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Volume 19, Issue 1 (January 2017) 19, 39–42; DOI:10.4103/1008-682X.189211

Men with a complete absence of normal sperm morphology exhibit high rates of success without assisted reproduction

Jason R Kovac1, Ryan P Smith2, Miguel Cajipe1, Dolores J Lamb1, Larry I Lipshultz1

1 Center of Reproductive Medicine and the Department of Molecular and Cellular Biology, Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
2 Department of Urology, University of Virginia, Charlottesville, VA, USA

Correspondence: Dr. RP Smith (rps2k@virginia.edu)

Date of Submission 07-May-2016 Date of Decision 15-Jun-2016 Date of Acceptance 11-Aug-2016 Date of Web Publication 30-Sep-2016


In couples with infertility, abnormal strict morphology of 0% normal forms (NF) is a criterion to proceed rapidly to in vitro fertilization (IVF). Since no data currently exist, we investigated the outcomes for men with 0% NF to determine reproductive success without the use of assisted reproductive technologies (ART). A cohort of 24 men with 0% NF were identified (2010-2013) with 27 randomly selected men with ≥4% NF as controls. Patient charts were reviewed with men contacted and administered an Institutional Review Board (IRB)-approved telephone questionnaire to ascertain outcomes. After a median follow-up time of 2.5 years, 29.2% of men with 0% NF did not require ART for their first pregnancy (controls = 55.6%, P ≤ 0.05). When all pregnancies were analyzed together, men with 0% NF achieved twenty pregnancies of which 75% did not require IVF (controls = thirty pregnancies; 76.7% did not require IVF). The average age of men and female partners was similar between men with 0% NF and ≥4% NF. All men had normal follicle-stimulating hormone (FSH), testosterone, prolactin, sex hormone-binding globulin (SHBG), and estradiol. Although, global semen parameters were worse in men with 0% NF, when a first pregnancy was a natural conception (NC), 100% of men with 0% NF (n = 7/7) and 37.5% of controls (n = 3/8) went on to have a subsequent pregnancy via NC. Men with 0% NF conceived without IVF in 29.2% of cases compared to 55.6% of controls. Strict morphology should not be used to predict fertilization, pregnancy, or live birth potential. In men with 0% NF, alternative modalities should be considered before immediate IVF.

Keywords: conception; infertility; intrauterine insemination; in vitro fertilization; strict morphology; success

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