The spermocytogram is one of the key examinations in the exploration of male fertility. An integral part of the sperm assessment, it consists in observing under a microscope the morphology of the 3 three constituent elements of spermatozoa: the head, the intermediate part and the flagellum.

The spermocytogram is an examination aimed at analyzing the morphology of sperm, one of the sperm parameters studied as part of a fertility check-up. It allows to define the percentage of typical forms, that is to say of spermatozoa of normal morphology, an important prognostic data to define the chances of fertilization. in vivo (natural pregnancy) and in vivo. The spermocytogram is therefore one of the key elements to guide the management of the couple in insemination, classic in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI).

The spermocytogram is performed on a sample of semen from the man. In order to have reliable results, the collection of semen must be done under strict conditions:

• have observed a period of sexual abstinence of 2 to 7 days, according to the WHO recommendations of 2010 (1);
• in the event of fever, medication, X-ray, surgery, collection will be postponed because these events may transiently alter spermatogenesis.

Collection takes place in the laboratory. In a specially dedicated isolated room, after careful washing of the hands and the glans, the man collects his sperm in a sterile bottle, after masturbation.

The sperm is then placed in an oven at 37 ° C for 30 minutes, then various sperm parameters are analyzed: the sperm concentration, their mobility, their vitality and their morphology.

This last parameter, or spermocytogram, is the longest and most difficult stage of the spermogram. Under the X1000 microscope, on fixed and stained smears, the biologist studies the different parts of the spermatozoa in order to identify any abnormalities:

• abnormalities of the head;
• anomalies of the intermediate part;
• abnormalities of the flagellum, or main part.

From this reading, the biologist will then define the percentage of morphologically typical or atypical spermatozoa, as well as the incidence of observed abnormalities. 

The spermocytogram is carried out as part of the spermogram (semen analysis), an examination systematically prescribed to men during the fertility check-up of the couple consulting for difficulties in conceiving.

Two classifications exist for the results of the spermocytogram: the modified David classification (2), French, and the Kruger classification, international, recommended by the World Health Organization (WHO). The classification used will be indicated on the results.

The two systems list all the abnormalities found on a minimum of 100 spermatozoa, but with a different system:

• Kruger’s classification identifies 4 classes of anomalies in order of importance: anomalies concerning the acrosome (part at the front of the head), those of the head, those of the intermediate part and those of the flagellum. It only takes one anomaly in one of the 4 classes for the spermatozoon to be classified as “atypical form”;
• David’s modified classification identifies 7 anomalies of the head (elongated, thinned, microcephalic, macrocephalic, multiple head, presenting an abnormal or absent acrosome, presenting an abnormal base), 3 anomalies of the intermediate part (presence of cytoplasmic residue, small intestine, angulated) and 5 anomalies flagellum (absent, cut short, irregular gauge, coiled and multiple) in a double entry table.

The threshold of typical shapes also differs according to the two classifications. According to the Kruger classification, the sperm morphology is said to be normal when one observes the presence of at least 4% of typical spermatozoa, against 15% according to the modified David classification. Below, we talk about teratospermia (or teratozoospermia), an abnormality of the sperm that can reduce the chances of pregnancy.

However, an abnormal spermogram always requires a second check at 3 months (the duration of a spermatogenesis cycle being 74 days), because many factors (stress, infection, etc.) can transiently alter the spermatic parameters.

In the event of proven teratozoospermia, IVF-ICSI (in vitro fertilization with intracytoplasmic injection) may be offered to the couple. This AMP technique consists of injecting a single sperm, previously selected and prepared, directly into the cytoplasm of the mature oocyte.