SA- Morphology guidelines changed

[babybumpage]

As a master's student, I learned how to search a few journals, and one medical journal was by a gentlemen you will see below. The journal referenced new SA guidelines, so I went to the Dr.'s website and found this. I think the new morphology guidelines make a LOT more sense, so anyone who has had a SA please read this.


THURSDAY, JULY 01, 2010
Sperm Morphology: New Guidelines Announced: 4% is Normal
Wow, what a relief to know that what we have been saying for years is now
finally officially stated. Any sperm morphology over 3% is considered normal.

How did this change come about? The World Health Organization (WHO) determines
the normal parameters for semen including volume, count, motility, forward
progression and morphology. The WHO published their guidelines in 1987, with
updates in 1992 and 1999. The original “normal” cutoffs were based on estimates
from old data, some of it dating back to the 1950’s. There were inconsistencies
in the way data was collected, ie the sperm studied was collected and analyzed
in many centers, but there was little regulation of how the tests were being
performed. Plus there was not clear data on the history of the men.

This time the semen tests were performed using similar protocols in all of the
testing centers. Plus, some history was obtained from the men, mostly related to
fertility status.

4500 men in 14 countries on 4 continents were tested. Australia, China, Denmark,
Germany, Chile, Singapore, France, the UK, and the USA were some of the
countries included.

Men were placed into one of 4 groups.
Fertile men. All men in this group had initiated a pregnancy sometime in the 12
months preceding testing. This was the most important group because the
researchers could establish normal values based on men know to have fertile
sperm.
There were 3 other groups evaluated. To save a little confusion, I’ll summarize
and say 2 groups were a little more random in nature and the fertility status of
the men was mostly unknown. The 4th group was also fertile, but the time since
last pregnancy was unknown and may have been longer than 12 months.

The results.
The normal fertile men’s sperm had the following results.
Volume: The median (midway between the lowest and highest results) was 3.7 cc,
but anything over 1.5 cc was considered normal
Concentration: the median was 73 million but anything over 15 million was
considered normal
Motility: the median was 61%, anything over 40% being normal
Morphology: the median was 15%, anything over 3% was deemed normal.

Some important points.
You may have noticed that morphology is not the only parameter with a new normal
value. Volume was at 2.0 cc, now it is at 1.5cc. A normal count was 20 million,
this changed to 15 million. Motility was 50%, now it’s 40%. The normal
morphology had the biggest change, as it went from 15% to 4%.

Keep in mind that in this group, all of these men were fertile, so even men with
levels lower than the new definition of normal had working sperm. The normal
values were established mathematically. If you were in the upper 95% of the
fertile people you were deemed normal. The bottom 5% of the fertile people was
deemed abnormal. This 95%/5% cutoff is the system used to define cut offs for
other tests such as TSH, Prolactin and many others.

When comparing the different groups of men there were very slight differences in
volume, count, etc, but hardly worth mentioning. Fertile men did have slightly
higher volume and counts then men whose fertility status was unknown. Morphology
was mostly similar in the different groups. Remember, there was no group of men
who had established infertility, so in this study there is no way to compare
normal fertile men to known infertile men.

And even though we have no details on the women, knowing that they became
pregnant in the past year is probably all the information we need.

So now you know. Any morphology over 3% is considered normal. If your doctor
tells you otherwise, ask him if he has seen the new WHO guidelines.

To take it one step farther, can there really be difference between 4% and 2%? I
doubt that there is a difference between having 96% abnormally shaped sperm and
98% abnormally shaped sperm. So as I have said before, at our practice here at
NYU, morphology is not considered with much respect, except in some rare cases
where the sperm is unusually abnormal.

I hope this helps.

For those of you who want more details, here is the link.

www.who.int/reproductivehealth/topics/infertility/cooper_et_al_hru.pdf

Dr. Licciardi

https://infertilityblog.blogspot.com/

ABOUT ME
DR. LICCIARDI
I have been practicing infertility at NYU for 17 years. Basic infertility,
reproductive surgery, ovulation induction, IVF, and egg donation are all areas
of my expertise. Most of my patients are from New York , but people come to see
me from other states and other countries. You can read all about me at my
website, DrLicciardi.com.

 

[Megg33k]

Oh wow! Thank you! That makes me feel better about our 5%!

 

[MrsJA]

Hi girls,

I've seen this article before, but I am dubious...

If 3% is "normal", then how come so many of us LTTTC'ers are borderline, or around that level and not pregnant?

It might be normal but it sure doesn't mean you get pregnant in a "normal" timeframe.

And I don't know about you guys, but I have no desire to turn up at my doctor's office saying "it's OK - we are normal! No need to treat us!" I want to be treated!

Anyway, sorry I really sound like a downer here! But I'm just not sure that this change in guidelines is actually helpful for us.

Lots of luck to you all

 

[Leila Fae]

It's an interesting article although I wonder if the term 'normal' is misleading. It sounds to me like it's being used to describe a result which doesn't necessarily require additional help but as MrsJA says it doesn't mean you'll get pregnant within a normal timeframe.

I have mixed feelings about the categorisation of normal. My DH's latest result was 5% down from 6% last year. On the one hand it's encouraging to hear that even 5% is 'normal' but equally there's clearly something not working. While I would adore to get pregnant naturally there's a teeny bit of me that wants his morphology to be bad enough to get some help and just get the ball rolling!

 

[FBbaby]

totally agree with you MrsJA. I've been ttc for 20 cycles since my chemical m/c first month ttc. We got tested last February and were told by FS OH results were a big problem and we needed icsi. His results were total volume 3.5, count 18mil, 61% motility and 4% morphology which would put him in the normal category under the new guidelines. We decided to wait and did 2nd test 3 months later, results had gone up, volume same, count 29mil, motility 60%, morphology 6%. The FS did say that this was a lot better, but still hinted that considering my age (39) we should really consider IVF. The thing is, I do ovulate regularly every single month and we bd at the right times (except last month, -2.5 days). It is very doubtful I have blocked tubes as had 3 pregnancies, or that I have endometriosis (very light AF and no pain), my womb is clear. So why oh why am I still not pregnant????

My FS still thinks that 6% morphology is low and although it doesn't make pregnancy impossible, it does mean that it very well could not happen after a long time. I am quite with him, yes, we CAN get pregnant, but that doesn't mean it WILL happen.

We have decided to give IVF a go next march, not so much in the hope to get our longed for baby, but because we need closure and be able to look back without any regrets.

Good luck with your second attempt MrsJA

 

[Quaver]

I see what you mean MrsJA, but since my DH's morphology is 1% and motility is 22% nothing's changed for us (just thought I'll let you know some people are even lower than the guidelines).

 

[foxyloxy28]

Thanks for posting that

My OH's morphology was 3% - our FS considered it borderline (going by 4% + as normal) but wasn't concerned. 2nd sample to be done in a month or so's time - hopefully it'll be 3%+ next time.

 

[babybumpage]

I think maybe you ladies were missing the point to the article a bit. What the doctor was saying that was shocking is

"To take it one step farther, can there really be difference between 4% and 2%? I
doubt that there is a difference between having 96% abnormally shaped sperm and
98% abnormally shaped sperm. So as I have said before, at our practice here at
NYU, morphology is not considered with much respect, except in some rare cases
where the sperm is unusually abnormal."

What this means is that there really is very very little difference from a 3 to a 5 or a 5 to a 7. And the who is saying that most Americans are around a 5 (that's why they set their guidelines there, humans have evolved and the guidelines follow a very tiny evolution). So what this breaks down to mean is that if 5 is a normal, with most people being around there and having kids, and you are a 3, the difference may be microscopically different, and it may not be the reason you aren't getting pregnant. I fall into this category too, our SA gave us a morphology of 5, and so far it has been the only problem. So i can understand the question "if not this, then what" and I too want to believe we found the problem so we can fix it and have a child. But I certainly am not going to wish that my husbands morphology is bad enough to get help, sorry. As bad as I want an answer, I don't think I want anything to be wrong with either of us.

 

[Megg33k]

We also had 5%. Hoping for better today though!

 

[FBbaby]

Unexplained infertility is the highest 'group' of couple accessing assisted conception. Unexplained means either that there is a problem but it hasn't been possible to identified, OR there really are no problems, it is just the luck of the draw. There are probably people getting pregnant first month trying when everything was stacked against them, but they had no idea and actually problably believe they are super fertile as a result of falling pregnant quickly. That could have been us, we managed to fall pregnant first month ttc and if we hadn't m/c, we would never have known that actually, we fell pregnant against the odds. Similarly, some couple with no problems will take much longer for no apparent reason.

That's why I personally didn't jump for joy when I read these guidelines. Yes, it means that my OH semen is normal and according to statistics, means that I should be able to fall pregnant within a year, but in reality, nothing has changed at all for us, we had been ttc 1 year by the time the guidelines came out, so it made no difference to our feelings of hope.

 

[Leila Fae]

But I certainly am not going to wish that my husbands morphology is bad enough to get help, sorry. As bad as I want an answer, I don't think I want anything to be wrong with either of us.

If you read my original post I certainly don't want this either. What I was trying to get across is that the experience of LTTTC can be so frustrating that it can mess with your head. I don't want there to be anything wrong with DH or I either but equally the not knowing is difficult to deal with.