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

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

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
	<100 %	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

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]

ISSN: 2051-4190