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By T F Kruger; Daniel R Franken

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31 found the AI cut­off value to be at 8% normal acrosomes.  Liu and Baker16 found that in cases with <30% morphologically normal spermatozoa (according to WHO criteria), the acrosome status (% normal) was an important prognosticator of expected fertilization in vitro. 17 showed that, by increasing the insemination concentration of acrosomally normal spermatozoa to at least 25 000/ml in patients with poor acrosomal morphology, fertilization rates and pregnancy rates reached similar levels to couples with normal acrosomal morphology These publications confirm the fact that a minimum number or percentage of spermatozoa with normal acrosomes are needed for normal fertilization to occur in vitro, and underline the important physiological role played by the acrosomes in the fertilization pathway14.

Sperm morphology training Sperm morphology assessment is a subjective method, and intensive training is therefore needed to ensure that the technologists possess the required evaluation skills.

This additional role of the acrosome index in assisted reproduction, particularly with regard to intracytoplasmic sperm injection (ICSI), will be discussed shortly in this chapter, based on the functional role played by the acrosome in the fertilization pathway.  A number of enzymes, such as (pro)acrosin, which plays a vital role in the fertilization pathway13, are contained within the acrosome.  The ability for zona pellucida­bound spermatozoa to undergo the zona pellucida­induced acrosome reaction may also play an important role in non­fertilization18,19.

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