Is semen analysis without strict criteria misleading decisions in IVF ? A prospective systematic study

Background: Sperm morphology has been strongly linked to fertilization. This makes it an important component in semen analysis. They are usually assessed by world health organization (WHO) standard or Kruger strict criteria in in-vitro fertilization (IVF) centers all over the world. Sperm count, motility, and morphology together form the basis by which patients are allocated into IVF or intra-cytoplasmic sperm injection. Objective: This study aimed to compare fertilization rates in standard IVF from patients with normal sperm count and motility with and without morphological assessment by WHO guideline. Materials and Methods: In this prospective cohort study, sperm count, motility, and morphology of 504 men candidate for IVF program over a three years period in our center were evaluated in two groups: Group A (case group) included men with normal sperm count and motility but with a poor morphology and group B (control group) included men with normal sperm count, motility and morphology evaluated by WHO criteria. Fertilization rate in both groups were then analyzed after 16-18 hr post insemination. Results: Fertilization rate was higher in group B (p=0.028). Participants in group B, apart from having a normal sperm count (32.9±7.2) and motility (62.4±8.9), have a strict morphology of ≥30%. Our result has shown that spermatozoa in group B had a higher fertilization rate (71.4%). Though the sperm count (36.4±6.7) and motility (66.3±7.4) in group A were slightly higher (p=0.058 and p=0.060 respectively) than group B, the fertilization rate was lower. Conclusion: Our study showed that sperm morphology could be a very important consideration before decisions towards allocation of patients into IVF or intracytoplasmic sperm injection