Sperm Morphology, Motility, and Concentration in Fertile and Infertile Men
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Background Although semen analysis is routinely used to evaluate the male partner in infertile couples, sperm measurements that discriminate between fertile and infertile men are not well defined. Methods We evaluated two semen specimens from each of the male partners in 765 infertile couples and 696 fertile couples at nine sites. The female partners in the infertile couples had normal results on fertility evaluation. The sperm concentration and motility were determined at the sites; semen smears were stained at the sites and shipped to a central laboratory for an assessment of morphologic features of sperm with the use of strict criteria. We used classification-and-regression-tree analysis to estimate threshold values for subfertility and fertility with respect to the sperm concentration, motility, and morphology. We also used an analysis of receiver-operating-characteristic curves to assess the relative value of these sperm measurements in discriminating between fertile and infertile men. Results The subfertile ranges were a sperm concentration of less than 13.5 x 10(6) per milliliter, less than 32 percent of sperm with motility, and less than 9 percent with normal morphologic features. The fertile ranges were a concentration of more than 48.0 x 10(6) per milliliter, greater than 63 percent motility, and greater than 12 percent normal morphologic features. Values between these ranges indicated indeterminate fertility. There was extensive overlap between the fertile and the…
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Semen analysis is the most basic evaluation of male infertility, and evaluation of semen parameters is currently based on the standards defined in the WHO laboratory manual for the examination and processing of human semen.
“Semen analysis (SA) represents the most basic evaluation of male infertility. The evaluation of semen parameters is currently based on the standards defined in the laboratory manual for the examination and processing of human semen created by the World Health Organization (WHO) [8,9,10].”
From The Sixth Edition of the WHO Manual for Human Semen Analysis: A Critical Review and SWOT Analysis (2021) · cites this paper as [9]
Sperm morphology is correlated with the chances of natural pregnancy in epidemiological studies comparing fertile men whose partners achieved natural pregnancy and infertile men.
“Epidemiological studies comparing fertile men whose partners achieved natural pregnancy and infertile men have demonstrated that sperm morphology was correlated with the chances of natural pregnancy [1, 2, 3].”
From Recommendations for Human Sperm Morphology Assessment in 2025: An Expert Review From the French BLEFCO Group (2026) · cites this paper as [1]
The predictive value of sperm parameters for detecting infertility is low.
“In these studies, although correlations were observed between morphology and natural fertility, the predictive value of sperm parameters for detecting infertility was low.”
From Recommendations for Human Sperm Morphology Assessment in 2025: An Expert Review From the French BLEFCO Group (2026) · cites this paper as [1]
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 [2]
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- Authors
- Guzick, D. S., Overstreet, J. W., Factor-Litvak, P., Brazil, C. K., Nakajima, S. T., Coutifaris, C., Carson, S. A., Cisneros, P., Steinkampf, M. P., Hill, J. A., Xu, D., & Vogel, D. L.
- Affiliations
- University of Rochester Medicine (US)
- University of California, Davis (US)
- Columbia University (US)
- University of Pennsylvania (US)
- Baylor College of Medicine (US)
- University of Alabama at Birmingham (US)
- Brigham and Women's Hospital (US)
- National Institutes of Health (US)
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2001-11-08
- Volume
- 345
- Issue
- 19
- Pages
- 1388-1393
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W1997352429
- Cited by
- 1,336
- References
- 0
- Citations by year
- 2026: 38 · 2025: 31 · 2024: 54 · 2023: 59 · 2022: 70 · 2021: 63 · 2020: 69 · 2019: 57 · 2018: 65 · 2017: 70 · 2016: 60 · 2015: 63 · 2014: 75 · 2013: 83 · 2012: 74
- FWCI
- 26.58
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (5u10hd033173-02, 5u01hd027006-07, 5u10hd027009-11, 1u10hd026975-01, 5u10hd026981-10)
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (U10HD033172, U10HD27049, U10 HD33173, U10 HD27001, U10 HD27009, U01-HD 27006, U10 HD26975, U10HD027049, U10 HD33172, U10-HD26981)
- 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
- male infertility, sperm morphology, sperm motility, sperm concentration, semen analysis, subfertility, classification and regression trees, receiver operating characteristic, infertile couples
- MeSH terms
- Adult, Alcohol Drinking, Educational Status, Humans, Infertility, Male, Male, Reference Values, Regression Analysis, ROC Curve, Semen, Sensitivity and Specificity, Smoking, Sperm Count, Sperm Motility, Spermatozoa, Odds Ratio
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