Alternative povs re bad semen analysis

[catheleni]

Hi all,

I post in the TTC forum usually, but we have been trying since 7/09 for our #1 and now just found out

DP has morphology and motility issues, but good count.

Where can I find alternative information?  When I google this, I get nothing helpful.  The fertility center where we went for the SA

is just that...and in a factory setting.  I feel like no one is explaining my options and I am feeling lost!

Thanks!

[RosieL]

Hey Cathe! As you know form TTC, I'm in a similar boat. SA came back with fine mobility and count, but they gave me two numbers for morphology, one 2% and on 40%. I am *assuming* that the 2% was with Kruger strict criteria (http://www.ncbi.nlm.nih.gov/pubmed/1550422) and the 40% was WHO criteria (http://humupd.oxfordjournals.org/content/16/3/231). 

The first thing I found when googling morphology was this: 

 

When we test sperm (the semen analysis) we look at a few different parameters. First is the volume, which should be 2cc or higher. Second is the count. This is the number of sperm per cc, so it’s technically a measure of the sperm concentration. This should be 20 million per cc or higher. The average is around 35 million. Next is the motility: the percentage of sperm moving. Should be 50%, most normal samples are not much higher. And then there is the morphology: the percentage of sperm normally shaped. This should be 14% or higher. The average is 2-6%, but why?
The original guidelines for sperm parameters, from the WHO, stated normal morphology should be 30%. Then about 20 years ago, Dr. Kruger came out and said we really need to be looking more carefully at sperm shapes. If we are really careful we will see that there are more abnormal sperm than we think, and the cutoff should be 14%. He called his classification "strict criteria". He also said that by being more careful we could better identify the men who are infertile due to badly shaped sperm. This all sounded well so the andrologists (the people who do your sperm test) started looking harder, and harder, and harder. They now deduct for every sperm that does not look perfect. So over the past 20 years, the andrologists have been getting pickier and pickier, and now a man is lucky if his morphology is over 5%, and almost everyone is less than 14%.

http://infertilityblog.blogspot.com/2006/05/sperm-morphology-mythology.html

So, if this guy thinks that average morphology is about 5%, then my DH's 2% doesn't sound so bad. I don't know...

And then I see this: that basically says if less than 5%, IVF and ICSI is recommended. I'm 100% skeptical of fertility clinics recommending fertility treatments, because they have every economic incentive to over-prescribe. 

[RosieL]

Cathe - I've been pulling down some research on morphology. The preponderance of research seems to be on morphology percentage's impact on IVF outcomes. I found one study that looked at in vivo pregnancy and morphology in which they compared a fertile group of men to an infertile group, selecting the infertile group based on sperm counts. They found that the FERTILE group had a range of strict criteria morphology scores of 1-19%, with an average of 6.5%+/-3.9%. The infertile group had 3.0+/- 2.6 and a range of 0 to 12. 

While it's clear morphology was lower on average in the infertile group, morphology alone doesn't seem to be a great predictor of fertility, even at levels like 2 and 3%.

Menkveld, R., Wong, W. Y., Lombard, C. J., Wetzels, a M., Thomas, C. M., Merkus, H. M., et al. (2001). Semen parameters, including WHO and strict criteria morphology, in a fertile and subfertile population: an effort towards standardization of in-vivo thresholds. Human reproduction (Oxford, England), 16(6), 1165-71.