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Purpose: Men with abnormal sperm morphology are often counseled that natural conception and intrauterine insemination are ineffective, and in vitro fertilization is the only option. Our objective was to determine the effect of sperm morphology on the pregnancy success of intrauterine insemination.Materials and Methods: We systematically searched for studies published prior to January 2017 that 1) reported ultrasound verified clinical pregnancies per intrauterine insemination cycle, 2) assessed sperm morphology using the Kruger strict criteria and 3) described morphology at the greater than 4% and 4% or less and/or the 1% or greater and less than 1% thresholds. In all studies mean female age was between 25 and 40 years and mean total motile sperm count was greater than 10 million. Estimates were pooled using random effects meta-analysis.Results: Data were extracted from 20 observational studies involving a total of 41,018 cycles. When comparing men at the greater than 4% and 4% or less thresholds, the rate...

INTRODUCTION:Couples in which the man has abnormal sperm morphology are often counseled that natural conception and intrauterine insemination are ineffective and that in vitro fertilization is the only option. Our objective is to determine the effect of sperm morphology on pregnancy success using in

INTRODUCTION AND OBJECTIVES: It is generally accepted that semen quality, as judged by the volume, motility, and morphology of spermatozoa, predicts both in vitro and in vivo fertilization. Kruger et al. demonstrated that microscopic assessment of sperm morphology plays an integral role in evaluating the male. This study aims to determine whether there is a correlation between specimens with extremely low percentages of structurally normal sperm and embryonic aneuploidy in couples that pursue IVF with Comprehensive Chromosomal Screening (CCS). METHODS: Couples who underwent IVF and utilized aneuploidy screening (preimplantation genetic screening (PGS)) from July 2010 e October 2015 were included. At least 100 sperm in four different areas of the slide were evaluated according to Kruger’s strict criteria (Kruger et al: 1⁄44%: normal; >4%: abnormal). Female and male partner ages were binned (A: 1⁄435; B: (35-38]; C: (38-41]; D: (41-43]; and E: >43). Male age group E was subbinned (a: 1⁄443; b: (43-50]; c: (50-55]; d: (55-60]; and e: >60). Aneuploidy rate for each female age group was calculated, with 95% confidence intervals calculated by Clopper-Pearson method. Chi-square and ANOVA were used to test significance, established at p 4% was similar between all five male age groups (A: 61.7%, B: 66.2%, C: 59.7%, D: 75.2%, E: 59.7%). When male age group E was subdivided, the proportion of patients with an abnormal morphology count increased with age (a: 36.2%, b: 44.1%, c: 70.4%, d: n/a, e: 100%). Aneuploidy rate was similar between normal and abnormal sperm morphology groups in all five age female groups (Table 1). Additionally, PR, clinical PR and early pregnancy loss rate were similar between groups in each female age group (Table 1). CONCLUSIONS: No correlation was identified between teratozoospermic specimens and increased incidence of embryonic aneuploidy. Male partners with specimens found to have abnormal Kruger morphology should be reassured that they do not have an increased incidence of producing chromosomally abnormal embryos.

Purpose: We studied the effect of varicocelectomy on Kruger morphology and semen parameters.Materials and Methods: A total of 33 subfertile men diagnosed with varicoceles was evaluated 3 months before, and 3 to 4 and 6 to 8 months after varicocelectomy. Evaluation involved routine semen analysis and sperm morphology using Kruger classification.Results: Significant improvement in sperm concentration and count was found after varicocelectomy (sperm count preoperatively 117.1 +/− 29, 3 to 4 months postoperatively 162.5 +/− 41 and 6 to 8 months postoperatively 139.8 +/− 25 million sperm, p = 0.0095). Using Kruger classification, evaluation of sperm morphology revealed overall significant increase in percentage of normal A forms at 3 to 4 and 6 to 8 months after surgery (from 9.8 +/− 5.8 % A forms, 13.6 +/− 7.7 % A forms, and 14.5 +/− 7.5 % A forms, respectively, p = 0.0002, normal greater than 14%). Twelve of the 26 patients (46%) with abnormal sperm morphology preoperatively and greater than 4% A for...

INTRODUCTION AND OBJECTIVES: Despite numerous genes known to affect fertility in animal models, little is known about the contribution of individual genes to human fertility. We previously identified 9 genes associated with reduced fertility in a founder population and lower sperm count and motility in a validation cohort (Kosova et al. 2012; AJHG 90). Here we examine the effects of these genes on sperm morphology in the same validation cohort. METHODS: We studied 269 married men from a founder population, the Hutterites, that proscribes contraception and has large family sizes for discovery of genes associated with family size and birth rate. Of the 250,000 autosomal single-nucleotide polymorphisms (SNPs) included in studies of male fertility traits, 41 SNPs with P 1x10-4 were taken forward to a validation study of abnormal sperm morphology in 123 ethnically diverse men from Chicago who had previously undergone semen analyses. Sperm morphology analyses were performed using Kruger strict criteria with %normal morphology considered as a continuous outcome variable, and normal or abnormal sperm morphology as a categorical variable. We tested associations between each of 41 SNPs and semen parameters using linear regression and Fisher’s exact test, as appropriate; the direction of the effect for a given allele (increased or decreased fertility) was kept consistent with the initial association observed in the Hutterites. RESULTS: Two SNPs, rs680730 (in DSCAML1) and rs10129954 (in DPF3), that were associated with fertility in Hutterite men were also associated with %normal sperm morphology in ethnically diverse Chicago men (P 0.017 and 0.022, respectively). The C allele at rs680739 was also associated with abnormal sperm morphology when tested as a binary outcome (P 0.033). Further analyses with % of specific morphological abnormalities suggest that associations with these two markers may be due to sperm head defects. Interestingly, in our previous study these two variants were also associated with sperm motility parameters, including total motile sperm count, linearity and beat frequency. CONCLUSIONS: We identified variants in two genes, DSCAML1 and DPF3, that code for proteins involved in stem cell selection and self-avoidance, and are associated with poor sperm morphology in our study. Future work in larger sample sizes will be needed to replicate these findings and to characterize their role in male reproductive processes.

Sperm morphology is a critical factor in the evaluation of infertile men. Patients often exhibit a morphology profile with consistent increases of specific abnormal categories of sperm morphology. We analyzed the functional ability of 7 categories of sperm morphology using assays that measure sperm viability longevity, deoxyribonucleic acid packing, acrosomal status, and the stimulation of the acrosome reaction with human cumulus/oocyte complexes and calcium ionophore A23187. Each morphology category was separately analyzed initially and at 3, 6, 12, 18 and 24hours of in vitro culture. The data indicate that all categories of abnormal sperm morphology exhibit various functional debilities. However, tapered sperm most closely approached normal sperm function. All abnormal categories possessed subpopulations of sperm that functioned normally to the limits of these assays. These data indicate that increases in any of the categories of abnormal sperm morphology may lead to decreased fertility due to d...

INTRODUCTION AND OBJECTIVES: Despite intrauterine insemination (IUI) often has been used as a treatment for male factor infertility, seminal characteristics indicative of IUI success have not been defined clearly. Recently, the 5th World Health Organization (WHO) data described lower reference limits for the number of morphologically normal spermatozoa. The aim of our study was to assess the likelihood of IUI success as a function of the sperm morphology according to the new reference values defined by the recently published WHO guideline. METHODS: We performed a retrospective study among 300 couples that completed their first IUI cycle, using father’s fresh sperm as a result of cervical infertility, relative male factor infertility, anovulation or unexplained infertility. Pregnancy rates were compared between the patients characterized as having normal and abnormal sperm morphology values according to the previous and the recent WHO reference values and the number of inseminated motile sperm was compared between the patients who did and did not achieve a pregnancy. RESULTS: The overall pregnancy rate was 12.3%. Women older than 35 years showed a lower pregnancy rate as compared to women younger than 35 years (6.5% vs 18.2%, p 0.017). The presence of two or more preovulatory follicles on the day of hCG administration resulted in higher pregnancy rate when compared to cases in which only one preovulatory follicle was present (18.6% vs 8.2%, p 0.011). There were no significant differences between the mean total number of inseminated sperm (26.4 21.7 vs 34.86 33.12, p 0.1237) and the mean number of inseminated motile sperm (22.3 18.6 vs 27.0 24.5, p 0.3156) between the patients who did and did not achieve a pregnancy. The number of inseminated motile sperm 1x106 M/mL positively influenced pregnancy occurrence (OD: 1.47; CI: 0.88–3.14, p 0.027). Pregnancy rates did not differed neither when the male partners were characterized as having normal or abnormal sperm morphology according to the previous WHO reference values (9.8% vs 11.6%, p 0.6584), nor when the male partners were characterized as having normal or abnormal sperm morphology according to the recent WHO reference values (9.4% vs 11.3%, p 0.7469). Finally, normal sperm morphology had no influence on pregnancy rate (OD: 1.05; CI: 0.56–3.02, p 0.936). CONCLUSIONS: Our results suggest that even after the establishment of new reference values for semen parameters, sperm morphological normalcy still does not have any predictive value on IUI outcomes.