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Table 1 Reports of patients with large-headed spermatozoa and the associated ART decisions and outcomes

From: Is intracouple assisted reproductive technology an option for men with large-headed spermatozoa? A literature review and a decision guide proposal

Reference Number of patients Spermatozoa with Description of semen Spermatozoa with aneuploidies Additive analysis Status of intracouple ART Outcome (s) for ART programmes with the patient’s sperm
Large heads Multiple flagella Sperm count (106/ml) Motility (%) Atypical form (%)
Yurov et al., 1996 [11] 1 40 % / 1.0 1 % 97 % 100 % / ICSI: 5 cycles no pregnancies
In’t veld et al., 1997 [8] 1 100 % 1 to 3 flagella 15.0    100 % Head area 25.4+/−4 μm2 ICSI: 1 cycles 15 oocytes, 2 embryos transferred, no pregnancies
Weissenberg et al., 1998 [14] 1 100 %   10.3 23.7 %   99.2 % / ICSI: 2 cycles 14 oocytes, 2 embryos transferred, no pregnancies
Kahraman et al., 1999 [6] 17 68.5 %   3.8 4.7 % 0 % not determined / ICSI: 22 cycles Fertilization rate: 43 %
9 embryo transfers
2 pregnancies and 3 live births
Viville et al., 2002 [40] 1 64 % with multiple flagella 2.0 <5 %   89.2 % / ICSI: 3 cycles No pregnancies.
Benzaken et al., 2001 [3] 1 100 % 72 % 2.0 <5 %   100 % / Not performed /
Devillard et al., 2002 [17] 3 100 % (irregular shape) 30 % 3.2 25 %   100 % / Not performed /
>95 % / 30.0 reduced   100 %
100 % / 10.0 reduced   100 %
Lewis-Hones et al., 2003 [15] 3 46 % 72 % Oligo-asthenospermia   100 % 100 % / Not performed /
60 % 49 % 46 %
54 % 50 %     82.5 %    
Vicari et al., 2003 [18] 3 54.3 % / 14.4 % 14 % 100 % 69.5 % / Not performed /
18.9 % 3.7 % 13 % 5.2 %
26.5 % 0.25 % 8 % 13.1 %
Kahraman et al., 2004 [31] 21 predominantly macrocephalic and pinhead spermatozoa 6.7 14.1 % / / / ICSI and PGD, 23 cycles Implantation rate: 25 %
Pregnancy rate: 33 %
Abortion rate: 14.3 %
52 11.9 17 % ICSI (no PGD), 60 cycles Implantation rate: 12.3 %
Pregnancy rate: 27.8 %
Abortion rate: 46.7 %
Guthauser et al., 2006 [4] 2 91 % with multiple flagella 30.4 0 % 100 % 100 %, 95 % for spermatozoa with normal-sized heads Not performed /
82 % with multiple flagella 3.6 100 %, 90 % for spermatozoa with normal-sized heads
Achard et al., 2007 [10] 4 29.5 % / 8.2 32 % 70 % 51.4 % / ICSI, 7 cycles Fertilisation rate: 65.6 %
22 % / 6.2 33 % 69 % 43.6 %
49.7 % / 1.3 7 % 91.5 % 71.7 % One live birth (for patient 1)
19 % / 1.7 9 % 96 % 25.6 %
Perrin et al., 2008 [16] 1 62 % 54 % 2.8 0 % 100 % 99.3 % / Not performed /
Guthauser et al., 2011 [7] 1 47 % 0 % 28.3 8 % 98 % 3 % Uncondensed chromatin:46 % ICSI Lost to follow-up
Ben Khelifa et al., 2011 [9] 2 100 % 28 % 0.9 8 % MAI: 3.5 / / ICSI, 6 cycles Fertilization rate: 17.0 %
100 % 52 % 0.8 7 % MAI: 3.6 ICSI, 5 cycles
No pregnancies
Guthauser et al., 2013 [26] 1 12 %, Normally shaped 0 % 89 40 % 80 % 78 %, 68 % for spermatozoa with normal-sized heads Uncondensed chromatin: 11 % Not performed /
Shimizu et al., 2012 [5] 1 “Almost all” (exact % not specified) 0.2 25 % 99.7 % Not determined   ICSI One ICSI cycle, one live birth
  1. Studies with sample sizes evaluating the relationship between the percentage of spermatozoa with large heads, multiple flagella, semen characteristics, percentage of spermatozoa with aneuploidies, ART (assisted reproductive technology) performed, and outcomes