Sperm morphology: Evaluating its clinical relevance in contemporary fertility practice

The World Health Organization (WHO) recommends reporting sperm morphology in a standard semen analysis. However, the clinical utility and prognostic value of morphology is often debated.

We reviewed and summarized studies that assessed both the benefits and limitations of sperm morphology in the context of natural fertility, assisted reproductive technologies, and recurrent pregnancy loss. We additionally describe possible environmental and anatomical etiologies of teratozoospermia.

Sperm morphology evaluation has continuously evolved since the release of the first WHO manual in 1980. Initially, several large studies reported significant inverse associations between fertility outcomes and teratozoospermia. Most recent studies, however, fail to show an association between sperm morphology and natural or assisted fertility outcomes.

Sperm morphology analysis may have limited diagnostic and prognostic value. Providers should be aware of these limitations when counseling or managing infertile patients.