title: Evaluation of a cut-off value for normal sperm morphology using strict criteria to predict fertilization after conventional in-vitro fertilization and embryo transfer in asthenozoospermia.
abstract: The predictive value of sperm morphology evaluation using strict criteria (MEUSC) on fertilization and pregnancy rates was evaluated in 60 couples undergoing in-vitro fertilization (IVF) and embryo transfer. In all, 47 of the male partners had a progressive sperm motility < 50% with a density > 20 x 10(6)/ml (asthenozoospermia) and 13 had normozoospermia. MEUSC was performed on the same semen sample that was used for IVF on at least 100 spermatozoa after Papanicolaou staining at x 1250 magnification. Defects in the head, mid-piece and tail were counted separately, borderline forms were classified as abnormal and the teratozoospermia index was calculated for each sample. Of the spermatozoa in the asthenozoospermic group, 13.0% were judged as normal on MEUSC versus 19.8% in normozoospermia (P = 0.0013). The number of normal spermatozoa on MEUSC correlated with the progressive motility in asthenozoospermia (rho = 0.41, P = 0.0043). Defects in the mid-piece (P = 0.0004) and tail (P = 0.025) were more common, and the teratozoospermia index (P = 0.015) was higher in asthenozoospermic than normozoospermic samples. The parameters of MEUSC did not correlate with the fertilization rate. In asthenozoospermia, differences in fertilization rates were calculated for each cut-off value between 4 and 10% normal spermatozoa on MEUSC. A cut-off value of 6% gave the best statistical power. If > 6% of spermatozoa were normal, a median of 66.7% of ova were fertilized, compared with a median fertilization rate of 35.4% if < or = 6% of spermatozoa were normal (P = 0.022). The highest cut-off value still giving significant discrimination was 8% (normal MEUSC > 8%, median fertilization rate 66.7%; < or = 8%, median fertilization rate 35.7%, P = 0.028), and this may be used as the critical value for normal morphology in asthenozoospermia. It is concluded that despite a significant linear relationship between morphology using strict criteria and progressive motility, MEUSC is still useful as a predictor for fertilization in asthenozoospermia. In cases of asthenozoospermia with < or = 8% normal spermatozoa on MEUSC, micromanipulation should be considered.
authors.affiliation: Department of Obstetrics and Gynecology, University of Würzburg, Germany.
authors.forename: U
authors.initials: U
authors.lastname: Zollner
authors.forename: M
authors.initials: M
authors.lastname: Schleyer
authors.forename: T
authors.initials: T
authors.lastname: Steck
mesh_terms: D000328:Adult; D004624:Embryo Transfer; D005069:Evaluation Studies as Topic; D005260:Female; D005306:Fertilization; D005307:Fertilization in Vitro; D005544:Forecasting; D006801:Humans; D007248:Infertility, Male / Q000473:pathology* / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011247:Pregnancy; D018873:Pregnancy Rate; D011446:Prospective Studies; D012016:Reference Values; D013094:Spermatozoa / Q000473:pathology* / Q000502:physiology