An Evaluation of the Efficacy of In Vitro Fertilization with Intracytoplasmic Sperm Injection for Sperm with Low Hypoosmotic Swelling Test Scores and Poor Morphology

  • Matthew Check
  • Jerome H. Check
  • Donna Summers-Chase
  • Kimberly Swenson
  • Wei Yuan


Purpose: To corroborate or refute a previous study demonstrating that in vitro fertilization (IVF) with intracytoplasmic sperm injection (ICSI) is an effective therapy for infertility related to males with subnormal hypoosmotic swelling tests (HOST). The study would also determine if the copresence of poor morphology has any adverse effect on outcome.

Methods: Clinical and viable pregnancy rates and implantation rates were evaluated in a second series of patients. The data were further stratified according to whether the semen specimen demonstrated morphology using strict criteria <4% normal vs ≥4%.

Results: Clinical and viable pregnancy rates and implantation rates were 49.1, 45.3, and 23.4% for those with subnormal HOST scores and subnormal morphology vs 38.0, 34.3, and 22.5% for those with low HOST and strict morphology ≥4% (p = NS, chi-square analysis).

Conclusions: In vitro fertilization with ICSI is an effective therapy for infertility related to subnormal HOST scores. Poor morphology does not adversely affect the outcome.

Hypoosmotic swelling test intracytoplasmic sperm injection sperm morphology strict criteria 


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  1. 1.
    JeyendranRS, Van der VenHH, Perez-PalaezM, CraboBG, ZaneveldLJD: Development of an assay to assess the functional integrity of the human sperm membrane and its relationship to other semen characteristics. J Reprod Fertil 1984;70:219–228PubMedGoogle Scholar
  2. 2.
    CheckJH, EpsteinR, NowrooziK, ShanisBS, WuCH, BollendorfA: The hypoosmotic swelling test as a useful adjunct to the semen analysis to predict fertility potential. Fertil Steril 1989;52:159–161PubMedGoogle Scholar
  3. 3.
    BarrattCLR, OsbornJC, HarrisonPE, MonksN, DunphyBC, LentonEA, CookeID: The hypoosmotic swelling test and the sperm mucus penetration test in determining fertilization of the human oocyte. Hum Reprod 1989;4:430–434PubMedGoogle Scholar
  4. 4.
    SjoblumP, CocciaE: On the diagnostic value of the hypoosmotic sperm swelling test in an in vitro fertilization program. J In Vitro Fertil Embryo Transfer 1989;6:41–43Google Scholar
  5. 5.
    AveryS, BoltonUM, MasonBA: An evaluation of the hypoosmotic sperm swelling test as a predictor of fertilizing capacity in vitro. Int J Androl 1990;13:93–99PubMedGoogle Scholar
  6. 6.
    EnginsuME, DumoulinJCM, PietersMHEC, BergersM, EversJLH, GeraedtsJPM: Comparison between the hypoosmotic swelling test and morphology evaluation using strict criteria in predicting in vitro fertilization (IVF). J Assist Reprod Genet 1992;9:259–264PubMedGoogle Scholar
  7. 7.
    ChanSYW, WangC, ChanSTH, HoPC: Differential evaluation of human sperm hypoosmotic swelling test and its relationship with the outcome of in-vitro fertilization of human oocytes. Hum Reprod 1990;5:84–88PubMedGoogle Scholar
  8. 8.
    CheckJH, StumpoL, LurieD, BenferK, CallanC: A comparative prospective study using matched samples to determine the influence of subnormal hypo-osmotic test scores of spermatozoa on subsequent fertilization and pregnancy rates following in-vitro fertilization. Hum Reprod 1995;10:1197–1200PubMedGoogle Scholar
  9. 9.
    KatsoffD, CheckML, CheckJH: Evidence that sperm with low hypoosmotic swelling test scores cause embryo implantation defects. Arch Androl 2000;44:227–230PubMedGoogle Scholar
  10. 10.
    CheckJH, KatsoffD, CheckML: Some semen abnormalities may cause infertility by impairing implantation rather than fertilization. Med Hypoth 2001;56:653–657Google Scholar
  11. 11.
    KrugerTF, AcostAA, SimmonsKF, SwansonRJ, MattaJF, OehningerS: Predictive value of abnormal sperm morphology in in vitro fertilization. Fertil Steril 1988;49:112–117PubMedGoogle Scholar
  12. 12.
    OehningerS, SwansonRJ, AcostaAA, SimmonsKF, MorsttediM, RosenwaksZ, VeeckL: Corrective measures and pregnancy outcome in in vitro fertilization in patients with severe sperm morphology abnormalities. Fertil Steril 1988;50:283–287PubMedGoogle Scholar
  13. 13.
    RogersBJ, BentwoodH, Van CampenG, HelmbrechtD, SoderdahlD, HaleRW: Sperm morphology assessment as an indicator of human fertilizing capacity. J Androl 1983;4:119–125PubMedGoogle Scholar
  14. 14.
    CheckJH, AdelsonHG, SchubertBR, BollendorfA: Evaluation of sperm morphology using Kruger's strict criteria. Arch Androl 1992;28:15–17PubMedGoogle Scholar
  15. 15.
    CheckML, BollendorfA, CheckJH, KatsoffD: Reevaluation of the clinical importance of evaluating sperm morphology using strict criteria. Arch Androl 2002;48:1–3PubMedGoogle Scholar
  16. 16.
    KieferD, CheckJH, KatsoffD: The value of motile density, strict morphology, and the hypoosmotic swelling test in in vitro fertilization-embryo transfer. Arch Androl 1996;37:57–60PubMedGoogle Scholar
  17. 17.
    CheckJH, KatsoffD, CheckML, ChoeJK, SwensonK: In vitro fertilization with intracytoplasmic sperm injection is an effective therapy for male factor infertility related to subnormal hypo-osmotic swelling test scores. J Androl 2001;22:261–265PubMedGoogle Scholar
  18. 18.
    KrugerTF, AcostaAA, SimmonsKF, SwansonRJ, MattaJF, VeeckLL, MorshedimM, BrugoS: A new method of evaluating sperm morphology with with predictive value for in vitro fertilization. Urology 1987;30:248PubMedGoogle Scholar
  19. 19.
    GrowD, OehningerS, SeltmanH, TonerJ, SwansonRJ, DrugerT, MuasherSJ: 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;62:559–567PubMedGoogle Scholar
  20. 20.
    HammittDG, WalkerDL, SyropCH, MillerTM, BennettMR: Treatment of severe male factor infertility with high concentrations of motile sperm by microinsemination in embryo cryopreservation straws. J In Vitro Fertil Embryo Transf 1991;8:101–110Google Scholar
  21. 21.
    OehningerS, KrugerTF, SimonT, JonesD, MayerJ, LanzendorfS, TonerJP, MuasherSJ: A comparative analysis of embryo implantation potential in patients with severe teratozoospermia undergoing in-vitro fertilization with a high insemination concentration or intracytoplasmic sperm injection. Hum Reprod 1996;11:1086–1089PubMedGoogle Scholar

Copyright information

© Plenum Publishing Corporation 2003

Authors and Affiliations

  • Matthew Check
    • 1
  • Jerome H. Check
    • 1
  • Donna Summers-Chase
    • 1
  • Kimberly Swenson
    • 1
  • Wei Yuan
    • 1
  1. 1.Division of Reproductive Endocrinology & Infertility, Department of Obstetrics and Gynecology, Cooper Hospital/University Medical Center, Robert Wood Johnson Medical School at CamdenThe University of Medicine and Dentistry of New JerseyCamden

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