Assessment of Sperm Morphometry in Evaluating Male Infertility

Ramadan S. Hussein; Essam-Eldeen M. Mohamed; Refaat R Mohamed, Walid Kamal Abdelbasset, Wessam Ezzat Morsy, Shereen H. Elsayed

For citation: Hussein RS, Mohamed EEM, Mohamed RR, Abdelbasset WK, Morsy WE, Elsayed SH. Assessment of Sperm Morphometry in Evaluating Male Infertility. International Journal of Biomedicine. 2024;14(1):93-98. doi:10.21103/Article14(1)_ OA14
Originally published March 1, 2024


Background: Infertility is a complex issue affecting 15% of couples of reproductive age, with men accounting for 40%-50% of infertility cases. Semen analysis comprises various descriptive measures of sperm and seminal fluid to determine semen quality. Transforming qualitative descriptions of sperm deformities and shape changes into quantitative terms can aid in identifying sub-visual abnormalities. This study aimed to evaluate sperm morphometry parameters in both infertile and fertile men.
Methods and Results: The study enrolled a total of 101 participants, divided into three groups: Group A included 38 subfertile patients with varicocele, Group B included 33 patients with idiopathic infertility (23 with asthenozoospermia and 10 with oligozoospermia), and Group C (the control group) included 30 healthy fertile men. The mean age of patients was 31.6±5.81, 31.3±6.0, and 29.47±4.27 years in Groups A, B, and C, respectively. Scrotal duplex examinations were performed to identify the presence of varicocele. Semen samples were collected following WHO Manual (2010). Semen dynamic and morphological analyses were conducted using CASA (Computer-Assisted Semen Analysis, MIRALAB, ISO9001, ISO13485).
We found that sperm concentration, total sperm count, sperm progressive motility, and sperm progressive+non-progressive motility were significantly lower in Group A and Group B than in Group C (P=0.000 in all cases); however, there were no differences between Group A and Group B regarding these parameters (Table 5). The sperm morphology index was significantly lower in Group A than in Group C (P=0.0024); no differences were found between Group B and Group C and Group B and Group A. The mean value of the sperm deformity index was significantly lower in Group A than in Group C P=0.004).
Conclusion: Our study highlights the significant association between sperm morphology and male infertility in varicocele and idiopathic subfertile males.

infertility • semen quality • varicocele
  1. Zegers-Hochschild F, Adamson GD, de Mouzon J, Ishihara O, Mansour R, Nygren K, Sullivan E, van der Poel S; International Committee for Monitoring Assisted Reproductive Technology; World Health Organization. The International Committee for Monitoring Assisted Reproductive Technology (ICMART) and the World Health Organization (WHO) Revised Glossary on ART Terminology, 2009. Hum Reprod. 2009 Nov;24(11):2683-7. doi: 10.1093/humrep/dep343. 
  2. Speroff L, Glass RH, Kase NG. Clinical Gynecologic Endocrinology and Infertility. 6th Edition, Lippincott Williams & Wilkins, Philadelphia; 1999.
  3. Lotti F, Maggi M. Sexual dysfunction and male infertility. Nat Rev Urol. 2018 May;15(5):287-307. doi: 10.1038/nrurol.2018.20. 
  4. Skoracka K, Eder P, Łykowska-Szuber L, Dobrowolska A, Krela-Kaźmierczak I. Diet and Nutritional Factors in Male (In)fertility-Underestimated Factors. J Clin Med. 2020 May 9;9(5):1400. doi: 10.3390/jcm9051400. 
  5. Zhang X, Zhang J, Cai Z, Wang X, Lu W, Li H. Effect of unilateral testicular torsion at different ages on male fertility. J Int Med Res. 2020 Apr;48(4):300060520918792. doi: 10.1177/0300060520918792.
  6. Hallast P, Kibena L, Punab M, Arciero E, Rootsi S, Grigorova M, Flores R, Jobling MA, Poolamets O, Pomm K, Korrovits P, Rull K, Xue Y, Tyler-Smith C, Laan M. A common 1.6 mb Y-chromosomal inversion predisposes to subsequent deletions and severe spermatogenic failure in humans. Elife. 2021 Mar 30;10:e65420. doi: 10.7554/eLife.65420. 
  7. Turner KA, Rambhatla A, Schon S, Agarwal A, Krawetz SA, Dupree JM, Avidor-Reiss T. Male Infertility is a Women's Health Issue-Research and Clinical Evaluation of Male Infertility Is Needed. Cells. 2020 Apr 16;9(4):990. doi: 10.3390/cells9040990.
  8. Gorelick JI, Goldstein M. Loss of fertility in men with varicocele. Fertil Steril. 1993 Mar;59(3):613-6. 
  9. Naughton CK, Nangia AK, Agarwal A. Varicocele and male infertility: P:art II - Pathophysiology of varicocele in male infertility. Hum Reprod Update. 2001;7(5):473-481.
  10. Chan CC, Sun GH, Shui HA, Wu GJ. Differential spermatozoal protein expression profiles in men with varicocele compared to control subjects: upregulation of heat shock proteins 70 and 90 in varicocele. Urology. 2013 Jun;81(6):1379.e1-8. doi: 10.1016/j.urology.2013.01.031. 
  11. Samplaski MK, Agarwal A, Sharma R, Sabanegh E. New generation of diagnostic tests for infertility: review of specialized semen tests. Int J Urol. 2010 Oct;17(10):839-47. doi: 10.1111/j.1442-2042.2010.02619.x. Erratum in: Int J Urol. 2011 Mar;18(3):262.
  12. World Health Organization. WHO Laboratory Manual for the examination of human semen and semen-cervical mucus interaction. Fourth edition. Cambridge, UK: Cambridge University Press; 1999.
  13. Kruger TF, Lacquet FA, Sarmiento CA, Menkveld R, Ozgür K, Lombard CJ, Franken DR. A prospective study on the predictive value of normal sperm morphology as evaluated by computer (IVOS). Fertil Steril. 1996 Aug;66(2):285-91. doi: 10.1016/s0015-0282(16)58455-6. 
  14. Hidalgo M, Rodríguez I, Dorado J. Influence of staining and sampling procedures on goat sperm morphometry using the Sperm Class Analyzer. Theriogenology. 2006 Sep 1;66(4):996-1003. doi: 10.1016/j.theriogenology.2006.02.039. 
  15. Filimberti E, Degl'Innocenti S, Borsotti M, Quercioli M, Piomboni P, Natali I, Fino MG, Caglieresi C, Criscuoli L, Gandini L, Biggeri A, Maggi M, Baldi E. High variability in results of semen analysis in andrology laboratories in Tuscany (Italy): the experience of an external quality control (EQC) programme. Andrology. 2013 May;1(3):401-7. doi: 10.1111/j.2047-2927.2012.00042.x. 
  16. Verstegen J, Iguer-Ouada M, Onclin K. Computer assisted semen analyzers in andrology research and veterinary practice. Theriogenology. 2002 Jan 1;57(1):149-79. doi: 10.1016/s0093-691x(01)00664-1.
  17. Yániz JL, Capistrós S, Vicente-Fiel S, Soler C, Nuñez de Murga J, Santolaria P. Study of nuclear and acrosomal sperm morphometry in ram using a computer-assisted sperm morphometry analysis fluorescence (CASMA-F) method. Theriogenology. 2014 Oct 1;82(6):921-4. doi: 10.1016/j.theriogenology.2014.06.017. 
  18. Yániz JL, Vicente-Fiel S, Capistrós S, Palacín I, Santolaria P. Automatic evaluation of ram sperm morphometry. Theriogenology. 2012 Apr 15;77(7):1343-50. doi: 10.1016/j.theriogenology.2011.10.039.
  19. Soler C, García-Molina A, Sancho M, Contell J, Núñez M, Cooper TG. A new technique for analysis of human sperm morphology in unstained cells from raw semen. Reprod Fertil Dev. 2016 Mar;28(4):428-33. doi: 10.1071/RD14087. 
  20. Rrumbullaku L, Boci R, Dedja A, Dautaj K. Sperm morphology in infertile men with varicocele. 1st Balkan Symposium of Andrology. Alexandroupolis, Greece; June 12-14, 1998.
  21. Mancini A, Festa R, Raimondo S, Silvestrini A, Giacchi E, Littarru GP, Pontecorvi A, Meucci E. Biochemical alterations in semen of varicocele patients: a review of the literature. Adv Urol. 2012;2012:903931. doi: 10.1155/2012/903931.
  22. Saleh RA, Agarwal A, Sharma RK, Said TM, Sikka SC, Thomas AJ Jr. Evaluation of nuclear DNA damage in spermatozoa from infertile men with varicocele. Fertil Steril. 2003 Dec;80(6):1431-6. doi: 10.1016/s0015-0282(03)02211-8. 
  23. Al-Ali BM, Marszalek M, Shamloul R, Pummer K, Trummer H. Clinical parameters and semen analysis in 716 Austrian patients with varicocele. Urology. 2010 May;75(5):1069-73. doi: 10.1016/j.urology.2009.11.042.
  24. Nallella KP, Sharma RK, Aziz N, Agarwal A. Significance of sperm characteristics in the evaluation of male infertility. Fertil Steril. 2006 Mar;85(3):629-34. doi: 10.1016/j.fertnstert.2005.08.024.
  25. Al-Makhzoomi A, Lundeheim N, Håård M, Rodríguez-Martínez H. Sperm morphology and fertility of progeny-tested AI dairy bulls in Sweden. Theriogenology. 2008 Sep 1;70(4):682-91. doi: 10.1016/j.theriogenology.2008.04.049.
  26. Murphy C, Fahey AG, Shafat A, Fair S. Reducing sperm concentration is critical to limiting the oxidative stress challenge in liquid bull semen. J Dairy Sci. 2013 Jul;96(7):4447-54. doi: 10.3168/jds.2012-6484.
  27. Aziz N, Agarwal A, Nallella KP, Thomas AJ Jr. Relationship between epidemiological features and aetiology of male infertility as diagnosed by a comprehensive infertility service provider. Reprod Biomed Online. 2006 Feb;12(2):209-14. doi: 10.1016/s1472-6483(10)60863-2.
  28. Ahmad L, Jalali S, Shami SA, Akram Z. Sperm preparation: DNA damage by comet assay in normo- and teratozoospermics. Arch Androl. 2007 Nov-Dec;53(6):325-38. doi: 10.1080/01485010701730963.
  29. Pasqualotto FF, Sharma RK, Pasqualotto EB, Agarwal A. Poor semen quality and ROS-TAC scores in patients with idiopathic infertility. Urol Int. 2008;81(3):263-70. doi: 10.1159/000151401. 
  30. Blumer CG, Fariello RM, Restelli AE, Spaine DM, Bertolla RP, Cedenho AP. Sperm nuclear DNA fragmentation and mitochondrial activity in men with varicocele. Fertil Steril. 2008 Nov;90(5):1716-22. doi: 10.1016/j.fertnstert.2007.09.007.
  31. Vivas-Acevedo G, Lozano JR, Camejo MI. Effect of varicocele grade and age on seminal parameters. Urol Int. 2010;85(2):194-9. doi: 10.1159/000314226. 
  32. Saleh RA, Agarwal A. Oxidative stress and male infertility: from research bench to clinical practice. J Androl. 2002 Nov-Dec;23(6):737-52. 
  33. Tawadrous GA, Aziz AA, Mostafa T. Seminal soluble fas relationship with oxidative stress in infertile men with varicocele. Urology. 2013 Oct;82(4):820-3. doi: 10.1016/j.urology.2013.06.018. 
  34. Mostafa T, Rashed L, Nabil N, Amin R. Seminal BAX and BCL2 gene and protein expressions in infertile men with varicocele. Urology. 2014 Sep;84(3):590-5. doi: 10.1016/j.urology.2014.05.016. 
  35. Vivas-Acevedo G, Lozano-Hernández R, Camejo MI. Varicocele decreases epididymal neutral α-glucosidase and is associated with alteration of nuclear DNA and plasma membrane in spermatozoa. BJU Int. 2014 Apr;113(4):642-9. doi: 10.1111/bju.12523.
  36. The influence of varicocele on parameters of fertility in a large group of men presenting to infertility clinics. World Health Organization. Fertil Steril. 1992 Jun;57(6):1289-93. PMID: 1601152.
  37. Marmar JL. The pathophysiology of varicoceles in the light of current molecular and genetic information. Hum Reprod Update. 2001 Sep-Oct;7(5):461-72. doi: 10.1093/humupd/7.5.461. 
  38. Agarwal A, Virk G, Ong C, du Plessis SS. Effect of oxidative stress on male reproduction. World J Mens Health. 2014 Apr;32(1):1-17. doi: 10.5534/wjmh.2014.32.1.1. 
  39. Barratt CL, Mansell S, Beaton C, Tardif S, Oxenham SK. Diagnostic tools in male infertility-the question of sperm dysfunction. Asian J Androl. 2011 Jan;13(1):53-8. doi: 10.1038/aja.2010.63.
  40. Aziz N, Buchan I, Taylor C, Kingsland CR, Lewis-Jones I. The sperm deformity index: a reliable predictor of the outcome of oocyte fertilization in vitro. Fertil Steril. 1996 Dec;66(6):1000-8. doi: 10.1016/s0015-0282(16)58697-x. 
  41. Vazquez-Levin MH, Friedmann P, Goldberg SI, Medley NE, Nagler HM. Response of routine semen analysis and critical assessment of sperm morphology by Kruger classification to therapeutic varicocelectomy. J Urol. 1997 Nov;158(5):1804-7. doi: 10.1016/s0022-5347(01)64134-x. 
  42. Schatte EC, Hirshberg SJ, Fallick ML, Lipschultz LI, Kim ED. Varicocelectomy improves sperm strict morphology and motility. J Urol. 1998 Oct;160(4):1338-40. 
  43. MacLeod J. Seminal cytology in the presence of varicocele. Fertil Steril. 1965 Nov-Dec;16(6):735-57. doi: 10.1016/s0015-0282(16)35765-x. 
  44. Rodriguez-Rigau LJ, Smith KD, Steinberger E. Varicocele and the morphology of spermatozoa. Fertil Steril. 1981 Jan;35(1):54-7. doi: 10.1016/s0015-0282(16)45258-1.
  45. Wang C, McDonald V, Leung A, Superlano L, Berman N, Hull L, Swerdloff RS. Effect of increased scrotal temperature on sperm production in normal men. Fertil Steril. 1997 Aug;68(2):334-9. doi: 10.1016/s0015-0282(97)81525-7. 
  46. Rogel A, Popliker M, Webb CG, Oren M. p53 cellular tumor antigen: analysis of mRNA levels in normal adult tissues, embryos, and tumors. Mol Cell Biol. 1985 Oct;5(10):2851-5. doi: 10.1128/mcb.5.10.2851-2855.1985. 
  47. Almon E, Goldfinger N, Kapon A, Schwartz D, Levine AJ, Rotter V. Testicular tissue-specific expression of the p53 suppressor gene. Dev Biol. 1993 Mar;156(1):107-16. doi: 10.1006/dbio.1993.1062. 
  48. Schwartz D, Goldfinger N, Rotter V. Expression of p53 protein in spermatogenesis is confined to the tetraploid pachytene primary spermatocytes. Oncogene. 1993 Jun;8(6):1487-94. 
  49. Morgentaler A, Stahl BC, Yin Y. Testis and temperature: an historical, clinical, and research perspective. J Androl. 1999 Mar-Apr;20(2):189-95. 
  50. Yin Y, DeWolf WC, Morgentaler A. p53 is associated with the nuclear envelope in mouse testis. Biochem Biophys Res Commun. 1997 Jun 27;235(3):689-94. doi: 10.1006/bbrc.1997.6867. 

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Received November 6, 2023.
Accepted December 20, 2023.
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