Sperm morphology as diagnosed by strict criteria: probing the impact of teratozoospermia on fertilization rate and pregnancy outcome in a large in vitro fertilization population.

This practical, extensively illustrated handbook covers the procedures that are undertaken in andrology and ART laboratories to analyse and assess male-factor infertility, and to prepare spermatozoa for use in assisted conception therapy. The content is presented as brief, authoritative overviews of the relevant biological background for each area, plus detailed, step-by-step descriptions of the relevant analytical procedures. Each technical section includes pertinent quality control considerations, as well as the optimum presentation of results. In addition to the comprehensive 'basic' semen analysis, incorporating careful analysis of sperm morphology, the handbook provides established techniques for the use of computer-aided sperm analysis and sperm functional assessment. Throughout the handbook the interpretation of laboratory results in the clinical context is highlighted, and safe laboratory practice is emphasized. It is an invaluable resource to all scientists and technicians who perform diagnostic testing for male-factor infertility.

A Practical Guide to Basic Laboratory Andrology

In this study, a total of 95 ejaculates from infertile patients were investigated morphologically according to Kruger's strict criteria and 78 of the 95 ejaculates were stained for chromatin condensation with acidic aniline blue. Patients were divided into two groups based on the percentage of morphologically normal spermatozoa as follows: Men with normal sperm morphology 14% (Group 2). The relationship between percentage of normal sperm morphology and fertilization, cleavage and pregnancy rate was analysed. The rates were 33.7%, 57.1% and 0.0% respectively, in the first group. The corresponding values for the second group were 76.1%, 68.2% and 32.1%. The fertilization and pregnancy rates correlate significantly with morphologically normal spermatozoa. In regard to the percentage of morphologically normal spermatozoa stained with aniline blue, patients were divided into two groups: patients with 0-20% stained spermatozoa (Group I) and those with > 20% (Group 2). Fertilization and pregnancy rates were higher in the first group than in the second group (79.9%, 52.8% vs. 58.8%, 29.5%). The results demonstrate that chromatin condensation visualized by aniline blue staining is a good predictor for IVF outcome and should be considered besides morphology by sperm assessment for patients undergoing IVF treatment.

Association between sperm cell chromatin condensation, morphology based on strict criteria, and fertilization, cleavage and pregnancy rates in an IVF program.

This article attempts to evaluate the value of sperm morphology in assisted reproduction by summarizing a recent structured literature review covering the topic. New developments in the field of sperm morphology with emphasis on computer evaluation of morphology and its latest clinical application are highlighted, as well as the correlation between sperm functional tests and sperm morphology. Based on the correlation between the sperm functional tests and sperm morphology, as well as the latter's proven value as a predictor in in-vitro fertilization, one can assume that sperm morphology reflects function, although based on definition it is not a sperm functional test per se. The evaluation of sperm morphology by strict criteria is a simple, cost-effective method and can be used to guide the clinician and scientist on a day-to-day basis to make sound clinical decisions.

The role of sperm morphology in assisted reproduction

The present study was designed to determine the efficacy of intracytoplasmic sperm injection (ICSI) using spermatozoa with abnormal head morphology in 17 cases with total teratozoospermia. A total of 160 oocytes were retrieved and 144 metaphase II oocytes were injected. The fertilization and cleavage rates were 50.7 and 93.2% respectively. Fertilization failure occurred in two couples. A total of 54 embryos were transferred and pregnancy rates per initiated and per embryo transfer cycle were 17.6 and 20.0% respectively, while the clinical pregnancy rates per initiated and embryo transfer cycle were 11.8 and 13.3%. The implantation rate was 3.7% (2/54). Out of two pregnancies achieved, one resulted in abortion in the first trimester. The ongoing pregnancy rates per initiated and embryo transfer cycle were 5.88% (1/17) and 6.6% (1/15) respectively. Although the implantation and ongoing pregnancy rates are very low, ICSI seems to be the only treatment modality in cases where teratozoospermia was total with 100% abnormal head morphology.

Roelof Menkveld

Papers

Hemizona assay and teratozoospermia: increasing sperm insemination concentrations to enhance zona pellucida binding *