IVF or ICSI Selection Stratified by Sperm Head Morphology

To assess the suitability of intracytoplasmic sperm injection (ICSI) and in vitro fertilization (IVF) for infertile couples with teratozoospermia primarily caused by sperm head abnormalities.

A retrospective analysis was conducted on 856 infertile couples with teratozoospermia. Patients were stratified into four groups by sperm head malformation type and severity: head acrosome malformation < 95%/> 97%, and head shape malformation < 95%/> 97%. Key outcomes (fertilization rate, 2PN fertilization/cleavage rates, blastocyst formation/high-quality blastocyst rates, pregnancy/live birth rates) were compared across groups.

In the head shape malformation < 95% subgroup, IVF had higher fertilization and blastocyst formation rates. IVF also achieved a significantly higher fertilization rate in the head acrosome malformation < 95% subgroup (p < 0.05). ICSI yielded a higher proportion of high-quality blastocysts in the head acrosome malformation > 97% subgroup. No significant differences in 2PN fertilization/cleavage rates, pregnancy rates, or live birth rates were observed between IVF and ICSI across all subgroups (p > 0.05).

IVF is preferred for sperm head abnormality rate < 95% to enhance fertilization efficiency, while ICSI is advisable for acrosome malformation > 97% to improve high-quality embryo yield, providing evidence-based guidance for individualized assisted reproductive technology (ART) selection.