Annals of PIMS-Editorial Board

Objective: To determine the teratozoospermic index (TZI) of proven fertile males and compare this with that of infertile males.
Study Design: Cross-sectional comparative
Place and Duration: It was carried out at Islamic International Medical College Rawalpindi and Islamabad Clinic Serving Infertile Couples Islamabad, from July 2005 to July 2006.
Materials and Methods: 50 healthy fertile males were selected, while another 50 infertile males were recruited as controls. Their sperm morphology was determined according to Tygerberg’s strict criteria. And the Teratozoospermic index was calculated. The sampling technique used was convenience non-probability. Inclusion criterion for proven fertile males was pregnancy achieved within one year of marriage with successful coituses. In case of infertile males it was failure to achieve pregnancy without the use of assisted reproductive techniques, with no infertility factors in the female partner. The semen samples were obtained at the laboratory after 3 to 4 days of sexual abstinence with clear written and oral instructions given to the subjects before the collection of the sample.
Results: The infertile group was found to be statistically older than the proven fertile group i.e. (36.60 versus 31.32 years). TZI was significantly less in the proven fertile group (P < 0.021). TZI ranged from 1.25 to 2.09 in the proven male group and from 0 to 2.28 in the infertile group
Conclusion: TZI increases the clinical value of semen analysis and should also be used to differentiate between fertile and infertile males in addition to other semen parameters.
Key Words: Sperm morphology, Fertile males, Teratozoospermic Index

The estimation of sperm concentration, motility and morphology is the mainstay of the assessment of male reproductive health.¹ Decreased sperm concentration has been associated with decreased fertility.² Sperm motility has also been associated with the fertiliy.³The examination of sperm morphology by more standardized and stringent criteria, however, has enhanced objectivity and decreased intra-laboratory variability. The World Health Organization (WHO) has also recommended that strict criteria should be applied when assessing the morphological normality of the spermatozoon. This has led to the establishment of lower threshold levels for normality.¹Morphologically abnormal spermatozoa often have multiple defects i.e. head defects, mid-piece defects and tail defects. The following categories of defects are usually found^1,4Head defects: Large, small, tapered, pyriform, round and amorphous heads. Vacuolated heads (>20% of head area occupied by unstained vacuolar areas) or those with small acrosomal cap (<40% of head area) and double heads or combination of above are head defects.Neck and mid-piece defects: Normally neck/ mid-piece and tail should form an angle of 90^o to the horizontal axis of head. Bent, asymmetrical insertion of mid-piece into the head, thick or irregular shaped mid-piece, abnormally thin mid-piece (i.e. no mitochondrial sheath), or any combination of these are considered as mid-piece defects. Cytoplasmic droplets which are usually located in the mid-piece should not be greater than one-half of a normal sperm head.Tail defects: Short, multiple, hairpin, broken, bent tails, irregular width, coiled tails or any combination of these are the defects found in sperms.In earlier practice, when multiple defects were present only one defect was recorded. It is now customary to record total number of sperm defects divided by the number of defective spermatozoa, called multiple anomalies index (MAI) or teratozoospermic index (TZI). The MAI or TZI values should read between 1.00 (i.e. each abnormal sperm has only on defect) to 3.00 (i.e. each abnormal sperm has head, mid-piece and tail defects). For a spermatozoon to be classified as normal the size and shape must be within normal limits.^5-6 The aim of the present study was to determine the TZI of proven fertile males and compare this with that of infertile males in our population.

Introduction