In Vitro Fertilization IVF

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     One of the most predictive analyses is sperm morphology, and in the infertility literature there are a lot of schemes for spermatozoa morphology classification.
Also there are a lot of questions: what normal semen represents? What impact can have abnormal semen on reproduction?
     Surely it is not so important what scheme was used to determine the normality/abnormality of the semen morphology, once one spermatozoon selected from a majority abnormal sample is able to fecundate through sperm intracytoplasmic injection (SICI).
     Normal spermatozoa classification: according to World Health Organization:
     The normal spermatozoa has an oval head (4-5,5 μm thick) , the acrosome occupies 40% up to 70% of the head, it doesn’t present any head, neck, or intermediary abnormality ant if it presents cytoplasm it must occupy less than a third of the head volume.
     Head abnormal shape and dimension: there are many types of abnormalities- microcephalic sperm has approximately half of the normal sperm volume and megacephalic sperm is once and half bigger than the normal spermatozoa. There are cases of oblong headed sperm (in varicocele patients and patients who suffered recently from viral diseases). The abnormal sperm, with spherical head, oblong head also multicephalic (more than one head), or without acrosome, is not capable of fertilization.
     Neck and mid-piece abnormalities: a spermatozoon which has an abnormally inserted tail at a 90 degrees angle has a mid-piece defect. In this category are also placed irregular sperm, or abnormally thin sperm.
     Tail defects: the tail can be short, multiple, thick, or broken, usually those flaws indicate hypoosmotic stress or senescence.
     Cytoplasmic drop: indicates incomplete spermiogenesis, normally the cytoplasmic drop occupies less than a third of sperm’s head and is located at the level of the neck or mid-piece’s.
     Ejaculate’s morphology: it is important in determining possible infections, immature germinal cells and leucocytes.
     Moreover leucocytes and germinal cells are not included in sperm morphology. Inside the ejaculate, the leucocytes limit is 1-5×10.000.000 /ml.
     To sum up our investigation, we can say that in diagnosing an infertile patient, the spermatogram and its accuracy are of crucial importance. Semen characteristics as penetration, acrozomal reaction and capacitation are binding for the process of fecundation. Man’s investigation and evaluation has to be made simultaneously with the evaluation of his wife and also has to be combined with his hormonal investigation, endocrine function evaluation, inhibitor and antagonist gonadal steroid hormones response, GnRH tests, radiologic investigations and testicular biopsy.
     After the completion of these tests the currant physician will establish the proper approach to the patient’s medical condition, and moreover what is the best medical management which can be most beneficial to the infertile man.

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