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Cited by 32Sperm and Testicular FunctionReproductive Health and TechnologiesAssisted Reproductive Technology and Twin Pregnancy

Probing the Effect of Human Normal Sperm Morphology Rate on Cycle Outcomes and Assisted Reproductive Methods Selection

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Li, Bo, Ma, Yefei, Huang, Jianlei, Xiao, Xifeng, Li, Li, Liu, Chuang, Shi, Yongqian, Wang, Dong +1 more·2014·PLoS ONE
DOI 10.1371/journal.pone.0113392PMC PMC4239063
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Abstract

Sperm morphology is the best predictor of fertilization potential, and the critical predictive information for supporting assisted reproductive methods selection. Given its important predictive value and the declining reality of semen quality in recent years, the threshold of normal sperm morphology rate (NSMR) is being constantly corrected and controversial, from the 4th edition (14%) to the 5th version (4%). We retrospectively analyzed 4756 cases of infertility patients treated with conventional-IVF(c-IVF) or ICSI, which were divided into three groups according to NSMR: ≥14%, 4%-14% and <4%. Here, we demonstrate that, with decrease in NSMR(≥14%, 4%-14%, <4%), in the c-IVF group, the rate of fertilization, normal fertilization, high-quality embryo, multi-pregnancy and birth weight of twins gradually decreased significantly (P<0.05), while the miscarriage rate was significantly increased (p<0.01) and implantation rate, clinical pregnancy rate, ectopic pregnancy rate, preterm birth rate, live birth rate, sex ratio, and birth weight(Singleton) showed no significant change. In the ICSI group, with decrease in NSMR (≥14%, 4%-14%, <4%), high-quality embryo rate, multi-pregnancy rate and birth weight of twins were gradually decreased significantly (p<0.05), while other parameters had no significant difference. Considering the clinical assisted methods selection, in the NFMR ≥14% group, normal fertilization rate of c-IVF was significantly higher than the ICSI group (P<0.05), in the 4%-14% group, birth weight (twins) of c-IVF were significantly higher than the ICSI group, in the <4% group, miscarriage of IVF was significantly higher than the ICSI group. Therefore, we conclude that NSMR is positively related to embryo reproductive potential, and when NSMR<4% (5th edition), ICSI should be considered first, while the NSMR≥4%, c-IVF assisted reproduction might be preferred.

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  • Two other studies reported no effect of technique on fertilisation rates, while two studies paradoxically reported higher fertilisation rates with IVF than with ICSI in cases of severe teratozoospermia (normal forms <1%).

    “Two others studies reported no effect of technique on fertilisation rates [101, 106] while two studies paradoxically reported higher fertilisation rates with IVF than with ICSI in cases of severe teratozoospermia (normal forms < 1%).”

    From Recommendations for Human Sperm Morphology Assessment in 2025: An Expert Review From the French BLEFCO Group (2026) · cites this paper as [101]

  • Li et al. showed in 3922 IVF and 843 ICSI attempts that the fertilisation rate decreased with the percentage of morphologically normal sperm in conventional IVF but not in ICSI.

    “In this retrospective study of 3922 IVF and 843 ICSI attempts, the authors showed that the fertilisation rate decreased with the percentage of morphologically normal sperm in conventional IVF but not in ICSI.”

    From Recommendations for Human Sperm Morphology Assessment in 2025: An Expert Review From the French BLEFCO Group (2026) · cites this paper as [101]

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Cited by

Sorted by citations

Authors
Li, B., Ma, Y., Huang, J., Xiao, X., Li, L., Liu, C., Shi, Y., Wang, D., & Wang, X.
Affiliations
Tang Du Hospital (CN)
Corresponding author
  • Li, Bo
  • Wang, Xiaohong
ORCID
Venue
PLoS ONE
Publisher
Public Library of Science (PLoS)
Published
2014-11-20
Volume
9
Issue
11
Pages
e113392
ISSN
1932-6203 (ISSN-L)
DOI
10.1371/journal.pone.0113392
PMC
PMC4239063
OpenAlex
W2016822678
Cited by
32
References
0
Citations by year
2026: 2 · 2025: 1 · 2023: 2 · 2022: 4 · 2021: 7 · 2020: 4 · 2019: 2 · 2018: 3 · 2017: 4 · 2016: 1 · 2015: 2
FWCI
2.83
Type
journal article
Language
en
Open access
Licence
Locations
  • PLoS ONE (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Figshare (submittedVersion, cc-by)
Funders
National Natural Science Foundation of China
Topics
  • Health Sciences › Medicine › Reproductive Medicine › Sperm and Testicular Function
  • Health Sciences › Medicine › Reproductive Medicine › Reproductive Health and Technologies
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Assisted Reproductive Technology and Twin Pregnancy
Keywords
sperm morphology, conventional IVF, intracytoplasmic sperm injection, fertilization rate, embryo quality, miscarriage, multiple pregnancy, twin birth weight, semen quality, male infertility
MeSH terms
Adult, Female, Fertilization in Vitro, Humans, Infertility, Male, Male, Pregnancy, Pregnancy Outcome, Retrospective Studies, Spermatozoa, Treatment Outcome, Sperm Injections, Intracytoplasmic, Semen Analysis

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