Papanicolaou and Kruger assessment of sperm morphology: Thresholds and agreement

Mónica H. Vazquez-Levin, S. I. Goldberg, Patricia Friedmann, D. C. Des Jarlais, H. M. Nagler

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

The current World Health Organization guidelines suggest that the presence of ≥ 30% normal sperm forms (i.e. PAP criteria) is consistent with normal semen quality. Critical evaluation of sperm morphology (CE; Kruger classification) has shown an excellent correlation with human in vitro fertilization. Utilizing Kruger criteria, > 14% normal sperm forms has been proposed as indicative of normal semen quality. We have performed a retrospective analysis on 261 individuals to assess the agreement between PAP and Kruger criteria for normal sperm morphology (NSM). When the threshold for NSM by PAP was set at 30%, a significant agreement was found between the percentage normal forms of both criteria (Kappa coefficient = 0.37; p < 0.001). Sixty-seven (92%) of the 73 men found to have abnormal sperm morphology by PAP had abnormal semen by Kruger classification. When the threshold for NSM by PAP was established at 50%, the Kappa coefficient was 0.48 (p < 0.001). Sixty of the 72 samples (83%) classified as normal by PAP staining were normal by Kruger criteria. Interestingly, when NSM by PAP was between 30 and 50%, the specimen was just as likely to have normal or abnormal sperm morphology by Kruger (40 vs. 60%, respectively). These results strongly suggest that a high or low percentage of NSM by PAP is in agreement with the Kruger classification. The excellent agreement of Kruger and WHO criteria at the extremes (< 30% and > 50%) may obviate the need for Kruger assessment. However, when WHO morphology is between 30 and 50%, the addition of Kruger evaluation may provide meaningful information to help better diagnose a patient and plan his treatment.

Original languageEnglish (US)
Pages (from-to)327-331
Number of pages5
JournalInternational Journal of Andrology
Volume21
Issue number6
DOIs
StatePublished - 1998
Externally publishedYes

Fingerprint

Spermatozoa
Semen Analysis
Needs Assessment
Fertilization in Vitro
Guidelines
Therapeutics

Keywords

  • Kruger classification
  • Sperm morphology
  • WHO criteria

ASJC Scopus subject areas

  • Endocrinology

Cite this

Papanicolaou and Kruger assessment of sperm morphology : Thresholds and agreement. / Vazquez-Levin, Mónica H.; Goldberg, S. I.; Friedmann, Patricia; Des Jarlais, D. C.; Nagler, H. M.

In: International Journal of Andrology, Vol. 21, No. 6, 1998, p. 327-331.

Research output: Contribution to journalArticle

Vazquez-Levin, Mónica H. ; Goldberg, S. I. ; Friedmann, Patricia ; Des Jarlais, D. C. ; Nagler, H. M. / Papanicolaou and Kruger assessment of sperm morphology : Thresholds and agreement. In: International Journal of Andrology. 1998 ; Vol. 21, No. 6. pp. 327-331.
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abstract = "The current World Health Organization guidelines suggest that the presence of ≥ 30{\%} normal sperm forms (i.e. PAP criteria) is consistent with normal semen quality. Critical evaluation of sperm morphology (CE; Kruger classification) has shown an excellent correlation with human in vitro fertilization. Utilizing Kruger criteria, > 14{\%} normal sperm forms has been proposed as indicative of normal semen quality. We have performed a retrospective analysis on 261 individuals to assess the agreement between PAP and Kruger criteria for normal sperm morphology (NSM). When the threshold for NSM by PAP was set at 30{\%}, a significant agreement was found between the percentage normal forms of both criteria (Kappa coefficient = 0.37; p < 0.001). Sixty-seven (92{\%}) of the 73 men found to have abnormal sperm morphology by PAP had abnormal semen by Kruger classification. When the threshold for NSM by PAP was established at 50{\%}, the Kappa coefficient was 0.48 (p < 0.001). Sixty of the 72 samples (83{\%}) classified as normal by PAP staining were normal by Kruger criteria. Interestingly, when NSM by PAP was between 30 and 50{\%}, the specimen was just as likely to have normal or abnormal sperm morphology by Kruger (40 vs. 60{\%}, respectively). These results strongly suggest that a high or low percentage of NSM by PAP is in agreement with the Kruger classification. The excellent agreement of Kruger and WHO criteria at the extremes (< 30{\%} and > 50{\%}) may obviate the need for Kruger assessment. However, when WHO morphology is between 30 and 50{\%}, the addition of Kruger evaluation may provide meaningful information to help better diagnose a patient and plan his treatment.",
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