2% morphology

[LondonJem]

Hello, DH and I have been trying for 9 months, currently on cycle 10. He's just had a semen analysis done and got morphology reading of just 2%. Everything else normal / good.

Does anyone know anything about morphology? Jury seems to be out online - I have been googling lots. Some people it doesn't matter, others say you will need IUI or IVF.

Any thoughts or insights welcome.

Hi London, my dh has low morphology - it ranges between 0% on a bad day to 3-4 on a good one. We have been trying for 3 years for a second child (no idea what his morphology was when we conceived our 5 year old unfortunately).

There are lots of things you can try to improve it... lifestyle changes and taking vitamins etc. Unfortunately it hasn't worked for us and we will be having IVF in January. I also understand morphology is the hardest part to change.

That said, if the rest of his counts are normal, you have more to work with (so to speak!). My dh also had a low count ranging between under a million to about 10 million.

Personally, we have tried everything to fix DH's before heading to Ivf and although it has delayed us starting IVF, it was worth giving it a try first!

Thanks for your reply close. We are trying for number one so no previous experience to compare to. I want us to do this naturally if poss but I'm also feeling impatient. I'll be 33 in December and I want more than one bub!

We will definitely look at the lifestyle stuff. We're generally both healthy, he could probably cut down booze a bit and remember to take his supplements. He is in training for the London marathon though and I've heard running isn't great?

It took us 7 months to concieve our son, so it could be that our problem was there first time round too and we just got lucky. We'll
never know!

9 months is not too long tho, you may still get lucky too. How come you have had tests already if you don't mind me asking?

If not heard that about running, but they do need to keep cool, so make sure he's in loose shorts! My dh has his name in the ballot so I'd better do some research if he gets a place...

Not at all - I was a bit worried about the effect of his job. He's a long haul pilot and I worried about the effect of all the radiation. I'm glad we got it done as now we know we might need to get a bit of help. There's also an element of me just being so impatient just want a baby so much now.

I get that. The desire is pretty much primeval I think, can't be controlled!

If you do want to get on with investigations etc, you could always book a consultation with Dr Ramsay, a urologist at the London Clinic. He would be able to advise you on whether he thinks your dh needs further investigations. It might also be an idea to have some tests done in yourself. Your GP can run blood tests to check whether you're ovulating. You can also have your ovarian reserve tested (but would probably have to pay for that one).

On*

Thanks close I've seen his name mentioned a few times. DH has booked with a 'fertility specialism' doctor at our GP practise to discuss the results, so we will see what they say. The good thing is he has a high count and good motility, so it's a low morphology % but it's of a big count, if that makes sense.

I've had bloods done early cycle and that came back normal. GP said come back when you get to a year.

We shall see!

Good luck with your IVF - and good luck to your DH getting his marathon place.

I am still at a loss - my DH had 4% morphology, the consultant basically said this was a bad thing and booked him in for a re-test after a few months and lifestyle changes etc.

About a year later (they forgot to send us a new appointment after the second test) we spoke to a different consultant. This time the results were 5%. This time they told us it was nothing to worry about, that everyone in our city has a low morphology result (makes me wonder about the lab?) And that we just needed to have more sex and come back in a year.

Anyway, we decided to adopt instead (many other elements considered including my own health problems) and are now approved and waiting for a match...

Fingers crossed for you crazycat, DH and I have already said we would definitely consider adoption. I would probably adopt even if we do conceive.

The morphology thing seems such a grey area! I can't work out if it's terrible news or something we should disregard!

Hi

We've also found that morphology is a grey area. TTC for 2.5 years and currently unexplained. Initial tests we were told were OK - count and motility were good, morphology 6% and 7%.

Our first round of IVF earlier this year the sample wasn't so good on the day, morphology being the issue. We did half normal IVF and half ICSI. The IVF half had a fertilisation rate of 30% compared to 100% with ICSI. Got a bfp from one of the ICSI embryos but sadly miscarried.

We're going full ICSI with next cycle. The Dr still hasn't said that morphology is our issue though (still 'unexplained) so who knows!!! As long as there are enough normal sperm they said it shouldn't be so much of a problem but interested to read other's experiences of this.

Thanks for sharing your experiences annie good luck with the ICSI

Also worth noting there are two scales for morphology

The old WHO criteria set 15% normal forms as the benchmark for morphology

The new 'strict' Kruger criteria is (as the name suggests!) stricter about what is considered normal, and thus the bar for decent morphology is lower - 4% normal forms

My DH had 4% morphology and I asked my consultant if this was borderline. He said not at all, as far as morphology was concerned it was unusual to see anything above 6%, and that we could definitely do standard IVF rather than ICSI with those numbers (we were already doing IVF and male factor wasn't our issue)

As closephine said a higher count can help offset poor motility and morphology

My Dr recommended DH take vitamin C, zinc and selenium to support sperm quality (anti oxidants help reduce free radicals apparently)

You can get this in wellman vitamins - or if you want turbo charged vitamins, lots of Drs recommend 3 months+ of Proxeed, which is I believe formulated specifically for improving sperm

Thanks banana it was the Kruger scale he got his 2%. He read somewhere average is 3% so maybe it's not so bad. I feel like I'm maybe worrying for not enough good reason and probably stressing him out. This whole process is such a head fuck and I realise I don't know the half of it. Good luck with your treatment.

Yes, we had icsi.
There actually isn't evidence that " lifestyle changes" can have enough of an impact to make a meaningful improvement.
Obviously if your husband were a sloth smoking and drinking all day maybe, but within normal parameters all the supplements etc have not been proven by scientists to be effective. Otherwise you could just take those instead of years of invasive treatment ( in my case).

Echoing mouldy - supplements are tinkering round the edges for the most part. They can help with agglutination but can't fundamentally shift metrics like morphology (although many posters report improved count after taking supplements, the science doesn't bear out cause and effect)

They won't do any harm but any gains are likely to be marginal

So do you think we need to go down the ICSI route? I don't want to jump to conclusions but I don't want to keep waiting if it's not going to happen naturally

Under 4% is poor, you would need to see a fertility specialist - preferably an andrologist, such as Mr Ramsay who's already been mentioned - to get a clear recommendation for the best next steps in light of these results

It may be that ICSI is recommended - it may be that they say count and motility are good enough that they say it's worth TTC naturally for a a little while longer. In which case it would be prudent for you to have have the key investigations (if you haven't already) to check that there aren't any issues on your side that would indicate IVF. Eg HSG to check your tubes are open, progesterone day 21 test to confirm you're ovulating.

Was the SA private or via a GP? Many GPs won't refer you on for fertility investigations until you've been TTC at least 12 months (6 months if you're 35+) although most people are slightly economical with the truth about how long they've been trying

We've been trying 9 months, on cycle 10 currently. SA was private. I reckon we will get to 12 months and see the GP. So scary thinking we might need intervention I guess I should be grateful this option exists.

Banana time for you to set up as a fertility hand-holder/advisor/advocate/similar. This vast depth of fertility knowledge you've clued yourself up on must be monetised.

In the commercial property world both sides are (usually) represented by their own agents who provide them with advise and hold their hands through transactions. So many people must get fobbed off by uninterested consultants, an appointed fertility agent would be a godsend.

Jem - I know it's scary but modern medicine is bloody amazing. Fuck yeah science and all that. I realise it must be a tremendous shock, and right now it's all feeling very daunting and overwhelming, but just to offer a counterpoint - IF the male factor is such that IVF with ICSI were the recommended route, couples who are having tx due to male factor infertility (MFI - swimmers not kitchens!) are amongst those who have the highest chance of success. In these couples - like those with blocked tubes - there is a very identifiable mechanical reason for why they haven't yet conceived naturally, which IVF / ICSI can very effectively overcome. Those of us with more complicated or unexplained diagnoses are somewhat trickier, in the main. The other thing is that where there is an identifiable cause for infertility I believe that referral may come more quickly - unexplained patients may be told to keep trying for longer if on paper there's no obvious reason why they haven't conceived. Don't quote me on that, and obvs it varies depending on where you live (bastard postcode lottery) but it's worth bringing up if you do end up seeing your GP

Get your DH on the vitamins anyway - may not be a magic bullet but they won't do any harm. Sperm production takes 3 months start to finish, so any benefit is likely to be seen in 3 months time.

I hope all this becomes academic because you'll get upduffed before you go and see the GP!

(Worth pointing out that despite the lovely icy's very kind words, my extensive 'I've read some Internet' medical training - and status as a semi professional barren having been through a lot of (in)fertility treatment - should be taken with a pinch of salt!)

Your advice is so very much appreciated. I posted thinking I might get one or two people saying that happened to me. Getting all this clear and unbiased information is a godsend.

I wonder if it's worth both me and DH going to see this GP together? Do they do that? I'm hoping they will order more tests for us both, but I'd also like to get their thoughts on us getting ICSI done privately.

I think going together is a terrific idea. So much of this process is about the woman, that we find it's really important to feel like it's something we're doing as a couple.

I'd hazard a guess that this may be even more beneficial if the issue is male factor. I know it is hard for my DH to see me endlessly poked and prodded and the one going through all the treatment - I think he feels quite helpless, wants to fix it but he can't. The blokes can be quite marginalised in the process I think, so him being involved as much as possible really helps us to feel like it's something we're going through as a team. If the issue is male factor I think it can be even more difficult because although of course it's no one's 'fault', I know I feel sad that it's my body that doesn't work very well, and in my dark times that I'm broken and can't give us the child we so desperately want. If the problem is MFI then friends have take it can be particularly challenging for the guy to see their partner going through all these tests and procedures 'on their account'

It's no one's fault and it's something you go through together - so the more you can make it feel like you're both equally invested and equally involved, the better

Practically speaking it also means I don't have to download everything the Dr has said in the consult, and DH has the opportunity to ask his own questions!

Yes I know what you mean about marginalised. I think we both thought if there's something making it not happen then it's probably something to do with me. The female reproductive system seems more nuanced and complex. Men's a bit more functional IYSWIM.

In a way though I think we would both cope better if it WAS a problem with me. I think I'd be quite practical face it head on etc. DH felt instantly 'guilty' and 'emasculated' - his words There is more to their sperm than baby making.

I'll see if he is up for me coming with him. When he called the practise they said they were booking him in with a GP with a special interest in fertility. Music to my ears - it's all so complex and specialised I'm not sure how much your regular GP will know about all the detail of it.

We both went along to see the GP - the receptionist let us book a double appointment as there were two of us going. It had to be booked in my name though! I annoys my partner as all the IVF stuff is done under my name too and he feels a bit excluded sometimes.

As banana says, it's best to get on with all the other tests - sperm tests can be variable as we found out on the day of IVF unfortunately so it's best to check everything else is ok. GPs can be very helpful and knowledgeable on the subject - mine has been through infertility and IVF herself so has been fantastic.

At 9 months ttc it's still only early days, although I know it certainly won't feel like it. You GP will be able to advise in your next steps and what your local ccg will/ won't fund on the NHS. Good luck!

Thanks for your kind advice and for not scolding me off the infertility board. I know in the grand scheme of things 9 months is not that long but you are right - it really feels it.