Status of sperm morphology assessment: an evaluation of methodology and clinical value
Open accessAbstract
Objective To characterize methodological changes in sperm morphology assessment and to correlate sperm morphology with clinical outcome. Design In this observational study, sperm morphology profiles of patients were analyzed. The percentages of morphologically normal spermatozoa were evaluated with respect to changes in morphology assessment criteria; male aging; and prognostic value for outcomes after in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI). Setting Diagnostic and clinical laboratories. Patient(s) A total of 8,846 men who visited the diagnostic laboratory; 133 samples from a sperm bank; and 3,676 IVF/ICSI couples. Intervention(s) None. Main outcome measure(s) The percentage of morphologically normal spermatozoa in semen samples. The regression of the individual morphologically normal cell profiles. The relation between the percentage of normal forms with pregnancy outcome after IVF/ICSI. Result(s) The percentage of morphologically normal spermatozoa showed a decrease from roughly 30%-80% in 1984 to 0%-10% since 2004. With added evidence from sperm bank samples, this decrease was found to be attributable mainly to changes in morphology assessment criteria. Furthermore, an intraindividual aging effect of 0.51% per year was observed. A statistically significant relationship was found between decreases in percentage of normal forms and a lower probability of ongoing pregnancies after IVF, although the area under the curve was only 54%. Conclusion(s) Methodological changes had a strong effect on the percentage of morphologically normal spermatozoa over the past few decades. In addition, male aging results in decreasing sperm morphology. The percentage of morphologically normal spermatozoa has no prognostic value for individual IVF/ICSI patients.
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According to Van den Hoven et al., the percentage of normal forms was correlated with ongoing pregnancy rate with an OR of 1.06 [1.02-1.16] after conventional IVF (n = 2323).
“According to Van den Hoven et al. [98], the percentage of normal forms was correlated with ongoing pregnancy rate with an OR of 1.06 [1.02–1.16] after conventional IVF (n = 2323).”
From Recommendations for Human Sperm Morphology Assessment in 2025: An Expert Review From the French BLEFCO Group (2026) · cites this paper as [98]
The “Sperm Morphology and Pregnancy” section reports 2,323 IVF treatments and a statistically significant association between the percentage of normal spermatozoa and ongoing pregnancy. It gives an OR of 1.09 (95% CI 1.02–1.16), not the claimed 1.06; Table 1 confirms the 1.09 figure. The supplied passages do not identify an exact page. (LLM, conf=0.94)
Experimental — accuracy not yet measuredVan den Hoven et al. concluded that sperm morphology is not a useful tool to predict ongoing pregnancy rate after conventional IVF.
“The authors concluded that sperm morphology is not a useful tool to predict ongoing pregnancy rate after conventional IVF.”
From Recommendations for Human Sperm Morphology Assessment in 2025: An Expert Review From the French BLEFCO Group (2026) · cites this paper as [98]
There was a statistically significant relationship between a decreased percentage of normal forms and lower chances of ongoing pregnancy after conventional IVF, with an area under the curve of only 54%.
“There was a statistically significant relationship between a decreased percentage of normal forms and lower chances of ongoing pregnancy after conventional IVF, with however an area under the curve of only 54%.”
From Recommendations for Human Sperm Morphology Assessment in 2025: An Expert Review From the French BLEFCO Group (2026) · cites this paper as [98]
In a study by van den Hoven et al. of 1353 ICSI attempts, the percentage of normal forms was not correlated with the ongoing pregnancy rate.
“In a study by van den Hoven et al. [98] of 1353 ICSI attempts, the percentage of normal forms was not correlated with the ongoing pregnancy rate.”
From Recommendations for Human Sperm Morphology Assessment in 2025: An Expert Review From the French BLEFCO Group (2026) · cites this paper as [98]
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References 20 · Cited by 60
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- Authors
- van den Hoven, L., Hendriks, J. C. M., Verbeet, J. G. M., Westphal, J. R., & Wetzels, A. M. M.
- Affiliations
- Radboud University Medical Center (NL)
- Venue
- Fertility and Sterility
- Publisher
- Elsevier BV
- Published
- 2015-01
- Volume
- 103
- Issue
- 1
- Pages
- 53-58
- ISSN
- 0015-0282 (ISSN-L)
- OpenAlex
- W2018184314
- Cited by
- 60
- References
- 20
- Citations by year
- 2026: 4 · 2025: 7 · 2024: 8 · 2023: 5 · 2022: 2 · 2021: 13 · 2020: 3 · 2019: 5 · 2018: 4 · 2017: 3 · 2016: 5 · 2015: 1
- FWCI
- 3.64
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Fertility and Sterility (publishedVersion)
- PubMed (publishedVersion)
- Radboud Repository (Radboud University) (submittedVersion)
- 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, methodological change, male aging, in vitro fertilization, intracytoplasmic sperm injection, pregnancy outcomes, prognostic value, semen analysis
- MeSH terms
- Adolescent, Adult, Aging, Female, Humans, Infertility, Male, Male, Netherlands, Pregnancy, Pregnancy Outcome, Prognosis, Sensitivity and Specificity, Spermatozoa, Reproducibility of Results, Prevalence, Treatment Outcome, Age Distribution, Sperm Injections, Intracytoplasmic, Semen Analysis, Young Adult
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