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Table 3 Proposed classification for semen containing large-headed spermatozoa and ART possibilities decision

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

Light microscopy for large-headed spermatozoa Proposal of percentage of spermatozoa with large heads Proposal of FISH on selected spermatozoa with a normal head size Additional analysis proposal Classification ART possibility decision
Irregular head shape and multiple flagella 100 % Not recommend Screen for AURK mutations Type I Intracouple ART contraindicated
<100 % No euploid spermatozoa Screen for AURK mutations Type IIA Intracouple ART contraindicated
Presence of euploid spermatozoa Screen for AURK mutations? Type IIB ICSI + PGD if available
Normal head shape and a single flagella >10 %a Normal level of aneuploid spermatozoa Normal sperm chromatin condensation for spermatozoa with normal size head Type IIIA ICSI with spermatozoa with normal size head
Normal level of aneuploid spermatozoa Normal sperm chromatin condensation Type IIIB Intracouple ART
High level of aneuploid spermatozoa FISH Type IIIC ICSI + PGD if available
  1. Classification of sperm with enlarged head according to light microscopy evaluation, percentage of spermatozoa with large heads, FISH studies, additional analysis performed, and ART (assisted reproductive technology). aGuthauser et al., 2013 [26]