large nuclear vacuoles in spermatozoa negatively affect pregnancy rate in ivf cycles

background: recently, motile sperm organelle morphology examination (msome) criteria as a new real time tool for evaluation of spermatozoa in intracytoplasmic sperm injection (icsi) cycles has been considered. objective: the aim was to investigate the predictive value of msome in in vitro fertilization (ivf) in comparison to icsi cycles and evaluation of the association between msome parameters and traditional sperm parameters in both groups. materials and methods: this is a cross sectional prospective analysis of msome parameters in ivf (n=31) and icsi cycles (n=35). msome parameters were also evaluated as the presence of vacuole (none, small, medium, large or mix); head size (normal, small or large); cytoplasmic droplet; head shape and acrosome normality. in sub-analysis, msome parameters were compared between two groups with successful or failed clinical pregnancy in each group. results: in ivf group, the rate of large nuclear vacuole showed significant increase in failed as compared to successful pregnancies (13.81±9.7vs7.38±4.4, respectively, p=0.045) while msome parameters were the same between successful and failed pregnancies in icsi group. moreover, a negative correlation was noticed between lnv and sperm shape normalcy. in icsi group, a negative correlation was established between cytoplasmic droplet and sperm shape normalcy. in addition, there was a positive correlation between sperm shape normalcy and non-vacuolated spermatozoa. conclusion: the high rate of large nuclear vacuoles in sperm used in ivf cycles with failed pregnancies confirms that msome, is a helpful tool for fine sperm morphology assessment, and its application may enhance the assisted reproduction technology success rates.