Sperm morphology assessment: diagnostic potential and comparitive analysis of strict or WHO criteria in a fertile and a subfertile population

Abstract

SummaryThis prospective study compared the diagnostic and predictive potential of sperm morphology assessments in a fertile vs. a subfertile population, evaluated in three different laboratories. The fertile population included 144 men who had recently fertilized their partners. As subfertile controls, 136 men with a history of subfertility for more than 12 months were used. All semen samples (280) were evaluated in three different centres in a blind fashion, without any patient information. The evaluation of sperm morphology was performed according to the criteria normally used in the different laboratories: WHO (1992) criteria for laboratory A, and Tygerberg strict criteria for laboratories B and C. Using ROC analysis, the predictive power of sperm morphology turned out to be different in the three laboratories (area under ROC curve: 69% for lab A, 72% for lab B and 78% for lab C). Using percentile 10 of the fertile population as the cut-off value for normality, we obtained the following results: 2, 1 and 5% for laboratories A, B and C, respectively. Using ROC analysis cut-off values with optimal speci®city and sensitivity were 6, 1 and 10%, respectively.Although our data highlight a reasonable predictive power of sperm morphology in centres using different or the same criteria, cut-off values for normality were different, even when the same criteria were applied. These results stress the importance of standardization in sperm morphology evaluation and the need for examining a reference population in estimating the real threshold value in different laboratories.

Deficiency in Outer Dense Fiber 1 Is a Marker and Potential Driver of Idiopathic Male Infertility

“…Although a semen analysis is the best predictive test we have to date, it clearly falls short of a true diagnosis (5,6). Indeed, several studies have shown that men with sperm numbers (7)(8)(9), morphology (8,10), and motility (11)(12)(13)(14)(15)(16)(17) below the thresholds outlined by the WHO can be fertile. Furthermore, there are many instances of men with normal sperm parameters that are infertile (13, 18 -20).…”

Analysis of the correlation between sperm DNA integrity and conventional semen parameters in infertile men

“…[18] Particularly, the incidence of serious morphologic disorders such as abnormally small heads, megalocephaly, severe tail abnormalities, or globozoospermia has a significant correlation with abnormal chromatin structure and DNA strand breaks. [19] In such cases, there are also parallel increases in aneuploidy rates and unexplained recurrent pregnancy losses. [20] The shaping of the sperm head is probably related to the degree of chromatin condensation as well as developmental factors.…”

Assessment of Human Sperm Morphology by Strict Criteria: Comparison of Wet Preparation Versus Stained With the Modified Diff-Quik Method

“…Kruger et al [9] found that the Di -Quik staining method provided similar results with the Papanicolaou method in terms of the morphologically normal spermatozoa percentage. Even when the lique®ed sample, Di -Quik staining, and the strict criteria are used, there are still di erences in sperm morphology assessments between laboratories [14,16].…”

“…The assessment of sperm morphology, an integral component of basic semen evaluation, is useful in the management of the infertile male [13]. A good correlation between normal sperm morphology and in vitro and in vivo fertilization has been reported by many investigators [3,10,14]. Sperm morphology assessed by strict criteria (Kruger classi®cation) [8] has been shown to have a high predictive value for the outcome of assisted reproductive technologies and intrauterine insemination [6,7,10].…”