title: A new real-time morphology classification for human spermatozoa: a link for fertilization and improved embryo quality.
abstract: OBJECTIVE
  To understand the correlation between normalcy of the sperm, fertilization, and early embryo development, and to establish a detailed classification scoring scale for the individual spermatozoon with the highest predictive fertilizing potential in real time during intracytoplasmic sperm injection (ICSI).
  
  
  METHODS
  A retrospective and analysis.
  
  
  METHODS
  Laboratory Drouot.
  
  
  METHODS
  27 couples with male factor infertility referred for ICSI treatment.
  
  
  METHODS
  Before ICSI, motile spermatozoa were scored after aspiration.
  
  
  METHODS
  Oocyte fertilization, embryo development and morphology, outcome of scored motile injected spermatozoa.
  
  
  RESULTS
  Our suggested formula is (Normal head score = 2) + (Lack of vacuole score = 3) + (Normal base score = 1) = (Total score = 6) for a morphologic "normal top" spermatozoon, calculated with the major criteria affecting the outcome of ICSI. We take into account the normalcy of head size and shape, the base of the head, and the lack of vacuoles. Our scoring of three classes of injected spermatozoa revealed a statistically significant difference in fertilization rate: 39 out of 46 (84%), 94 out of 128 (73%), and 27 out of 44 (61%), respectively. Our examination of the contribution of maternal age in correlation to sperm score revealed a distinction between oocytes originating from women younger than 30 years and oocytes from women aged 30 years and older.
  
  
  CONCLUSIONS
  Our suggested classification provides allows the best spermatozoon to be chosen for ICSI, particularly for oocytes from women aged 30 years and older.
authors.affiliation: Laboratory Drouot Unit AMP, Paris, France. guycassuto@labodrouot.com
authors.forename: Nino Guy
authors.initials: NG
authors.lastname: Cassuto
authors.forename: Dominique
authors.initials: D
authors.lastname: Bouret
authors.forename: Jean Michel
authors.initials: JM
authors.lastname: Plouchart
authors.forename: Sonia
authors.initials: S
authors.lastname: Jellad
authors.forename: Pierre
authors.initials: P
authors.lastname: Vanderzwalmen
authors.forename: Richard
authors.initials: R
authors.lastname: Balet
authors.forename: Lionel
authors.initials: L
authors.lastname: Larue
authors.forename: Yona
authors.initials: Y
authors.lastname: Barak
mesh_terms: D000328:Adult; D001755:Blastocyst / Q000166:cytology* / Q000502:physiology; D048430:Cell Shape / Q000502:physiology; D002478:Cells, Cultured; D003199:Computer Systems; D047108:Embryonic Development / Q000502:physiology; D005260:Female; D005306:Fertilization / Q000502:physiology*; D006801:Humans; D007248:Infertility, Male / Q000628:therapy; D008297:Male; D010062:Ovulation Induction; D011247:Pregnancy; D018873:Pregnancy Rate; D011786:Quality Control; D012189:Retrospective Studies; D055101:Semen Analysis / Q000379:methods*; D020554:Sperm Injections, Intracytoplasmic / Q000379:methods; D013094:Spermatozoa / Q000145:classification* / Q000166:cytology*