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 meth odologies with regard to IVF outcome. Design: Blinded comparison of tw o methods of morphology assessment using the same morphology slides. P atients: Data were obtained from 132 couples in a consecutive series o f patients undergoing IVF. Main Outcome Measures: Two practical end po ints were selected for analysis for each couple: the presence of any f ertilization and the number of fertilized eggs. Normal traditional mor phology was defined as greater than or equal to 40% normal forms in a sample and normal strict criteria was defined as greater than or equal to 4%. Results: Traditional morphology demonstrated a higher sensitiv ity and negative predictive value than strict criteria (87% versus 61% , and 68% versus 36%, respectively). Positive predictive value and spe cificity were also numerically greater but did not reach statistical s ignificance. Abnormal traditional morphology, but not strict criteria, was associated with reduced fertilization even among samples with nor mal sperm concentration and motility. Samples with normal morphology w ere associated with a greater number of fertilized eggs per couple tha n those with abnormal morphology: this difference was 3.2 fertilized e ggs for traditional morphology and 1.6 for strict criteria. Overall, f or samples with <40% by traditional morphology only one case yielded m ore than two fertilized eggs. In contrast, up to five fertilized eggs were noted for the lowest strict criteria scores. Conclusions: Compari son of traditional morphology and strict criteria with regard to IVF o utcome favored traditional morphology in several areas. In particular, low scores were more predictive of poor IVF outcome.