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Current Urology Reports

, 20:43 | Cite as

Sperm Morphology: History, Challenges, and Impact on Natural and Assisted Fertility

  • Rachel B. DanisEmail author
  • Mary K. Samplaski
Men's Health (A Dabaja, Section Editor)
  • 118 Downloads
Part of the following topical collections:
  1. Topical Collection on Men’s Health

Abstract

Purpose of Review

The classification of morphologically normal sperm has been progressively redefined. Concurrently, our understanding of the significance of sperm morphology in relation to male factor infertility has evolved. In this review, we will discuss the evolution of sperm morphology assessment and factors that contribute to its measurement variability. We will examine the impact of sperm morphology on natural pregnancy, IUI, IVF, and ICSI outcomes.

Recent Findings

There is a lack of consensus on sperm morphology classification, technique, and inter-observer grading variability. Current evidence suggests sperm morphology has low predictive value for pregnancy success, for both natural and assisted reproduction. Additionally, the threshold for what is considered an adequate percentage of morphologically normal sperm has changed over time. These variables have called into question the relevance of this variable in predicting fertility outcomes.

Summary

Our understanding of the impact of sperm morphology on reproductive outcomes continues to evolve and seems to play less of a role than initially thought.

Keywords

Sperm morphology Semen analysis Teratozoospermia Infertility Assisted reproductive technology Male factor 

Notes

Compliance with Ethical Standards

Conflict of Interest

Rachel B. Danis and Mary K. Samplaski each declare no potential conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Gatimel N, Moreau J, Parinaud J, Leandri RD. Sperm morphology: assessment, pathophysiology, clinical relevance, and state of the art in 2017. Andrology. 2017;5:845–62.  https://doi.org/10.1111/andr.12389.CrossRefPubMedGoogle Scholar
  2. 2.
    Guzick DS, Overstreet JW, Factor-Litvak P, Brazil CK, Nakajima ST, Coutifaris C, et al. Sperm morphology, motility, and concentration in fertile and infertile men. N Engl J Med. 2001;345:1388–93.  https://doi.org/10.1056/NEJMoa003005.CrossRefPubMedGoogle Scholar
  3. 3.
    Menkveld R, Stander FS, Kotze TJ, Kruger TF, van Zyl JA. The evaluation of morphological characteristics of human spermatozoa according to stricter criteria. Hum Reprod. 1990;5:586–92.CrossRefGoogle Scholar
  4. 4.
    Ombelet W, Menkveld R, Kruger TF, Steeno O. Sperm morphology assessment: historical review in relation to fertility. Hum Reprod Update. 1995;1:543–57.CrossRefGoogle Scholar
  5. 5.
    Organization WH. WHO laboratory manual for the examination of human semen and semen-cervical mucus interaction. 1st ed. Singapore; 1980.Google Scholar
  6. 6.
    Organization WH. WHO laboratory manual for the examination of human semen and semen-cervical mucus interaction. 2nd ed. Cambridge; 1987.Google Scholar
  7. 7.
    Organization WH. WHO laboratory manual for the examination of human semen and sperm-cervical mucus interaction. 3rd ed. Cambridge: Cambridge University Press; 1992.Google Scholar
  8. 8.
    Organization WH. WHO laboratory manual for the examination of human semen and sperm-cervical mucus interaction. 4th ed. Cambridge: Cambridge University Press; 1999.Google Scholar
  9. 9.
    Cooper TG, Noonan E, von Eckardstein S, Auger J, Baker HWG, Behre HM, et al. World Health Organization reference values for human semen characteristics. Hum Reprod Update. 2010;16:231–45.  https://doi.org/10.1093/humupd/dmp048.CrossRefPubMedGoogle Scholar
  10. 10.
    Organization WH. WHO laboratory manual for the examination and processing of human semen. 5th ed. Geneva; 2010.Google Scholar
  11. 11.
    Menkveld R. Sperm morphology assessment using strict (tygerberg) criteria. Methods Mol Biol. 2013;927:39–50.  https://doi.org/10.1007/978-1-62703-038-0_5.CrossRefPubMedGoogle Scholar
  12. 12.
    Chang V, Heutte L, Petitjean C, Hartel S, Hitschfeld N. Automatic classification of human sperm head morphology. Comput Biol Med. 2017;84:205–16.  https://doi.org/10.1016/j.compbiomed.2017.03.029.CrossRefPubMedGoogle Scholar
  13. 13.
    Carlsen E, Giwercman A, Keiding N, Skakkebaek NE. Evidence for decreasing quality of semen during past 50 years. BMJ. 1992;305:609–13.  https://doi.org/10.1136/bmj.305.6854.609.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Franken DR, Menkveld R, Kruger TF, Sekadde-Kigondu C, Lombard C. Monitoring technologist reading skills in a sperm morphology quality control program. Fertil Steril. 2003;79 Suppl 3:1637–43.CrossRefGoogle Scholar
  15. 15.
    Perrin A, Morel F, Moy L, Colleu D, Amice V, De Braekeleer M. Study of aneuploidy in large-headed, multiple-tailed spermatozoa: case report and review of the literature. Fertil Steril. 2008;90:1201 e1213–07.  https://doi.org/10.1016/j.fertnstert.2007.09.013.CrossRefGoogle Scholar
  16. 16.
    Kruger TF, Acosta AA, Simmons KF, Swanson RJ, Matta JF, Oehninger S. Predictive value of abnormal sperm morphology in in vitro fertilization. Fertil Steril. 1988;49:112–7.CrossRefGoogle Scholar
  17. 17.
    Kruger TF, Menkveld R, Stander FS, Lombard CJ, Van der Merwe JP, van Zyl JA, et al. Sperm morphologic features as a prognostic factor in in vitro fertilization. Fertil Steril. 1986;46:1118–23.CrossRefGoogle Scholar
  18. 18.
    Palermo G, Joris H, Devroey P, Van Steirteghem AC. Pregnancies after intracytoplasmic injection of single spermatozoon into an oocyte. Lancet. 1992;340:17–8.CrossRefGoogle Scholar
  19. 19.
    Aziz N, Buchan I, Taylor C, Kingsland CR, Lewis-Jones I. The sperm deformity index: a reliable predictor of the outcome of oocyte fertilization in vitro. Fertil Steril. 1996;66:1000–8.CrossRefGoogle Scholar
  20. 20.
    •• Kovac JR, Smith RP, Cajipe M, Lamb DJ, Lipshultz LI. Men with a complete absence of normal sperm morphology exhibit high rates of success without assisted reproduction. Asian J Androl. 2017;19:39–42.  https://doi.org/10.4103/1008-682X.189211. This is an important reference because investigators focused on a subgroup of men with 0% morphologically normal sperm in the setting of a normal hormonal profile, which is an unusual subgroup of men. Taken further, investigators demonstrated that these men could still conceive naturally, without means of ART.
  21. 21.
    •• Kohn TP, Kohn JR, Ramasamy R. Effect of sperm morphology on pregnancy success via intrauterine insemination: a systematic review and meta-analysis. J Urol. 2018;199:812–22.  https://doi.org/10.1016/j.juro.2017.11.045. This reference is of importance as it is a relatively recent publication, where investigators conducted a large meta-analysis involving 20 observation studies. Investigators excluded total motile count less than 10 million and also restricted studies to include female partner age 25 to 40years. Total motile count and female age could confound fertilization and clinical pregnancy results, so findings in this meta-analysis are less biased given these inclusion and exclusion criteria.
  22. 22.
    Monraisin O, Chansel-Debordeaux L, Chiron A, Floret S, Cens S, Bourrinet S, et al. Evaluation of intrauterine insemination practices: a 1-year prospective study in seven French assisted reproduction technology centers. Fertil Steril. 2016;105:1589–93.  https://doi.org/10.1016/j.fertnstert.2016.01.039.CrossRefPubMedGoogle Scholar
  23. 23.
    Badawy A, Elnashar A, Eltotongy M. Effect of sperm morphology and number on success of intrauterine insemination. Fertil Steril. 2009;91:777–81.  https://doi.org/10.1016/j.fertnstert.2007.12.010.CrossRefPubMedGoogle Scholar
  24. 24.
    Grigoriou O, Pantos K, Makrakis E, Hassiakos D, Konidaris S, Creatsas G. Impact of isolated teratozoospermia on the outcome of intrauterine insemination. Fertil Steril. 2005;83:773–5.  https://doi.org/10.1016/j.fertnstert.2004.08.027.CrossRefPubMedGoogle Scholar
  25. 25.
    Nikbakht R, Saharkhiz N. The influence of sperm morphology, total motile sperm count of semen and the number of motile sperm inseminated in sperm samples on the success of intrauterine insemination. Int J Fertil Steril. 2011;5:168–73.PubMedPubMedCentralGoogle Scholar
  26. 26.
    Check ML, Bollendorf A, Check JH, Katsoff D. Reevaluation of the clinical importance of evaluating sperm morphology using strict criteria. Arch Androl. 2002;48:1–3.CrossRefGoogle Scholar
  27. 27.
    Karabinus DS, Gelety TJ. The impact of sperm morphology evaluated by strict criteria on intrauterine insemination success. Fertil Steril. 1997;67:536–41.CrossRefGoogle Scholar
  28. 28.
    Deveneau NE, Sinno O, Krause M, Eastwood D, Sandlow JI, Robb P, et al. Impact of sperm morphology on the likelihood of pregnancy after intrauterine insemination. Fertil Steril. 2014;102:1584–1590 e1582.  https://doi.org/10.1016/j.fertnstert.2014.09.016.CrossRefPubMedGoogle Scholar
  29. 29.
    Lockwood GM, Deveneau NE, Shridharani AN, Strawn EY, Sandlow JI. Isolated abnormal strict morphology is not a contraindication for intrauterine insemination. Andrology. 2015;3:1088–93.  https://doi.org/10.1111/andr.12098.CrossRefPubMedGoogle Scholar
  30. 30.
    Sun Y, Li B, Fan LQ, Zhu WB, Chen XJ, Feng JH, et al. Does sperm morphology affect the outcome of intrauterine insemination in patients with normal sperm concentration and motility? Andrologia. 2012;44:299–304.  https://doi.org/10.1111/j.1439-0272.2012.01280.x.CrossRefPubMedGoogle Scholar
  31. 31.
    •• Erdem M, Erdem A, Mutlu MF, Ozisik S, Yildiz S, Guler I, et al. The impact of sperm morphology on the outcome of intrauterine insemination cycles with gonadotropins in unexplained and male subfertility. Eur J Obstet Gynecol Reprod Biol. 2016;197:120–4.  https://doi.org/10.1016/j.ejogrb.2015.12.014. This reference is important as it includes a large sample size, 412 couples with 530 IUI cycles, uses live birth as a primary objective (versus fertilization rate and/or clinical pregnancy rate), and uses couples with unexplained infertility as the control group, which minimizes the contribution of female factors as reasons for infertility.
  32. 32.
    Lemmens L, Kos S, Beijer C, Brinkman JW, van der Horst FAL, van den Hoven L, et al. Predictive value of sperm morphology and progressively motile sperm count for pregnancy outcomes in intrauterine insemination. Fertil Steril. 2016;105:1462–8.  https://doi.org/10.1016/j.fertnstert.2016.02.012.CrossRefPubMedGoogle Scholar
  33. 33.
    Nandi A, Bhide P, Hooper R, Gudi A, Shah A, Khan K, et al. Intrauterine insemination with gonadotropin stimulation or in vitro fertilization for the treatment of unexplained subfertility: a randomized controlled trial. Fertil Steril. 2017;107:1329–1335 e1322.  https://doi.org/10.1016/j.fertnstert.2017.03.028.CrossRefPubMedGoogle Scholar
  34. 34.
    Ombelet W, Fourie FL, Vandeput H, Bosmans E, Cox A, Janssen M, et al. Teratozoospermia and in-vitro fertilization: a randomized prospective study. Hum Reprod. 1994;9:1479–84.CrossRefGoogle Scholar
  35. 35.
    Hotaling JM, Smith JF, Rosen M, Muller CH, Walsh TJ. The relationship between isolated teratozoospermia and clinical pregnancy after in vitro fertilization with or without intracytoplasmic sperm injection: a systematic review and meta-analysis. Fertil Steril. 2011;95:1141–5.  https://doi.org/10.1016/j.fertnstert.2010.09.029.CrossRefPubMedGoogle Scholar
  36. 36.
    McKenzie LJ, Kovanci E, Amato P, Cisneros P, Lamb D, Carson SA. Pregnancy outcome of in vitro fertilization/intracytoplasmic sperm injection with profound teratospermia. Fertil Steril. 2004;82:847–9.  https://doi.org/10.1016/j.fertnstert.2004.03.054.CrossRefPubMedGoogle Scholar
  37. 37.
    Coetzee K, Kruge TF, Lombard CJ. Predictive value of normal sperm morphology: a structured literature review. Hum Reprod Update. 1998;4:73–82.CrossRefGoogle Scholar
  38. 38.
    Gunalp S, Onculoglu C, Gurgan T, Kruger TF, Lombard CJ. A study of semen parameters with emphasis on sperm morphology in a fertile population: an attempt to develop clinical thresholds. Hum Reprod. 2001;16:110–4.CrossRefGoogle Scholar
  39. 39.
    Marnet B, Vieitez G, Milhet P, Richoilley G, Lesourd F, Parinaud J. Computer-assisted assessment of sperm morphology: comparison with conventional techniques. Int J Androl. 2000;23:22–8.CrossRefGoogle Scholar
  40. 40.
    Menkveld R, Wong WY, Lombard CJ, Wetzels AM, Thomas CM, Merkus HM, et al. Semen parameters, including WHO and strict criteria morphology, in a fertile and subfertile population: an effort towards standardization of in-vivo thresholds. Hum Reprod. 2001;16:1165–71.CrossRefGoogle Scholar
  41. 41.
    Keegan BR, Barton S, Sanchez X, Berkeley AS, Krey LC, Grifo J. Isolated teratozoospermia does not affect in vitro fertilization outcome and is not an indication for intracytoplasmic sperm injection. Fertil Steril. 2007;88:1583–8.  https://doi.org/10.1016/j.fertnstert.2007.01.057.CrossRefPubMedGoogle Scholar
  42. 42.
    Lundin K. The impact of sperm morphology analysis on IVF results. Journal de Gynecologie, Obstetrique et Biologie de la Reproduction. 2007;36 Suppl 3:S69–73.  https://doi.org/10.1016/S0368-2315(07)78733-1.
  43. 43.
    Terriou P, Giorgetti C, Auquier P, Hans E, Spach JL, Salzmann J, et al. Teratozoospermia influences fertilization rate in vitro but not embryo quality. Hum Reprod. 1997;12:1069–72.CrossRefGoogle Scholar
  44. 44.
    Grow DR, Oehninger S, Seltman HJ, Toner JP, Swanson RJ, Kruger TF, et al. Sperm morphology as diagnosed by strict criteria: probing the impact of teratozoospermia on fertilization rate and pregnancy outcome in a large in vitro fertilization population. Fertil Steril. 1994;62:559–67.CrossRefGoogle Scholar
  45. 45.
    French DB, Sabanegh ES Jr, Goldfarb J, Desai N. Does severe teratozoospermia affect blastocyst formation, live birth rate, and other clinical outcome parameters in ICSI cycles? Fertil Steril. 2010;93:1097–103.  https://doi.org/10.1016/j.fertnstert.2008.10.051.CrossRefPubMedGoogle Scholar
  46. 46.
    Pisarska MD, Casson PR, Cisneros PL, Lamb DJ, Lipshultz LI, Buster JE, et al. Fertilization after standard in vitro fertilization versus intracytoplasmic sperm injection in subfertile males using sibling oocytes. Fertil Steril. 1999;71:627–32.CrossRefGoogle Scholar
  47. 47.
    Bartoov B, Berkovitz A, Eltes F. Selection of spermatozoa with normal nuclei to improve the pregnancy rate with intracytoplasmic sperm injection. N Engl J Med. 2001;345:1067–8.  https://doi.org/10.1056/NEJM200110043451416.CrossRefPubMedGoogle Scholar
  48. 48.
    Bartoov B, Berkovitz A, Eltes F, Kogosovsky A, Yagoda A, Lederman H, et al. Pregnancy rates are higher with intracytoplasmic morphologically selected sperm injection than with conventional intracytoplasmic injection. Fertil Steril. 2003;80:1413–9.CrossRefGoogle Scholar
  49. 49.
    Hazout A, Dumont-Hassan M, Junca AM, Cohen Bacrie P, Tesarik J. High-magnification ICSI overcomes paternal effect resistant to conventional ICSI. Reprod BioMed Online. 2006;12:19–25.CrossRefGoogle Scholar
  50. 50.
    Antinori M, Licata E, Dani G, Cerusico F, Versaci C, d'Angelo D, et al. Intracytoplasmic morphologically selected sperm injection: a prospective randomized trial. Reprod BioMed Online. 2008;16:835–41.CrossRefGoogle Scholar
  51. 51.
    van den Hoven L, Hendriks JC, Verbeet JG, Westphal JR, Wetzels AM. Status of sperm morphology assessment: an evaluation of methodology and clinical value. Fertil Steril. 2015;103:53–8.  https://doi.org/10.1016/j.fertnstert.2014.09.036.CrossRefPubMedGoogle Scholar
  52. 52.
    Li B, Ma Y, Huang J, Xiao X, Li L, Liu C, et al. Probing the effect of human normal sperm morphology rate on cycle outcomes and assisted reproductive methods selection. PLoS One. 2014;9:e113392.  https://doi.org/10.1371/journal.pone.0113392.CrossRefPubMedPubMedCentralGoogle Scholar
  53. 53.
    Demko ZP, Simon AL, McCoy RC, Petrov DA, Rabinowitz M. Effects of maternal age on euploidy rates in a large cohort of embryos analyzed with 24-chromosome single-nucleotide polymorphism-based preimplantation genetic screening. Fertil Steril. 2016;105:1307–13.  https://doi.org/10.1016/j.fertnstert.2016.01.025.CrossRefPubMedGoogle Scholar
  54. 54.
    Begueria R, Garcia D, Obradors A, Poisot F, Vassena R, Vernaeve V. Paternal age and assisted reproductive outcomes in ICSI donor oocytes: is there an effect of older fathers? Hum Reprod. 2014;29:2114–22.  https://doi.org/10.1093/humrep/deu189.CrossRefPubMedPubMedCentralGoogle Scholar
  55. 55.
    Parinaud J, Mieusset R, Vieitez G, Labal B, Richoilley G. Influence of sperm parameters on embryo quality. Fertil Steril. 1993;60:888–92.CrossRefGoogle Scholar
  56. 56.
    Coban O, Serdarogullari M, Onar Sekerci Z, Bilgin EM, Serakinci N. Evaluation of the impact of sperm morphology on embryo aneuploidy rates in a donor oocyte program. Syst Biol Reprod Med. 2018;64:169–73.  https://doi.org/10.1080/19396368.2018.1428384.CrossRefPubMedGoogle Scholar
  57. 57.
    Kidd SA, Eskenazi B, Wyrobek AJ. Effects of male age on semen quality and fertility: a review of the literature. Fertil Steril. 2001;75:237–48.CrossRefGoogle Scholar
  58. 58.
    Stone BA, Alex A, Werlin LB, Marrs RP. Age thresholds for changes in semen parameters in men. Fertil Steril. 2013;100:952–8.  https://doi.org/10.1016/j.fertnstert.2013.05.046.CrossRefPubMedGoogle Scholar
  59. 59.
    Eustache F, Auger J. Inter-individual variability in the morphological assessment of human sperm: effect of the level of experience and the use of standard methods. Hum Reprod. 2003;18:1018–22.CrossRefGoogle Scholar
  60. 60.
    Mortimer D, Menkveld R. Sperm morphology assessment--historical perspectives and current opinions. J Androl. 2001;22:192–205.PubMedGoogle Scholar
  61. 61.
    Punjabi U, Wyns C, Mahmoud A, Vernelen K, China B, Verheyen G. Fifteen years of Belgian experience with external quality assessment of semen analysis. Andrology. 2016;4:1084–93.  https://doi.org/10.1111/andr.12230.CrossRefPubMedGoogle Scholar
  62. 62.
    Matson PL. External quality assessment for semen analysis and sperm antibody detection: results of a pilot scheme. Hum Reprod. 1995;10:620–5.PubMedGoogle Scholar
  63. 63.
    Wang Y, Yang J, Jia Y, Xiong C, Meng T, Guan H, et al. Variability in the morphologic assessment of human sperm: use of the strict criteria recommended by the World Health Organization in 2010. Fertil Steril. 2014;101:945–9.  https://doi.org/10.1016/j.fertnstert.2013.12.047.CrossRefPubMedGoogle Scholar
  64. 64.
    Practice Committee of the American Society for Reproductive M. The clinical utility of sperm DNA integrity testing: a guideline. Fertil Steril. 2013;99:673–7.  https://doi.org/10.1016/j.fertnstert.2012.12.049.CrossRefGoogle Scholar

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© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Division of Reproductive EndocrinologyUniversity of Southern CaliforniaLos AngelesUSA
  2. 2.Institute of UrologyUniversity of Southern CaliforniaLos AngelesUSA

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