and live birth rate (p=0.026) following IUI. In each of these outcome measures, patients with 1% normal forms had the lowest percentage of success, and patients with 4% or greater normal forms had the most success. Relative outcome percentages, however, were similar in each group. Live birth rates in the 1%, 2%, 3% and > 4% group were 12.3%, 13.1%, 12.7% and 13.9%, respectively. Sperm morphology is not a significant predictor of miscarriage rate per clinical pregnancy post IUI (p=0.054). ConclusionsSperm morphology was a statistically significant predictor of pregnancy, clinical pregnancy, and live birth but not miscarriage rate after an IUI cycle. Higher morphology percentages were associated with increasingly favorable outcomes. However, the small observed differences did not demonstrate clinical significance.

(212) The Questionable Clinical Utility of Sperm Morphology: Rate of Isolated Teratospermia in a Population of Fertile Men

Abstract Introduction Over the last several decades, sperm morphology has represented a standard component of semen analysis. However, its clinical utility is not well-defined, despite continual efforts by the WHO to address critiques of semen morphology criteria through increasingly strict guidelines. Issues with intra- and inter-laboratory technical variability, in addition to the subjective nature of the morphology assessment, have been thoroughly discussed in existing literature. Furthermore, current literature has highlighted the low predictive value of sperm morphology abnormalities in assisted fertility treatment (ART) and natural pregnancy outcomes. As of 2020, the American Society for Reproductive Medicine (ASRM) guidelines have noted that morphology alone is not highly predictive or diagnostic of infertility. However, past survey studies have demonstrated the pervasive belief among physicians of the value of sperm morphology, potentially leading to counseling patients towards more expensive ART methods. These concerns call into question the emphasis placed on sperm morphology assessment and its value in the clinical setting. Objective To better understand the impact of sperm morphology on fertility, we assessed sperm morphology in a population of known fertile men. Methods Healthy men over 18 years of age were recruited to provide one semen sample prior to vasectomy from March 2020 through November 2022. Inclusion criteria for the study was as follows: (1) patients were required to have biological children under the age of 5 years old, with no history of difficulty achieving pregnancy, and (2) had undergone no prior fertility procedures. Sperm morphology was analyzed using Papanicolaou stain with Kruger strict criteria by two technicians in an Andrology specialty laboratory per the WHO 5th edition manual. Results There were 83 men who participated in the study, 68 of whom (81.9%) had a complete sperm morphology assessment available. On average, participants were 37 years of age and had a mean BMI of 28 (22.8, 33.2). Of those with a smoking history available (n=61), 38 (62.3%) were non-smokers, 7 (11.5%) were former smokers, and 16 (26.2%) were current smokers. Patients had an average of 3 children with a mean youngest child age of 11.5 months old. There were 38 patients (55.9%) with 3% or lower normal sperm morphology, including two patients who had 0% normal morphology (Table 1). The most common morphologic abnormalities were head shape defects (n=59, 84.3%), followed by coiled tails (n=14, 20.3). Men 3% or lower normal sperm morphology were four times as likely to have both head and tail abnormalities than men with 4% or greater normal sperm morphology (n=8 vs n=2, respectively); half of these men also had lower than normal motility, whereas none of the men with 4% or greater normal sperm morphology had lower than normal motility. Conclusions More than half of fertile male patients (65.6%) had lower than normal sperm morphology in our study. The results of our study further question the clinical relevance of sperm morphology on fertility outcomes and if the current approach in assessing morphology is too strict. Disclosure No.

P-044 Abnormal sperm morphology, so what? The clinical outcome of medical assisted reproduction is not affected by 100% teratospermic semen samples

Abstract Study question What is the success rate (clinical outcome) in medical assisted reproduction (MAR) when 0% normal spermatozoa forms are observed using strict morphology criteria (SMC)? Summary answer Strict criteria morphology has no predictive value for the clinical outcome of MAR. Absence of normal morphology spermatozoa does not preclude high cumulative pregnancy rates. What is known already Many studies have questioned the clinical value of sperm morphology since no effect on treatment outcome is apparent when sperm samples with &amp;lt;4% normal forms are used. However, data evaluating treatment outcome when 0% normal sperm at diagnose (evaluated by strict morphology criteria, WHO 2010) scarce. While teratozoospermia values are known to have a negative correlation with fertilization per cycle, data on cumulative ongoing pregnancy rates (COPR) or live birth rates (LBR) are missing in this selected group. Study design, size, duration This is a retrospective analysis (January 2010-June 2021) of the clinical outcome for couples when the male partner presents with 0% normal morphology (WHO 2010) at diagnostic semen analysis. Cases with 100% globozoospermia, cilia abnormalities or other MMAF phenotypes were excluded. Depending on the total progressively motile sperm count (TPMSC), couples were referred for MAR. The primary outcome presented is COPR/treatment and LBR/couple. Secondary outcomes were total fertilization failure (TFF) and mean fertilization rate (FR). Participants/materials, setting, methods All 193 cases included in this study presented with 100% teratozoospermia, as evaluated by two independent technicians following WHO 2010 manual recommendations. Couples were treated with IUI,IVF or ICSI depending on TPMSC at diagnosis. A total of 17 couples underwent 68 IUI treatments, 20 couples underwent 36 IVF ovum-pickups (OPU) (with respectively fresh embryo transfer (ET) and frozen ET, FET); 156 couples underwent 394 ICSI-OPU (with respectively fresh-ET and FET). Cumulative-OPR per treatment/couple is presented. Main results and the role of chance From the 17 couples undergoing IUI (mean 4 IUI cycles/couple; with or without mild ovarian stimulation) 3 ongoing pregnancies were reported (all singletons; 18% LBR per couple). Twenty IVF couples (mean 1.8 OPUs/couple) resulted in a total of 13 ongoing pregnancies (12 singletons, 1 twin pregnancy), therefore, the LBR per IVF-couple was 65%. In six cycles a TFF was observed even with sufficient motile sperm during insemination (5x with TPMSC &amp;gt;5 x 10^6/ml). If TFF was observed after IVF cycle, then ICSI was performed in the next cycle. The IVF mean %FR using 100% teratozoospermic samples was 54%, compared to 58% in cases with &amp;gt;1% normal forms. Regarding ICSI, 156 couples underwent a total of 377 cycles (mean of 2.4 OPUs/couple). These treatments resulted in a total of 357 fresh-ET and 458 FET. A total of 103 couples achieved 154 ongoing pregnancies (146 singletons, 7 twins), therefore the COPR was 39%/cycle and LBR was 66%/couple. In 13 cycles (3.4%) TFF was observed and in 15 cases the fertilization rate was &amp;lt;20%. The mean FR with ICSI using teratozoospermic samples was 55%. Comparingly, using samples with &amp;gt;1% normal morphology, the laboratory mean for FR is 68% and 3.7% for TFF. Limitations, reasons for caution This is a retrospective study and not matched case-control cohort was used in this analysis. Not all couples have completed 3 complete IVF/ICSI cycles. As not all frozen embryos have been transferred, cumulative pregnancy rates might be higher than the rates reported here. Wider implications of the findings The data presented here confirms the limited value of the actual strict criteria for sperm morphology evaluation. Morphology is important for identification of sporadic sperm samples with atypical malformations such as globozoospermia, MMAF and other aberrant forms of a genetic origin, however SMC evaluation and interpretation should be reconsidered Trial registration number N.A.

Assessing the clinical value of the Kruger strict morphology criteria over the World Health Organization fourth edition criteria

ObjectiveTo assess if the newer Kruger strict morphology (WHO5; normal ≥4%) adds any clinical value beyond the criteria of the World Health Organization fourth edition (WHO4; normal ≥14%).DesignRetrospective study.SettingTertiary hospital.Patient(s)Men without known azoospermia who had semen analysis (SA) collected over a 10-year period of time.Intervention(s)Morphology classification under Kruger WHO5 strict criteria and WHO4 criteria.Main Outcome Measure(s)Correlation between the WHO5 and WHO4 morphological classifications.Result(s)A total of 4,510 SAs were identified during the study period. Of these, both Kruger WHO5 and WHO4 morphologies were included in 932 SAs (20.7%) from a total of 691 men. The median age of the men was 37 years (interquartile range, 32.0–43.8 years). The mean (±SD) semen volume, sperm concentration, and motility were 2.6 ± 1.4 mL, 50.0 ± 35.6 × 106/mL, and 53.1% ± 18.6%, respectively. The correlation between the WHO4 and WHO5 morphology assessments was high (Spearman correlation coefficient = 0.94). Only 545 (58.5%) of 932 SAs had abnormal Kruger WHO5 morphology, of which 543 (99.6%) of 545 also had abnormal morphology by the WHO4 criteria.Conclusion(s)The Kruger WHO5 and WHO4 morphologic criteria correlate closely. Only two men (0.4%) with an abnormal Kruger morphology had normal WHO4 morphology. Given the limited predictive value of sperm morphology, the additional cost and effort of Kruger criteria may not be warranted in lieu of, or in addition to, the WHO4 classification.

Quality of domestic cat semen collected by urethral catheterization after the use of different alpha 2-adrenergic agonists.

We compared the effects of two alpha (α)2-adrenergic agonists on semen traits. In this study, 13 adult domestic cats were divided into two experimental groups, according to the chemical ejaculation protocol used: the first group received medetomidine hydrochloride (100 µg/kg) and ketamine (5000 µg/kg); the second group received dexmedetomidine hydrochloride (25 µg/kg) and ketamine (5000 µg/kg), both by the intramuscular route. The animals responded positively (P >0.05) to chemical collection. Seminal parameters evaluated included volume, sperm vigor, total motility, progressive motility, sperm concentration, and the structural and functional integrity of the plasma membrane; sperm morphology values did not differ between groups (P >0.05). The results indicated that dexmedetomidine is a more viable and economical alternative to medetomidine in domestic cats submitted to semen collection by urethral catheterization. Semen collection by urethral catheterization after using α2-adrenergic agonists is a recently developed technique in feline species that is considered to be quick and highly applicable to assisted reproduction programs in felids.

Can Panax Ginseng Aqueous Extract Improve Chilled and Cryopreserved Bull Spermatozoa?

This study was to evaluate the influence of Panax ginseng aqueous extract on chilled and frozen-thawed bull sperm quality. Samples of semen were acquired from four bulls through the use of an electro-ejaculator. Extension of the semen was done with tris-egg yolk diluent which was augmented with 0.0, 0.25, 0.5, 1.0, 2.5, 5.0, and 7.5 mg/mL Panax ginseng aqueous extract. Diluted chilled portions of the semen were chilled for 6 days at 5 ̊C whereas the frozen semen was cryopreserved in liquid nitrogen. Results revealed that in chilled and frozen-thawed semen, the control group, T1 and T2 recorded higher percentages in terms of sperm motility and viability in all three groups evaluated compared to others, while the high dose of Panax ginseng aqueous extract in T6 and T5 recorded the lowest percentage. Moreover, the values of sperm morphology for chilled and frozen-thawed semen were not significant among the groups. The results of chromatin stability of the present study showed that T2 and control were higher than for other groups. In conclusion, the low dosage groups (T1, T2 and T3) which were received (0.25 mg/mL, 0.5 mg/mL and 1 mg/mL, respectively) from Panax ginseng aqueous extract were not significant as compared with the control group while high-dosage groups (T4, T5 and T6) which were received (2.5 mg/mL, 5 mg/mL and 7.5 mg/mL, respectively) from Panax ginseng aqueous extract were highly decreased spermatozoa characteristics.

Re-evaluation of the value of sperm morphology in classical in vitro fertilization in a Northeastern Chinese population.

ObjectiveThis study aimed to re-evaluate the clinical value of a 4% cut-off threshold of sperm morphology in in vitro fertilization (IVF) in a cohort of a Northeastern Chinese population.MethodsA total of 375 IVF cycles that met strict inclusion criteria were included. These cycles were conducted with semen analysis and oocyte fertilization. A total of 188 embryo-transferred cycles proceeded. According to sperm morphology, 375 cycles were divided into group 1 (329 cycles, <4% normal sperm morphology rate [NSMR]) and group 2 (46 cycles, ≥4% NSMR), and 188 transferred cycles into group A (151 cycles, < 4% NSMR) and group B (37 cycles, ≥4% NSMR).ResultsThe fertilization and normal fertilization rates were significantly lower in group 1 than in group 2. The normal fertilization rate was significantly correlated with an NSMR < 4% or ≥4%, but the fertilization rate was not significantly correlated with the NSMR. No significant differences were found in pregnancy outcomes between groups A and B.ConclusionsThis study suggests that infertile patients with an NSMR < 4% are more likely to have a poor normal fertilization status in IVF.

Predictive value of sperm morphology and progressively motile sperm count for pregnancy outcomes in intrauterine insemination

To investigate the value of sperm parameters to predict an ongoing pregnancy outcome in couples treated with intrauterine insemination (IUI), during a methodologically stable period of time. Retrospective, observational study with logistic regression analyses. University hospital. A total of 1,166 couples visiting the fertility laboratory for their first IUI episode, including 4,251 IUI cycles. None. Sperm morphology, total progressively motile sperm count (TPMSC), and number of inseminated progressively motile spermatozoa (NIPMS); odds ratios (ORs) of the sperm parameters after the first IUI cycle and the first finished IUI episode; discriminatory accuracy of the multivariable model. None of the sperm parameters was of predictive value for pregnancy after the first IUI cycle. In the first finished IUI episode, a positive relationship was found for ≤4% of morphologically normal spermatozoa (OR 1.39) and a moderate NIPMS (5-10 million; OR 1.73). Low NIPMS showed a negative relation (≤1 million; OR 0.42). The TPMSC had no predictive value. The multivariable model (i.e., sperm morphology, NIPMS, female age, male age, and the number of cycles in the episode) had a moderate discriminatory accuracy (area under the curve 0.73). Intrauterine insemination is especially relevant for couples with moderate male factor infertility (sperm morphology ≤4%, NIPMS 5-10 million). In the multivariable model, however, the predictive power of these sperm parameters is rather low.

Single and mixed interaction of experimental Trypanosoma brucei brucei and Trypanosoma evansi on the semen collection reaction time and spermatozoa morphology of Yankasa rams

Objective: This study was conducted to evaluate the pathological effects of experimental trypanosomosis on the semen collection reaction time and spermatozoa morphology of Yankasa rams. Materials and Methods: Twelve apparently healthy Yankasa rams aging 24-30 months and weighing 22-25 Kg were randomly selected and were distributed into four (4) groups. Groups I and II were challenged with experimental Trypanosoma brucei brucei (Federe strain) and T. evansi (Sokoto strain) respectively, while group III was challenged with both T. brucei brucei and T. evansi parasites. Group IV was left as uninfected control. Each infected ram received 2 mL of the infected blood containing 2x10 6 trypomastigotes via the jugular vein. The animals were examined for clinical observations, reaction time for semen collection and abnormalities in the morphology of the spermatozoa. Results: Infection of rams with trypanosomes showed scrotal edema, scrotal atrophy, loss of libido, increased semen collection reaction time, and significant increase of spermatozoa morphological abnormalities in all the infected rams. The rams especially in groups I and III were all deemed unfit for breeding by the end of the 98 days post infection, while the uninfected rams remained as healthy and had normal values of sperm morphology throughout the study period. Conclusion: Single or mixed interaction with T. brucei brucei or T. evansi is capable of causing infertility and reproductive failure in Yankasa rams. http://doi.org/10.5455/javar.2016.c174

Sperm DNA Fragmentation is Significantly Increased in Those Men with Morphologically Abnormal Spermatozoa

Purpose: To evaluate the levels of DNA fragmentation regarding to spermatozoa morphology in male infertility patients attending Andrology Laboratory at fertility center. Methods: Semen samples of 196 patients were analyzed using computer-assisted semen analysis (CASA). Sperm DNA fragmentation was measured by the sperm chromatin dispersion test. According to the values of sperm morphology, the groups were conformed by teratozoospermic (105 patients) and normozoospermic (91 patients) men. Results: Subjects’ ages ranged from 21 to 68 years. Teratozoospermic men were older that the normozoospermic men (39.72 ± 7.86 vs. 36.57 ± 6.29 years; P<0.05). Values of pH were similar in both evaluated groups (P:NS). Parameters of volume, concentration, motility and vitality in teratozoospermic men were significantly lower compared to those normozoospermic patients (P<0.05). High levels of DNA fragmentation were observed in those patients with abnormal sperm morphology compared to normozoospermic men (44.31 ± 7.52 vs. 34.92 ± 5.89; P<0.05). Conclusions: Men with abnormal spermatozoa morphology showed high levels of DNA fragmentation. These significantly high percentages of sperm DNA damage will be an additional factor that drastically reduces the possibility of success in these infertile men.

Ultrastructural Characteristics of the Testis, Spermatogenesis and Taxonomic Values of Sperm Morphology in Male Ruditapes philippinarum in Western Korea.

Ultrastructural characteristics of the germ cells and accessory cells in testis during spermatogenesis and taxonomic values of mature sperm morphology of Ruditapes philippinarum were investigated by the transmission electron microscope and scanning electron microscope observations. The testis is the diffuse organ that consists of branching acini containing developing germ cells and accessory cells associated with spermatogenesis. The morphology of the spermatozoon is of the primitive type and is somewhat different to those of other bivalves. The morphologies of the sperm nucleus type and the acrosome shape of this species have a cylinderical type and a modified cone shape, respectively. As some ultrastructural characteristics of the acrosomal vesicle, the peripheral parts of two basal rings show electron opaque part, while the apex part of the acrosome shows electron lucent part. These characteristics of sperm belong to the family Veneridae in the subclass Heterodonta, unlike a characteristic of the subclass Pteriomorphia showing all part of the acrosome being composed of electron opaque part. In particular, a cylinder-like nucleus of the sperm is curved. The spermatozoon is approximately 48-51 μm in length, including a long acrosome (about 2.40 μm in length), a curved sperm nucleus (about 3.40 μm in length), and a tail flagellum. The axoneme of the sperm tail shows a 9+2 structure.

Scoring human sperm morphology using Testsimplets and Diff-Quik slides

To compare two staining methods to assess sperm morphology: Diff-Quik (DQ), which is the fastest of the recommended techniques, and Testsimplets (TS), a technique that uses prestained slides and is quite popular in invitro fertilization (IVF) centers. Prospective study. Patients at the Sterility Center of the Obstetrics and Gynecology Unit of the Hospital of S.S. Cosma and Damiano (Azienda USL 3 of Pistoia, Italy). 104 randomly enrolled male patients evaluated by the seminology laboratory. None. Statistical comparison of sperm morphology results obtained after staining of semen samples both with DQ and TS. Our data show that TS gives a statistically significantly lower number of normal forms than DQ (median: 6% [range: 0-29%] vs. 12% [range: 0-40%], respectively) as well as an overestimation of sperm head defects (median: 92.0% [range: 67%-100%] vs. 82.3% [range: 55%-100%], respectively). The two staining methods should not be considered equivalent. Specifically, the lower reference limit established by the World Health Organization is not appropriate when sperm morphology is assessed by TS. The routine application of TS in the evaluation of sperm morphology is therefore not recommended because it leads to an overestimation of patients with sperm morphology values below the lower reference limit (4%), thus potentially influencing clinical decisions.

Trends in sperm morphology after implementation of a quality improvement initiative

A quality improvement (QI) review in 2006 showed our average sperm morphology (SM) had decreased and resulted in a loss of predictive value of SM for intrauterine insemination (IUI) outcomes compared to 1996-7 values (Morbeck et al 2011). A QI initiative was implemented to standardize SM and correct the classification drift that had occurred. The aim of this study was to analyze SM and IUI outcomes before and after the QI initiative and to determine its effectiveness in restoring predictive value.

2275 PREDICTIVE FACTORS OF INTRAUTERINE INSEMINATION SUCCESS: SPERM MORPHOLOGY ACCORDING TO THE NEW WORLD HEALTH ORGANIZATION LABORATORY MANUAL

You have accessJournal of UrologyInfertility: Therapy1 Apr 20112275 PREDICTIVE FACTORS OF INTRAUTERINE INSEMINATION SUCCESS: SPERM MORPHOLOGY ACCORDING TO THE NEW WORLD HEALTH ORGANIZATION LABORATORY MANUAL Edson Borges, Amanda Setti, Rita Figueira, Daniela Braga, Assumpto Iaconelli, and Fabio Pasqualotto Edson BorgesEdson Borges São Paulo, Brazil More articles by this author , Amanda SettiAmanda Setti São Paulo, Brazil More articles by this author , Rita FigueiraRita Figueira São Paulo, Brazil More articles by this author , Daniela BragaDaniela Braga São Paulo, Brazil More articles by this author , Assumpto IaconelliAssumpto Iaconelli São Paulo, Brazil More articles by this author , and Fabio PasqualottoFabio Pasqualotto Caxias do Sul, Brazil More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.2519AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Despite intrauterine insemination (IUI) often has been used as a treatment for male factor infertility, seminal characteristics indicative of IUI success have not been defined clearly. Recently, the 5th World Health Organization (WHO) data described lower reference limits for the number of morphologically normal spermatozoa. The aim of our study was to assess the likelihood of IUI success as a function of the sperm morphology according to the new reference values defined by the recently published WHO guideline. METHODS We performed a retrospective study among 300 couples that completed their first IUI cycle, using father's fresh sperm as a result of cervical infertility, relative male factor infertility, anovulation or unexplained infertility. Pregnancy rates were compared between the patients characterized as having normal and abnormal sperm morphology values according to the previous and the recent WHO reference values and the number of inseminated motile sperm was compared between the patients who did and did not achieve a pregnancy. RESULTS The overall pregnancy rate was 12.3%. Women older than 35 years showed a lower pregnancy rate as compared to women younger than 35 years (6.5% vs 18.2%, p= 0.017). The presence of two or more preovulatory follicles on the day of hCG administration resulted in higher pregnancy rate when compared to cases in which only one preovulatory follicle was present (18.6% vs 8.2%, p= 0.011). There were no significant differences between the mean total number of inseminated sperm (26.4±21.7 vs 34.86±33.12, p= 0.1237) and the mean number of inseminated motile sperm (22.3±18.6 vs 27.0±24.5, p= 0.3156) between the patients who did and did not achieve a pregnancy. The number of inseminated motile sperm ≥ 1x106 M/mL positively influenced pregnancy occurrence (OD: 1.47; CI: 0.88–3.14, p =0.027). Pregnancy rates did not differed neither when the male partners were characterized as having normal or abnormal sperm morphology according to the previous WHO reference values (9.8% vs 11.6%, p= 0.6584), nor when the male partners were characterized as having normal or abnormal sperm morphology according to the recent WHO reference values (9.4% vs 11.3%, p= 0.7469). Finally, normal sperm morphology had no influence on pregnancy rate (OD: 1.05; CI: 0.56–3.02, p= 0.936). CONCLUSIONS Our results suggest that even after the establishment of new reference values for semen parameters, sperm morphological normalcy still does not have any predictive value on IUI outcomes. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e912 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Edson Borges São Paulo, Brazil More articles by this author Amanda Setti São Paulo, Brazil More articles by this author Rita Figueira São Paulo, Brazil More articles by this author Daniela Braga São Paulo, Brazil More articles by this author Assumpto Iaconelli São Paulo, Brazil More articles by this author Fabio Pasqualotto Caxias do Sul, Brazil More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

SELECTED ORAL COMMUNICATION SESSION, SESSION 70: ANDROLOGY AND SEMINAL FACTORS Wednesday 6 July 2011 14:00 - 15:45

Introduction: Couples who have not achieved a pregnancy within one year of unprotected intercourse qualify for a fertility work-up. A semen analysis is part of this work-up and includes the assessment of sperm concentration, motility and morphology. The predictive value of sperm morphology has been

Measurement and significance of sperm morphology

The measurement or evaluation and clinical significance of human sperm morphology has always been and still is a controversial aspect of the semen analysis for the determination of a male's fertility potential. In this review the background of the development of the evaluation criteria for sperm morphology will be discussed. Aspects of criticism on the strict criteria definition and use of the criteria for sperm morphology evaluation will be discussed as well as possible reasons for the decline in normal sperm morphology values and how we can compromise for this phenomenon resulting in the very low normal reference value as published in the 2010 WHO manual for the Examination and Processing of Human Semen. One of the possible solutions may be to give more attention to a limited number of abnormal sperm morphology categories and the inclusion of sperm morphology patterns. It is concluded in this review that if done correctly and with care and with strict application of existing guidelines as outlined in the 2010 WHO manual, sperm morphology measurement still has a very important role to play in the clinical evaluation of male fertility potential.

Clinical significance of the low normal sperm morphology value as proposed in the fifth edition of the WHO Laboratory Manual for the Examination and Processing of Human Semen.

The very low cut-off value for sperm morphology of 4% morphologically normal spermatozoa, as proposed in the new edition of the World Health Organization (WHO) manual on semen analysis, is in agreement with recently published values and reflects the trend of a decline in reported mean values for normal sperm morphology. The reduced value for morphologically normal spermatozoa over the years may be due to several factors. The first is the introduction of strict criteria for the evaluation of sperm morphology. Other reasons may include the introduction of additional criteria for sperm morphology abnormalities and the suggested decrease in semen parameters because of increasing negative environmental influences. Although on its own the newly proposed very low normal value may not provide the strong predictive value for a males' fertility potential, as originally reported for sperm morphology evaluated according to strict criteria, a good predictive value can still be obtained if the holistic, strict approach for sperm morphology evaluation is followed together with additional sperm morphology parameters now available, because certain morphology patterns and sperm abnormalities are now known to be of strong prognostic value. In addition, better international standardization of the technical methodology, consensus on the interpretation of sperm morphology evaluation criteria and standardized international external quality control (EQC) schemes, are of utmost importance to maintain the good predictive value of sperm morphology.

The effective cumulative pregnancy rate of different modes of treatment of male infertility.

The clinical efficacy of conventional and advanced methods of treatment was assessed in 814 couples with infertility due to a male factor. The monthly and effective cumulative rate of ongoing or term pregnancies was calculated during 4712 couple-months. Treatment of varicocele by transcatheter embolization, resulting in 3.9% pregnancies per cycle and an effective cumulative pregnancy rate of 41% after 1 year, is more effective than counselling and timed intercourse (9% pregnancies after 12 months). Intrauterine insemination (IUI) of washed spermatozoa produced 17% pregnancies in the initial 4 months, but the success rate of the subsequent cycles (1.7% per cycle) was not different from that of the controls. In vitro fertilization (IVF) resulted in 16% pregnancies per attempt, but the effective cumulative pregnancy rate was only 31% in 12 months due to the long interval between treatment attempts and the high drop-out rate. With subzonal microinjection of sperm, the fertilization rate was higher (71%) than with regular IVF (29%) but both the pregnancy rate per attempt (9%) and the effective cumulative pregnancy rate (17% after 12 months) were low. The 10th percentile of sperm characteristics (cut-off values) of successful cases showed intrauterine insemination to be advantageous in cases with a lower percentage of spermatozoa with progressive motility (9%) than in the controls (15%). The cut-off value of sperm morphology in IVF (4%) is lower than that of IUI (8%) and of the controls (9%), but higher than that of subzonal insemination (1%). Treatment strategy must be defined selecting or combining conventional and assisted reproductive technology for each individual couple with male factor infertility.

Value of sperm morphology assessed by strict criteria for prediction of the outcome of artificial (intrauterine) insemination.

The purpose of this study was to investigate the relationship between sperm parameters and the outcome of artificial (intrauterine) insemination (IUI). One hundred and twenty-six patients undergoing 395 consecutive IUI cycles in a 1-year period in our institution were studied. In all cases, controlled ovarian stimulation and hCG-timed IUI were performed, followed by progesterone supplementation of the luteal phase. In 86 patients, (243 cycles) the husband's sperm was utilized, whereas in 40 couples (152 cycles), donor sperm was used due to severe male factor infertility. Among the sperm parameters of the original ejaculate, % normal morphology (assessed by strict criteria) was the most significant predictor of pregnancy (stepwise regression analysis, P = 0.003). Using logistic regression, morphology was the best predictor of pregnancy (r = 0.12); linearity of movement significantly enhanced the predictive value of morphology alone (r = 0.17, P = 0.004). Overall, the pregnancy rates were significantly higher (P = 0.01) in cases with > or = 14% normal morphology (15% per cycle) compared to cases with < 14% normal morphology (7% per cycle). This threshold level for morphology is in agreement with previously published IVF results. These results underscore the significance of sperm morphology assessed by strict criteria as a predictor of pregnancy outcome in the IUI setting.

Monitoring technologist reading skills in a sperm morphology quality control program

Objective The value of sperm morphology as a predictor of a man’s fertilizing potential has often been challenged because of different classification systems used to distinguish between normal and abnormal spermatozoa. The study aimed to monitor the reading skills of 53 laboratory technologists who are enrolled in a continuous quality control program for sperm morphology assessment. Design Prospective analytical study. Setting Academic hospital and academic institution setting. Patient(s) Sperm samples from the sperm donor program and andrology technicians from sub-Saharan Africa. Intervention(s) Papanicolaou-stained sperm slides were prepared and shipped on a quarterly basis to participating laboratories. Papanicolaou-prestained sperm morphology slides were used as test material for 21 months. Main outcome measure(s) Percentage normal spermatozoa. Result(s) A new statistical model was developed to record reading skills of the participating technicians. Reading skills were classified as marginal (5.7% of cases), good (11.3% of cases), and excellent (83% of cases). Participants maintained their morphological reading skills and agreed with the reference laboratory by not exceeding a SD limit of 0.2 to set stringent standards for the program. Conclusion(s) Technician proficiency can be monitored using the results of a quality control program. A continuous quality control program can be initiated only after intensive training, because baseline values at the onset of the quality control program serves as an internal reference value.