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

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.

Correlation between sperm morphology using strict criteria in original semen and swim-up inseminate and human in vitro fertilization

To study the value of sperm morphology using strict criteria in raw semen and in swim-up inseminate of human in vitro fertilization (IVF), 135 cycles of IVF with normal sperm concentration and motility were recruited. At least two mature oocytes were recovered in each cycle. The correlation between the percentages of normal forms and fertilization rates of mature oocytes was analyzed. The results demonstrate that the percentage of normal forms in both the raw semen and swim-up sample of patients with poor fertilization was significantly lower than in those with acceptable fertilization. The percentages of normal forms both in raw semen and in swim-up sample were significantly correlated with fertilization rates in vitro, however, the former seemed to have a better correlation (r = .51 and .19, respectively). Regarding the percentages of normal forms in raw semen, the fertilization rate in patients with normal forms < 4% was 6 +/- 11%, for 4-14% it was 58 +/- 36%, and for > 14% it was 88 +/- 20%. The fertilization rates were significantly different among these three groups of patients. The evaluation of sperm morphology using strict criteria in raw semen before IVF is predictive of fertilization outcome and may also help doctors to choose an optimal method of treatment for patients.

Derivatives of 2-nitrofluorene cause changes of human sperm motility

The effects on human sperm motility characteristics of 2-nitrofluorene and selected derivatives were studied in vitro, using computer aided sperm analysis (Cellsoft). Substances to be tested were dissolved in acetone and added to separated spermatozoa in culture media to final concentrations of 100 and 1000 microM. Aliquots were removed immediately (< 5 min.) and 24 hr after the addition and tested for sperm motility characteristics. Four of the substances tested; 2,4,7-trinitrofluoren-9-one (2,4,7-tNFO), 2,5-diaminofluorene (2,5-dAF), 7-hydroxy-2-nitrofluorene (7-OH-NF) and 2,7-diaminofluorene (2,7-dAF) showed strong detrimental effects on the sperm motility. Slight detrimental effects were also recorded using 2-nitrofluorene and 2,5-dinitrofluorene (2,5-dNF). Weak stimulatory effects were obtained using 2-acetoamidofluorene (AAF) and 2,7-dinitrofluorene (2,7-dNF). No significant effects were seen with 5-hydroxy-2-nitrofluorene (5-OH-NF), 2-aminofluorene (AF), 2-aminofluoren-9-one (AFO), 2-amino-9-hydroxyfluorene (9-OH-AF) or 9-hydroxy-2-nitrofluorene (9-OH-NF). The mechanism behind this effect is not known but it could be speculated that these lipophilic substances interact with the membranes or the cellular respiration.

Factors affecting sperm yield during swim-up

PURPOSE

The migration of sperm (expressed as the percentage of the total motile cells in the ejaculate aliquot) from seminal plasma into overlying medium (swim-up) was increased with time, temperature, and increasing the surface area of contact between the two phases by increasing the angle of tube inclination.

RESULTS

The proportion of sperm migrating into the medium was relatively constant with varying sperm count. Stimulation of the progressive motility of spermatozoa in vitro using a motility enhancing drug (2-deoxyadenosine) increased sperm migration initially but no more than the maximum reached by controls after extended incubation.

CONCLUSION

Sperm yield from normozoospermic men and men with borderline asthenoteratozoospermia represented approximately 40 and 15% of the total motile cells in the ejaculate aliquots, respectively. In general, in both groups spermatozoa in the swim-up fraction exhibited superior motility, vitality, and morphology compared to the original ejaculates. Tail abnormalities were reduced more than head abnormalities and subjects with borderline sperm qualities exhibited less dramatic improvements in quality than the normozoospermic individuals.