Semen morphology abnormal - help with next steps!

[Kateeeeeeee]

Hello all,
my husband has just received his semen analysis and I was really shocked to see only 2% of normal morphology. All other markers like count, concentration and motility had very good results though, so I am confused to only see this one marker off. I thought if someone had an issue, all of the results would be slightly off.

Has anyone else experienced this, and what have you done to improve this? Has your doctor investigated further? If so, what other tests can be done? Since this is really just a morphology issue, I wonder if this is tied to anything particular…?

Side note: I am so lucky that my husband never smoked, never drinks, not even a drop, eats a whole foods diet with me, takes some supplements, exercises etc. so I am really wondering what else he could do to help. I guess I am mainly curious about what the next steps would be regarding further investigations so would massively appreciate your guidance.
Also: I know that officially these days, normal morphology is 4% which is still shocking since not long ago, a minimum of 14% was required to be classed as normal, and this is about the ideal number for conception. It’s shocking how they lowered the threshold this significantly.

Morphology is notoriously tricky to assess, and more so than the other semen parameters is down to the judgment of the tech performing the analysis. See the Mayo Clinic here:

"Sperm morphology is poorly understood, and it can be subjective. Scores can vary on the same semen sample, in the same lab, using the same scoring techniques. Most male fertility experts agree that the role of sperm morphology in predicting pregnancy is unclear, and that it's a poor predictor of infertility unless nearly 100% of the sperm are abnormal."

In terms of what can be done, I don't think there's a massive range of options beyond keeping up a good lifestyle, reviewing the supplements used (is he taking something specific to improving semen quality?) and ensuring his testicles aren't overheating. If his overall count was also low I think there might be options to pursue in terms of medication, but if morphology is the only issue I don't know how applicable that is.

DH had low morphology - i think his was 3%? We were being treated through the NHS and they advised him to make some lifestyle changes whilst i was also undergoing my investigations. It takes 3 months for things to have an impact on sperm quality so he was due to be retested then. He doesn't smoke, had already stopped drinking, we changed his standard vitamins to specific conception ones, he stopped using his laptop on his knees, switched to loose boxers and lost some weight. We actually fell pregnant before the retest so we didn't do any further investigations.

My DH had 2% normal morphology also and we were told we would need IVF with ICSI. I don't ovulate either.

We got pregnant with the help of Clomid to help me ovulate. All it takes is 1 "normal" one to break through!

Wishing you luck.

Oh wow I had no idea about this. Thank you so much for sharing!
It really is literally just the morphology, I am actually positively surprised how high his count is at 177, concentration 70 and motility 68% with 65% progressive.
Now my thought is that perhaps this isn’t such an issue since obviously 2% of 177 million will be very different than, for example, 2% of 10 million, right? I am just speculating. Could the number be low because the overall count is so high?

Aw I love this positive story! That’s wonderful.
Were his other markers good, do you remember?
And were all your investigations ok?

Oh wow that’s wonderful! I love hearing positive stories. Did you get pregnant naturally on the clomid or was that with IVF too?

Have you had his DNA fragmentation done? As from what I understand when we were doing IVF, that was more important. We had the opposite problem in that the sperm count was quite normal but his DNA fragmentation was high.

So I have ended up doing ivf because my tubes are blocked. My husband’s SA was really good apart morphology which I think was either 2 or 3%. The fertility specialist said to us that it wasn’t really anything to worry about and that the World Health organisation are even considering taking it out of sperm analysis because it can be misleading. As it turns out we had a very successful ivf round (the embryo part anyway) which leads me to believe that the only thing in our way was my tubes. If you are worried about the fact that you haven’t conceived yet and going off those results, I would start getting investigations done for you for peace of mind if nothing else! Good luck!

I don't know if the overall number being high means the morphology is likely to be lower, but my clinic definitely considered morphology to be less of a concern where count, concentration and motility were good - as you say, 2% morphology with a count of 177m means 3.5m sperm with good morphology vs 200k with a 10m count, almost 20x more. Even with 14% morphology, the 10m count guy still has less than half the amount of sperm with good morphology than 177m at 2%. Male fertility is a numbers game, for sure!

Yes all his other markers were fine. He was very put out at this one marker dropping!

So this was for our second child. Our first child was born in 2021 - i have PCOS so we used letrozole to conceive her. DH's test results were all fine then. When we went back to do letrozole again for our second child in 2023, that's when we found out about DH. Whilst DH was getting his results back up, I lost 12kg and we actually had a natural conception for me and him. So doubly positive all round ☺️

Not done DNA fragmentation yet because we literally only just found out those results. Does the NHS do that test at all or do you have to go private for that?

Wow that’s wonderful! :) really love those kind of stories.

Oh I see! Did you find out why your tubes were blocked?

I have been investigating myself quite a lot already and at first took all the blame myself. All my hormones are good but I had an endometrioma found on my ovary which made me feel really depressed since it could mean endometriosis despite me having zero symptoms so this felt like a massive shock and still does really, but I try not to think about it. So who knows, I may potentially have blocked tubes too, if it takes even longer to conceive I will surely look into that test.

@Kateeeeeeee nope I haven’t found out why nor do they really know. I have adenomyosis so it might be something to do with that but who knows. I didn’t want to dwell on it or waste time trying to investigate it. Honestly it was just such a relief to have answers and to finally be taking answers. Yes ivf has been hard (and still ongoing) but it’s better than not knowing and the time ticking by with nothing to go off. And I consider myself lucky that we knew what the problem was and that we’ve had positive outcomes so far. My only regret is that we didn’t do the HyCoSy six months or so earlier to move things along as ivf was always going to be the answer. I’m sorry about your endometrioma and I know it’s easy for me to say, but try to not lose hope. I know women who have one and go on to have successful (assisted) pregnancies and as an Adenomyosis sufferer (with suspected endometriosis) trust me when I say, you are lucky you don’t have symptoms because it really is hell on earth. The advances they’ve made on this stuff in the last few years are really positive and you definitely have options!

That’s all very true and I am grateful to not have any symptoms. And grateful for the options these days, however they are all so massively expensive….

@Kateeeeeeee thats absolutely true. We don’t get any rounds on nhs so had to say goodbye to house deposit but then were glad of the fact we had savings so swings and roundabouts I guess. I think there are fertility specific loans and funding opportunities but we haven’t had to look into any of that.

@Kateeeeeeee I got pregnant with A variety of medications and scans (Clomid, progesterone pessaries, trigger shot) but no IVF required. Even at the age of 41!

I'm 43 now and considering trying again within the next 6 months!

I wonder whether the type of sperm defect plays a role in whether a couple with low morphology can conceive or not. My husband has had 2 SAs, sperm morphology is an issue in both, although it improved by 1% in the second one.
He's fit and healthy, plays football, runs and goes to the gym, doesn't eat processed food, doesn't have any underlying health conditions. He quit alcohol 4 months ago after his first SA, but I struggle to believe that him going out with his friends to have some drinks once a month was the reason for low morphology. In his second SA, his count was 270m but for every 100 whole spermatozoa, there are 72 headless tails (pinheads). 15 months and 17 tries after we started ( I was 33 and he was 37), we've never had a positive pregnancy test. I have low AMH but a regular cycle. All other tests including Hycosy came back normal. We even tried Letrozole to produce more eggs for a better chance. I had 3 follicles last month, 5 this month but no luck. This is honestly baffling 😅

My partner had less than 1% morphology and he was able to turn it around and get a normal sample in less than 3 months my baby is asleep in my arms right now . What he did :

Cut out all alcohol
Cut way way down on caffeine
Lose boxers
Took Zinc and selenium
Took fenugreek
Took CoQ10 (zita west)
Took vitamin d

Basically followed all the advice in this video it helped us so much