Modified strict sperm morphology threshold aids in the clinical selection of conventional in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI)
Open accessAbstract
For infertility treatment, the selection of in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) is decided by multiplying indicators (including fallopian tube factors, semen count, and semen motility), except for sperm morphology. In this study, we conducted a retrospective analysis, from implantation to birth, over a period of 5 years. A total of 1873 couples with primary or secondary fallopian tube factors and an increased defective sperm morphology rate (DSMR) were divided into different groups to receive IVF or ICSI cycles. By comparing the outcomes, we found that the F1 group (DSMR <96%, IVF group 1) had higher cleavage rate, biochemical pregnancy rate, clinical pregnancy rate, and live birth rate than the F3 group (DSMR >98%, IVF group 3; P < 0.05). In contrast, there was no significant difference in the ICSI subgroups. Furthermore, a comparison of the outcomes between IVF and ICSI showed that the S3 group (DSMR >98%, ICSI group 3) had higher cleavage rate (P < 0.001), biochemical pregnancy rate (P < 0.05), clinical pregnancy rate (P < 0.05) and live birth rate (P < 0.05) than the F3 group. However, the ICSI subgroup had a lower two pronuclei fertilization rate than the IVF subgroup (P < 0.05). Our data suggest that the sperm morphology should also be considered when selecting IVF or ICSI combined with other semen parameters before the first assisted reproductive technologies (ART) cycle, especially for males with severe sperm defects.
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For Zhu et al., teratozoospermia had an impact on pregnancy rate when divided into subgroups, with pregnancy rates of 37%, 56.5% and 53.4% for <2%, 2%-4% and ≥4% morphologically normal sperm, respectively.
“For Zhu et al. [99], teratozoospermia had an impact on pregnancy rate when divided into subgroups. These authors observed pregnancy rates of 37%, 56.5% and 53.4% for < 2%, 2%–4% and ≥ 4% morphologically normal sperm, respectively.”
From Recommendations for Human Sperm Morphology Assessment in 2025: An Expert Review From the French BLEFCO Group (2026) · cites this paper as [99]
Table 2 (Results; page unavailable) reports clinical pregnancy rates of 37.0%, 56.5%, and 53.4% for the corresponding sperm-morphology groups, but these figures are for conventional IVF only. The Results section on implantation outcomes says pregnancy rates changed significantly across IVF groups, while the ICSI groups showed no significant differences. The citing sentence omits that treatment-specific qualification. (LLM, conf=0.90)
Experimental — accuracy not yet measuredThis study [99], graded level of evidence 1, presented several factors of bias, in particular the possible association of teratozoospermia with other sperm abnormalities, and also the limited number of IVF cycles analysed in this subgroup (n=46).
“However, this study, graded level of evidence 1, presented several factors of bias, in particular the possible association of teratozoospermia with other sperm abnormalities, and also the limited number of IVF cycles analysed in this subgroup (n = 46).”
From Recommendations for Human Sperm Morphology Assessment in 2025: An Expert Review From the French BLEFCO Group (2026) · cites this paper as [99]
Split into 2 atoms — 1 confirmed, 0 partially supported, 0 disputed, 0 misattributed, 1 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredIn Zhu et al., there was a major bias related to the older age of women in the <2% group (36.11, 34.26 and 33.82 years, respectively, with no statistical analysis).
“Of note was a major bias related to the older age of the women in the < 2% group (36.11, 34.26 and 33.82 years, respectively, with no statistical analysis).”
From Recommendations for Human Sperm Morphology Assessment in 2025: An Expert Review From the French BLEFCO Group (2026) · cites this paper as [99]
A single study observed higher pregnancy rates after ICSI, but only in the subgroup of patients with severe teratozoospermia (<2%).
“A single study observed higher pregnancy rates after ICSI, but only in the subgroup of patients with severe teratozoospermia (< 2%) [99].”
From Recommendations for Human Sperm Morphology Assessment in 2025: An Expert Review From the French BLEFCO Group (2026) · cites this paper as [99]
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Self-citation
- Authors
- Zhu, Y., Zhang, F., Cheng, H., Sun, X.-X., & Jiang, F.
- Affiliations
- Fudan University (CN)
- Corresponding author
- Jiang, Feng
- Venue
- Asian Journal of Andrology
- Published
- 2022-01
- Volume
- 24
- Issue
- 1
- Pages
- 62-66
- ISSN
- 1008-682X (ISSN-L)
- PMC
- PMC8788610
- OpenAlex
- W3166070550
- Cited by
- 9
- References
- 27
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 2 · 2023: 2 · 2022: 2
- FWCI
- 1.30
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by-nc-sa
- Locations
- Asian Journal of Andrology (publishedVersion, cc-by-nc-sa)
- PubMed Central (publishedVersion, cc-by-nc-sa)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- 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, intracytoplasmic sperm injection, in vitro fertilization, male infertility, cleavage rate, live birth rate, biochemical pregnancy rate, clinical pregnancy rate
- MeSH terms
- Female, Fertilization in Vitro, Humans, Male, Pregnancy, Retrospective Studies, Spermatozoa, Pregnancy Rate, Sperm Injections, Intracytoplasmic, Reproductive Techniques, Assisted
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