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Commonly found artifacts include bowed midpieces (also called bowed tails) and bent tails (also called simple bent tails and hypotonic shock). Neither of these anomalies should be counted as abnormal in the differential count. Bowed midpieces are easy to recognize as rainbow‐shaped, C‐shaped, or U‐shaped. A key characteristic is that the tails (midpiece and principal piece) do not fold as is the case with the distal midpiece reflex. The occurrence of bowed midpieces is associated with faulty slide preparation, most often when slides and the stain are cold. Examination of motile sperm on a wet mount can be used to confirm that this aberration is artifact [27].

Hypotonic shock is usually manifested as terminal whipping or looping of the principal piece and is caused by prolonged exposure to hypotonic stains (eosin‐nigrosin and eosin‐aniline blue) before drying. Drying is often prolonged when stains and slides are cold. The looping may appear similar to the distal midpiece defect (DMR) except that there will be no trapped droplet material. Closely examining the terminal portion of the midpiece and comparing the aberrant sperm with other sperm on the smear will facilitate classification (Figure 9.8).

Figure 9.8 A sperm with a bowed midpiece and a sperm displaying hypotonic shock (looped tail).

Other debris includes white blood cells, shed droplets, and spheroid cells (shown in Figure 9.3) as well as epithelial cells, bacteria, and red blood cells.