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Cited by 34Sperm and Testicular FunctionReproductive Health and TechnologiesMale Reproductive Health Studies

Isolated abnormal strict morphology is not a contraindication for intrauterine insemination

Open access
Lockwood, G. M., Deveneau, N. E., Shridharani, A. N., Strawn, E. Y., Sandlow, J. I.·2015·Andrology
DOI 10.1111/andr.12098
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Abstract

Summary: This 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.

AI snapshot

Written from the paper’s full text.

TL;DR

In this retrospective study of 856 IUI cycles, isolated abnormal strict morphology (<5% normal forms) was not associated with lower clinical pregnancy rate per IUI cycle compared with normal morphology. Even very low morphology (0–1%) showed no significant reduction, though the subgroup was small.

Key findings

  • Clinical pregnancy rate per IUI cycle was 15.7% (11/70) in the isolated abnormal strict morphology group (<5%) vs 13.9% (39/281) in the normal morphology group (≥5%), adjusted p = 0.74; odds ratio of normal to abnormal morphology for clinical pregnancy was 0.917 (95% CI 0.393–2.140; p = 0.841).
  • The abnormal morphology group did not differ significantly from the overall institutional IUI pregnancy rate: 15.7% vs 16.9% (145/856), p = 0.87.
  • The very low morphology group (0–1%) had a clinical pregnancy rate of 21.4% (3/14), not significantly different from normal morphology (p = 0.43) or the overall institutional rate (p = 0.72).
  • Ovulation induction differed between groups: clomiphene citrate was used in 57% (40/70) of abnormal vs 77% (217/281) of normal morphology cycles (p = 0.0014), and letrozole in 43% (30/70) vs 18.5% (52/281) (p = 0.0001).

Methods

  • Retrospective IRB-approved chart review at an academic Reproductive Medicine Center, 2005–2010; 856 IUI cycles in 408 couples met inclusion criteria. Exclusions included undocumented morphology before IUI, outside-laboratory semen testing, no documented IUI/pregnancy outcome, and donor sperm cycles.
  • Primary outcome was clinical pregnancy per IUI cycle, confirmed by fetal heart activity on maternal ultrasound. Groups included isolated teratozoospermia (<5% strict morphology with concentration ≥20 million/mL, total motility ≥50%, total progressive motile sperm ≥20 million), normal morphology (≥5%) with normal semen parameters, very low morphology (0–1%), and overall institutional IUI outcomes.
  • Abnormal vs normal morphology outcomes were compared using repeated-measures logistic regression via Generalized Estimating Equations, controlling for female age, diagnosis, and type of ovulation induction; very low morphology and overall institutional comparisons used Fisher’s exact test with two-tailed p values; p < 0.05 was significant.

Limitations

  • The paper states the study was retrospective with intrinsic biases, was powered only to detect a 10% difference in clinical pregnancy rate, and the very low morphology subgroup comprised only 14 IUI cycles in six couples and was not adequately powered. It also states data were not collected on cycles aborted for low post-preparation sperm count, and significant ovulation induction differences between groups could act as confounders.
  • The paper notes morphology assessment is inherently subjective with technician variability and possible classification drift; assessment for drift in morphology values over the 2005–2010 period was not performed.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1111/andr.12098

Cites

42 of 42 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

1 of 9 cited sources checked · 0 supported · 0 flagged · accuracy not yet measured

  • Premisecitation

    Standard semen parameters are poorly predictive for producing a pregnancy in vivo.

    “Semen analysis is widely used as a surrogate measure of a man's reproductive capacity, but in truth, standard semen parameters are poorly predictive for producing a pregnancy in vivo (McLachlan et al., 2003;Li et al., 2006;Nallella et al., 2006).”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites McLachlan et al., 2003 source
    • cites Li et al., 2006

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites Nallella et al., 2006 source

      The introductory passage (indexed as Abstract; page unavailable) says a normal spermiogram does not necessarily indicate satisfactory fertility potential, and the Discussion reports substantial overlap in semen characteristics between fertile men and male-factor infertility patients. These findings support limits to standard semen parameters, but the paper evaluates discrimination between those groups rather than directly testing prediction of an in-vivo pregnancy. (LLM, conf=0.84)

      Experimental — accuracy not yet measured
  • Findingown data

    In couples with isolated abnormal strict morphology (<5% normal forms) and otherwise normal semen parameters, the clinical pregnancy rate per IUI cycle (11/70, 15.7%) did not differ significantly from that of couples with normal strict morphology (≥5%) (39/281, 13.9%), p = 0.74, with female age, diagnosis and type of ovulation induction controlled.

    “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%)].”
    • Also stated in: § RESULTS · plain
      “There was no statistically significant difference in clinical pregnancy rate per cycle between the abnormal strict morphology group and the normal strict morphology group (15.7% vs. 13.9%,p = 0.74), with female age, diagnosis and type of ovulation induction controlled.”
    Quote in the paperSubstantial claim
  • Findingown data

    The 95% confidence interval for the difference in pregnancy rates between the normal and abnormal morphology groups was -7.6% to 11.27%.

    “The 95% confidence interval for difference in pregnancy rates between the normal and abnormal groups was À7.6% to 11.27%, indicating that the pregnancy rates between groups are truly similar.”
    Quote in the paperSubstantial claim
  • Findingown data

    The odds ratio of normal morphology to abnormal morphology for clinical pregnancy was 0.917 (95% confidence interval 0.393-2.140; p = 0.841).

    “Odds ratio of normal morphology to abnormal morphology for clinical pregnancy was 0.917 (95% confidence interval 0.393-2.140;p = 0.841).”
    Quote in the paperSubstantial claim
  • Findingown data

    The clinical pregnancy rate per IUI cycle in the isolated abnormal strict morphology group (15.7%) did not differ significantly from the overall institutional IUI pregnancy rate (145/856, 16.9%), p = 0.87.

    “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%)].”
    • Also stated in: § RESULTS · plain
      “On univariate analysis, there was no significant difference between the abnormal strict morphology group and the overall institutional pregnancy rate for IUI (15.7% vs. 16.9%,p = 0.87).”
    Quote in the paperSubstantial claim
  • Classified as probably not a substantial claim. 11
  • May combine two claims. 7

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    More patients in the normal morphology group underwent clomiphene citrate induction than in the abnormal morphology group (77% (217/281) vs. 57% (40/70); p = 0.0014).

    “More patients in the normal morphology group underwent clomiphene citrate induction than in the abnormal group (77% (217/ 281) vs. 57% (40/70); p = 0.0014).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    More patients in the abnormal morphology group underwent letrozole induction than in the normal morphology group (43% (30/70) vs. 18.5% (52/281); p = 0.0001).

    “In the abnormal group, 43% (30/70) of patients underwent letrozole induction, as opposed to 18.5% (52/281) in the normal group (p = 0.0001).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    On multivariate analysis there were no statistically significant differences in female age or infertility diagnoses between the abnormal and normal strict morphology groups.

    “On multivariate analysis, there were no statistical differences between female age or diagnoses between the two groups.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The clinical pregnancy rate per IUI cycle in the very low strict morphology group (0-1% normal forms; 3/14, 21.4%) did not differ significantly from that of the normal morphology group (13.9%, p = 0.43) or the overall institutional IUI pregnancy rate (16.9%, p = 0.72).

    “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.”
    • Also stated in: § RESULTS · plain
      “Furthermore, there were no significant differences between the very low morphology group and those with normal morphology, or the overall institutional pregnancy rate (21.4% vs. 13.9%;p = 0.43 and 21.4% vs. 16.9%;p = 0.72).”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Assessment for drift in morphology values over the 2005-2010 study period was not performed.

    “Assessment for drift in morphology values over this time period was not assessed.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    Quality control of semen concentration assessment was performed daily with microbead suspensions verifying low and high bead solutions, and technician proficiency was tested semiannually.

    “Sperm concentration was calculated with use of a disposable microcell chamber (Vitrolife, Sweden), and quality control was performed daily with microbead suspensions verifying low and high bead solutions.Proficiency of technicians was tested semiannually to ensure accurate assessment of concentration, total and progressive motility.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    Montanaro et al. (2001), reviewing 522 IUI cycles, concluded that abnormal morphology of ≤14% significantly and independently negatively affected pregnancy outcomes with IUI.

    “In 2001 Montanaro, et al. retrospectively reviewed data on 522 IUI cycles and concluded that abnormal morphology of ≤14% significantly and independently negatively affected pregnancy outcomes with IUI.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Montanaro et al., 2001

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Recent studies have called into question the predictive value of sperm morphology for pregnancy and the need to move directly to ICSI in those with teratozoospermia.

    “Recent studies have called into question the predictive value of sperm morphology for pregnancy and the need to move directly to ICSI in those with teratozoospermia (Matorras et al., 1995;Karabinus & Gelety, 1997;Check et al., 2007;Deveneau et al., 2014).”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites Matorras et al., 1995 source
    • cites Karabinus & Gelety, 1997 source
    • cites Check et al., 2007 source

  • Classified as probably not a substantial claim.

    Study design and conductown data

    Pregnancy outcomes between the normal and abnormal morphology groups were compared using repeated measures logistic regression via Generalized Estimating Equations, controlling for female age, diagnosis and type of ovulation induction.

    “Pregnancy outcomes between the normal morphology (≥5%) and abnormal morphology (<5%) groups were compared using repeated measures logistic regression via Generalized Estimating Equations (GEE).This allowed us to control for variables of female age, diagnosis and type of ovulation induction.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The study was powered only to detect a 10% difference in clinical pregnancy rate.

    “In addition, although our overall sample size was large, our study was only powered to detect a 10% difference in clinical pregnancy rate.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The retrospective chart review was performed under Institutional Review Board (IRB) approval.

    “Under Institutional Review Board (IRB) approval, retrospective chart review was performed for couples presenting to our Reproductive Medicine Center (RMC) during the years of 2005-2010.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductnone given

    Sperm morphology was graded using strict criteria by one of two technicians trained using the Strict 1-2-3 Training and Quality Control Programs, with uniformity of grading ensured by assessment of standardized semen samples and quarterly re-certification.

    “Morphology was graded using strict criteria by one of two technicians trained using the Strict 1-2-3 Training and Quality Control Programs (MQ Medical, South Africa).”
    • Also stated in: § Semen collection/assessment of sperm morphology · plain
      “Uniformity of grading was ensured during and after training with assessment of standardized semen samples.Technicians were tested for re-certification quarterly.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationcitation

    There is flawed rationale in using strict morphology as a prognostic indicator and to direct fertility treatment.

    “There is flawed rationale in using strict morphology as a prognostic indicator and to direct fertility treatment.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductreasoning

    The study was retrospective and carries intrinsic biases.

    “Our study does have limitations including its retrospective nature with intrinsic biases.”
    Quote in the paperNot a substantial claim
14 of 14

  • The paper relies on this without support.

    Couples in whom the male has teratozoospermia (<5% normal forms by Kruger strict criteria) are steered toward IVF and ICSI and away from IUI in clinical practice.

    “In cases of idiopathic infertility, couples in whom the male has teratozoospermia (<5% normal forms according to Kruger strict criteria) may be steered toward in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) and away from intrauterine insemination (IUI) despite established safety and efficacy.”

  • The paper relies on this without support.

    This study is the largest to evaluate the effect of abnormal strict morphology in the setting of otherwise normal semen parameters on IUI results.

    “To our knowledge, this study is the largest to evaluate the effect of abnormal strict morphology in the setting of otherwise normal semen parameters on IUI results.”

  • The paper relies on this without support.

    This is the only publication to specifically address patients with essentially no normal forms (0-1%) on semen analysis.

    “In addition, ours is the only publication to specifically address patients with essentially no normal forms (0-1%) on semen analysis.”
3 of 3

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Endometriosis/uterine factor percentage does not match its count

    Minor

    The table reports 29 of 281 as 12.5%, but that fraction is approximately 10.3%.

    Reported 12.5 · recomputed 10.320285

  • Normal-morphology row gives conflicting cycle counts

    Minor

    Table 2 labels the normal-morphology row as 504 cycles but calculates its stated pregnancy rate from 281 cycles. The results identify 281 as the subset with both normal morphology and otherwise normal semen parameters.

2 of 2

Cites

Flagged first, then by citations

Research works printed but not linked: 1

  1. World Health Organization, 2010, WHO Laboratory Manual for the Examination and Processing of Human Semen

Cited by

Sorted by citations

Related

Authors
Lockwood, G. M., Deveneau, N. E., Shridharani, A. N., Strawn, E. Y., & Sandlow, J. I.
Affiliations
Froedtert Hospital (US)
Corresponding author
Sandlow, J. I.
ORCID
Venue
Andrology
Publisher
Wiley
Published
2015-09-18
Volume
3
Issue
6
Pages
1088-1093
ISSN
  • 2047-2919 (ISSN-L)
  • 2047-2927
DOI
10.1111/andr.12098
OpenAlex
W1897092998
Cited by
34
References
39
Citations by year
2026: 1 · 2025: 1 · 2024: 6 · 2022: 3 · 2021: 4 · 2020: 1 · 2019: 5 · 2018: 5 · 2017: 4 · 2016: 4
FWCI
4.27
Type
journal article
Language
en
Open access
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations
  • Andrology (publishedVersion)
  • PubMed (publishedVersion)
Funders
Medical College of Wisconsin
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
intrauterine insemination, sperm morphology, morphological abnormalities, clinical pregnancy rate, semen parameters, assisted reproduction
MeSH terms
Adult, Female, Humans, Infertility, Male, Insemination, Artificial, Homologous, Male, Predictive Value of Tests, Pregnancy, Retrospective Studies, Risk Factors, Spermatozoa, Treatment Outcome, Pregnancy Rate, Semen Analysis

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Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-26.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-26.

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