Does severe teratozoospermia affect blastocyst formation, live birth rate, and other clinical outcome parameters in ICSI cycles?
Open accessAbstract
Objective To determine if strict morphology correlates with outcome parameters in couples undergoing intracytoplasmic sperm injection (ICSI). Design Retrospective review. Setting Academic nonprofit IVF center. Patient(s) Couples undergoing IVF/ICSI. Intervention(s) In vitro fertilization and ICSI. Main outcome measure(s) Samples were evaluated for total sperm count, motlity, progression, and morphology using Kruger's strict criteria. The ICSI cycle outcome parameters included fertilization, clinical pregnancy, implantation, live birth, and blastulation rates and blastocyst quality. Result(s) Fertilization rates were high (74%-77%), and clinical pregnancy rates ranged from 60% (subgroup with 0% normal sperm) to 56% (subgroup with >/=7% normal forms). The highest pregnancy and live birth rates were observed in eggs fertilized with sperm from specimens with the most severe teratozoospermia. The blastulation rate was similar among subgroups. The percentage of high-quality blastocysts was significantly greater in the severely teratozoospermic patients compared with patients with >/=5% normal sperm (37% vs. 28%). This is likely because in the lower morphology subgroups, female factors are less prevalent and the primary infertility problem is male factor. Conclusion(s) These data suggest that we reconsider the diagnostic value of strict morphology in assisted reproductive technology cycles involving ICSI. Sperm morphology assessed by Kruger's strict criteria had little prognostic value in ICSI cycle outcomes. Sperm morphology did not appear to influence blastocyst development or blastocyst morphology. Microscopic selection of sperm with "normal" morphology during the ICSI procedure allowed excellent outcomes even in samples with severe teratozoospermia.
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Publications examining the impact of morphology on spontaneous pregnancy, intrauterine insemination, and in vitro fertilization reach varying conclusions.
“Despite efforts to standardize methodology for grading sperm morphology, publications examining the impact morphology on spontaneous pregnancy, intrauterine insemination, and in vitro fertilization reach varying conclusions (2, 3, 4, 5, 6, 7, 8, 9, 10).”
From Poor reproducibility of percentage of normally shaped sperm using the World Health Organization Fifth Edition strict grading criteria (2022) · cites this paper as [8]
The Discussion (page unavailable) says morphology may affect fertilization in IUI and conventional IVF, while this study found no significant differences in ICSI outcomes across morphology groups. That supports differing conclusions across assisted-reproduction methods, but our copy does not address spontaneous pregnancy or establish that publications on all three settings reach varying conclusions. (LLM, conf=0.82)
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Do morphological anomalies reflect chromosomal aneuploidies?*: Case Report
Viville, S., Mollard, R., Bach, M.-L., Falquet, C., Gerlinger, P., & Warter, S. (2000) · Human Reproduction · doi:10.1093/humrep/15.12.2563 · Cited by 129 · see citing works
Oehninger, S., Kruger, T. F., Simon, T., Jones, D., Mayer, J., Lanzendorf, S., Toner, J. P., & Muasher, S. J. (1996) · Human Reproduction · doi:10.1093/oxfordjournals.humrep.a019302 · Cited by 71 · see citing works
Kihaile, P. E., Misumi, J., Hirotsuru, K., Kumasako, Y., Kisanga, R. E., & Utsunomiya, T. (2003) · International Journal of Andrology · doi:10.1046/j.1365-2605.2003.00391.x · Cited by 36 · see citing works
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Research works printed but not linked: 4
- [1]1. Kruger, T.F. ∙ Menkveld, R. ∙ Stander, F.S. ... Sperm morphologic features as a prognostic factor in in vitro fertilization Fertil Steril. 1986; 46:1118-1123 Crossref Scopus (1103) PubMed Google Scholar
- [2]2. Van Waart, J. ∙ Kruger, T.F. ∙ Lombard, C.J. ... Predictive value of normal sperm morphology in intrauterine insemination (IUI): a structured literature review Hum Reprod Update. 2001; 7:495-500 Crossref Scopus (182) PubMed Google Scholar
- [3]3. Kruger, T.F. ∙ Acosta, A.A. ∙ Simmons, K.F. ... Predictive value of abnormal sperm morphology in in vitro fertilization Fertil Steril. 1988; 49:112-117 Crossref Scopus (1073) PubMed Google Scholar
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Chen, H., Zhu, Y., Zhu, Z., Zhi, E., Lu, K., Wang, X., Liu, F., Li, Z., & Xia, W. (2018) · Journal of Medical Genetics · doi:10.1136/jmedgenet-2016-104404 · Cited by 43 · see citing works
Baker, K. C., Steiner, A. Z., Hansen, K. R., Barnhart, K. T., Cedars, M. I., Legro, R. S., Diamond, M. P., Krawetz, S. A., Usadi, R., Baker, V. L., et al. (2022) · F&S Reports · doi:10.1016/j.xfre.2022.03.003 · Cited by 14 · see citing works
- Authors
- French, D. B., Sabanegh, E. S., Goldfarb, J., & Desai, N.
- Affiliations
- Cleveland Clinic (US)
- Corresponding author
- Desai, Nina
- Venue
- Fertility and Sterility
- Publisher
- Elsevier BV
- Published
- 2010-03
- Volume
- 93
- Issue
- 4
- Pages
- 1097-1103
- ISSN
- 0015-0282 (ISSN-L)
- OpenAlex
- W2117637119
- Cited by
- 105
- References
- 3
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 5 · 2023: 5 · 2022: 8 · 2021: 7 · 2020: 3 · 2019: 10 · 2018: 5 · 2017: 6 · 2016: 7 · 2015: 6 · 2014: 9 · 2013: 8 · 2012: 7
- FWCI
- 8.25
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Fertility and Sterility (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Reproductive Medicine › Sperm and Testicular Function
- Health Sciences › Medicine › Reproductive Medicine › Reproductive Health and Technologies
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Reproductive Biology and Fertility
- Keywords
- teratozoospermia, intracytoplasmic sperm injection, sperm morphology, blastocyst quality, blastocyst development, live birth rate, clinical pregnancy rate, fertilization rate, male infertility, sperm selection, IVF outcomes
- MeSH terms
- Adult, Birth Rate, Blastocyst, Female, Humans, Infertility, Male, Male, Pregnancy, Retrospective Studies, Treatment Outcome, Sperm Injections, Intracytoplasmic, Embryonic Development, Live Birth, Azoospermia
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