Status of sperm morphology assessment An evaluation of methodology and clinical value

Morphology levels in sperm assessments decreased over time, owing to changes in methodological factors, and male aging. No prognostic value was found for individual in vitro fertilization or intracytoplasmic sperm injection patients.

Leonie van den Hoven, B.Sc., Jan C.M. Hendriks, Ph.D., Jozé G.M. Verbeet, B.Sc., Johan R. Westphal, Ph.D., Alex M.M. Wetzels, Ph.D.

Volume 103, Issue 1, Pages 53-58


To characterize methodological changes in sperm morphology assessment and to correlate sperm morphology with clinical outcome.

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).

Diagnostic and clinical laboratories.

A total of 8,846 men who visited the diagnostic laboratory; 133 samples from a sperm bank; and 3,676 IVF/ICSI couples.


Main Outcome Measure(s):
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.

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%.

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.

  • msamplaski

    It is assumed that the most “normal” sperm are selected for IVF/ICSI. Therefore the most abnormal forms are excluded. While “normal” is actually not the norm for sperm, IVF/ICSI by definition attempts to bypass this factor.

  • Large scale study looking at >8000 studies in a retrospective manner spanning almost 3 decades and comparing their semen analyses across the different WHO morphology criteria. Not surprisingly, as the WHO continued to update and revise their SA criteria, the normal morphology decreased accordingly with the stringent definition of “normal” morphology.

    This study reinforces the ongoing debate of whether morphology is that important in counseling infertile males with abnormal semen analyses. Unless they have severely abnormal or bizarre morphology, I usually just ignore the morphology, especially if their count and motility are normal.

    The SA is only a single snapshot in time. We have to be weary of giving our patients absolutes as to their fertility prognosis. This points to the importance of having multiple properly collected and assessed semen analyses over a period to time to get a better overall picture of fertility potential, and not to get hung up on the numbers. There are probably plenty of men with abnormal semen analyses that can father children, while there are many more men that cannot with completely normal semen analyses.

    Great study. Also emphasizes the need for better semen/sperm studies to be developed.

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