title: Men with a complete absence of normal sperm morphology exhibit high rates of success without assisted reproduction.
abstract: In couples with infertility, abnormal strict morphology of 0% normal forms (NF) is a criterion to proceed rapidly to in vitro fertilization (IVF). Since no data currently exist, we investigated the outcomes for men with 0% NF to determine reproductive success without the use of assisted reproductive technologies (ART). A cohort of 24 men with 0% NF were identified (2010-2013) with 27 randomly selected men with ≥4% NF as controls. Patient charts were reviewed with men contacted and administered an Institutional Review Board (IRB)-approved telephone questionnaire to ascertain outcomes. After a median follow-up time of 2.5 years, 29.2% of men with 0% NF did not require ART for their first pregnancy (controls = 55.6%, P ≤ 0.05). When all pregnancies were analyzed together, men with 0% NF achieved twenty pregnancies of which 75% did not require IVF (controls = thirty pregnancies; 76.7% did not require IVF). The average age of men and female partners was similar between men with 0% NF and ≥4% NF. All men had normal follicle-stimulating hormone (FSH), testosterone, prolactin, sex hormone-binding globulin (SHBG), and estradiol. Although, global semen parameters were worse in men with 0% NF, when a first pregnancy was a natural conception (NC), 100% of men with 0% NF (n = 7/7) and 37.5% of controls (n = 3/8) went on to have a subsequent pregnancy via NC. Men with 0% NF conceived without IVF in 29.2% of cases compared to 55.6% of controls. Strict morphology should not be used to predict fertilization, pregnancy, or live birth potential. In men with 0% NF, alternative modalities should be considered before immediate IVF.
authors.affiliation: Center of Reproductive Medicine and the Department of Molecular and Cellular Biology, Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Jason R
authors.initials: JR
authors.lastname: Kovac
authors.affiliation: Department of Urology, University of Virginia, Charlottesville, VA, USA.
authors.forename: Ryan P
authors.initials: RP
authors.lastname: Smith
authors.affiliation: Center of Reproductive Medicine and the Department of Molecular and Cellular Biology, Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Miguel
authors.initials: M
authors.lastname: Cajipe
authors.affiliation: Center of Reproductive Medicine and the Department of Molecular and Cellular Biology, Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Dolores J
authors.initials: DJ
authors.lastname: Lamb
authors.affiliation: Center of Reproductive Medicine and the Department of Molecular and Cellular Biology, Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Larry I
authors.initials: LI
authors.lastname: Lipshultz
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D004958:Estradiol / Q000378:metabolism; D005260:Female; D005307:Fertilization in Vitro / Q000706:statistics & numerical data*; D005640:Follicle Stimulating Hormone / Q000378:metabolism; D005500:Follow-Up Studies; D006801:Humans; D007986:Luteinizing Hormone / Q000378:metabolism; D008297:Male; D011247:Pregnancy; D018873:Pregnancy Rate; D011388:Prolactin / Q000378:metabolism; D027724:Reproductive Techniques, Assisted / Q000706:statistics & numerical data; D012720:Severity of Illness Index; D012738:Sex Hormone-Binding Globulin / Q000378:metabolism; D013094:Spermatozoa / Q000002:abnormalities; D000072660:Teratozoospermia / Q000378:metabolism / Q000503:physiopathology*; D013739:Testosterone / Q000378:metabolism
chemical_list: D012738:Sex Hormone-Binding Globulin; D013739:Testosterone; D004958:Estradiol; D011388:Prolactin; D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone