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Year : 2018  |  Volume : 61  |  Issue : 2  |  Page : 233-235
Qualitative defects with normal sperm counts in a patient attending infertility clinic

Department of Pathology, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, India

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Date of Web Publication20-Apr-2018


Background: Sperm morphology is an important qualitative parameter in semen analysis. Aim: To assess qualitative defects in the semen with normal sperm counts. Setting and Design: This was a prospective and descriptive study done in a tertiary care center. Materials and Methods: Seventy-five semen samples with normal sperm counts were evaluated. Qualitative defects of sperms on Papanicolaou-stained slides were assessed. The defects were noted as follows: head (tapering head, large head, small head, round head, bifid head), middle piece (bent neck, broad middle piece, excess residual cytoplasm), and tail (coiled tail). Results: All cases showed the qualitative defects in spite of the normal counts. The defects found in head – pointed/tapering head (1%–20%), round head (1%–7%), large head (1%–3%) and others (0%–2%); in middle piece – bent neck (1%–8%), excess cytoplasm (1%–3%) or broad middle piece (1%–12%); and in tail – coiled tail (1%–5%). Conclusions: Qualitative defects are often seen even in cases with normal sperm counts.

Keywords: Morphological defects, semen analysis, sperm counts

How to cite this article:
Goyal R, Kotru M, Gogia A, Sharma S. Qualitative defects with normal sperm counts in a patient attending infertility clinic. Indian J Pathol Microbiol 2018;61:233-5

How to cite this URL:
Goyal R, Kotru M, Gogia A, Sharma S. Qualitative defects with normal sperm counts in a patient attending infertility clinic. Indian J Pathol Microbiol [serial online] 2018 [cited 2023 Jan 30];61:233-5. Available from:

   Introduction Top

Infertility affects 15% of couples globally.[1] 20%–30% infertility cases are due to defects in semen. Semen analysis is an important investigation for the detection of infertility in men.[2] In most of the infertility clinics, this investigation is done as baseline investigation along with other investigations. However, in some centers, it is advised after exclusion of causes of infertility in women.

Semen analysis done using the WHO criteria includes quantitative and qualitative examination.[3] Quantitative parameters include measuring of semen volume and semen counts. Qualitative parameters include assessment of semen morphology and semen viscosity. Semen morphology is an important factor that affects male fertility. For analysis of qualitative defects, sperm is assessed for head, middle piece, and tail defects.[4] Qualitative defects can occur in any of these parts. There is not enough literature on the frequency of their occurrence in patients with normal sperm counts. Hence, this study was done with the aim of finding the occurrence of various qualitative defects in patients with normal sperm counts, which were referred for baseline investigation.

   Materials and Methods Top

This was a descriptive study in a tertiary care hospital from December 2015 to September 2016. Convenient sampling of 95 semen samples was done. All specimens with normal sperm count (15 million/ml) were included (75/95) and studied for the presence of morphological defects. Sample collection was done as recommended.[3] Samples were collected in a clean-capped plastic container. After collection and with proper liquefaction, samples were assessed for volume, viscosity, color, appearance, sperm count, motility, presence and absence of red blood cells/white blood cells, agglutination, and sperm morphology. All other parameters were assessed on fresh sample; however, for sperm morphology, smears were fixed in ethanol and then assessed after Papanicolaou staining. Morphology was classified as defects in the head, middle piece, and tail. The abnormalities were noted for their presence or absence. These were tapering head, large head, small head, round head, and bifid head for head [Figure 1]; bent neck, broad middle piece, and excess residual cytoplasm for middle piece [Figure 2]; and coiled tail for tail [Figure 2]. The frequencies of all these morphological abnormalities were studied.
Figure 1: Morphological defects in the head (PAP stain): (a) tapering head, (b) large head, (c) round head, (d) small head

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Figure 2: Morphological defects in middle piece and tail (PAP stain): (a) bent neck, (b) thick midpiece, (c) excess residual cytoplasm, (d) coiled tail

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   Results Top

Seventy-five semen samples with normal sperm counts included in the study were studied for the presence of various morphological defects. Morphological abnormalities were found in all samples with normal sperm counts [Table 1]. The defects found in head – pointed/tapering head (1%–20%), round head (1%–7%), large head (1%–3%), and others (0%–2%); in middle piece – bent neck (1%–8%), excess cytoplasm (1%–3%), or broad middle piece (1%–12%); and in tail – coiled tail (1%–5%). Most commonly defects found in the head followed by middle piece defects. There was, however, a variation in the presence of abnormalities in the cases. It ranged from 1% to 20%. No case showed >20% abnormality. Most common defect observed was tapering head. The least common defect was coiled tail. Seventy-two cases showed more than one defect [Table 2]. Head abnormalities and middle piece abnormalities were the most frequent combinations observed. Other common combination was combined defects in the neck, head, and middle piece. Some cases had multiple defects only in the head. Only three cases had no multiple abnormalities. Sperm count ranging from 15 to 140 million/ml.
Table 1: Morphological abnormalities in cases with normal sperm count (>15 million/ml)

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Table 2: Frequency of cases with multiple abnormalities (72/75)

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   Discussion Top

Sperm morphology is an important parameter in semen analysis.[4] It is assessed by microscopic examination of sperms. Normal sperm contains head, middle piece, and tail. Different types of morphological defects can be found in different part of sperm. Some studies show that these defects have a prognostic bearing as some defects are irreversible, and others which are due to acquired/environmental factors can be reversible.[5],[6]

Most of the studies describe the association of low sperm count and abnormal morphology. They studied that sperm morphological defects increases with decreasing sperm count.[7] Only few studied the defects with normal sperm counts also.[8] Defects in the head are the most common defects.[9] Various defects described in the head are tapering head, large head, round head, short head, amorphous head, and bifid head. Clinical significance of some of these defects described by many authors such as tapering and megaloheads are reversible defects. It is mainly due to ongoing stress or some medication. After stopping the precipitating factor, most of them are revert back. Amorphous head is a defect with genetic aberration, so this is a severe form and incapable of fertilization. Globozoospermia small round head with no acrosome are also genetically determined and due to the absence of acrosin unable to bind zona pellucida. Small head spermatozoa also have very small, abnormally formed acrosome. Large head spermatozoa have severely abnormal megaloheads.[6] Teratozoospermia is also increase the miscarriage rate.[10] In our study, however, tapering head was the most common abnormality seen.

Head neck attachment or neck defects such as misalignment or abnormal insertion-like bent neck are also genetically determined and have poor prognosis.[6] The presence of cytoplasmic residues or excess residual cytoplasm is associated with sperm immaturity and production of reactive oxygen species, i.e., ongoing stress.[6] The second common abnormality detected in our study is broad middle piece.

Short tail syndrome is also genetically determined and has poor prognosis.[6] These cases have very poor chances of future fertility. Coiled tails are also causing a problem due to defective propulsion.[4] Tail abnormalities increased in smokers.[5] Coiled tail is the least common abnormality detected in our study.

However, these morphological abnormalities mostly occur in combination with defects in other parts of the sperm. These have been previously described. Some have noted the association of multiple defects with increased chances of spontaneous abortions. They found that sperms with multiple abnormalities cause defective embryo development and lead to spontaneous abortion.[11] Others found the association of defects with seasonal variations.[12] In our study, we also found many cases with multiple abnormalities due to the fact that we did not clinically follow-up the cases. Hence, our study is limited owing to lack of follow-up. Further studies are required to support the findings.

   Conclusions Top

Qualitative defects are often seen even in patients with normal sperm counts and should be noted.

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Conflicts of interest

There are no conflicts of interest.

   References Top

Agarwal A, Mulgund A, Hamada A, Chyatte MR. A unique view on male infertility around the globe. Reprod Biol Endocrinol 2015;13:37.  Back to cited text no. 1
Vasan SS. Semen analysis and sperm function tests: How much to test? Indian J Urol 2011;27:41-8.  Back to cited text no. 2
[PUBMED]  [Full text]  
World Health Organization. Standard procedures. In: Cooper TG, editor. WHO Laboratory Manual for the Examination and Processing of Human Semen. 5th ed. Geneva: World Health Organization; 2010. p. 7-10.  Back to cited text no. 3
Auger J. Assessing human sperm morphology: Top models, underdogs or biometrics? Asian J Androl 2010;12:36-46.  Back to cited text no. 4
Singh S, Sharma S, Jain M, Chauhan R. Importance of papanicolaou staining for sperm morphologic analysis: Comparison with an automated sperm quality analyzer. Am J Clin Pathol 2011;136:247-51.  Back to cited text no. 5
Menkveld R. Clinical significance of the low normal sperm morphology value as proposed in the fifth edition of the WHO laboratory manual for the examination and processing of human semen. Asian J Androl 2010;12:47-58.  Back to cited text no. 6
Karabulut A, Tekin A. Alterations in the morphology and motility of spermatozoa: Relation with total sperm count. Pam Med J 2013;6:1-4.  Back to cited text no. 7
Andrade-Rocha FT. Sperm parameters in men with suspected infertility. Sperm characteristics, strict criteria sperm morphology analysis and hypoosmotic swelling test. J Reprod Med 2001;46:577-82.  Back to cited text no. 8
Nikolettos N, Küpker W, Demirel C, Schöpper B, Blasig C, Sturm R, et al. Fertilization potential of spermatozoa with abnormal morphology. Hum Reprod 1999;14 Suppl 1:47-70.  Back to cited text no. 9
Taşdemir I, Taşdemir M, Tavukçuoglu S, Kahraman S, Biberoģlu K. Effect of abnormal sperm head morphology on the outcome of intracytoplasmic sperm injection in humans. Hum Reprod 1997;12:1214-7.  Back to cited text no. 10
Cao X, Cui Y, Zhang X, Lou J, Zhou J, Wei R, et al. The correlation of sperm morphology with unexplained recurrent spontaneous abortion: A systematic review and meta-analysis. Oncotarget 2017;8:55646-56.  Back to cited text no. 11
Auger J, Eustache F, Andersen AG, Irvine DS, Jørgensen N, Skakkebaek NE, et al. Sperm morphological defects related to environment, lifestyle and medical history of 1001 male partners of pregnant women from four European cities. Hum Reprod 2001;16:2710-7.  Back to cited text no. 12

Correspondence Address:
Mrinalini Kotru
Department of Pathology, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/IJPM.IJPM_460_17

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