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Cited by 45Sperm and Testicular FunctionReproductive Health and TechnologiesMale Reproductive Health Studies

Sperm Morphology Assessment in the Era of Intracytoplasmic Sperm Injection: Reliable Results Require Focus on Standardization, Quality Control, and Training

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Agarwal, Ashok, Sharma, Rakesh, Gupta, Sajal, Finelli, Renata, Parekh, Neel, Panner Selvam, Manesh Kumar, Henkel, Ralf, Durairajanayagam, Damayanthi +33 more·2022·The World Journal of Men's Health
DOI 10.5534/wjmh.210054PMC PMC9253798
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Abstract

Semen analysis is the first, and frequently, the only step in the evaluation of male fertility. Although the laboratory procedures are conducted according to the World Health Organization (WHO) guidelines, semen analysis and especially sperm morphology assessment is very difficult to standardize and obtain reproducible results. This is mainly due to the highly subjective nature of their evaluation. ICSI is the choice of treatment when sperm morphology is severely abnormal (teratozoospermic). Hence, the standardization of laboratory protocols for sperm morphology evaluation represents a fundamental step to ensure reliable, accurate and consistent laboratory results that avoid misdiagnoses and inadequate treatment of the infertile patient. This article aims to promote standardized laboratory procedures for an accurate evaluation of sperm morphology, including the establishment of quality control and quality assurance policies. Additionally, the clinical importance of sperm morphology results in assisted reproductive outcomes is discussed, along with the clinical management of teratozoospermic patients.

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  • The assessment of sperm morphology continues to be one of the most challenging assessments due to its very subjective nature, which results in difficulties in standardization and achieving consistent and reproducible findings.

    “However, the assessment of sperm morphology continues to be one of the most challenging assessments due to its very subjective nature which results in difficulties in standardization and achieving consistent and reproducible findings (12).”

    From Isolated teratozoospermia: revisiting its relevance in male infertility: a narrative review (2024) · cites this paper as [12]

  • Morphological assessment can be highly subjective, with high intra- and inter-laboratory variations resulting in questionable reliability and high heterogeneity of the available evidence.

    “To further complicate matters, morphological assessment can be highly subjective, with high intra- and inter-laboratory variations resulting in questionable reliability and high heterogeneity of the available evidence (12).”

    From Isolated teratozoospermia: revisiting its relevance in male infertility: a narrative review (2024) · cites this paper as [12]

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Cited by

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Authors
Agarwal, A., Sharma, R., Gupta, S., Finelli, R., Parekh, N., Panner Selvam, M. K., Henkel, R., Durairajanayagam, D., Pompeu, C., Madani, S., Belo, A., Singh, N., Covarrubias, S., Darbandi, S., Sadeghi, R., Darbandi, M., Vogiatzi, P., Boitrelle, F., Simopoulou, M., Saleh, R., Arafa, M., Majzoub, A., Kandil, H., Zini, A., Ko, E., Alvarez, J. G., Martinez, M., Ramsay, J., Jindal, S., Busetto, G. M., Sallam, H., Maldonado, I., Anagnostopoulou, C., Alves, M. G., Sengupta, P., Gilany, K., Evenson, D. P., Lewis, S. E. M., Gosalvez, J., Ambar, R. F., & Shah, R.
Affiliations
  • Cleveland Clinic (US)
  • American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA.
  • Universiti Teknologi MARA System (MY)
  • Bolivian Forest Research Institute (BO)
  • University of Sciences and Technology Houari Boumediene (DZ)
  • Huntington Centro de Medicina Reproditiva S/A, Sao Paulo, São Paulo, Brazil.
  • NOVA IVF, Gorakhpur, India.
  • University of San Francisco (US)
  • Fetal Health Research Center, Hope Generation Foundation, Tehran, Iran.
  • Andromed Health & Reproduction, Fertility Diagnostics Laboratory, Maroussi, Athens, Greece.
  • Université de Versailles Saint-Quentin-en-Yvelines (FR)
  • National and Kapodistrian University of Athens (GR)
  • Sohag University (EG)
  • Fakih IVF Fertility Center, Abu Dhabi, UAE.
  • McGill University (CA)
  • Loma Linda University (US)
  • Centro ANDROGEN, La Coruña, Spain.
  • University of Santo Tomas Hospital (PH)
  • Hammersmith Hospital (GB)
  • Department of Andrology and Reproductive Medicine, Jindal Hospital, Meerut, India.
  • University of Foggia (IT)
  • Alexandria University (EG)
  • Citmer Reproductive Medicine, IVF LAB, Mexico City, Mexico.
  • IVF Clinic “Akeso-Embryo ART”, Athens, Greece.
  • Universidade do Porto (PT)
  • Mahsa University (MY)
  • Academic Center for Education, Culture and Research (IR)
  • SCSA Diagnostics, Brookings, SD, USA.
  • Queen's University Belfast (GB)
  • Genetic Unit, Department of Biology, Universidad Autónoma de Madrid, Madrid, Spain.
  • Faculdade de Medicina do ABC (BR)
  • Lilavati Hospital & Research Centre (IN)
Corresponding author
Agarwal, Ashok
ORCID
Venue
The World Journal of Men's Health
Publisher
XMLink
Published
2022
Volume
40
Issue
3
Pages
347
ISSN
  • 2287-4208 (ISSN-L)
  • 2287-4690
DOI
10.5534/wjmh.210054
PMC
PMC9253798
OpenAlex
W3175131791
Cited by
45
References
6
Citations by year
2026: 6 · 2025: 18 · 2024: 9 · 2023: 8 · 2022: 1 · 2021: 3
FWCI
0.86
Type
journal article
Language
en
Open access
Licence
Locations
  • The World Journal of Men s Health (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • Research Portal (Queen's University Belfast) (publishedVersion, cc-by-nc)
  • HAL (submittedVersion, cc-by-nc)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • UWC Research Repository (University of the Western Cape) (submittedVersion)
  • Spiral (Imperial College London) (submittedVersion, other-oa)
Funders
  • Cleveland Clinic
  • American Center for Reproductive Medicine, Cleveland Clinic
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 assessment, intracytoplasmic sperm injection, teratozoospermia, semen analysis, laboratory standardization, quality control, quality assurance, male infertility, WHO guidelines

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