Impact of sperm morphology on the likelihood of pregnancy after intrauterine insemination
Abstract
Objective To determine whether there is a difference in ongoing pregnancy rates (PRs) between patients undergoing IUI with strict sperm morphology ≤4% compared with >4% on initial semen analysis. Design Retrospective chart review with multivariate analysis. Setting Academic outpatient reproductive center. Patient(s) A total of 408 couples with male and/or female factor infertility and known strict sperm morphology (SSM). Intervention(s) A total of 856 IUIs with partner's sperm (IUI-P). Main outcome measure(s) Ongoing PRs based on ultrasound documentation of intrauterine pregnancy with fetal heart tones. Result(s) There is no statistically significant difference in per cycle PRs when comparing patients with a strict sperm morphology of ≤4% versus >4% who undergo IUI-P (17.3% vs. 16.7%; odds ratio 0.954, 95% confidence interval 0.66-1.37). Multiple potential confounding factors were assessed using multivariate analysis. Conclusion(s) Strict sperm morphology ≤4% is not associated with lower PRs in couples undergoing IUI-P, and thus should not be the sole reason for advancing to IVF.
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The finding that morphology was not discriminative is in agreement with Deveneau et al. (2014) in an IUI program.
“This is in agreement with the recent study of Deveneau et al. (2014) in an IUI program.”
From Total motile sperm count: a better indicator for the severity of male factor infertility than the WHO sperm classification system (2015) · cites this paper as Deveneau et al. (2014)
Deveneau et al. (2014) found that morphology did not have a predictive value for the pregnancy rate in an intrauterine insemination program.
“In a recent paper of Deveneau et al. (2014), the TMSC was studied in an intrauterine insemination (IUI) program and morphology did not have a predictive value for the pregnancy rate.”
From Total motile sperm count: a better indicator for the severity of male factor infertility than the WHO sperm classification system (2015) · cites this paper as Deveneau et al. (2014)
Deveneau et al. (2014) showed no significant difference in pregnancy rate between those with normal (>4%) and abnormal (≤4%) morphology on multivariate analysis.
“Most recently, Deveneau et al. (2014) showed no significant difference in pregnancy rate between those with normal (>4%) and abnormal morphology (≤4%) on multivariate analysis.”
From Isolated abnormal strict morphology is not a contraindication for intrauterine insemination (2015) · cites this paper as Deveneau et al., 2014
Most recent studies of smaller series confirmed that sperm morphology had no impact on pregnancy rates after IUI.
“Most recent studies, of smaller series, confirmed these results [76, 77, 78, 79, 80, 81, 82, 83]”
From Recommendations for Human Sperm Morphology Assessment in 2025: An Expert Review From the French BLEFCO Group (2026) · cites this paper as [77]
Deveneau et al. found that the number of motile spermatozoa after preparation was the most important parameter affecting pregnancy rate after insemination and considered that sperm morphology should not influence recommendations for offering IUI.
“The authors found that the number of motile spermatozoa after preparation was the most important parameter affecting pregnancy rate after insemination and considered that sperm morphology should not influence the recommendations for offering a couple intrauterine insemination.”
From Recommendations for Human Sperm Morphology Assessment in 2025: An Expert Review From the French BLEFCO Group (2026) · cites this paper as [77]
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Isolated teratozoospermia and intrauterine insemination
Spiessens, C., Vanderschueren, D., Meuleman, C., & D'Hooghe, T. (2003) · Fertility and Sterility · doi:10.1016/s0015-0282(03)01172-5 · Cited by 43 · see citing works
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Hamilton, J. A. M., Cissen, M., Brandes, M., Smeenk, J. M. J., de Bruin, J. P., Kremer, J. A. M., Nelen, W. L. D. M., & Hamilton, C. J. C. M. (2015) · Human Reproduction · doi:10.1093/humrep/dev058 · Cited by 236 · see citing works
Kohn, T. P., Kohn, J. R., & Ramasamy, R. (2018) · Journal of Urology · doi:10.1016/j.juro.2017.11.045 · Cited by 56 · see citing works
Isolated abnormal strict morphology is not a contraindication for intrauterine insemination
Lockwood, G. M., Deveneau, N. E., Shridharani, A. N., Strawn, E. Y., & Sandlow, J. I. (2015) · Andrology · doi:10.1111/andr.12098 · Cited by 34 · see citing works
Self-citationLuo, Y., Wu, S., Yuan, J., Zhou, H., Zhong, Y., Zhang, M., Li, Q., Xu, X., Sun, X., & Zhu, D. (2021) · Frontiers in Medicine · doi:10.3389/fmed.2021.638560 · Cited by 13 · see citing works
Is Varicocelectomy Useful for Subfertile Men with Isolated Teratozoospermia?
Choe, J. H., & Seo, J. T. (2015) · Urology · doi:10.1016/j.urology.2015.08.014 · Cited by 11 · see citing works
Gatimel, N., Barbotin, A., Mery, L., Beauvillard, D., Bendayan, M., Boursier, A., Boueilh, T., Pereira, B., Chammas, J., Jacquet, J., et al. (2026) · Andrology · doi:10.1111/andr.70134 · Cited by 2 · see citing works
- Authors
- Deveneau, N. E., Sinno, O., Krause, M., Eastwood, D., Sandlow, J. I., Robb, P., Granlund, A., & Strawn, E. Y.
- Affiliations
- Medical College of Wisconsin (US)
- Froedtert Hospital (US)
- University of Louisville (US)
- Corresponding author
- Deveneau, Nicolette E.
- Venue
- Fertility and Sterility
- Publisher
- Elsevier BV
- Published
- 2014-12
- Volume
- 102
- Issue
- 6
- Pages
- 1584-1590.e2
- ISSN
- 0015-0282 (ISSN-L)
- OpenAlex
- W2016576177
- Cited by
- 49
- References
- 3
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 5 · 2023: 2 · 2022: 3 · 2021: 11 · 2020: 2 · 2019: 2 · 2018: 2 · 2017: 5 · 2016: 4 · 2015: 7 · 2014: 2
- FWCI
- 7.27
- Type
- journal article
- Language
- en
- Open access
- closed
- 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 › Health Professions › General Health Professions › Male Reproductive Health Studies
- Keywords
- sperm morphology, intrauterine insemination, ongoing pregnancy rate, male factor infertility, female factor infertility, semen analysis, intrauterine pregnancy, assisted reproduction
- MeSH terms
- Adult, Female, Humans, Infertility, Male, Insemination, Insemination, Artificial, Homologous, Male, Pregnancy, Retrospective Studies, Spermatozoa, Varicocele, Pregnancy Rate
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