Reevaluation of the clinical importance of evaluating sperm morphology using strict criteria.

Several studies suggest that sperm with < or =4% normal morphology (NM) using strict criteria are subfertile and IVF with ICSI may be needed. However, not all studies agree on the clinical importance of the use of NM with strict criteria. One study of males with oligozoospermia found a lower pregnancy rate (PR) following intercourse with sperm with NM > 14% compared to specimen with < or = 4%. The study presented herein evaluated the efficacy of intrauterine insemination (IUI) according to NM using strict criteria. The clinical PRs for first IUI cycles were 30% (28/91 ) for 0-4% normal forms, 26% (71/268) for range of 5-14%, and 20% (11/53) for >14%. This study corroborates previous data with intercourse only, suggesting that sperm with NM < or =4%, using strict criteria are not necessarily associated with lower fecundity.