Human Reproduction, Vol 13, 2512-2520, Copyright © 1998 by Oxford University Press
C De Geyter, M De Geyter, B Koppers and E Nieschlag
One retrospective and two prospective studies were conducted among 218
couples treated with in-vitro fertilization (IVF) to establish the
reproducibility and diagnostic accuracy of computer-assisted sperm analysis
(CASA) with swim-up spermatozoa for the prediction of the fertilization
rate of oocytes in vitro. Based on the results of a preliminary
retrospective analysis in 49 patients, the 'curvilinear velocity' (VCL) was
chosen as the most distinctive motion parameter of sperm function and the
median was used to represent the entire sperm population. The number of
inseminated motile spermatozoa was then adjusted to median VCL during two
subsequent prospective studies with clinical IVF. Whereas in the first
prospective study (90 couples) the threshold values of VCL with regard to
the number of spermatozoa inseminated were based on the results of the
preliminary retrospective study (49 couples), in the second prospective
study (79 couples) the settings were based on the results of the first
prospective study. The reproducibility of CASA was tested by analysing the
motion characteristics of spermatozoa at different intervals after
termination of swim-up, by repeated analysis of the same video-recording of
the incubated spermatozoa by different observers, and by the repeated
video- recording of the freshly prepared sperm samples and analysis of both
video-recordings by the same observer. Under these conditions the frequency
of disagreement between two measurements varied between 2.0 and 8.2%. In
both prospective studies the sensitivity of CASA for the prediction of
fertilization was high (74.0%), whereas the specificity was low (40.0%). In
contrast to successful fertilization, unsuccessful fertilization of oocytes
in vitro could not be predicted reliably with CASA. However, the pregnancy
rate per cycle among patients with predicted low fertilization rates was
significantly lower (5.3%) than in couples with high predicted
fertilization rates (24.3%, P < 0.001). Therefore, CASA of washed
spermatozoa may still help to identify couples who would benefit more from
intracytoplasmic sperm injection (ICSI) than from IVF. A definite threshold
level could not be identified for any of the motion parameters to
distinguish the motion characteristics of fertilizing and non-fertilizing
spermatozoa. Using various algorithms for hyperactivated motility, the
percentage of hyperactivated spermatozoa was significantly higher among the
successfully fertilizing patients than among the nonfertilizing group.
However, the absolute number of hyperactivated spermatozoa added to the
oocytes was higher in non-fertilizing couples. Therefore, the lack of
fertilization in some patients may be caused by a generalized defect in
sperm function rather than by insufficient hyperactivation.
ARTICLES
Diagnostic accuracy of computer-assisted sperm motion analysis
Institute of Reproductive Medicine of the University of Munster, Germany.
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