IVF or ICSI Selection Stratified by Sperm Head Morphology

AIM: To assess the suitability of intracytoplasmic sperm injection (ICSI) and in vitro fertilization (IVF) for infertile couples with teratozoospermia primarily caused by sperm head abnormalities. METHODS: A retrospective analysis was conducted on 856 infertile couples with teratozoospermia. Patients were stratified into four groups by sperm head malformation type and severity: head acrosome malformation < 95%/> 97%, and head shape malformation < 95%/> 97%. Key outcomes (fertilization rate, 2PN fertilization/cleavage rates, blastocyst formation/high-quality blastocyst rates, pregnancy/live birth rates) were compared across groups. RESULTS: In the head shape malformation < 95% subgroup, IVF had higher fertilization and blastocyst formation rates. IVF also achieved a significantly higher fertilization rate in the head acrosome malformation < 95% subgroup (p < 0.05). ICSI yielded a higher proportion of high-quality blastocysts in the head acrosome malformation > 97% subgroup. No significant differences in 2PN fertilization/cleavage rates, pregnancy rates, or live birth rates were observed between IVF and ICSI across all subgroups (p > 0.05). CONCLUSIONS: IVF is preferred for sperm head abnormality rate < 95% to enhance fertilization efficiency, while ICSI is advisable for acrosome malformation > 97% to improve high-quality embryo yield, providing evidence-based guidance for individualized assisted reproductive technology (ART) selection.