DOES ISOLATED TERATOZOOSPERMIA AFFECT PERFORMANCE IN IN-VITRO FERTILIZATION AND EMBRYO-TRANSFER

The effect of the strict classification of spermatozoal morphology on the outcome of in-vitro fertilization and embryo transfer treatment cy cles has been assessed in a retrospective analysis of 2144 consecutive cycles. The patients all had a standardized long protocol gonadotroph in-releasing hormone analogue cycle, with luteal phase start, to achie ve down-regulation. All treatment cycles where the sperm density was a bnormal (< 20 x 10(6)/ml), or where progressive motility was abnormal (< 40%), were excluded. The study excluded treatment cycles where the oocytes inseminated did not include at least one grade 1 or grade 2 oo cyte. The percentage of couples achieving the normalized results of th e clinic, including median fertilization rate per patient, inseminatio n rates, numbers of embryos transferred, rates of 'spare embryo' blast ocyst formation, cumulative pregnancy rates and pregnancy outcome, wer e calculated. No statistically significant difference arose between th e two groups of patients with regard to the percentage of patients ach ieving the normalized median fertilization rate or higher (group 1 wit h > 14% normal forms, and group 2 with greater than or equal to 4%, le ss than or equal to 14% normal forms). There was a statistically signi ficantly lower chance of achieving this rate in patients of group 3 (< 4% normal forms) (P < 0.005), but 68.6% did achieve that fertilizatio n rate or higher. There was no statistically significant difference in any of the other end points. In conclusion, a morphological classific ation may be appropriate as an indicator for counselling patients with regard to treatment expectations, but its use would be seem inappropr iate as an index of fertilizing potential in clinical management. The majority of patients achieved the normalized median fertilization rate even with group 3 morphology as long as sperm concentration and motil ity were within the normal range.