Probing the Effect of Human Normal Sperm Morphology Rate on Cycle Outcomes and Assisted Reproductive Methods Selection

Abstract

Sperm morphology is the best predictor of fertilization potential, and the critical predictive information for supporting assisted reproductive methods selection. Given its important predictive value and the declining reality of semen quality in recent years, the threshold of normal sperm morphology rate (NSMR) is being constantly corrected and controversial, from the 4th edition (14%) to the 5th version (4%). We retrospectively analyzed 4756 cases of infertility patients treated with conventional-IVF(c-IVF) or ICSI, which were divided into three groups according to NSMR: ≥14%, 4%–14% and <4%. Here, we demonstrate that, with decrease in NSMR(≥14%, 4%–14%, <4%), in the c-IVF group, the rate of fertilization, normal fertilization, high-quality embryo, multi-pregnancy and birth weight of twins gradually decreased significantly (P<0.05), while the miscarriage rate was significantly increased (p<0.01) and implantation rate, clinical pregnancy rate, ectopic pregnancy rate, preterm birth rate, live birth rate, sex ratio, and birth weight(Singleton) showed no significant change. In the ICSI group, with decrease in NSMR (≥14%, 4%–14%, <4%), high-quality embryo rate, multi-pregnancy rate and birth weight of twins were gradually decreased significantly (p<0.05), while other parameters had no significant difference. Considering the clinical assisted methods selection, in the NFMR ≥14% group, normal fertilization rate of c-IVF was significantly higher than the ICSI group (P<0.05), in the 4%–14% group, birth weight (twins) of c-IVF were significantly higher than the ICSI group, in the <4% group, miscarriage of IVF was significantly higher than the ICSI group. Therefore, we conclude that NSMR is positively related to embryo reproductive potential, and when NSMR<4% (5th edition), ICSI should be considered first, while the NSMR≥4%, c-IVF assisted reproduction might be preferred.

A retrospective Comparison of Clinical Outcome Following Conventional In-Vitro Fertilization (c-IVF) vs Intracytoplasmic Sperm Injection (ICSI) for 100% Teratozoospermia Patients

“…Some studies had shown that the ectopic rate was significantly higher in ICSI assisted reproduction than that in c-IVF assisted reproduction due to fewer risk factors in c-IVF assisted reproduction [19]. We also observed that the abortion rate was improved in ICSI assisted reproduction which was not consistent with Li's study [11]. Previous studies had indicated that, for teratozoospermia patients, ICSI assisted reproduction could reduce the abortion rate.…”

“…Some studies have demonstrated that ICSI assisted reproduction have a higher fertilization rate compared with c-IVF assisted reproduction for the patients with NSMR<4% [11]. And in a large retrospective study for NSMR<4% patients, Li et al [11] observed that the abortion rate was significantly lower in ICSI group than that in IVF group (6.32 versus 13.6%; p<0.001).…”

“…And in a large retrospective study for NSMR<4% patients, Li et al [11] observed that the abortion rate was significantly lower in ICSI group than that in IVF group (6.32 versus 13.6%; p<0.001). These results suggested ICSI assisted reproduction might be a good choice for the teratozoospermia patients.…”

“…The oocytes were pre-cultured in the fertilization medium (IVF, Vitrolife, Sweden) with 10% protein supplement for 2-4 h before ICSI. Each oocyte was placed into 4 μL droplets of IVF medium covered under warm mineral oil for ICSI [11].…”

Role of Male Infertility in Assisted Reproductive Technology Programs (A Literature Review)

“…(2014) при процедуре ЭКО в группе, где NSMR составлял ≥14 %, частота оплодотворения была значительно вы-ше, чем в группе ИКСИ (р <0,05), в группе с NSMR 4-14 % масса при рождении близнецов была значи-тельно выше, чем в группах ИКСИ, а в группе с NSMR менее 4 % показатель невынашивания беременности значительно превысил аналогичный показатель в груп-пе ИКСИ. Таким образом, авторы пришли к выводу, что показатель NSMR положительно связан с резуль-тативностью методов, и рекомендовали при NSMR свыше 4 %, считать предпочтительным проведение ИКСИ, а при NSMR 4 % и более -ЭКО [52].…”