Skip to main content Accessibility help
  • Print publication year: 2009
  • Online publication date: May 2010

Chapter 34 - Strict criteria for sperm morphology


Vasectomy is typically performed as an outpatient procedure using local anesthetics. The technique employed for occlusion of the vasal lumina may influence the incidence of recanalization. Suture ligature, still the common method employed worldwide, may result in necrosis and sloughing of the cut end distal to the ligature. Hematoma is the common complication of vasectomy, with an average incidence of 2%. Sperm granulomas form when sperm leak from the testicular end of the vas. Sperm are highly antigenic, and an intense inflammatory reaction occurs when sperm escape outside the reproductive epithelium. The concept of male hormonal manipulation for contraception predated the era of female hormonal contraception by 20 years. Progestins have been used in multiple small studies for suppression of spermatogenesis and testosterone production in men. Along with hormonal manipulation, immunocontraception appears to offer reasonable hope for a nonsurgical contraceptive option in men.


[1] KrugerTF, MenkveldR, StanderFSH, et al. Sperm morphologic features as a prognostic factor in in vitro fertilization. Fertil Steril 1986; 46: 1118–23.
[2] DonnellyET, LewisSEM, McNallyJA, ThompsonW. In vitro fertilization and pregnancy rates: the influence of sperm motility and morphology on IVF outcome. Fertil Steril 1998; 70: 305–14.
[3] SallamHN, EzzeldinF, SallamA, AgameyaAF, FarragA. Sperm velocity and morphology, female characteristics and the hypo-osmotic swelling test as predictors of fertilization potential: experience from the IVF model. Int J Fertil Women’s Med 2003; 48: 88–95.
[4] BastianHS, WindtML, MenkveldR, et al. Relationship between zona pellucida-induced acrosome reaction, sperm morphology, sperm–zona pellucida binding and in vitro fertilization. Fertil Steril 2003; 79: 49–55.
[5] RafaelliRJ, SpaineDMG, CedenhoAP, SrougiM. The relationship between morphology of human spermatozoa and hemizona assay. Braz J Urol 2001; 27: 255–61.
[6] Eggert-KruseW, Reimann-AndersonJ, RohrG, et al. Clinical relevance of sperm morphology assessment using strict criteria and relationship with sperm–mucus interaction in vivo and in vitro. Fertil Steril 1995; 63: 612–24.
[7] AzizN, AgarwalA, Lewis-JonesI, SharmaRK, ThomasAJ. Novel associations between specific sperm morphological defects and leukocytospermia. Fertil Steril 2004; 82: 621–7.
[8] GuzickDS, OverstreetJW, Factor-LitvakP, et al. Sperm morphology, motility, and concentration in fertile and infertile men. N Engl J Med 2001; 345: 1388–93.
[9] NallellaKP, SharmaRK, AzizN, AgarwalA. Significance of sperm characteristics in the evaluation of male infertility. Fertil Steril 2006; 85: 629–34.
[10] McLeodJ. A testicular response during and following a severe allergic reaction. Fertil Steril 1962; 13: 531–41.
[11] EliassonR. Standards for investigation of human semen. Andrologia 1971; 3: 49–64.
[12] EliassonR. Analysis of semen. In: BehrmanSJ, KistnerRW, eds. Progress in Infertility, II. Boston, MA: Little Brown, 1975: 691–713.
[13] EliassonR. Analysis of semen. In: BurgerH, DeKretserD, eds. The Testis. New York, NY: Raven Press, 1981: 381–99.
[14] EliassonR. Basic semen analysis. In: MatsonP, ed. Current Topics in Andrology. Perth: Ladybrook, 2003: 35–89.
[15] AdelmanMM, CahillEM, eds. Atlas of Sperm Morphology. Chicago, IL: ASCP Press, 1989.
[16] World Health Organization. WHO Laboratory Manual for the Examination of Human Semen and Semen–Cervical Mucus Interaction, 2nd edn. Cambridge: Cambridge University Press, 1987.
[17] World Health Organization. WHO Laboratory Manual for the Examination of Human Semen and Sperm–Cervical Mucus Interaction, 3rd edn. Cambridge: Cambridge University Press, 1992.
[18] World Health Organization. WHO Laboratory Manual for the Examination of Human Semen and Sperm–Cervical Mucus Interactions, 4th edn. Cambridge: Cambridge University Press, 1999.
[19] KrugerTF, AcostaAA, SimmonsKF, et al. Predictive value of abnormal sperm morphology in in vitro fertilization. Fertil Steril 1988; 49: 112–17.
[20] KeelBA, StembridgeTW, PinedaG, SerafyNT. Lack of standardization in performance of the semen analysis among laboratories in the United States. Fertil Steril 2002; 78: 603–8.
[21] KeelBA. How reliable are results from the semen analysis? Fertil Steril 2004; 82: 41–4.
[22] KeelBA, QuinnP, SchmidtCF, et al. Results of the American Association of Bioanalysts national proficiency testing programme in andrology. Hum Reprod 2000; 15: 680–6.
[23] MortimerD, MenkveldR. Sperm morphology assessment: historical perspectives and current opinions. J Androl 2001; 22: 192–205.
[24] OmbeletW, PolletH, BosmansE, VereeckenA. Results of a questionnaire on sperm morphology assessment. Hum Reprod 1997; 12: 1015–20.
[25] MacLeodJ, GoldRZ. The male factor in fertility and infertility. IV. Sperm morphology in fertile and infertile marriage. Fertil Steril 1951; 2: 394–414.
[26] MacLeodJ. The basis and clinical significance of deviations in human cytology. In: MoghissiKS, HafezESE, eds. Biology of Mammalian Fertilization and Implantation. Springfield, IL: Charles C. Thomas, 1972: 139–52.
[27] HellingaG. Clinical Andrology. London: Heinemann, 1976.
[28] JeyendranRS, ZaneveldLjd. Semen analysis: the method and interpretation. In: SciarraJJ, ed. Gynecology and Obstetrics. Philadelphia, PA: Lippincott, 1993; 5: 1–15.
[29] IssidoridesMR. Observations in chronic hashish users: nuclear aberrations in blood and sperm and abnormal acrosomes in spermatozoa. Adv Biosci 1978; 22–23: 377–88.
[30] BrunB, ClavertA. Morphologic acrosomal malformation in man exposed to heat. J Gynecol Obstet Biol Reprod (Paris) 1977; 6: 907–11.
[31] MenkveldR, StanderFSH, KotzeTJ, KrugerTF, van ZylJA. The evaluation of morphological characteristics of human spermatozoa according to stricter criteria. Hum Reprod 1990; 5: 586–92.
[32] MenkveldR, FrankenD, KrugerTF, OehningerS, HodgenGD. Sperm selection capacity of the human zona pellucida. Mol Reprod Devel 1991; 30: 346–52.
[33] LiuDY, BakerHwg. Morphology of spermatozoa bound to the zona pellucida of human oocytes that failed to fertilize in vitro. J Reprod Fertil 1992; 94: 71–84.
[34] LiuDY, BakerHwg. Acrosome status and morphology of human spermatozoa bound to the zona pellucida and oolemma determined using occytes that failed to fertilize in vitro. Hum Reprod 1994; 9: 673–9.
[35] GarrettC, LiuDY, BakerHwg. Selectivity of the human sperm–zona pellucida binding process to sperm head morphometry. Fertil Steril 1997; 67: 362–71.
[36] OehningerS, AcostaAA, MorshediM, et al. Corrective measures and pregnancy outcome in in-vitro fertilization in patients with severe sperm morphology abnormalities. Fertil Steril 1988; 50: 283–7.
[37] Van ZylJA, KotzeTJ, MenkveldR. Predictive value of spermatozoa morphology in natural fertilization. In: AcostaAA, SwansonRJ, AckermanSB, et al., eds. Human Spermatozoa in Assisted Reproduction. Baltimore, MD: Williams & Wilkins, 1990.
[38] EnginsuME, DumoulinJCM, PietersMhec, et al. Evaluation of human sperm morphology using strict criteria after Diff-Quik staining: correlation of morphology with fertilization in vitro. Hum Reprod 1991; 6: 854–8.
[39] EnginsuME, DumoulinJCM, PietersMhec, EversJLH, GeraedtsJPM. Predictive value of morphologically normal sperm concentration in the medium for in vitro fertilization. Int J Androl 1993; 16: 113–20.
[40] EnginsuME, PietersMhec, DumoulinJCM, EversJLH, GeraedtsJpm. Male factor as determinant of in vitro fertilization outcome Hum Reprod 1992; 7: 1136–40.
[41] GrowDR, OehningerS, SeltmanHJ, et al. Sperm morphology as diagnosed by strict criteria: probing the impact of teratozoospermia on fertilization rate and pregnancy outcome in a large in vitro fertilization population Fertil Steril 1994; 62: 559–67.
[42] OmbeletW, FourieFL, VandeputH, et al. Teratozoospermia and in-vitro fertilization: a randomized prospective study. Hum Reprod 1994; 9: 1479–84.
[43] YangYS, ChenSU, HoHN, et al. Correlation between sperm morphology using strict criteria in original semen and swim-up inseminate and human in vitro fertilization. Arch Androl 1995; 34: 105–13.
[44] VawdaAI, GunbyJ, YouglaiEV. Semen parameters as predictors of in-vitro fertilization: The importance of strict criteria sperm morphology. Hum Reprod 1996; 11: 1445–50.
[45] OehningerS, KrugerTF, SimonT, et al. A comparative analysis of embryo implantation potential in patients with severe teratozoospermia undergoing in-vitro fertilization with a high insemination concentration or intracytoplasmic sperm injection. Hum Reprod 1996; 11: 1086–9.
[46] CoetzeeK, KrugerTF, LombardCJ. Predictive value of normal sperm morphology: a structured literature review. Hum Reprod Update 1998; 4: 73–82.
[47] SalumetsA, SuikkariAM, MolsT, Soderstrom-AnttilaV, TuuriT. Influence of oocytes and spermatozoa on early embryonic development. Fertil Steril 2002; 78: 1082–7.
[48] MorgentalerA, FungMY, HarrisDH, PowersRD, AlperMM. Sperm morphology and in vitro fertilization outcome: a direct comparison of World Health Organization and strict criteria methodologies. Fertil Steril 1995; 64: 1177–82.
[49] LundinK, SoderlundB, HambergerL. The relationship between sperm morphology and rates of fertilization, pregnancy and spontaneous abortion in an in-vitro fertilization/intracytoplasmic sperm injection programme. Hum Reprod 1997; 12: 2676–81.
[50] HostE, ErnstE, LindenbergS, Smidt-JensenS. Morphology of spermatozoa used in IVF and ICSI from oligozoospermic men. Reprod Biomed Online 2001; 3: 212–15.
[51] MahutteNG, AriciA. Failed fertilization: is it predictable? Curr Opin Obstet Gynecol 2003; 15: 211–18.
[52] EmeryBR, ThorpC, MaloJW, CarrellDT. Pregnancy from intracytoplasmic sperm injection of a sperm head and detached tail. Fertil Steril 2004; 81: 686–8.
[53] SvalanderP, JakobssonAH, ForsbergAS, BengtssonAC, WiklandM. The outcome of intracytoplasmic sperm injection in unrelated to “strict criteria” sperm morphology. Hum Reprod 1996; 11: 1019–22.
[54] TonerJP, MossadH, GrowDR, et al. Value of sperm morphology assessed by strict criteria for prediction of the outcome of artificial (intrauterine) insemination. Andrologia 1995; 27: 143–8.
[55] OmbeletW, DeblaereK, BosmansE, et al. Semen quality and intrauterine insemination. Reprod Biomed Online 2003; 7: 485–92.
[56] LindheimSR, BaradDH, ZingerM, et al. Abnormal sperm morphology is highly predictive of pregnancy outcome during controlled ovarian hyperstimulation and intrauterine insemination. J Assist Reprod Genet 1996; 13: 569–72.
[57] HauserR, YogevL, BotchanA, et al. Intrauterine insemination in male factor subfertility: Significance of sperm motility and morphology assessed by strict criteria. Andrologia 2001; 33: 13–17.
[58] Van WaartJ, KrugerTF, LombardCJ, OmbeletW. Predictive value of normal sperm morphology in intrauterine insemination (IUI): a structured literature review. Hum Reprod Update 2001; 7: 495–500.
[59] LeeRK, HouJW, HoHY, et al. Sperm morphology analysis using strict criteria as a prognostic factor in intrauterine insemination. Int J Androl 2002; 5: 277–80.
[60] SpiessensC, VanderschuerenD, MeulemanC, D’HoogheT. Isolated teratozoospermia and intrauterine insemination. Fertil Steril 2003; 80: 1185–9.
[61] CheckJH, AdelsonHG, SchubertBR, BollendorfA. Evaluation of sperm morphology using Kruger’s strict criteria. Arch Androl 1992; 28: 15–17.
[62] MatorrasR, CorcosteguiB, PerezC, et al. Sperm morphology analysis (strict criteria) in male infertility is not a prognostic factor in intrauterine insemination with husband’s sperm. Fertil Steril 1995; 63: 608–11.
[63] KarabinusDS, GeletyTJ. The impact of sperm morphology evaluated by strict criteria on intrauterine insemination success. Fertil Steril 1997; 67: 536–41.
[64] CheckML, BollendorfA, CheckJH, KatsoffD. Reevaluation of the clinical importance of evaluation sperm morphology using strict criteria. Arch Androl 2002; 48: 1–3.
[65] JeyendranRS, Van der VenHH, KennedyWP, et al. Acrosomeless sperm: a cause of primary male infertility. Andrologia 1985; 17: 31–6.
[66] Celik-OzencilC, JakabA, KovacsT, et al. Sperm selection for ICSI: shape properties do not predict the absence or presence of numerical chromosomal aberrations. Hum Reprod 2004; 19: 2052–9.
[67] RyuHM, LinWW, LambDJ, et al. Increased chromosome X Y 18 nondisjunction in sperm from infertile patients that were identified as normal by strict morphology: implication for intracytoplasmic sperm injection. Fertil Steril 2001; 76: 879–83.
[68] NiederbergerC. Responses to semen analysis CART report. J Androl 2003; 24: 329–31.
[69] KrugerTF, CoetzeeK. The role of sperm morphology in assisted reproduction. Hum Reprod Update 1999; 2: 172–8.
[70] FrankenDR, KrugerTF. Lessons learned from a sperm morphology quality control programme. Andrologia 2006; 38: 225–9.
[71] BouchotO, PrunetD, GaschignardN, BuzelinJM. Surgery of varicocele: results concerning sperm motility and morphology. Prog Urol 1999; 9: 703–6.
[72] KibarY, SeckinB, ErduranD. The effects of subinguinal varicocelectomy on Kruger morphology and semen parameters. J Urol 2002; 168: 1071–4.
[73] BissonJP, DavidG, MagninC. Ultrastructural study of anomalies of the acrosome in spermatozoa with irregular heads. Bull Assoc Anat 1975; 59: 345–56.
[74] CamatiniM, FranchiE, FaleriM. Ultraobstructive azoospermia. Arch Androl 1978; 1: 203–9.
[75] SoderstromKO. An acrosomal abnormality in spermatids from infertile men. Arch Androl 1981; 7: 275–8.
[76] BaccettiB, RenieriT, RosatiF, SelmiMG, CasanovaS. Further observations on the morphogenesis of the round headed human spermatozoa. Andrologia 1977; 9: 255–64.
[77] MeekerJD, Godfrey-BaileyL, HauserR. Relationships between serum hormone levels and semen quality among men from an infertility clinic. J Androl 2007; 28: 397–406.
[78] HuangI, JonesJ, KhorramO. Human seminal plasma nitric oxide: correlation with sperm morphology and testosterone. Med Sci Monit 2006; 12: 103–6.
[79] SchraderSM, TurnerTW, BreitensteinMJ, SimonSD. Longitudinal study of semen quality of unexposed workers. I. Study overview. Reprod Toxicol 1988; 2: 183–90.
[80] MacLeodJ. Human seminal cytology as a sensitive indicator of the germinal epithelium. Int J Fertil 1964; 9: 281–95.