SPERM MORPHOLOGY ASSESSMENT - HISTORICAL REVIEW IN RELATION TO FERTILITY

Careful analysis of sperm morphology has always been an important part of a routine semen examination, However, the usefulness of sperm morp hology assessment as a predictor of a man's fertilizing potential has often been challenged due to different classification systems, various slide preparation techniques and inconsistency of analyses within and between laboratories, Automated sperm morphology analysis instruments may overcome the subjective nature of visual assessments of sperm mor phology, but the technical problems are numerous and the validity of t hese instruments has still to be proven, Having reviewed the literatur e, it seems clear that there is general agreement concerning the clini cal relevance and predictive value of this single semen parameter bl v ivo and in vitro, Nevertheless, even in cases of severe teratozoosperm ia, fertilization may be possible, Studies on the acrosome reaction ar e very promising for patients with severe sperm morphology abnormaliti es that do not have major effects on the fertilizing potential, Most p romising is the development of intracytoplasmic sperm injection (ICSI) as the treatment of first choice in cases of severe teratozoospermia with failed fertilization in vitro, Normal fertilization and pregnancy rates can be obtained with ICSI in the presence of extreme teratozoos permia, suggesting that sperm morphology may be important in spermatoz oa-zona binding, penetration and spermatozoon-oocyte fusion but fails to be of any predictive value once the spermatozoon reaches the cytopl asm of the oocyte, To conclude, accurate and strict sperm morphology a ssessment is very useful in evaluating a patient's fertilizing potenti al, with the main advantage that the methods used to examine this para meter are easy to learn on equipment found in most laboratories.