Sperm morphology: assessment, pathophysiology, clinical relevance, and state of the art in 2017
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Summary: For over 30 years, sperm morphology assessment has been one of the most common tests in evaluation of fertility. This review examines the clinical relevance of sperm morphology assessment in the diagnosis of infertility and in assisted reproductive technology, as well as its analytical reliability. Publications on the pathophysiology, the analytical reliability of the test and its clinical relevance in diagnosis and in Assisted Reproductive Technology ( ART ) were evaluated. This review compared and discussed study methodologies and results, including patient characteristics, preparation, smear staining methods and classification systems. The assessment of the percentage of some abnormalities such as for example thin head, amorphous head, or bent or asymmetrical neck is of little clinical use, and their pathophysiology is not well explained as most are physiological traits. Some studies have highlighted correlations between the percentage of normal forms and functional sperm abnormalities, as well as correlations with ability to conceive in vivo and, in some situations, with the success of intra‐uterine insemination ( IUI ) or conventional IVF . However, except in the case of some specific sperm defects (easy to detect with 99 or 100% of spermatozoa affected) and which are often linked to genetic disorders (globozoospermia, macrocephaly, decapitated sperm syndrome and fibrous sheath dysplasia), sperm morphology assessment has very poor sensitivity and specificity in the diagnosis of infertility. Moreover, there is very little evidence that indices of multiple sperm defects [sperm deformity index ( SDI ), teratozoospermia index ( TZI ), and multiple abnormalities index ( MAI )] are relevant. Above all, many publications report a major lack of analytical reliability of this test, mainly in assessment of the details of sperm abnormalities. Many questions arise concerning how and when sperm morphology should be assessed, and how to interpret the thresholds of normal forms. Questions are raised on the real clinical impact of this test.
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The strict criteria consider a slight or borderline abnormality as abnormal, resulting in a significantly lower threshold of normally shaped sperm compared to the liberal approach.
“These criteria consider a slight or borderline abnormality as abnormal, which results in a significantly lower threshold of normally shaped sperm compared to the liberal approach (30).”
From Isolated teratozoospermia: revisiting its relevance in male infertility: a narrative review (2024) · cites this paper as [30]
There needs to be more evidence of the clinical value of multiple sperm defect indices.
“There needs to be more evidence of their clinical value (30).”
From Isolated teratozoospermia: revisiting its relevance in male infertility: a narrative review (2024) · cites this paper as [30]
Differences in classification and method of morphological assessment can have a significant impact on diagnostic interpretation.
“Differences in classification and method of morphological assessment can have a significant impact on diagnostic interpretation (30).”
From Isolated teratozoospermia: revisiting its relevance in male infertility: a narrative review (2024) · cites this paper as [30]
The method for sperm morphology assessment, the stains used, the thresholds that define teratozoospermia, and the morphological classifications employed suffer from extreme heterogeneity over time and between laboratories.
“The method for sperm morphology assessment, the stains used, the thresholds that define teratozoospermia, as well as the morphological classifications employed, suffer from extreme heterogeneity over time and between laboratories [4].”
From Recommendations for Human Sperm Morphology Assessment in 2025: An Expert Review From the French BLEFCO Group (2026) · cites this paper as [4]
Assessment of the percentage of some abnormalities, such as thin heads, amorphous heads, bent or asymmetrical necks, is of low clinical utility.
“Assessment of the percentage of some abnormalities, such as thin heads, amorphous heads, bent or asymmetrical necks, is of low clinical utility, and their pathophysiology is not well explained as they are mostly ‘physiological traits’ [4].”
From Recommendations for Human Sperm Morphology Assessment in 2025: An Expert Review From the French BLEFCO Group (2026) · cites this paper as [4]
Detailed abnormalities are of low clinical diagnostic value with the exception of monomorphic syndromes.
“In a previous literature review, focusing on the clinical relevance of detailed morphology assessment with a view to andrological diagnosis during fertility workup, we have demonstrated detailed abnormalities are of low clinical diagnostic value with the exception of the monomorphic syndromes.”
From Recommendations for Human Sperm Morphology Assessment in 2025: An Expert Review From the French BLEFCO Group (2026) · cites this paper as [4]
The origin and impact of certain traits or morphological abnormalities are still not clear, probably because the occurrence of these abnormalities is physiological in human spermatozoa cells.
“Looking at publications over more than the last 30 years, the origin and the impact of certain traits or morphological abnormalities are still not clear, probably because the occurrence of these abnormalities is physiological in human spermatozoa cells [4].”
From Recommendations for Human Sperm Morphology Assessment in 2025: An Expert Review From the French BLEFCO Group (2026) · cites this paper as [4]
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Cites
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Cited by
Sorted by citations
Isolated teratozoospermia: revisiting its relevance in male infertility: a narrative review
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“Differences in classification and method of morphological assessment can have a significant impact on diagnostic interpretation (30).”
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Evaluating the effect of smoking and its cessation on semen parameters
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Self-citation
- Authors
- Gatimel, N., Moreau, J., Parinaud, J., & Léandri, R. D.
- Affiliations
- Centre Hospitalier Universitaire de Toulouse (FR)
- Corresponding author
- Gatimel, N.
- Venue
- Andrology
- Publisher
- Wiley
- Published
- 2017-07-10
- Volume
- 5
- Issue
- 5
- Pages
- 845-862
- ISSN
- 2047-2919 (ISSN-L)
- 2047-2927
- OpenAlex
- W2736162018
- Cited by
- 172
- References
- 15
- Citations by year
- 2026: 21 · 2025: 14 · 2024: 27 · 2023: 32 · 2022: 18 · 2021: 15 · 2020: 21 · 2019: 12 · 2018: 12
- FWCI
- 2.01
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Andrology (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, male infertility, assisted reproduction, sperm abnormalities, analytical reliability, teratozoospermia, globozoospermia, intrauterine insemination, in vitro fertilization, sperm head abnormalities
- MeSH terms
- Humans, Infertility, Male, Male, Reference Values, Spermatozoa, Reproductive Techniques, Assisted, Semen Analysis
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