Morphology does matter: The influence of sperm pathology on ICSI outcome

RAWE V; CHEMES H.E.

Advances in Fertility Studies and Reproductive Medicine

Juta & Co Ltd

Lugar: Cape Town; Año: 2007; p. 293 - 301

Sperm pathology used jointly with classical sperm morphology (in particular the strict criteria) allows a clear appreciation of the cellular structures affected in spermatozoa with abnormal shapes and facilitates a rational approach when patients with high proportions of abnormal spermatozoa are subjected to ART. Based on ultramorphological definitions of spermatozoa, methods for individual selection of living sperm cells have been reported.  The ´motile sperm organellar morphology examination´ (MSOME), was recently developed by Bartoov et al. (2003) using techniques that magnify the image of individual spermatozoon up to 6000 times through high-power light microscopy. This technique allow to identify spermatozoa with severe nuclear abnormalities and select normal cells for injection. Normal spermatozoa display smooth, symmetric, oval heads with a homogeneous chromatin (any extrusion or invagination of the nuclear mass is defined as a malformation). In 2005, Berkovitz et al., compared microinjection of the ‘best’ and the ‘second best’ spermatozoa with ICSI outcomes. Microinjection of spermatozoa with morphologically normal nuclei (“best”) gave significantly better results than those obtained with ‘second best’ sperm cells (in cases where normal sperm cells were not available). Although a confirmation of these results by other investigators is still lacking, the concept of strict gamete selection seems to be the latest tendency before performing ICSI. The introduction of ICSI has revolutionized the field of reproductive medicine. Beyond its obvious advantages for men with severe male factor infertility, it has created new concerns on the ethical and social role of therapeutic interventions. When injecting morphologically abnormal spermatozoa, special attention has to be paid to the possible genetic alterations in spermatozoa, which theoretically could have long term consequences for the offspring.