Choosing fertilization method by analyzing sperm morphology or by performing swim-up preparation

Background. Evaluation of sperm morphology has been used as a screening method for choosing between intracytoplasmic sperm injection (ICSI) and conventional in vitro fertilization (IVF). However, sperm morphology analysis is a time-consuming and often subjective scoring method, and may lead to an unnecessarily large proportion of invasive and costly ICSI treatments. The aim of this study was to evaluate if the yield after swim-up preparation could be of advantage over sperm morphology evaluation for choosing fertilization method. Material and methods. In the first part of the study 53 split cycles with less than 5% normal forms in the ejaculate were retrospectively evaluated. Part 2 is a prospective evaluation including 357 cycles where the number of sperm available after a standardized swim-up procedure was used for choosing fertilization method. In all cycles where <= 1 million sperm were obtained after swim-up, conventional IVF was performed. Results. In the first part no statistically significant difference in fertilization rates was found for IVF and ICSI respectively (59.2% versus 64.7%). Four IVF cycles ended up in total fertilization failure (TFF) while in no ICSI cycle was TFF obtained. In the second part 8.9% TFF was obtained in the poor sperm morphology group compared to 1.3% in the good morphology group. These TFF corresponded to 1% of all our treatment cycles. Conclusion. The present strategy reduced ICSI treatments by 10%, thereby reducing the cost and workload. It can be discussed if an increase of TFF in absolute number of eight is balanced by a reduced workload of 100 ICSI treatments.