Predictive value of sperm morphology and movement characteristics in the outcome of in vitro fertilization of human oocytes

Low-density lipoproteins protect sperm during cryopreservation in buffalo: Unraveling mechanism of action

This study was carried out to reveal factors and the mechanism of action by which low-density lipoproteins (LDLs) protect sperm better than egg yolk (EY) during cryopreservation. We extracted LDL from EY and compared the amount of calcium, progesterone, and antioxidants in EY and LDL. We found a very high concentration of progesterone (1423.95 vs. 10.46 ng/ml) and calcium (29.19 vs. 0.47 mM) in EY as compared with LDL. Antioxidant assays like DPPH (2,2-diphenyl-1-picrylhydrazyl) and the ferric reducing antioxidants power assay revealed that the LDL extender had almost double ability to lose hydrogen than the EY extender. For sperm cryopreservation, 20 ejaculates from four Murrah buffalo bulls were collected. Each ejaculate was divided into four aliquots and extended in 10%, 12%, and 14% LDL (w/v) and EY-based extenders, followed by cryopreservation. The LDL-based extender prevented excessive cholesterol efflux, and its high content of antioxidants minimized reactive oxygen species generated during cryopreservation, resulting in a functional CatSper channel. The EY-based extender promoted excess cholesterol efflux due to the presence of high-density lipoprotein, resulting in a compromised CatSper channel. High intracellular calcium in a cryopreserved sperm in the EY group as compared with the LDL group indicates that progesterone present in EY activates the CatSper channel, resulting in a heavy calcium influx into the sperm. The greater tyrosine phosphorylation and increased number of F-pattern in the sperm cryopreserved in the EY extender indicate that high intracellular calcium triggers more capacitation-like changes in the sperm cryopreserved in EY than LDL extender. In conclusion, we demonstrated the new facts and understandings about LDL and EY for semen cryopreservation.

Sperm abnormalities in post-thawed semen of Tunisian Arab stallions

The study was undertaken in order to evaluate sperm morphology features of post-thawed semen of Tunisian Arab stallions. Forty two ejaculates was collected and frozen, during years 2009 and 2010, from 9 stallions aged between 9 to 24 years. After thawing, sperm morphology was studied after eosin-nigrosin stain. The percentages of abnormal head, mid piece, flagella, sperm with droplets and the total abnormal sperm were determined. Analysis of variance was carried out using SAS software. The results showed that all sperm morphology features varied among ejaculates within stallion and among stallions (p<0.01). The percentage of abnormal flagella and total abnormal sperm varied between young and old stallions (p<0.01). We concluded that freezing and thawing processes increased abnormal sperm that is due to cell alteration for old and young stallions, and consequently, the decrease of the quality of the thawed semen of Tunisian Arab stallions.

Low-dose lisinopril in normotensive men with idiopathic oligospermia and infertility: a 5-year randomized, controlled, crossover pilot study

The outcomes of drug treatment for male infertility remain conjectural, with controversial study results. Our pilot study employed a randomized, placebo-controlled, crossover methodology with intention-to-treat analysis. Thirty-three men with idiopathic oligospermia were randomized to start either daily oral lisinopril 2.5 mg (n = 17) or daily oral placebo (n = 16). Lisinopril was found to cause a normalization of seminal parameters in 53.6% of the participants. Although the mean ejaculate volume was unchanged (P ≥ 0.093), the total sperm cell count and the percentage of motile sperm cells increased (P ≤ 0.03 and P < 0.001, respectively), whereas the percentage of sperm cells with abnormal morphology decreased (P ≤ 0.04). The pregnancy rate was 48.5%, and there was no serious adverse drug event. It is concluded, albeit cautiously, that prolonged treatment with 2.5 mg/day of oral lisinopril may be well tolerated in normotensive men with idiopathic oligospermia, may improve sperm quantity and quality, and may enhance fertility in approximately half of those treated.

Ram Sperm Motility Parameters under The Influence of Epidermal Growth Factor

Epidermal growth factor (EGF) is one of the important cytokines that play a role in fertility. It is known that EGF affects both male and female reproduction, but its effect on sperm parameters is not fully understood. Up to the present, the effect of EGF on ram sperm motility parameters has not been published. We analyzed motility parameters of ejaculates after 24, 48, and 72 hours from the EGF addition. EGF was added to chilled ram sperm at concentrations of 0, 100, 200, and 400 ng·ml⁻¹. Analyses were realized using computer, assisted semen analyzer (CASA)—Hamilton Thorn motility analyzer (version 7). The effect of EGF was already visible after 30 min of incubation. Significant effect on ram sperm total motility and progressive movement was observed at higher EGF concentrations after 48 h of incubation. Our results show that EGF affects sperm motility parameters depending on concentration and time of exposure.

Canine fresh and cryopreserved semen evaluation

There is little doubt that objective assessment of multiple parameters related to the functional and morphological characteristics of spermatozoa, increase the predictability of the fertilizing potential of a semen sample. Conventional microscopic methods for sperm evaluation in combination with the more objective computer-assisted sperm motility and morphology analyzers and flow cytometry, have allowed investigators to obtain precise information about the morphofunctional status of spermatozoa, which already has resulted in a better understanding of sperm biology and of some of the mechanisms involved in sperm cryoinjury. In addition, assays based on in vitro fertilization provide valuable information about the functional ability of spermatozoa when interacting with the oocyte. Although objective methods for dog sperm evaluation are available for many researchers, considerable effort has still to be invested in order to standardize physiological sperm parameters for the results to be interpretable under unified criteria. In the present paper some of the classical and new methods currently used for dog sperm evaluation are reviewed, though not exhaustively, covering some aspects of the sperm cell that are useful in estimating its functional ability.

Use of the Sperm-Class Analyser for objective assessment of human sperm morphology

The Sperm-Class Analyser was validated for assessing morphometric parameters of the head and midpiece of unwashed and washed human ejaculated spermatozoa from volunteers providing a wide range of semen quality. A higher proportion of sperm could be assessed (86% fresh semen and 75% washed sperm) if Hemacolor staining was used rather than DiffQuik (80 and 73%) or Papanicolaou (78 and 68%). Different stains employed different fixatives and the area, length, width and perimeter of the sperm head was significantly larger for washed sperm stained by Hemacolor and DiffQuik. Acrosomal area ranged from 48 to 51% of the sperm head area and this percentage was larger for washed sperm stained with DiffQuik. Sperm at the end of the slide, distant from the initial semen droplet, were larger in area and perimeter than those at that site or in the middle. The high precision and reproducibility of the equipment required assessing only 50 sperm on the slide. Far greater variation was found in head width, relative acrosomal area and midpiece width between different slides prepared from the same ejaculate, highlighting the inherent variability within the ejaculate and smear preparation, and requiring more than one slide to be assessed.

Assessment of human sperm morphology by strict criteria: comparison of wet preparation versus stained with the modified Diff-Quik method

Routine semen examination remains an important tool for the diagnosis and treatment in human subfertility. Of all semen parameters, sperm morphology seems to be one of the most powerful indicators of a man's fertilizing potential in vitro and in vivo. Lack of standardization of sperm morphology assessments remains the main reason for the usefulness of this parameter. The aim of this study was to analyze the agreement between the wet-stained preparations versus those stained with modified Diff-Quik for sperm morphology. A total of 100 unselected semen samples from infertile couples were analyzed. Sperm morphology was evaluated with unstained specimens and following modified Diff-Quik staining according to the strict (Kruger classification) criteria by two different examiners (intralaboratory blind assessment). Mean percentages of morphologically normal spermatozoa were identical on wet and stained preparation slides (4.79 vs. 4.61, p >.05). Wide divergence of results was found with respect to the percentage of sperm with head and midpiece defects with the two different preparations (p >.001). The percentage of sperm tail defects was similar in both methods (p >.05). Simple linear regression analysis between the two methods revealed very good correlation for the morphologically normal spermatozoa (r =.83), but poor correlation for the sperm head, midpiece, and tail defects (r =.25,.25, and.28, respectively). Wet preparation is suitable only for the morphologically normal spermatozoa, but to determine the percentage of the defective spermatozoa, staining the smear is recommended.

Accuracy of the normal sperm morphology value by Sperm Quality Analyzer IIC: comparison with the strict criteria

The aim of the present study is to investigate the accuracy of the normal sperm morphology value by Sperm Quality Analyzer IIC (SQA IIC), which was developed to provide a rapid and low-cost quantitative evaluation of semen quality. Normal sperm morphology was assessed using SQA IIC in comparison with that by the strict criteria in 62 semen samples. Normal sperm morphology value by SQA IIC was based on the studies of three traditional sperm parameters from over 4000 fresh, untreated semen samples, while the strict criteria was based on the method by Kruger et al. The mean +/- SD of percent normal morphology by SQA IIC and the strict criteria were 37.6 +/- 10.9% (range 15-52) and 19.9 +/- 8.2 (range 1-34), respectively. There was a significant correlation of the sperm morphology assessment between the two methods (r=0.454, p < 0.001). Using the cut-off value of >30% normal morphology by SQA IIC, the positive predictive value and the negative predictive value of the 'normal' strict criteria were 79.6% (39/49) and 46.2% (6/13), respectively. These results indicate that SQA IIC might be used as an initial screening test for the evaluation of sperm morphology. However, sperm morphological assessment by the strict criteria should be performed in order to make decisions in planning strategies for the treatment of infertile couples.

Influence of sample preparation, staining procedure and analysis conditions on bull sperm head morphometry using the morphology analyser integrated visual optical system

The importance of standardizing the procedures of sample and slide preparation for computer-assisted morphologic analysis has been emphasized in human and veterinary andrology. The purpose of this study was to optimize slide preparation (dilution grade and sperm washing), staining procedures and analysis conditions (colour of light source and objective magnification) for the morphometric analysis of bull spermatozoa using the Hamilton Thorne morphology analyzer integrated visual optical system (IVOS). For experiment 1, one ejaculate was collected from one bull and diluted to 200,000-300,000 spermatozoa/microl. Slides were prepared and stained using seven different procedures: rapid Papanicolaou (PAP), rapid Papanicolaou with prolonged staining times (PAP+). Diff-Quik (DIF), haematoxylin (HEM). Farelly (FAR), Spermac (SPER) and the modified GZIN (MGZIN) staining. All slides were analysed using a Hamilton Thorne Morphology Analyser IVOS equipped alternatively with a red, green or blue light source, and a 40x or 100x oil immersion objective. Recognition and digitization errors as well as morphometric parameters were determined. The IVOS was unable to detect DIF-stained spermatozoa. The GZIN and the SPER staining as well as the blue light source led to unsatisfactory results. Among the staining methods examined, the FAR, HEM, PAP+, and PAP staining, preferably in combination with the green light source, and the 40x objective yielded optimal results concerning sperm recognition and digitization. The 100x objective did not allow reliable analysis of the sperm heads because of a frequently appearing digitization error. For experiment 2, three ejaculates were collected from each of three bulls and diluted to five dilution grades (100 000-500 000 spermatozoa/microl). An aliquot of each dilution grade was washed additionally. The percentage of correctly digitized sperm heads decreased with increasing spermatozoal concentration. However, the evaluation speed increased. The range of 200 000-300 000 spermatozoa/microl appeared to be a reasonable compromise for both criteria. Sperm washing failed to further improve the analysis results. Sperm head dimensions were influenced significantly by all variations of the methods in both experiments. In conclusion, using the proposed methods, the IVOS allows precise and reliable morphometric analyses of bull spermatozoa. The consistent application of these procedures may lead to an inter-laboratory standardization and to further establishment of generally accepted morphometric criteria used in human andrology (e.g. World Health Organisation or strict criteria).

Prediction of unexpectedly poor fertilization and pregnancy outcome using the strict criteria for sperm morphology before and after sperm separation in IVF-ET

This study was performed to investigate if unexpectedly poor fertilization and in-vitro fertilization (IVF) outcome could be predicted using sperm morphology as diagnosed by the strict criteria. Sperm morphology was assessed in 137 IVF-ET cycles with at least three oocytes collected. The lowest amount of normal forms was 5% in 137 samples, indicating there were no patients belonging to 'poor prognosis' (<5% normal forms). Treatment using intracytoplasmic sperm injection (ICSI) was also excluded. Before sperm separation by the swim-up method, sperm morphology demonstrated a significant correlation with the fertilization rate (p < 0.0001). The fertilization rate (80.5%) in 110 'normal' samples (>14% normal forms) was significantly higher (p < 0.01) than that (55.4%) in 27 samples with 'good prognosis' (those with 5--14% normal forms). No embryo was available for transfer (ET) in 4 (3.6%) of 110 'normal' cycles and in 3 (11.1%) of 27 'good prognosis' cycles (not significant). Fresh ET was intentionally cancelled to avoid severe ovarian hyperstimulation syndrome (OHSS) in six of 110 'normal' cycles as well as in one of 27 'good prognosis' cycles. The pregnancy rate per ET was 31.0% (31/100) in the former group, while it was 26.1% (6/23) in the latter group. There was no difference between the two groups. In the post swim-up evaluation of sperm characteristics, morphology was significantly correlated with the fertilization rate in IVF-ET (p < 0.05) while other sperm parameters were not. When the cut off level for the post swim-up sperm morphology was set at 25%, there was a significant difference in the fertilization rates between patients (78.6%) with post-swim-up >25% and those (55.0%) with post-swim-up < or =25% (p < 0.01). Taken together, a relative indication for ICSI using sperm morphology before and after swim-up was established. Category A includes < or =14% normal forms in the ejaculate and post-swim-up < or =25%, while Category B includes < or =14% in the ejaculate and post-swim-up >25%. There was a significant difference in the fertilization rates between patients (47.2%) in Category A and those (60.2%) in Category B (p < 0.05). The clinical pregnancy rate was 11.1% for patients in Category A compared with 35.7% for patients in Category B. However, there was no significant difference between the two categories. These results indicate that the strict criteria provide a reliable estimation of the fertilizing ability of human spermatozoa. ICSI might be considered in Category A patients to avoid poor fertilization and pregnancy outcome.

Multicenter study on reproducibility of sperm morphology assessments

Sperm morphology has always been considered an important tool in evaluating a man's fertilizing potential. The objective of this multicentric study was to evaluate intra- and interindividual variability and between-laboratory variation using the same or different criteria of sperm morphology assessment. Semen samples were obtained from 20 males and 32 smears were made of all samples. Eighty coded smears (4 per patient) were sent to 8 laboratories for morphology assessment. The centers applied different classification systems (strict criteria, WHO 1987, Düsseldorf criteria) and participants were asked to analyze the 80 smears twice, with an interval of 1 week between each participant's two analyses. Intraclass correlations between repeats showed that sperm morphology can be assessed with acceptable within observer reproducibility. Expected increases in imprecision were observed up to coefficients of variation of >30% with decreasing morphology scores, regardless of the classification system used. Agreement in correct classification of samples as normal/abnormal was obtained in 80% of cases. Differences in reproducibility between slides may reflect an important source of heterogeneity due to smear preparation. These results emphasize the importance of external quality control systems to improve the value of sperm morphology assessments in the investigation of the male partner in a subfertile couple.

Spermatozoa recovered by IxaPrep gradient have improved longevity and better motion characteristics than those by Percoll gradient

To compare the effectiveness of various sperm preparation methods, we examined sperm concentration, percentage of progressive motility, recovery rate, and various motion characteristics in 32 semen samples after Percoll and IxaPrep preparations. Except for sperm concentration, which was much higher after IxaPrep preparation, no statistical differences existed between these two methods in terms of motile sperm concentration (MSC), recovery rate, mean curvilinear velocity (VCL), mean straight-line velocity (VSL) and mean amplitude of lateral head displacement (ALH). Among 22 samples that were allocated in a 37 degrees C, 5% CO2 incubator, the mean MSC after 3 hours was significantly higher following IxaPrep preparation than following Percoll preparation (63.2 x 10(6)/mL vs. 42.8 x 10(6)/mL, p < .03). VCL and VSL were much higher after IxaPrep preparation than after Percoll preparation, both at 3 hours (p < .01) and at 24 hours (p < .03). ALH was also higher after IxaPrep preparation than after Percoll preparation, and it was statistically significant after 3 hours of incubation (p < .03). We conclude that the IxaPrep gradient may be adopted as the preferred method to the Percoll gradient in preparing spermatozoa for assisted reproduction because of the spermatozoa's persistent and better motion activities after incubation.

Semen analysis and antisperm antibody

Evaluation of the fertilizing potential of sperm is an important procedure in in vitro fertilization and embryo transfer (IVF-ET) clinic, in order to avoid performing invalid conventional IVF-ET or unnecessary intracytoplasmic sperm injection (ICSI). However, none of the standard semen parameters are reliable indices in predicting IVF outcome. The test examining sperm-zona interaction is the best present method, though the short supply of the human zona component should be solved. IVF-ET treatment is useful for pregnancy in women having sperm immobilizing antibodies because it avoids exposing sperms to antibodies that block fertilization. ICSI should be used in immunologically infertile men diagnosed by specific method to demonstrate the in vivo exposure of sperms to antisperm autoantibodies that block fertilization.

Sperm head morphometry analysis of ejaculate and dismount stallion semen samples

The evaluation of seminal characteristics is important in the clinical detection of stallion subfertility. Conventional semen evaluation includes subjective determination of sperm concentration, motility, and gross morphology. Due to the subjectivity and variability of the manual morphology assessment, computer automated sperm morphology analyses has been developed. Computer automated sperm morphology analysis was applied in the current study to determine if the morphometric measurements of sperm heads from collected and dismount samples of the same ejaculate were similar. If the post-ejaculate dismount sample is representative of the entire ejaculate, this sample may be utilised in determining the fertility of the ejaculate. Ejaculate samples were collected from ten stallions using an artificial vagina. Post-ejaculate dismount samples of the same ejaculate were taken from the head of the penis. A thin smear of the collected and dismount samples were prepared onto microscope slides and spermatozoa were stained for 40 min in haematoxylin. At least 200 properly digitised sperm heads from each slide were analysed using computer automated sperm morphometry analysis. The mean values for length, width, width/length, area, and perimeter were recorded from each analysis of collected and dismount samples and compared by paired t-test. The coefficients of variation of each analysis was also recorded and compared between collected and dismount samples by paired t-test. No significant differences (P > 0.10) in any measurements were found between collected and dismount samples. The mean values for all stallions for collected and dismount samples were length = 5.96 microM and 6.06 microM, width = 2.95 microM and 2.98 microM, width/length = 0.49 and 0.49, area = 13.31 microM2 and 13.65 microM2 and perimeter = 15.54 microM and 15.74 microM respectively. No significant differences were detected in the coefficients of variation of sperm head measurements from collected and dismount samples. These results indicate sperm head measurements from dismount semen are representative of those of the ejaculate. Hence, sperm head measurements of dismount samples may be viably applied to studies of fertility or in case of clinical fertility assessment. This finding will further assist in the development of normal sperm head morphometry criteria in the stallion. Clinically, a slide can be prepared in the field after natural services matings and analysed accurately and objectively by ASMA.

Morphometric differences in sperm head dimensions of fertile and subfertile stallions

Gross morphological evaluation of stallion spermatozoa is of clinical value in assessing male fertility in the horse. While of value, methods of subjective sperm classification yield highly variable results. Recent development of computer-assisted sperm morphometry analysis (ASMA) technology has allowed for the objective analysis of sperm head morphometry. In the current study, ASMA was employed to determine morphometric differences in sperm head dimensions between fertile and subfertile stallions. At least 200 spermatozoa from each of 10 fertile and 10 subfertile stallions were analyzed by a commercial ASMA instrument. The mean measurements for length, width, area, perimeter, and width/length for each stallion were recorded and group means compared by a two-sample t-test. The mean measurements for length, area and perimeter were significantly larger in the subfertile than the fertile group (5.77 microm vs 5.33 microm, 12.66 microm vs 11.37 microm and 14.59 microm vs 13.64 microm, respectively). The width of sperm heads from stallions in the subfertile group also tended to be larger than those of fertile stallions. The data suggest that differences in the dimensions of sperm heads may exist between fertile and subfertile stallions.

Combination of direct swim-up technique and discontinuous Percoll gradient centrifugation for sperm preparation of oligoasthenozoospermic samples

Sperm recovery for assisted reproduction in oligoasthenozoospermic patients is not satisfying either by the swim-up technique or by Percoll gradient centrifugation, and no single technique is constantly preferred. The design of this study was to evaluate the effects of combining the two methods on improving the efficacy of sperm preparation in these poor samples. For each semen sample, 1 mL was treated with a combination method, which used direct swim-up technique to recover motile sperm swimming to the supernatant, and then the residual semen was subjected to two-layer discontinuous Percoll gradient procedure for further recovery of motile sperm. Another 1 mL was prepared with two-layer discontinuous Percoll gradient centrifugation alone for comparison. Parameters measured included sperm concentration, number of progressively motile sperm, percentage of progressive motility, percentage of motile sperm recovery, amount of debris, percentage of normal forms according to Kruger's strict criteria, and motion characteristics of sperm using computer-aided motility analysis. The results of 30 oligoasthenozoospermic samples demonstrated that the combination method achieved a significantly greater recovery of motile sperm than the two-layer discontinuous Percoll gradient centrifugation did (43.2 +/- 19.7% vs. 32.2 +/- 14.3%, p < .05). The percentage of progressive motility was higher in the samples of the combination method than in those of Percoll gradient centrifugation alone, but the difference was not significant (63.7 +/- 21.8% vs. 58.7 +/- 20.1%). The debris of semen was removed equally well by both methods. The percentage of normal forms as well as motion characteristics, including curvilinear velocity, straight-line velocity, mean amplitude of lateral head displacement, and linearity, were similar in the samples treated by these two procedures. The combination of the direct swim-up technique and discontinuous Percoll gradient centrifugation combines the advantages of each procedure and results in greater recovery of motile sperm in oligoasthenozoospermic samples.

Evaluation of the percentage of sperm motility at 24 h and sperm survival ratio for prediction of in vitro fertilization

The present study was carried out to investigate the predictive value of the percentage of sperm motility after 24-h incubation and sperm survival ratio from semen and inseminated sperm suspension using grading of motility by WHO criteria with respect to the fertilization of oocytes in vitro. A total of 789 oocytes from 85 cases were inseminated and the mean fertilization rate obtained was 72.5%. There was no significant correlation between all of the sperm motility results with fertilization rate in vitro. All sperm motility results were not significantly different between the non-fertilizing group and the fertilizing group and also between the group of fertilization rate < or = 25th percentile (fertilization rate < or = 62.5%) and the group of fertilization rate > 62.5%. However, the initial percentage of rapid progressive sperm motility and progressive motility in semen and inseminated sperm suspension at 24 h gave significant differences between the group of fertilization < or = 50th percentile (fertilization rate < or = 80%) and the group of fertilization rate > 80%. Overall accuracy using these parameters for prediction of fertilization rate > 80% was only about 60%. In conclusion, the percentage of sperm motility at 24 h and sperm survival ratio in both semen and inseminated sperm suspension have no practical value in predicting fertilization rate in vitro. Moreover, detailed motility grading cannot improve the predictivity of these sperm motility parameters.

Effects of caffeine and dbcAMP on zona pellucida penetration by epididymal spermatozoa of cynomolgus monkeys (Macaca fascicularis)

Spermatozoa mature during epididymal transit, acquiring the abilities to swim progressively, fertilize oocytes, and produce viable offspring. In this study, we investigate the capacity of spermatozoa retrieved from the midcorpus and distal cauda regions of the epididymis of the cynomolgus monkey to penetrate homologous zona pellucida. Successful in vitro fertilization by ejaculated macaque sperm is dependent upon the addition of caffeine and dbcAMP. Therefore, the effect of these cyclic nucleotide mediators was also examined in this study. Results of sperm motion analysis indicate no difference in baseline values (without stimulators) for any motion parameter. With the addition of caffeine and dbcAMP, curvilinear velocity significantly increased only for the distal cauda sperm (P = 0.05). Amplitude of the lateral head displacement was significantly increased for distal cauda sperm (P < 0.01); although elevated above baseline, the increase observed after activation by corpus sperm was significantly lower than that achieved by cauda sperm (P < 0.05). The addition of caffeine and dbcAMP was an absolute requirement for zona penetration by both midcorpus and distal cauda sperm. With activation, zona penetration was significantly decreased for corpus sperm compared to cauda sperm (P < 0.001). These results suggest that cynomolgus monkey sperm reaching the midcorpus region of the epididymis have not completed all of the maturational changes requisite for successful fertilization; this immaturity is evidenced by decreased sperm motion and by impedance at the level of zona penetration.

Profiles of sperm morphology and motility after discontinuous multiple-step Percoll density gradient centrifugation

Morphology and motility are important parameters for assessing the fertilizing capacity of spermatozoa. This investigation reports a systematic study on the profiles of these parameters after percoll gradient centrifugation. Spermatozoa from normal human semen were fractionated by discontinuous Percoll gradients (30%, 45%, 75%, 90%). Spermatozoa washed with Earle's balanced salt solution were used as a control. After centrifugation, sperm morphology was evaluated according to strict criteria; motility was assessed by a computer-assisted semen analysis system. The results showed that the percentage of spermatozoa with normal morphology increased, while those with severe morphological defects decreased, as the density of Percoll increased. The percentages of motile spermatozoa and hyperactivated spermatozoa, and the velocity and amplitude of lateral head displacement of the spermatozoa were significantly higher in the 75% and 90% Percoll fractions than that in the 30% and 45% ones, and in the control. These results demonstrated that Percoll density gradient centrifugation enriched spermatozoa in terms of morphology and motility.

The combination of two semen preparation techniques (glass wool filtration and swim-up) and their effect on the morphology of recovered spermatozoa and outcome of IVF-ET

The aim of this prospective study was to relate sperm quality, especially sperm morphology, to the outcome of IVF results, when glass wool filtration (GWF) and swim-up were used in combination for the preparation of spermatozoa. A total of 60 ejaculates were analysed. GWF was compared with glass wool filtration/swim-up (GWF-SU) by using aliquots from the same semen samples to increase the precision of the comparison and to establish the cumulative effect of these two semen preparation methods on the morphology of the recovered spermatozoa. Sperm parameters were examined in native semen, in semen preparation samples after GWF and GWF-SU. The mean percentages for motility, morphology and velocity were improved significantly over those in fresh semen only when GWF-SU was used. GWF alone resulted only in a significantly higher recovery of motile spermatozoa. In semen preparation, 10% of spermatozoa with normal morphology appeared to be the cut-off point as there was a significantly higher recovery in fresh semen samples containing > 10% morphologically normal spermatozoa after GWF-SU. Outcome of IVF-ET following preparation with GWF-SU showed better results in comparison to the swim-up procedure alone, though this difference was not statistically significant. The cut-off point was also > 10% morphologically normal spermatozoa. Improvement in all aspects of IVF-ET occurred when native semen contained > 10% morphologically normal spermatozoa. It is concluded that GWF alone did not produce significantly better results but, in combination with swim-up, it resulted in significantly better sperm morphology and in an improved outcome of IVF-ET for fresh semen samples with > 10% morphologically normal spermatozoa.

Sperm morphology and in vitro fertilization outcome: a direct comparison of World Health Organization and strict criteria methodologies

OBJECTIVE

To perform a direct comparison of two sperm morphology methodologies with regard to IVF outcome.

DESIGN

Blinded comparison of two methods of morphology assessment using the same morphology slides.

PATIENTS

Data were obtained from 132 couples in a consecutive series of patients undergoing IVF.

MAIN OUTCOME MEASURES

Two practical end points were selected for analysis for each couple: the presence of any fertilization and the number of fertilized eggs. Normal traditional morphology was defined as > or = 40% normal forms in a sample and normal strict criteria was defined as > or = 4%.

RESULTS

Traditional morphology demonstrated a higher sensitivity and negative predictive value than strict criteria (87% versus 61%, and 68% versus 36%, respectively). Positive predictive value and specificity were also numerically greater but did not reach statistical significance. Abnormal traditional morphology, but not strict criteria, was associated with reduced fertilization even among samples with normal sperm concentration and motility. Samples with normal morphology were associated with a greater number of fertilized eggs per couple than those with abnormal morphology: this difference was 3.2 fertilized eggs for traditional morphology and 1.6 for strict criteria. Overall, for samples with < 40% by traditional morphology only one case yielded more than two fertilized eggs. In contrast, up to five fertilized eggs were noted for the lowest strict criteria scores.

CONCLUSIONS

Comparison of traditional morphology and strict criteria with regard to IVF outcome favored traditional morphology in several areas. In particular, low scores were more predictive of poor IVF outcome.

A study of spermatozoal motility in type 1 diabetes mellitus

The aim of the study was to examine an aspect of male fertility in patients with Type 1 diabetes mellitus (n = 17) compared to healthy control subjects (n = 16) using parameters of sperm motility, measured using a computerized image analysis system (the Hamilton Thorn Research HTM-2030 Motility Analyzer), as indicators of potential fertility. Within the diabetic group no correlations were found between sperm motility and age, age of onset of diabetes, duration of diabetes or glycated haemoglobin. When the diabetic and control groups were compared, track speed, path velocity, progressive velocity, and lateral head displacement were not significantly different, whereas linearity and linear index, measures of straightness of swimming, were significantly greater in the diabetic subjects (59.2% vs 69.8%, p = 0.0005 and 76.4% vs 83.6%, p = 0.0016, respectively). We conclude that diabetic men, in the absence of complications, do not appear to be at a disadvantage in terms of sperm motility compared to healthy individuals.

The effect of the antisperm auto-antibody-bound sperm on in vitro fertilization outcome

To evaluate the effects of antisperm auto-antibody-bound sperm on the outcome of in vitro fertilization-embryo transfer (IVF-ET), 160 infertile couples undergoing treatment by in vitro fertilization were recruited in this study. In the study group (11 couples, 15 cycles), the male partners were positive for antisperm autoantibodies determined by immunobead test (IBT). In the control group (149 couples, 152 cycles), the men had no such antibodies. The percentages of fertilization rate, cleavage rate and pregnancy rate of the study group and control group wer 75.0 +/- 5.2% vs. 69.3 +/- 2.4%; 82.8% +/- 3.7% and 6.7% +/- 11.8%, respectively. There were no significant differences in in vitro region, type and/or percentage of sperm-bound antibodies also had no effect on the in vitro fertilization outcome. In conclusion, in vitro fertilization-embryo transfer is not significantly affected by antisperm autoantibody-bound sperm determined by immunobead test.

Human sperm movement assessed with the Hamilton-Thorn motility analyzer and in vitro fertilization

The relationship between sperm movement characteristics obtained by computerized analysis and the in vitro fertilization rates of human oocytes was studied. In 144 consecutive in vitro fertilization treatments a sample of prepared semen was analysed by a Hamilton-Thorn Motility Analyzer. In addition a visual estimation of sperm count and motility was made. Significant correlations with the fertilization rate were found for all visual parameters. Of the computerized measurements, the mean velocities of motile spermatozoa and the concentration of motile cells were significantly correlated. The average path velocity correlated best (r = 0.42, P < 0.001). There was no relationship between the percentage of motile sperm showing hyperactivated movement and the fertilization rate. A forward stepwise logistic regression analysis selected the following variables of predictive value for fertilization: average path velocity, male factor infertility as indication for in vitro fertilization, motility and concentration, as measured by the Hamilton-Thorn analyzer. A logistic regression model to predict the cases with low (< 0.2) or high fertilization rates, included the average path velocity as a significant variable and classified the samples with 90% overall accuracy.

IN CONCLUSION

movement characteristics of spermatozoa in culture medium, especially the average path velocity are of prognostic value in prediction of human oocyte fertilization rates.

The relationship between morphology, motility and zona pellucida binding potential of human spermatozoa

Prediction of the fertilizing potential of human gametes under in vitro conditions has been a major field of interest of assisted reproductive programmes. However, sperm morphology has been regarded as a predictor of human in vitro fertilization rate. This paper prospectively evaluates the relationships among normal sperm morphology and (1) motion characteristics viz. curvilinear velocity (VCL), straight line velocity (VSL), and linearity (LIN) (n = 37) and (2) sperm-zona pellucida binding capacity under HZA conditions (n = 144) of two separate groups of infertile couples. Semen was evaluated for sperm concentration, percentage motility, forward progression, and percentage normal morphology (strict criteria). The motility characteristics were measured using a computerized Sperm Motility Quantifier (SMQ). The zona binding potential of sperm was evaluated using the hemizona assay. Firstly, the VCL significantly differed between the P-pattern and both the G (72.9 +/- 7 vs. 86.3 +/- 16 microns s-1; P = 0.04) and N patterns (72.9 +/- 7 vs. 91.0 +/- 15 microns s-1; P = 0.002). The VSL differed only between the P and N patterns, being 19.7 +/- 7 vs. 32.6 +/- 15 microns s-1 (P = 0.02), respectively. No significant differences in LIN were noted between any of the three patterns. The sperm concentration differed significantly between the P and both the G (37.9 +/- 35 vs. 80.8 +/- 9 x 10(6) ml-1; P = 0.03) and the N patterns (37.9 +/- 35 vs. 89.7 +/- 72 x 10(6) ml-1; P = 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Association between human in vitro fertilization rate and pregnancy outcome: a possible involvement of spermatozoal quality in subsequent embryonic viability

A conventional view of mammalian fertilization is that the active component of the process: the spermatozoon, by virtue of its progressive motility and acrosomal enzymes, penetrates an otherwise passive oocyte. This concept has placed bias on spermatozoal normality as largely determining the outcome of fertilization; once this has been achieved then the contribution of the spermatozoon is often forgotten, and attention switches to the maternally derived "blue-print" for early embryonic development. Paternal genomic contribution is known to start at the eight-cell stage in the human, but this is usually after the time when early cleavage stage (2 to 8-cell stage) embryos are replaced in human assisted reproductive technologies (ART) procedures such as in vitro fertilization and embryo transfer (IVF-ET). Hence, fundamental abnormal contributions to embryogenesis derived from the fertilizing spermatozoon have often been ignored. Human IVF-ET has permitted far greater powers of analysis of the fertilization event, and fertilization success appears to be determined in such a system by three main factors: spermatozoal quality, oocyte quality, and quality of in vitro culture conditions (the gamete environment). If the second two factors are more carefully controlled than the first, as is the usual emphasis in routine human IVF practice, then any large variation in fertilization rates that are also significantly related to embryonic viability and ultimately pregnancy outcome, may be thought to be more directly associated with original quality of the fertilizing spermatozoon. An analysis of results of 758 IVF cases provides preliminary evidence to show that there is a close association between human in vitro fertilization rate and subsequent embryo viability following replacement. In accepting this hypothesis as a possibility, we should drastically change our attitude from one of the spermatozoon as a robust, simple initiator of embryonic development, and embrace the idea of the vulnerability of such germ cells both during and after their production, and how detrimental influences on this might profoundly affect embryogenesis after successful fertilization.

Localization of antibodies on spermatozoa and sperm movement characteristics are good predictors of in vitro fertilization success in cases of male autoimmune infertility

OBJECTIVE

To define sperm factors related to in vitro fertilization (IVF) failure in cases of antisperm autoimmunity.

DESIGN

A detailed analysis of sperm morphology, movement characteristics, acrosomal function, and antibody binding was performed on the sperm population selected on a discontinuous two-layer Percoll gradient and used for IVF. The results were compared retrospectively between fertilizing (n = 13) and nonfertilizing (n = 11) sperm populations.

PATIENTS

Twenty-one infertile couples undergoing 24 cycles of IVF treatment because of antisperm autoimmunity were included in this study.

RESULTS

Fertilizing and nonfertilizing sperm populations were not different with respect to the percentage of motility, the normal morphology, the multiple anomalies index, the acrosome abnormalities, and the spontaneous or induced acrosome reaction. If the proportion of spermatozoa coated with either immunoglobulin (Ig)A or IgG antibodies was similar in the two groups, their localization was often different: antibodies were mainly on the sperm heads in the cases of fertilization failure. There were significant differences between fertilizing and nonfertilizing sperm samples in several movement parameters. Among them, the amplitude of lateral head displacement (ALH) was the most significantly correlated with fertilization success. Finally, spermatozoa were poorly bound to the zona pellucida (ZP) when fertilization failed, whereas high numbers of spermatozoa were attached to the ZP when fertilization occurred.

CONCLUSION

Fertilization failure in patients with antisperm antibodies may be the result of several factors in which the impact of the antibodies on the membrane function play a critical role. Movement parameters, particularly the ALH and the localization of antibodies on migrated spermatozoa could predict the IVF failure or success more accurately than the proportion of antibody-coated spermatozoa in the inseminated populations. The fertilization failure was associated with an incapacity of spermatozoa to bind to ZP.

Standardization of specimen preparation, staining, and sampling methods improves automated sperm-head morphometry analysis

OBJECTIVES

To evaluate the accuracy and performance of the CellForm-Human automated sperm morphometry instrument (Motion Analysis Corp., Santa Rosa, CA) using different specimen preparation, staining, and analysis techniques.

SETTING

Clinical and research andrology and in vitro fertilization laboratories.

PATIENTS

Individuals who were undergoing semen evaluation and infertility work-up.

RESULTS

The percentage of normal sperm detected by CellForm-Human was not different for washed specimens compared with nonwashed controls. Washing and resuspension to a standard concentration in medium significantly increased spermatozoan density and homogeneity on the slide. Comparison of digitization errors and morphometric measures of sperm stained by the Papanicolaou (PAP) method, the hematoxylin portion of the PAP method, and a new method developed by us, GZIN (pronounced Gee-ZIN), showed that GZIN produced larger measures for length, width, area, and perimeter, but not for width/length, and also produced less variability for most measures than PAP or hematoxylin. The number of digitization errors was significantly less for GZIN than for PAP. Visual inspection revealed that GZIN produced a more consistent stain over the entire sperm head than hematoxylin. The number of sperm analyzed affected the percentage of normal sperm detected. The % normal stabilized only after at least 200 sperm had been analyzed for each man.

CONCLUSIONS

Technical variability arising from semen preparation and slide staining methods can be reduced when specimens are washed and resuspended to a standard concentration before smearing. At least 200 sperm should be analyzed to obtain a stable estimate of the percentage of normal sperm. More sperm should be analyzed if the % normal is < 50%. Morphometric measurements are more accurate and precise when sperm are stained with GZIN than when stained with PAP or hematoxylin.

Prediction of fertilization in vitro with human gametes: is there a litmus test?

OBJECTIVES

The objectives of this study were as follows: (1) to evaluate the relationships between sperm concentration, morphologic pattern, motion parameters, and sperm-zona pellucida binding capacity and (2) to assess their ability to predict fertilization outcome under in vitro fertilization conditions.

STUDY DESIGN

Semen samples from 44 infertile men were prospectively evaluated for density, morphologic pattern (strict criteria), computerized motion parameters (motility, velocity, and linearity), and hemizona assay (outcome expressed as hemizona assay index), and results were correlated with fertilization outcomes of preovulatory oocytes during in vitro fertilization.

RESULTS

Of all sperm parameters, morphologic pattern was the best predictor of the ability of the sperm to bind to the zona pellucida. Hemizona assay index was the best predictor of fertilization rate. Stepwise regression analysis provided a model of hemizona assay index plus motility with highest predictability (R2 = 53.4%).

CONCLUSIONS

(1) The influence of sperm morphologic pattern as a prognosticator of fertilization outcome is established in major part as a determinant of sperm binding ability to the zona pellucida; (2) the hemizona assay provides a robust index that is highly predictive of the potential of human gametes to achieve fertilization and highlights its use in infertility and contraception testing.

Poor in vitro fertilization outcome with semen yielding low sperm density "swim-ups" is not because of altered sperm motion parameters

OBJECTIVE

To examine fertilization, cleavage, and pregnancy rates (PRs) with semen samples yielding numbers of total motile sperm per swim-up ranging from < 1 to > 20 x 10(6) and to correlate the findings with changes, if any, in the sperm motion parameters.

DESIGN

Fertilization, cleavage, and pregnancy outcomes in 439 in vitro fertilization (IVF) cycles were correlated with the total number of motile sperm per swim-up and the sperm motion parameters as determined with an automated semen analyzer.

SETTING

A university-based tertiary referral hospital center.

PATIENTS

Patients undergoing IVF or intrauterine insemination treatments for multiple etiologies.

RESULTS

Higher numbers of motile sperm per swim-up, most notably above the value of 3 x 10(6) motile sperm, were associated with improved fertilization rates and viable PRs. Sperm velocity, linearity, amplitude of lateral head displacement, and flagellar beat per cross frequency for sperm from swim-ups with poor or good pregnancy outcome, however, showed no significant differences.

CONCLUSIONS

As a group, semen samples that yield < or = 3 x 10(6) motile sperm per swim-up are associated with poor fertilization rates, cleavage rates, and PRs. This relationship can not be attributed to differences in sperm motion parameters.

Tests of human sperm function and fertilization in vitro

OBJECTIVE

To review recent studies on the development of new tests of human sperm function and evaluation of which sperm characteristics are most important for fertilization in vitro by logistic regression analysis.

STUDY SELECTION

Recent studies on the relationship between putative and new tests of human sperm function and fertility in vitro or in vivo are discussed in this review. Some physiological and technical aspects are included.

MAIN OUTCOME MEASURES

Fertilization rates in vitro and sperm tests including standard semen analysis, improved morphology assessment, objective assessment of sperm motility and movement characteristics, nuclear maturity, hypo-osmotic swelling, the acrosome and the acrosome reaction, acrosin activity, human sperm-hamster oocyte penetration assay, and sperm-zona pellucida (ZP) and sperm-oolemma binding.

RESULTS

The percentages of sperm with normal morphology and a normal intact acrosome, mean linearity, and the number of sperm binding to the ZP were highly significant related to fertilization rates in vitro. Other sperm tests evaluated usually provided no additional information about fertilization rates. The human ZP is highly selective for binding of morphologically normal sperm. Acrosome-reacted human sperm have little or no ability to bind to the ZP.

CONCLUSION

Results of in vitro fertilization can be used to evaluate tests of human sperm function. Logistic regression analysis is a powerful method for determining which groups of sperm characteristics are independently related to fertilization rates. Normal morphology, linearity, acrosome status, and sperm-ZP binding are the most important characteristics for fertilization in vitro.

Evaluation of testicular function

The evaluation of testicular function is based primarily on a detailed medical history, a careful physical examination, basal measurements of FSH, LH and testosterone and a routine semen analysis. In a patient with androgen deficiency, the diagnosis can often be made with these basic tests. The clinician will then decide on other investigations to localize the organic lesion and to plan further treatment for the patient. Sperm function tests are often performed in patients presenting with infertility. These newer tests may help to delineate the abnormality of the spermatozoa at each stage during the achievement of fertilizing capacity such as adequate forward motility, penetration of cervical mucus, acrosome reaction, development of hyperactivated motility, binding to the zona pellucida, and fusion with the oocyte. Currently, many of these sperm function tests depend on cumbersome bioassays with many limiting factors contributing to their availability, accuracy and precision. The development of biochemical tests as markers of sperm function may allow more precise definition of sperm functional abnormalities. With the continued improvement of computer-aided sperm analysis, objective motion parameter measurements are possible and morphological assessment are being developed. These newer objective methods of semen analysis have to be shown to be valuable in the clinical assessment of patients with testicular dysfunction.

Comparative study on the use of human follicular fluid or egg yolk medium to enhance the performance of human sperm in the zona-free hamster oocyte penetration assay

A prospective study was conducted on 61 unselected semen samples from infertile patients to compare the efficacy of human follicular fluid (hFF) or TEST-egg yolk medium treatment in enhancing sperm performance in the zona-free hamster oocyte penetration (HOP) test. Both hFF and TEST-egg yolk enhanced penetration scores significantly in the HOP test in comparison with the control swim-up sperm preparation. The TEST-egg yolk medium treatment, however, exhibited the highest penetration scores, and there were higher percentages of preparations passing the 10 or 20% penetration rate cut-off point with sperm exposed to the TEST-egg yolk medium than those exposed to hFF. These results indicate that modification of the original HOP-test protocol by incorporation of TEST-egg yolk medium gives a greatly increased penetration rate when compared to the addition of hFF in such a system.

Comparison of measurements of human sperm motility characteristics by the automated CellSoft system and time-exposure photomicrography

Human sperm motility characteristics in 28 semen samples with sperm concentrations less than 40 x 10(6) ml-1, as determined by the World Health Organization manual analysis (WHO, 1987), were measured by the automated CellSoft semen analyser (Cryo Resources Ltd, New York, NY, USA) using different system parameter settings (Mortimer & Mortimer, 1988a). The results were compared with those obtained by time-exposure photomicrographic (TEP) analysis. It was found that the settings of the minimum video frame rate and the threshold velocity used to distinguish motile from immotile sperm by the automated CellSoft system had a significant influence on measurements of percentage motility but not on linear velocity. At the five different parameter settings used in the present study, the automated CellSoft system gave significantly lower mean values for percentage motility in comparison with the WHO manual and TEP analyses. Measurements for linear velocity between the automated CellSoft system and TEP analyses were found not to be significantly different in these defined semen samples.

Computer-assisted assessment of human sperm morphology: usefulness in predicting fertilizing capacity of human spermatozoa

OBJECTIVE

The usefulness of sperm morphology to predict the outcome of human sperm fertilizing capacity was examined.

DESIGN, SETTING, PATIENTS

Semen samples from 50 male patients attending the infertility clinic of a tertiary referral institution were studied.

MAIN OUTCOME MEASURES

Sperm morphology was classified both by visual assessment and computer-assisted image analysis. In addition, morphometric analysis of the spermatozoa was measured by the morphologizer. Multivariate discriminant analysis was used to evaluate the usefulness of these morphology parameters for predicting the outcome of the zona-free hamster oocyte sperm penetration assay.

RESULTS

The manually derived percent of spermatozoa with normal and small head were selected to be of discriminating value in predicting the outcome of the zona-free hamster oocyte penetration test. The accuracy of correctly classifying the outcome of zona-free hamster oocyte penetration test by these two parameters in combination was 84%, whereas assessment of sperm morphology with morphometric analysis by the morphologizer selected a total of eight variables, which together predicted sperm fertilizing capacity with 74% accuracy. Addition of the morphologizer-derived parameters to those derived manually did not significantly improve the predictive value.

CONCLUSION

We conclude that the results of the zona-free hamster egg penetration test could be predicted using manual assessment of sperm morphology and computer-assisted morphometric analysis did not add further information.

Comparison of characteristics of human spermatozoa selected by the multiple-tube swim-up and simple discontinuous Percoll gradient centrifugation

The multiple-tube swim-up (MT-SU) and simple, discontinuous Percoll gradient centrifugation are two recent methods for the processing of human spermatozoa for assisted reproductive technologies. The present study was undertaken to compare the effects of these two methods on various parameters of spermatozoal qualities of normospermic semen samples. Both methods were found to select spermatozoa of better percentage motility, percentage normal morphology, viability, functional integrity of plasma membrane, movement characteristics including the curvilinear velocity, linearity of movement and head beat frequency, and in vitro fertilizing capacity with comparable degree of efficacy. It is concluded that both methods are effective for the separation of spermatozoa from normospermic semen samples for use in infertility treatment.

The diagnostic value of seminal adenosine triphosphate (ATP) in an in vitro fertilization (IVF) program

The level of adenosine triphosphate (ATP) was quantitated in semen samples used for in vitro fertilization of human oocytes. Seminal ATP level correlated with the concentration and percentage motility of spermatozoa but not with the in vitro fertilization rate of human oocytes. Seminal ATP measurement appears to have little diagnostic value in predicting the fertilizing capacity of spermatozoa as evaluated by the multivariate stepwise discriminant analysis.

Morphology of seminal and swim-up spermatozoa and the outcome of in vitro fertilization and embryo transfer

Tubal infertility was treated by in vitro fertilization-embryo transfer (IVF-ET) in 112 couples. Twenty-eight pregnancies were obtained in 140 treatment cycles. Couples are accepted for treatment in our IVF-ET programme if previous semen samples fulfil the inclusion criteria: ejaculate volume greater than 1.5 ml, concentration of spermatozoa greater than 15 x 10(6) ml-1, greater than 40% motile spermatozoa, and greater than 25% spermatozoa with normal morphology. In order to determine to which extent IVF-ET treatment results are influenced by sperm morphology, within this selected group of patients, we have retrospectively analysed the data from both original semen samples and swim-up preparations. The sperm morphology was not related to the outcome of treatment in terms of fertilization (ovum cleavage rate), early embryo development, or pregnancy. Nor was any relationship detected between early embryo development or pregnancy and the degree of improvement in morphology resulting from the swim-up procedure. However, if improvement in morphology by swim-up was high, ovum cleavage rate was low. Sperm morphology within the limits set by our inclusion criteria could not predict the outcome of IVF-ET treatment. It is further concluded that the presence of abnormal spermatozoa at the site of fertilization may be without harm if only the number of normal sperms is high enough.