Continued existence of significant disparities in the technical practices of sperm morphology assessment and the clinical implications: results of a French questionnaire

Gatimel, Nicolas; Mansoux, Lucile; Moreau, Jessika; Parinaud, Jean; Léandri, Roger

doi:10.1016/j.fertnstert.2016.10.038

Cited by 20 publications

(12 citation statements)

References 52 publications

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“…Intracytoplasmic sperm injection (ICSI) subsequently has become the most effective treatment for infertility due to male factors (oligozoospermia, asthenozoospermia and teratozoospermia). Sperm morphology is more difficult to evaluate than sperm concentration or progressive motility, and there have been inconsistencies between different laboratories due to the subjective nature of the sperm morphological assessment (Gatimel, Mansoux, Moreau, Parinaud, & Léandri, 2017; Punjabi et al, 2016; Wang et al, 2014). With the progressive description of normal sperm and sperm abnormalities (Danis & Samplaski, 2019), the thresholds for the normal sperm morphology rate (NSMR) in different editions of the World Health Organization (WHO) laboratory manual for the examination of human semen have been revised over time; the NSMRs in the 3rd, 4th and 5th editions are ≥30% (World Health Organization 1992), >14% (World Health Organization 1999) and ≥4% (World Health Organization 2010) respectively.…”

Section: Introductionmentioning

confidence: 99%

Effects of the normal sperm morphology rate on the clinical and neonatal outcomes of conventional IVF cycles

Chen

Liu

et al. 2020

Andrologia

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The present study assessed the influences of the normal sperm morphology rate on the clinical and neonatal outcomes of conventional in vitro fertilisation cycles. This retrospective study analysed 427 and 2,728 cycles from the normal sperm morphology rate <4% and ≥4% group respectively. The clinical (total fertilisation failure, clinical pregnancy, implantation and abortion) and neonatal (sex, gestational age, preterm birth, birthweight, low birth weight, live births and birth defects of newborns) outcomes were compared. The rate of total fertilisation failure in the normal sperm morphology rate <4% group was significantly higher compared with that in the normal sperm morphology rate ≥4% group (2.8% versus 1.2%, p = .012). Total fertilisation failure was completely resolved by early rescue intracytoplasmic sperm injection. The clinical pregnancy, implantation and abortion rates were not significantly different between the two groups. Additionally, the sex, preterm birth, low birth weight, live births and birth defect rates, gestational age and birthweight of newborns were not significantly different between the two groups. Thus, normal sperm morphology rate <4% significantly increased the total fertilisation failure rate but did not affect the clinical or neonatal outcomes.

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Section: Introductionmentioning

confidence: 99%

Effects of the normal sperm morphology rate on the clinical and neonatal outcomes of conventional IVF cycles

Chen

Liu

et al. 2020

Andrologia

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“…(Blanchard et al ., ) have shown that the David classification was not discriminant for the rate of fertilization by conventional IVF compared with assessment using the strict criteria in the computer‐assisted sperm analysis (CASA) system. According to a French survey, there is considerable heterogeneity not only in the different reference thresholds used, but also between laboratories that claim to use standardized values from the literature; 33.6% of them use inadequate reference values for their classification (Gatimel et al ., ). Concerning the definition of reference values, it has been suggested that each laboratory could define its own standards (Matson, ) in view of the wide range of variability related to the technique and the operator and because of the considerable heterogeneity in the methods used from one laboratory to another.…”

Section: Resultsmentioning

confidence: 97%

“…The question thus arises of whether it is clinically relevant to systematically evaluate specific abnormalities in fertility check‐ups. Most laboratories systematically count the different abnormalities, while 47.7% of clinicians interviewed do not take them into consideration (Gatimel et al ., ). This is probably due to the very moderate clinical relevance of these different abnormalities, apart from the rare monomorphic abnormalities syndromes.…”

Section: Resultsmentioning

confidence: 97%

Sperm morphology: assessment, pathophysiology, clinical relevance, and state of the art in 2017

et al. 2017

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For over 30 years, sperm morphology assessment has been one of the most common tests in evaluation of fertility. This review examines the clinical relevance of sperm morphology assessment in the diagnosis of infertility and in assisted reproductive technology, as well as its analytical reliability. Publications on the pathophysiology, the analytical reliability of the test and its clinical relevance in diagnosis and in Assisted Reproductive Technology (ART) were evaluated. This review compared and discussed study methodologies and results, including patient characteristics, preparation, smear staining methods and classification systems. The assessment of the percentage of some abnormalities such as for example thin head, amorphous head, or bent or asymmetrical neck is of little clinical use, and their pathophysiology is not well explained as most are physiological traits. Some studies have highlighted correlations between the percentage of normal forms and functional sperm abnormalities, as well as correlations with ability to conceive in vivo and, in some situations, with the success of intra-uterine insemination (IUI) or conventional IVF. However, except in the case of some specific sperm defects (easy to detect with 99 or 100% of spermatozoa affected) and which are often linked to genetic disorders (globozoospermia, macrocephaly, decapitated sperm syndrome and fibrous sheath dysplasia), sperm morphology assessment has very poor sensitivity and specificity in the diagnosis of infertility. Moreover, there is very little evidence that indices of multiple sperm defects [sperm deformity index (SDI), teratozoospermia index (TZI), and multiple abnormalities index (MAI)] are relevant. Above all, many publications report a major lack of analytical reliability of this test, mainly in assessment of the details of sperm abnormalities. Many questions arise concerning how and when sperm morphology should be assessed, and how to interpret the thresholds of normal forms. Questions are raised on the real clinical impact of this test.

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“…An increased probability of error often results from lack of adherence to a standardized protocol for the various duties carried out in the andrology laboratory [1,27,28]. A 15-year study of 151 andrology laboratories in Belgium that underwent repeated external quality assessments and controls (EQA/C) revealed many areas for concern, the most notable being limited funding for laboratory training, highly variable frequency of SA performance per month, and completion of proper training courses by only 40% of laboratory staff at the beginning of the study.…”

Section: Lack Of Standardized Protocols Training and Quality Assuramentioning

confidence: 99%

A Novel Approach to Improving the Reliability of Manual Semen Analysis: A Paradigm Shift in the Workup of Infertile Men

Douglas

Parekh

Kahn

et al. 2021

World J Mens Health

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Conventional semen analysis (SA) is an essential component of the male infertility workup, but requires laboratories to rigorously train and monitor technicians as well as regularly perform quality assurance assessments. Without such measures there is room for error and, consequently, unreliable results. Furthermore, clinicians often rely heavily on SA results when making diagnostic and treatment decisions, however conventional SA is only a surrogate marker of male fecundity and does not guarantee fertility. Considering these challenges, the last several decades have seen the development of many advances in SA methodology, including tests for sperm DNA fragmentation, acrosome reaction, and capacitation. While these new diagnostic tests have improved the scope of information available to clinicians, they are expensive, time-consuming, and require specialized training. The latest advance in laboratory diagnostics is the measurement of seminal oxidation-reduction potential (ORP). The measurement of ORP in an easy, reproducible manner using a new tool called the Male Infertility Oxidative Stress System (MiOXSYS) has demonstrated ORP's potential as a feasible adjunct test to conventional SA. Additionally, the measurement of ORP by this device has been shown to be predictive of both poor semen quality and male infertility. Assessing ORP is a novel approach to both validating manual SA results and identifying patients who may benefit from treatment of male oxidative stress infertility.

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Continued existence of significant disparities in the technical practices of sperm morphology assessment and the clinical implications: results of a French questionnaire

Cited by 20 publications

References 52 publications

Effects of the normal sperm morphology rate on the clinical and neonatal outcomes of conventional IVF cycles

Effects of the normal sperm morphology rate on the clinical and neonatal outcomes of conventional IVF cycles

Sperm morphology: assessment, pathophysiology, clinical relevance, and state of the art in 2017

A Novel Approach to Improving the Reliability of Manual Semen Analysis: A Paradigm Shift in the Workup of Infertile Men

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