title: Status of sperm morphology assessment: an evaluation of methodology and clinical value.
abstract: OBJECTIVE
  To characterize methodological changes in sperm morphology assessment and to correlate sperm morphology with clinical outcome.
  
  
  METHODS
  In this observational study, sperm morphology profiles of patients were analyzed. The percentages of morphologically normal spermatozoa were evaluated with respect to changes in morphology assessment criteria; male aging; and prognostic value for outcomes after in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI).
  
  
  METHODS
  Diagnostic and clinical laboratories.
  
  
  METHODS
  A total of 8,846 men who visited the diagnostic laboratory; 133 samples from a sperm bank; and 3,676 IVF/ICSI couples.
  
  
  METHODS
  None.
  
  
  METHODS
  The percentage of morphologically normal spermatozoa in semen samples. The regression of the individual morphologically normal cell profiles. The relation between the percentage of normal forms with pregnancy outcome after IVF/ICSI.
  
  
  RESULTS
  The percentage of morphologically normal spermatozoa showed a decrease from roughly 30%-80% in 1984 to 0%-10% since 2004. With added evidence from sperm bank samples, this decrease was found to be attributable mainly to changes in morphology assessment criteria. Furthermore, an intraindividual aging effect of 0.51% per year was observed. A statistically significant relationship was found between decreases in percentage of normal forms and a lower probability of ongoing pregnancies after IVF, although the area under the curve was only 54%.
  
  
  CONCLUSIONS
  Methodological changes had a strong effect on the percentage of morphologically normal spermatozoa over the past few decades. In addition, male aging results in decreasing sperm morphology. The percentage of morphologically normal spermatozoa has no prognostic value for individual IVF/ICSI patients.
authors.affiliation: Fertility Laboratory, Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, the Netherlands. Electronic address: Leonie.vandenHoven@Radboudumc.nl.
authors.forename: Leonie
authors.initials: L
authors.lastname: van den Hoven
authors.affiliation: Department for Health Evidence, Radboud University Medical Centre, Nijmegen, the Netherlands.
authors.forename: Jan C M
authors.initials: JC
authors.lastname: Hendriks
authors.affiliation: Fertility Laboratory, Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, the Netherlands.
authors.forename: Jozé G M
authors.initials: JG
authors.lastname: Verbeet
authors.affiliation: Fertility Laboratory, Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, the Netherlands.
authors.forename: Johan R
authors.initials: JR
authors.lastname: Westphal
authors.affiliation: Fertility Laboratory, Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, the Netherlands.
authors.forename: Alex M M
authors.initials: AM
authors.lastname: Wetzels
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000375:Aging / Q000473:pathology*; D005260:Female; D006801:Humans; D007248:Infertility, Male / Q000453:epidemiology / Q000473:pathology* / Q000628:therapy*; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology*; D015995:Prevalence; D011379:Prognosis; D015203:Reproducibility of Results; D055101:Semen Analysis / Q000379:methods / Q000706:statistics & numerical data*; D012680:Sensitivity and Specificity; D020554:Sperm Injections, Intracytoplasmic / Q000706:statistics & numerical data*; D013094:Spermatozoa / Q000473:pathology*; D016896:Treatment Outcome; D055815:Young Adult
keywords: ICSI; IVF; Sperm morphology; male aging; prognostic value