Sperm Morphology Assessment in the Era of Intracytoplasmic Sperm Injection: Reliable Results Require Focus on Standardization, Quality Control, and Training

Agarwal, Ashok; Sharma, Rakesh; Gupta, Sajal; Finelli, Renata; Parekh, Neel; Selvam, Manesh Kumar Panner; Henkel, Ralf; Durairajanayagam, Damayanthi; Pompeu, Camila; Madani, Sarah; Belo, Andrea; Singh, Neha; Covarrubias, Simryn; Darbandi, Sara; Sadeghi, Raha; Darbandi, Mahsa; Vogiatzi, Paraskevi; Boitrelle, Florence; Simopoulou, Mara; Saleh, Ramadan; Arafa, Mohamed; Majzoub, Ahmad; Kandil, Hussein; Zini, Armand; Ko, Edmund; Álvarez, Juan G.; Martínez, Marlon; Ramsay, Jonathan; Jindal, Sunil; Busetto, Gian Maria; Sallam, Hassan; Maldonado, Israel; Anagnostopoulou, Christina; Alves, Marco G.; Sengupta, Pallav; Gilany, Kambiz; Evenson, Donald P.; Lewis, Sheena; Gosálvez, Jaime; Ambar, Rafael F.; Shah, Rupin

doi:10.5534/wjmh.210054

Cited by 19 publications

(11 citation statements)

References 84 publications

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“…Indeed, the current application of ICSI is not justified by the minimal increase of live birth rate obtained at disproportionately increased costs. Our result confirms the previous demonstration of the relevant role of sperm morphology in ART outcomes 62–64 . The impact of teratozoospermia on IVF/ICSI offspring was inconclusive so far 35 .…”

Section: Discussionsupporting

confidence: 88%

“…Our result confirms the previous demonstration of the relevant role of sperm morphology in ART outcomes. [62][63][64] The impact of teratozoospermia on IVF/ICSI offspring was inconclusive so far. 35 Recently, Zhou et al evaluated the influence of teratozoospermia on pregnancy outcome and newborn status after IVF and ICSI, detecting a limited predictive value for pregnancy outcomes and little impact on the resulting offspring.…”

Section: Discussionmentioning

confidence: 99%

“…Our result confirms the previous demonstration of the relevant role of sperm morphology in ART outcomes. 62 , 63 , 64 The impact of teratozoospermia on IVF/ICSI offspring was inconclusive so far. 35 Recently, Zhou et al.…”

Section: Discussionmentioning

confidence: 99%

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Are sperm parameters able to predict the success of assisted reproductive technology? A retrospective analysis of over 22,000 assisted reproductive technology cycles

et al. 2021

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Background: An explosive increase in couples attending assisted reproductive technology has been recently observed, despite an overall success rate of about 20%-30%.Considering the assisted reproductive technology-related economic and psycho-social costs, the improvement of these percentages is extremely relevant. However, in the identification of predictive markers of assisted reproductive technology success, male parameters are largely underestimated so far. Study design: Retrospective, observational study.Objectives: To evaluate whether conventional semen parameters could predict assisted reproductive technology success. Materials and methods:All couples attending a single third-level fertility center from 1992 to 2020 were retrospectively enrolled, collecting all semen and assisted reproductive technology parameters of fresh cycles. Fertilization rate was the primary end-point, representing a parameter immediately dependent on male contribution. Pregnancy and live birth rates were considered in relation to semen variables. Statistical analyses were performed using the parameters obtained according to the World Health Organization manual editions used for semen analysis.Results: Note that, 22,013 in vitro fertilization and intracytoplasmic sperm injection cycles were considered. Overall, fertilization rate was significantly lower in patients with abnormal semen parameters compared to normozoospermic men, irrespective of the World Health Organization manual edition. In the in vitro fertilization setting, both progressive motility (p = 0.012) and motility after capacitation (p = 0.002) significantly predicted the fertilization rate (statistical accuracy = 71.1%). Sperm motilities also predicted pregnancy (p < 0.001) and live birth (p = 0.001) rates. In intracytoplasmic sperm injection cycles, sperm morphology predicted fertilization rate (p = 0.001, statistical accuracy = 90.3%). Sperm morphology significantly predicted bothThis is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

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Are sperm parameters able to predict the success of assisted reproductive technology? A retrospective analysis of over 22,000 assisted reproductive technology cycles

et al. 2021

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“…If flagellar dyskinesia is suspected, other clinical or sperm elements may help the diagnosis ( Table 1 ). For example, the observation of short, bent or coiled flagella may be suggestive of such flagellar/ciliary problems [ 49 ].…”

Section: Management Of Necrozoospermiamentioning

confidence: 99%

Sperm Vitality and Necrozoospermia: Diagnosis, Management, and Results of a Global Survey of Clinical Practice

Agarwal

Sharma

Gupta

et al. 2022

World J Mens Health

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Sperm vitality testing is a basic semen examination that has been described in the World Health Organization (WHO) Laboratory Manual for the Examination and Processing of Human Semen from its primary edition, 40 years ago. Several methods can be used to test sperm vitality, such as the eosin-nigrosin (E-N) stain or the hypoosmotic swelling (HOS) test. In the 6th (2021) edition of the WHO Laboratory Manual, sperm vitality assessment is mainly recommended if the total motility is less than 40%. Hence, a motile spermatozoon is considered alive, however, in certain conditions an immotile spermatozoon can also be alive. Therefore, the differentiation between asthenozoospermia (pathological decrease in sperm motility) and necrozoospermia (pathological decrease in sperm vitality) is important in directing further investigation and management of infertile patients. The causes leading to necrozoospermia are diverse and can either be local or general, testicular or extra-testicular. The andrological management of necrozoospermia depends on its etiology. However, there is no standardized treatment available presently and practice varies among clinicians. In this study, we report the results of a global survey to understand current practices regarding the physician order of sperm vitality tests as well as the management practices for necrozoospermia. Laboratory and clinical scenarios are presented to guide the reader in the management of necrozoospermia with the overall objective of establishing a benchmark ranging from the diagnosis of necrozoospermia by sperm vitality testing to its clinical management.

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“…Over the years, the sperm morphology evaluation has become much more severe, indicating that a careful analysis of this parameter plays an important role in routine semen analysis (2). The reference value for normal sperm morphology, reported in the different editions of World Health Organization (WHO) guidelines for semen analysis, sharply decreased from ≥ 80.5% reported in the 1st edition (3,4) to ≥ 14% in the 4th edition (5). They lowered up to ≥ 4% in the 5th and 6th editions (2, 6).…”

Section: Introductionmentioning

confidence: 99%

The relevance of sperm morphology in male infertility

Moretti

Signorini

Noto

et al. 2022

Front. Reprod. Health

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This brief report concerns the role of human sperm morphology assessment in different fields of male infertility: basic research, genetics, assisted reproduction technologies, oxidative stress. One of the best methods in studying sperm morphology is transmission electron microscopy (TEM) that enables defining the concept of sperm pathology and classifying alterations in non-systematic and systematic. Non-systematic sperm defects affect head and tail in variable ratio, whereas the rare systematic defects are characterized by a particular anomaly that marks most sperm of an ejaculate. TEM analysis and fluorescence in situ hybridization represent outstanding methods in the study of sperm morphology and cytogenetic in patients with altered karyotype characterizing their semen quality before intracytoplasmic sperm injection. In recent years, the genetic investigations on systematic sperm defects, made extraordinary progress identifying candidate genes whose mutations induce morphological sperm anomalies. The question if sperm morphology has an impact on assisted fertilization outcome is debated. Nowadays, oxidative stress represents one of the most important causes of altered sperm morphology and function and can be analyzed from two points of view: 1) spermatozoa with cytoplasmic residue produce reactive oxygen species, 2) the pathologies with inflammatory/oxidative stress background cause morphological alterations. Finally, sperm morphology is also considered an important endpoint in in vitro experiments where toxic substances, drugs, antioxidants are tested. We think that the field of sperm morphology is far from being exhausted and needs other research. This parameter can be still considered a valuable indicator of sperm dysfunction both in basic and clinical research.

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Sperm Morphology Assessment in the Era of Intracytoplasmic Sperm Injection: Reliable Results Require Focus on Standardization, Quality Control, and Training

Cited by 19 publications

References 84 publications

Are sperm parameters able to predict the success of assisted reproductive technology? A retrospective analysis of over 22,000 assisted reproductive technology cycles

Are sperm parameters able to predict the success of assisted reproductive technology? A retrospective analysis of over 22,000 assisted reproductive technology cycles

Sperm Vitality and Necrozoospermia: Diagnosis, Management, and Results of a Global Survey of Clinical Practice

The relevance of sperm morphology in male infertility

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