Sperm morphology: classification drift over time and clinical implications

Morbeck, Dean E.; Leonard, Phoebe H.; Weaver, Amy L.; Shimek, Katherine M.; Bouwsma, Esther V.A.; Coddington, Charles C.

doi:10.1016/j.fertnstert.2011.08.036

Cited by 19 publications

(9 citation statements)

References 39 publications

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“…In the context of these aforementioned limitations, studies have been performed examining sperm morphology and pregnancy outcomes following IUI7891011 and IVF112131415161718 with variable results.…”

Section: Introductionmentioning

confidence: 99%

Men with a complete absence of normal sperm morphology exhibit high rates of success without assisted reproduction

et al. 2017

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In couples with infertility, abnormal strict morphology of 0% normal forms (NF) is a criterion to proceed rapidly to in vitro fertilization (IVF). Since no data currently exist, we investigated the outcomes for men with 0% NF to determine reproductive success without the use of assisted reproductive technologies (ART). A cohort of 24 men with 0% NF were identified (2010–2013) with 27 randomly selected men with ≥4% NF as controls. Patient charts were reviewed with men contacted and administered an Institutional Review Board (IRB)-approved telephone questionnaire to ascertain outcomes. After a median follow-up time of 2.5 years, 29.2% of men with 0% NF did not require ART for their first pregnancy (controls = 55.6%, P ≤ 0.05). When all pregnancies were analyzed together, men with 0% NF achieved twenty pregnancies of which 75% did not require IVF (controls = thirty pregnancies; 76.7% did not require IVF). The average age of men and female partners was similar between men with 0% NF and ≥4% NF. All men had normal follicle-stimulating hormone (FSH), testosterone, prolactin, sex hormone-binding globulin (SHBG), and estradiol. Although, global semen parameters were worse in men with 0% NF, when a first pregnancy was a natural conception (NC), 100% of men with 0% NF (n = 7/7) and 37.5% of controls (n = 3/8) went on to have a subsequent pregnancy via NC. Men with 0% NF conceived without IVF in 29.2% of cases compared to 55.6% of controls. Strict morphology should not be used to predict fertilization, pregnancy, or live birth potential. In men with 0% NF, alternative modalities should be considered before immediate IVF.

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Section: Introductionmentioning

confidence: 99%

Men with a complete absence of normal sperm morphology exhibit high rates of success without assisted reproduction

et al. 2017

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“…Morbeck et al . () found a relationship between sperm morphology and pregnancy rate in intra‐uterine insemination (IUI) during the years 1996–1997, whereas this relationship was not present in 2005–2006 due to a marked difference in the use of the classification in their laboratory. This difference was related to changes in technicians, differences in training, lack of quality control and changes in international standards.…”

Section: Resultsmentioning

confidence: 99%

Sperm morphology: assessment, pathophysiology, clinical relevance, and state of the art in 2017

et al. 2017

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For over 30 years, sperm morphology assessment has been one of the most common tests in evaluation of fertility. This review examines the clinical relevance of sperm morphology assessment in the diagnosis of infertility and in assisted reproductive technology, as well as its analytical reliability. Publications on the pathophysiology, the analytical reliability of the test and its clinical relevance in diagnosis and in Assisted Reproductive Technology (ART) were evaluated. This review compared and discussed study methodologies and results, including patient characteristics, preparation, smear staining methods and classification systems. The assessment of the percentage of some abnormalities such as for example thin head, amorphous head, or bent or asymmetrical neck is of little clinical use, and their pathophysiology is not well explained as most are physiological traits. Some studies have highlighted correlations between the percentage of normal forms and functional sperm abnormalities, as well as correlations with ability to conceive in vivo and, in some situations, with the success of intra-uterine insemination (IUI) or conventional IVF. However, except in the case of some specific sperm defects (easy to detect with 99 or 100% of spermatozoa affected) and which are often linked to genetic disorders (globozoospermia, macrocephaly, decapitated sperm syndrome and fibrous sheath dysplasia), sperm morphology assessment has very poor sensitivity and specificity in the diagnosis of infertility. Moreover, there is very little evidence that indices of multiple sperm defects [sperm deformity index (SDI), teratozoospermia index (TZI), and multiple abnormalities index (MAI)] are relevant. Above all, many publications report a major lack of analytical reliability of this test, mainly in assessment of the details of sperm abnormalities. Many questions arise concerning how and when sperm morphology should be assessed, and how to interpret the thresholds of normal forms. Questions are raised on the real clinical impact of this test.

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“…This suggests that a classification drift increased the proportion of men diagnosed with teratozoospermia, resulting in a loss of predictive value for sperm morphology. This shift did not occur with a concomitant change in other semen parameters (Morbeck et al ., ). The World Health Organization () manual for semen analysis does accept Kruger's criteria as its new reference value, and provides a broad atlas for strict morphology (World Health Organization, ).…”

Section: Discussionmentioning

confidence: 97%

Isolated abnormal strict morphology is not a contraindication for intrauterine insemination

et al. 2015

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SUMMARYThis study sought to investigate whether isolated abnormal strict morphology (<5% normal forms) and very low strict morphology (0-1% normal forms) affects pregnancy rates in intrauterine insemination (IUI). This was a retrospective study performed at an Academic Medical Center/Reproductive Medicine Center. Four hundred and eight couples were included for 856 IUI cycles. 70 IUI cycles were performed in couples with abnormal strict morphology and otherwise normal semen parameters. Outcomes were measured as clinical pregnancy rate per IUI cycle as documented by fetal heart activity on maternal ultrasound. Clinical pregnancy rate did not significantly differ between the group with abnormal strict morphology [11/70 (15.7%)] and the normal morphology group [39/281 (13.9%)]. Additionally, there was no significant difference between the pregnancy rate in the abnormal morphology group compared to that of our overall institutional IUI pregnancy rate [145/856 (16.9%)]. Furthermore, there was no significant difference between pregnancy rate in the very low morphology group [3/14 (21.4%)] compared to those with normal morphology or the overall IUI pregnancy rate. Patients with isolated abnormal strict morphology have clinical pregnancy rates similar to those with normal morphology for IUI. Even in those with very low normal forms, consideration of IUI for assisted reproduction should not be excluded.

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Sperm morphology: classification drift over time and clinical implications

Cited by 19 publications

References 39 publications

Men with a complete absence of normal sperm morphology exhibit high rates of success without assisted reproduction

Men with a complete absence of normal sperm morphology exhibit high rates of success without assisted reproduction

Sperm morphology: assessment, pathophysiology, clinical relevance, and state of the art in 2017

Isolated abnormal strict morphology is not a contraindication for intrauterine insemination

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