[The impact of sperm morphology analysis on IVF results]

Analysis of sperm factors correlates rather poorly with results and there is a considerable overlap between fertility and infertility. The threshold values for normal sperm morphology have changed, falling from 80% in 1951 to around 14% today. Using a threshold value of 10% normal sperm in the ejaculate, we find a high fertilisation rate and no reduction in pregnancy rate when performing conventional IVF in our department. Only a small group of these patients actually have such a low fertilisation rate that ICSI is required. Morphology analysis, even with training, is difficult, and using current morphology methods to establish the type of treatment to offer leads to an unnecessarily large number of ICSI being performed. It has to be remembered that ICSI is more invasive, more time-consuming and more expensive than conventional IVF. We have conducted a prospective, one year study of not analysing morphology before treatment. If the sperm sample appears normal overall and there are more than one million motile spermatozoa after swim-up preparation, we perform conventional IVF. We included a total of 369 cycles. The overall fertilisation failure rate was 4% and the proportion of ICSI fell from 61% to 48% after this work. As a result of this, we now no longer analyse sperm morphology, and we perform conventional IVF in the 1(st) cycle when we have normal sperm values and more than one million motile spermatozoa after swim-up. We thereby perform 150 fewer ICSI treatments per year.