title: Does severe teratozoospermia affect blastocyst formation, live birth rate, and other clinical outcome parameters in ICSI cycles?
abstract: OBJECTIVE
  To determine if strict morphology correlates with outcome parameters in couples undergoing intracytoplasmic sperm injection (ICSI).
  
  
  METHODS
  Retrospective review.
  
  
  METHODS
  Academic nonprofit IVF center.
  
  
  METHODS
  Couples undergoing IVF/ICSI.
  
  
  METHODS
  In vitro fertilization and ICSI.
  
  
  METHODS
  Samples were evaluated for total sperm count, motlity, progression, and morphology using Kruger's strict criteria. The ICSI cycle outcome parameters included fertilization, clinical pregnancy, implantation, live birth, and blastulation rates and blastocyst quality.
  
  
  RESULTS
  Fertilization rates were high (74%-77%), and clinical pregnancy rates ranged from 60% (subgroup with 0% normal sperm) to 56% (subgroup with >/=7% normal forms). The highest pregnancy and live birth rates were observed in eggs fertilized with sperm from specimens with the most severe teratozoospermia. The blastulation rate was similar among subgroups. The percentage of high-quality blastocysts was significantly greater in the severely teratozoospermic patients compared with patients with >/=5% normal sperm (37% vs. 28%). This is likely because in the lower morphology subgroups, female factors are less prevalent and the primary infertility problem is male factor.
  
  
  CONCLUSIONS
  These data suggest that we reconsider the diagnostic value of strict morphology in assisted reproductive technology cycles involving ICSI. Sperm morphology assessed by Kruger's strict criteria had little prognostic value in ICSI cycle outcomes. Sperm morphology did not appear to influence blastocyst development or blastocyst morphology. Microscopic selection of sperm with "normal" morphology during the ICSI procedure allowed excellent outcomes even in samples with severe teratozoospermia.
authors.affiliation: Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Dan B
authors.initials: DB
authors.lastname: French
authors.forename: Edmund S
authors.initials: ES
authors.lastname: Sabanegh
authors.forename: James
authors.initials: J
authors.lastname: Goldfarb
authors.forename: Nina
authors.initials: N
authors.lastname: Desai
mesh_terms: D000328:Adult; D053713:Azoospermia / Q000150:complications* / Q000473:pathology / Q000503:physiopathology; D001723:Birth Rate / Q000639:trends*; D001755:Blastocyst / Q000502:physiology*; D047108:Embryonic Development / Q000502:physiology*; D005260:Female; D006801:Humans; D007248:Infertility, Male / Q000150:complications / Q000473:pathology / Q000628:therapy; D050498:Live Birth; D008297:Male; D011247:Pregnancy; D012189:Retrospective Studies; D020554:Sperm Injections, Intracytoplasmic / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome