Is it possible to achieve pregnancy in men with teratozoospermia?

By (gynecologist), (gynecologist), (embryologist), (gynecologist), (embryologist) and (fertility counselor).
Last Update: 06/09/2023

With teratozoospermia, achieving a natural pregnancy might be a challenge. In fact, in the most severe cases, fertilization and subsequent embryo development are almost impossible.

Teratozoospermic males, unfortunately, have no choice but to turn to assisted reproduction to have children.

The most adequate treatment option to conceive in spite of teratospermia depends on a variety of factors and not on the severity only. The remainder of the seminal parameters, along with age and health of the female partner, are limiting factors when it comes to achieve a pregnancy.

Natural pregnancy

Sperms with malformations can make the TTC journey more challenging due to any of the following reasons:

  • Amorphous sperm have trouble moving forward due to their abnormal shape. As a result, they cannot complete their journey towards the egg.
  • Head deformities can prevent the sperm cell from penetrating the egg and fertilizing it.
  • When teratozoospermia is due to genetic causes, the resulting embryo can carry DNA abnormalities that prevent normal embryo development.

The causes listed above can prevent or postpone natural pregnancy.

With mild teratozoospermia, normal sperm present in the semen could cause a natural pregnancy in the woman. Depending on parameters like sperm count and motility, the probability may be higher or lower.

Conversely, in cases of moderate or even severe teratospermia, especially if it is associated with other sperm disorders, including oligozoospermia or asthenozoospermia, the chances are that the couple has no alternative but to undergo fertility treatment to have a child.

Fertility treatments

When a man is diagnosed with teratozoospermia, based on the severity level and the results of the semen analysis report, the specialist will recommend the best treatment option to correct teratozoospermia and boost the success rates for the couple.

It should be noted that female fertility plays a major role when making this decision.

The following are the assisted reproductive technologies that a couple with teratozoospermia could undergo:

Intrauterine Insemination (IUI)

IUI is a simple technique whereby sperm are placed directly into the woman's uterus or womb to cause a pregnancy. Before this, the sperm sample is processed through sperm capacitation technique and the woman undergoes ovarian stimulation.

This fertility treatment achieves satisfactory outcomes in cases of mild teratozoospermia (i.e. 3-4% of sperm are normal), provided that the sperm count and motility are normal.

For IUI to be possible, the total Motile Sperm Concentration (MSC) test should range between 2 and 3 million spermatozoa with progressive motility.

Furthermore, the woman should be aged between 35-36 years, have tubal patency, and do not have any significant fertility issue.

Check out this for information: What Is Artificial Insemination (AI)? – Process, Cost & Types.

In Vitro Fertilization (IVF)

IVF is one of the main fertility treatments available nowadays. Roughly, it involves retrieving multiple mature eggs from the woman through follicle puncture after she undergoes ovarian stimulation. The eggs collected are put in contact with a sample of sperm from the male partner in order to male fertilization possible.

If you need to undergo IVF to become a mother, we recommend that you generate your Fertility Report now. In 3 simple steps, it will show you a list of clinics that fit your preferences and meet our strict quality criteria. Moreover, you will receive a report via email with useful tips to visit a fertility clinic for the first time.

IVF offers positive outcomes in cases of mild-to-moderate teratozoospermia (1-2% of sperm are normal) where the woman is 35 years old or more. It would be the option of choice after multiple failed IUI cycles, too.

There exists an alternative IVF procedure that requires a greater degree of human involvement, since the sperm cell is injected manually into the egg cell. It is known as Intracytoplasmic Sperm Injection (ICSI).

ICSI is mostly used in cases of severe teratozoospermia (the total normal sperm count is fewer than 1%), or when other techniques have failed.

However, most IVF procedures performed today use ICSI to create the embryos, as it reaches higher success rates than with conventional IVF.

You might also like: What Is ICSI Technique? – Process, Success Rates & Cost.


IMSI or ultra-high magnification sperm selection is an improved version of ICSI. Thanks to it, the andrologist can select the best sperm cell more accurately, paying special attention to morphology.

To this end, ICSI is enhanced by digital imaging to achieve a magnification up to 6000x.

IMSI has many advantages for teratozoospermic males, since it allows sperms to be examined in detail, choosing the sperms with the best morphology.Also, IMSI helps to diminish the miscarriage rates.

Read this next: IMSI Procedure in IVF – Differences with ICSI, Cost & Success Rates.

FAQs from users

Can IVF be successful in men with teratozoospermia?

By Daniel Sosa M.D., M.Sc. (gynecologist).

IVF is successfully used in all types of sperm disorders. In patients with teratozoospermia, sperm selection techniques such as ICSI (Intracytoplasmic Sperm Injection) or Intracytoplasmic Sperm Injection; PICSI (Physiological Intracytoplasmic Sperm Injection) or physiological ICSI can be used, in which mature sperm are selected, discarding the immature ones; MACS (Magnetic Activated Cell Sorting), which selects healthy and optimal spermatozoa that have not started the process of apoptosis or programmed cell death.

The sperm that pass this strict selection process are those that have a greater capacity to fertilize the oocyte and generate an embryo of better quality, which can translate into a higher pregnancy rate. In other words, with sperm selection, the in vitro fertilization procedure is optimized, not leaving the selection of the spermatozoon to chance.
Read more

Is natural pregnancy with teratozoospermia possible?

By Sergio Rogel Cayetano M.D. (gynecologist).

Yes, it is possible.

Teratozoospermia is an increase in the percentage of abnormal spermatozoa. Nowadays, any sperm that is not perfect in its shape is considered abnormal. Many spermatozoa fall into this category, which is why most males do not have a percentage of normal spermatozoa of more than 10%. When the proportion is excessive (greater than 96%), the patient is considered to have teratozoospermia.

In general, sperm need to be normoconformed to perform their function correctly. However, it is absolutely normal to have sperm that are not normal in shape. In fact, in every male there are many more abnormal sperm than normal sperm, so that the abnormal sperm do not prevent healthy sperm from functioning.

Abnormal sperm will have a much lower chance of fertilising an oocyte, so their percentage increase in the sample will decrease the probability of pregnancy. However, teratozoospermia is a percentage concept, there will always be normal sperm that can fertilise the oocyte (and even some abnormal sperm, if the problem is mild). This is why a male with teratozoospermia can achieve a natural pregnancy... although this problem is not usually pure, but is often associated with a general decrease in sperm quality (sperm count/motility).

What is the best pregnancy option for a couple diagnosed with teratozoospermia and PCOS?

By Estefanía Rodríguez Ferradas M.D., M.Sc., Ph.D. (gynecologist).

Teratozoospermia is diagnosed when we see less than 4% of normal sperm in a semen study. Polycystic ovary syndrome (PCOS) is an entity related to excess production of androgen-derived hormones such as testosterone. These women frequently suffer from infertility as a result of a problem in ovulation, either by not ovulating (ovulation) or by a dysfunction (disovulation).

Initially, vitamin therapy is recommended for women with PCOS, including folic acid and inositol. In addition, at present, in the male we do not have any treatment that has proven to be a guarantee for the improvement of sperm morphology, but it is advisable to take a supplement of turmeric with piperine.

Generally, in severe teratozoospermia, it is advisable to perform in vitro fertilization procedures such as sperm microinjection in to the oocyte (ICSI). In mild teratozoospermia, the couple may perform a simpler method such as artificial insemination, always informing them of the results of each of the techniques and the pregnancy possibilities.

Regarding PCOS, the main and most recognized problem is the alteration of the ovulatory cycle. By means of ovarian stimulation we are able to control the ovulatory cycle and provoke ovulation in order to carry out the insemination when we know that the egg may be available, so from the first moment the indication could be to carry out inseminations.

What is the best treatment option to achieve pregnancy with teratozoospermia?

By Zaira Salvador B.Sc., M.Sc. (embryologist).

Once teratozoospermia has been diagnosed with a semen analysis, there are the following alternatives for having children of one's own:

Artificial insemination (AI)
in cases of mild teratozoospermia and in women under 35 years of age. It is the simplest option for a first attempt.
In vitro fertilisation (IVF)
when the teratozoospermia is moderate or severe, and if the woman is over 35 years old.
Imagen: Treatment options for achieving pregnancy with poor sperm morphology

On the other hand, IVF in men with teratozoospermia is usually performed by intracytoplasmic sperm injection (ICSI). There is also a newer technique: IMSI.

IMSI is a variant of conventional ICSI in which it is possible to observe the sperm at 6,000x magnification under the microscope. In this way, all sperm with any malformation are discarded and those with a perfect appearance for fertilisation are used.

Do abnormal sperm cause miscarriage?

By Zaira Salvador B.Sc., M.Sc. (embryologist).

The fact that a male has teratozoospermia does not translate into miscarriage if pregnancy has been achieved. Nonetheless, if teratozoospermia has a genetic origin and spermatozoa carry DNA mutations, it could increase the miscarriage rate or lead to the birth of a sick child.

Does teratozoospermia increase your chances of having a baby with Down syndrome?

By Zaira Salvador B.Sc., M.Sc. (embryologist).

No, teratozoospermia is not associated directly with trisomy 21, that is, the chromosomal abnormality that causes Down syndrome. Nonetheless, sperm with an abnormal morphology can cause genetic alterations leading to implantation failure, increase the chances of miscarrying, or other pathologies.

By Zaira Salvador B.Sc., M.Sc. (embryologist).

The truth is, the treatment in this case depends on how severe teratozoospermia is, as well as on the age of the woman. For instance, if it is a case of mild teratozoospermia, and the woman is younger than age 35 year, they could give IUI a try. But, if none of these requirements are met, the first option would be an In Vitro Fertilization (IVF).

Suggested for you

Males with mild teratozoospermia can try to improve their sperm quality with a natural treatment. See this for more: Treatment of Teratozoospermia – Can It Be Cured?

In case you are interested in learning about the different methods that can be used to detect teratozoospermia in males, we recommend that you visit this article: How Is Abnormal Sperm Morphology or Teratozoospermia Measured?

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El Khattabi L, Dupont C, Sermondade N, Hugues JN, Poncelet C, Porcher R, Cedrin-Durnerin I, Lévy R, Sifer C. Is intracytoplasmic morphologically selected sperm injection effective in patients with infertility related to teratozoospermia or repeated implantation failure? Fertil Steril. 2013;100(1):62-8 (View)

French DB, Sabanegh ES Jr, Goldfarb J, Desai N. Does severe teratozoospermia affect blastocyst formation, live birth rate, and other clinical outcome parameters in ICSI cycles? Fertil Steril. 2010;93(4):1097-103 (View)

Hotaling JM, Smith JF, Rosen M, Muller CH, Walsh TJ. The relationship between isolated teratozoospermia and clinical pregnancy after in vitro fertilization with or without intracytoplasmic sperm injection: a systematic review and meta-analysis. Fertil Steril. 2011;95(3):1141-5 (View)

Lee RK, Hou JW, Ho HY, et al. Sperm morphology analysis using strict criteria as a prognostic factor in intrauterine insemination. Int J Androl. 2002; 25: 277-80 (View)

Marchini M, Ruspa M, Baglioni A, Piffaretti-Yanez A, Campana A, Balerna M. Poor reproductive prognosis in severe teratozoospermia with a predominant sperm anomaly. Andrologia. 1989;21(5):468-75 (View)

Shabtaie SA, Gerkowicz SA, Kohn TP, Ramasamy R. Role of Abnormal Sperm Morphology in Predicting Pregnancy Outcomes. Curr Urol Rep. 2016;17(9):67 (View)

Spiessens C, Vanderschueren D, Meuleman C, D'Hooghe T. Isolated teratozoospermia and intrauterine insemination. Fertil Steril. 2003;80(5):1185-9 (View)

FAQs from users: 'Can IVF be successful in men with teratozoospermia?', 'Is natural pregnancy with teratozoospermia possible?', 'What is the best pregnancy option for a couple diagnosed with teratozoospermia and PCOS?', 'What is the best treatment option to achieve pregnancy with teratozoospermia?', 'Do abnormal sperm cause miscarriage?', 'Does teratozoospermia increase your chances of having a baby with Down syndrome?' and 'What treatment do you recommended for couples with teratozoospermia and PCOS?'.

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Authors and contributors

 Daniel Sosa
Daniel Sosa
M.D., M.Sc.
Degree in Medicine from the National University of Tucumán in Argentina. Specialist in Gynecology and Obstetrics. Master in Human Reproduction by the Universidad Rey Juan Carlos and the Instituto Valenciano de Infertilidad (IVI). Current medical director of the clinic Ovoclinic. More information about Daniel Sosa
Licence number: 290846745
 Estefanía  Rodríguez Ferradas
Estefanía Rodríguez Ferradas
M.D., M.Sc., Ph.D.
Dr. Estefanía Rodríguez Ferradas has a degree in medicine from the University of Navarra and a PhD from the University of the Basque Country. She is also an expert in Reproduction and Medical Genetics. More information about Estefanía Rodríguez Ferradas
Licence number: 202007777
 Marta Barranquero Gómez
Marta Barranquero Gómez
B.Sc., M.Sc.
Graduated in Biochemistry and Biomedical Sciences by the University of Valencia (UV) and specialized in Assisted Reproduction by the University of Alcalá de Henares (UAH) in collaboration with Ginefiv and in Clinical Genetics by the University of Alcalá de Henares (UAH). More information about Marta Barranquero Gómez
License: 3316-CV
 Sergio Rogel Cayetano
Sergio Rogel Cayetano
Bachelor's Degree in Medicine from the Miguel Hernández University of Elche. Specialist in Obstetrics & Gynecology via M. I. R. at Hospital General de Alicante. He become an expert in Reproductive Medicine by working at different clinics of Alicante and Murcia, in Spain, until he joined the medical team of IVF Spain back in 2011. More information about Sergio Rogel Cayetano
License: 03-0309100
 Zaira Salvador
Zaira Salvador
B.Sc., M.Sc.
Bachelor's Degree in Biotechnology from the Technical University of Valencia (UPV). Biotechnology Degree from the National University of Ireland en Galway (NUIG) and embryologist specializing in Assisted Reproduction, with a Master's Degree in Biotechnology of Human Reproduction from the University of Valencia (UV) and the Valencian Infertility Institute (IVI) More information about Zaira Salvador
License: 3185-CV
Adapted into english by:
 Sandra Fernández
Sandra Fernández
B.A., M.A.
Fertility Counselor
Bachelor of Arts in Translation and Interpreting (English, Spanish, Catalan, German) from the University of Valencia (UV) and Heriot-Watt University, Riccarton Campus (Edinburgh, UK). Postgraduate Course in Legal Translation from the University of Valencia. Specialist in Medical Translation, with several years of experience in the field of Assisted Reproduction. More information about Sandra Fernández

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