Hi all, I'm just trying to create a centralized thread for morphology as it seems to be one of the least understood SA issues. I'm interested to hear about your hubbies SA results and what the doctors said in particular about the morphology in relation to them. I've heard so many different things, but think its good to hear perspective from other people. This is what I have read from the WHO 2010 SA guidelines sent to fertility labs. So please post all the results if you like! I've read the gradient of how many percent are below and above each number and can help you out with count or motility numbers if you'd like.
50% have less than 15% morph and 50% have more than 15% morph
25% have less than 9% morph and 75% have more than 9% morph
10% have less than 5.5% morph and 90% have more than 5.5% morph
5% have less than 4% morph and 95% have more than 4% morph.
This is why WHO lowered the standard from 14% to 4%. If 50% of fertile men who fathered children had less than 14%, that couldn't exactly be a minimum standard.
My fiancee's results:
Count: 204 million (50% have less than 255 million, 50% have more and DH missed part of sample so assuming its about 255-300 million)
Rapid Progressive Motility: 61% (75% have less)
Total Motility: 65% (50% have less)
Vitality: 87% (90% have less)
Morphology: 4% (5% have less)
I have been told by 2 different fertility specialists that the norm these days is 4%. One of the specialists would definitely tell us the truth- I trust him.
The NHS professor we saw stated that they don't count morphology at all as there is a question over how important it is to conception, as the WHO lowered the level to 4% as men with such low levels were fathering children.
Plus you need to take into consideration the volume and other factors. So you could have a low morphology of 4% but if your volume is pretty high then it kinda evens things out!
By the looks of your fiance's results there is little to worry about. His count is incredible as is his motility. The fact that there is only 4% morphology has to be measured against the count etc.
HI Dancing EMR. Did a fertility doctor say that to you or your GP? I had my GP say that, but he had no idea what Kruger was and was basing it off prior WHO criteria and though the majority of sperm were supposed to be normal.
Here are three studies showing the low significance of morphology if the range if even 3% or greater normal forms. Hopes this helps some people out. I have read the full studies, but just posted the abstracts or conclusions for simplicity.
"Prospective and retrospective studies were conducted to evaluate sperm morphology using strict criteria for predicting fertilization capacity in males. Severely impaired male fertility potential was measured by a result of <4% (denotes percentage sperm having normal morphology) and scores of > 14% indicated normal fertilization potential. There were no statistically significant differences found in pregnancy rates in partners of men with normal morphology of <4% vs. those with 14% or greater (x2 analysis): the prospective study showed a 41 % pregnancy rate in <4% group vs. 29% rate in > 14%
group @ - 0.44 NS); the retrospective analysis showed a 50% pregnancy rate in the group with <4% morphology scores vs. 67% in > 14% group @ - 0.45 NS). When only the men with normal motile
density (> 10 x 106/ml) were evaluated, a statistical difference was found in the retrospective study between the group with morphology results > 14% (93%)
vs. the group <4% (40%). However, the 56% success rate in the men with < 10 x 106/ml sperm and normal morphology <4% reduces the significance of the diagnosis of sperm morphology using the new strict criteria."
Source: EVALUATION OF SPERM MORPHOLOGY USING
KRUGER’S STRICT CRITERIA
J. H. CHECK, H. G. ADELSON, B. R. SCHUBERT,
and A. BOLLENDORF
(Done in 1996)
This is another study classifying the minimum as 3%. (I'm a university student so have access to library database to read the studies)
In this study, the semen analysis results of a fertile population were compared with those from a subfertile population, in order to establish normal cut-off values for the standard semen parameters with the aid of receiver operating characteristic (ROC) curve analysis. The fertile group comprised healthy males (n = 107) without any history of fertility problems, the partners of whom had had a spontaneous pregnancy within one year of unprotected intercourse and were pregnant at the time of the male's inclusion into the study. A total of 103 males from couples attending the infertility clinic, and with an initial sperm count of <20×106/ml were recruited to form the subfertile population. The best discriminating parameter between the two populations was sperm morphology evaluated according to WHO criteria at a cut-off point of 31% normal spermatozoa. The other cut-off values were at 8% for the acrosome index, 45% for motility, and 4% normal spermatozoa for strict criteria. Recalculating the ROC curve cut-off values based on an assumed 50% prevalence of subfertility in an assisted reproductive setting, the cut-off points were reduced to 21% and 3% normal spermatozoa for WHO and strict criteria respectively. For motility, the new cut-off value was at 20% motile spermatozoa, for motility quality at 3.5 (on a scale of 1–6), the acrosome index at 3% normal acrosomes, and the teratozoospermia index at 2.09.
(Done in 2000)
Roelof Menkveld1, Wai Yee Wong2,3, Carl J. Lombard4, Alex M.M. Wetzels2, Chris M.G. Thomas2,5, Hans M.W.M. Merkus2 and Régine P.M. Steegers-Theunissen2,3,6
Study of Sperm Morphology in Fertile Pakistani Men
Mohammad Owais Ahmad, Saadat Ali Khan, M. Amjad Hameed**, Umar Ali Khan**
Departments of Physiology *Foundation University Medical College and **Islamic International Medical College, Rawlapindi. Pakistan
Pak J Physiol 2007;3(2)
Background: The aim of this study was to determine the sperm morphology of proven fertile
males and to compare the same with that of infertile males. Method: This study was carried out at
International Medical College Rawalpindi and its attached Railway hospital and Islamabad Clinic
Serving Infertile Couples Islamabad, from June 2005 to July 2006. 50 healthy fertile males were
selected and their semen morphology was determined according to Tygerberg’s strict criteria,
while another 50 infertile males were recruited as controls Results: Proven fertile group showed
significantly higher morphologically normal forms of sperms (3.04 ± 1.63) than the infertile
group (0.92+-0.72). Conclusion: Sperm morphology assessed by strict criteria is of value in the in-vivo situation to identify a group with greater chance of having an infertility problem and strict criteria sperm morphology analysis should be used to minimize variations in intra and inter-individual and inter-laboratory sperm morphology assessment.
Conclusion: Around 3% normal morphology was the average for the fertile group. The range found in the fertile men was only 0-8%. The maximum morph found was 8%. CRAZY!
WEBSITE WITH MORPH AND CONCENTRATION SPECIFIC INFO:
Figure: Morphology and Pregnancy. The main thing to note is that there is a gradual but small decreae in the probability of conception as morphology declines. It should be noted that the effect of morphology on the probability of conception is relatively minor compared to that of concentration. Modified from Bonde et al. Relation between semen quality and fertility: a population-based study of 430 first pregnancy planners. Lancet 1998. Specifically, the old WHO morphology criteria have been changed to the Kruger Strict criteria for illustrative purposes.
"Very commonly, the only 'abnormality' on a semen analysis report will be the morphology - the concentration and all other parameters will be 'within reference range'. This is known as isolated teratospermia. Most patients are alarmed at this. While a decrease in morphology can be associated with a decreased probability of conception, this is one instance in which there is probably no effect on the chances of conception and the morphology can be safely ignored." -Quoted from website.
Both my FS's dismissed 4% morphology as average. They're more concerned about my DH's low count and motility.
DancinEmr- How long have you guys been trying? Are there any female factors too? Because you should still be able to conceive with your DH's count and motility.
I wouldn't listen to the doctor in going with IVF (unless you have a female factor). If you wouldn't to go with alternative treatments, I'd go for an IUI..because there's no issues with motility. We're going to eventually do IVF due to my DH's low motility. I get my info from my FS, online, and here.
Hello everyone and thanks for all of the information. Morphology is so confusing I am glad to hear information that gives me hope. My hubby took the sperm analysis at a FS office, and the FS sent the results and the report to my Gynecologist's office. My Gynecologist gave us the report that said 4% morphology Kruger-Abnormal, refer for IVF.
I am still hopeful, as I have heard that 4% is the new normal and we have no female factors that we know of.
Good luck to everyone and I wish you all the best!
Thanks for posting this. My DH's SA was 4% which the FS said was on the low side but wasn't a major problem. His next one was 7% and they said there was no problem. It's so difficult when there is so much conflicting information. After 19 months TTC and various issues, tests and ops, my conclusion on most factors is that they just don't know!
My DH had S/A done and has 4% for morph....my Dr. called and said everything came back normal and no worries. I didn't even realize until I got onto evil google that 4% is as low as normal can be, so now I've worried since.
In May I did get PG after only 6 months of trying, but I did miscarry. But, at least I got PG so it's possible!
I called my Dr. last week because now 7 cycles later I'm still have not gotten PG again and she confirmed again she is not worried at all about the 4% morph because his count and motility were ok. Idk, I think it may just take us all a little longer, but it seems possible!!
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