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.

My clinic charges £4500 for IVF and then ICSI is £1000 on top

So £5500 for ICSI

£970 has to be the additional charge for ICSI on top of a standard IVF cycle

So is ICSI actually IVF? I'm confused

Is the Athens clinic a lot cheaper close?

Yes, ICSI is an extra process that you have as an additional aspect of the usual IVF procedure.

In normal IVF, the sperm and egg are put together in a dish to fertilise naturally. With ICSI/IMSI they select the best sperm under a microscope and insert them into the egg to hopefully fertilise.

Athens is going to cost €3000 for one round (including ICSI) or €4000 for two rounds if you have them within one year. I live offshore from the uk and we have no nhs, this also means we have no provisions for IVF, but we do get a prescription for our drugs. If you were to travel from the uk, you would need to pay for your drugs on top of your treatment (this will be the same within the uk if you're not having nhs treatment).

Hope that makes sense!

Nothing worked for my friend (clomid etc). Her husbands was 2 also. However they still had two children over 4 years of trying to conceive.

Really do look at lifestyle stuff

We are looking at lifestyle stuff - trying to drink less is the main thing. We are both pretty health conscious, non smokers, take exercise, normal BMI. Could drink less or not at all but we are not massive boozers.

It's just the not knowing how long this will take. At what point do you say right we are getting an intervention now?

Unfortunately I think only you can answer that question. It's taken me 3 years to get the the point where I really can't take any more/there are no more avenues to explore. For the sake of mine and my family's sanity we need to give IVF a go now. If you feel like you can hold off and see if it happens naturally, do. 9 months is not that long in the scheme of things. On the flip side, looking at the responses to your original post, there doesn't seem to be anyone who has had natural success with low morphology? It's interesting and I'm considering putting out a post on General mumsnet just to see if the natural success stories are not here because they are not looking in the infertility section, or if they just don't exist!?

I've seen some success stories on fertility friend, some people going so far to say morphology doesn't matter, which I think is a bit of a dangerous statement to make

After one year I would say.

I'm not an expert and there are lots of people on here with much more knowledge that me but I thought I'd share my story as we had 1% morphology. We were told by many, many doctors this was absolutely not a problem due to everything else being within normal parameters. I found this extremely annoying as clearly 1% is not brilliant, but no one was really interested in investigating it further or doing more sperm analysis. One doctor put it to me like this " it shouldn't be a problem but even if it is there is nothing we can do about it"- helpful!

After "trying" for 2 years we got dumped in the unexplained camp and were referred for IVF. At our first appointment the doctor went through our notes said everything looked fine- unexplained diagnosis then said WHOA! 1% morphology that's why you're not pregnant! He advised us to have ICSI. So a very annoying extreme difference of opinion.

When I questioned another doctor about it she said that even if that 1% look "normal" they may in fact have problems in fertilizing an egg as they can't test sperm in much detail so just have to go on the look of it which doesn't tell you much in terms of sperm function. Interestingly she said even if we managed to get the morphology up, by supplements etc. we would always be advised to have ICSI. Just because the sperm looks nicer doesn't mean it will function any differently.

Sorry I don't want to be a hope killer but I just thought I'd share my experience as I found it so hard to find any useful information about morphology. And on the other hand they did tell me that with 1% morphology it is not impossible to get pregnant just that it might take a really long time, and by that point I couldn't take anymore waiting, I needed to take action. Our first cycle of ICSI worked and I'm now 27 weeks pregnant.

Saying all that I still think lifestyle changes are worth looking at, and supplements such as proxeed were recommended at our clinic. As the others have said I would start the initial tests with your GP to check you are ovulating etc. I had all my bloods done after 10 months then went back 6 months later for the more invasive tests. I probably jumped the gun a bit but I was going mental with the monthly disappointment!

Good luck with it all!

So helpful thank you lemonade. Yes to the going mental at it all! It's crazy making. I feel like an awful lot is riding on this GP appointment , I really hope they take this seriously. I am going to be ready to say I think it should be!

Congrats on your successful ICSI also.

The other thing that's frustrating - not my personal experience but know others have found this - is what the basic SA doesn't pick up

It doesn't necessarily look for anti sperm antibodies or 24h survival rate

Both of which can affect natural pregnancy - and under IVF vs ICSI

Advanced SA will look at these but can be missed in basic tests

So sperm with a poor 24h survival rate are unlikely to fertilise an egg naturally because they may never be alive for long enough to wait for the egg

Stuff like that can be discovered further down the line but can be helpful to know sooner

Meant to ask - did your partner repeat the test? Did he ever see any improvement?

Thank you are good luck at the GP appointment- even if they say it's normal. push for another SA in three months time. And as Bananafish says an advanced SA would be helpful to see the true picture of what is going on!

A bit late to this thread, and I see you've already had lots of useful information, but just wanted to add in my two pence worth.

DH has morphology issues, with 0-1% normal results. We ended up seeing Dr Ramsay about this, to see if we could improve things.
He started by saying that morphology is the hardest of the parameters to improve, and lifestyle can have a small effect but there is no magic bullet for the vast majority of cases. DH did pay (a small fortune) to have a lot of additional tests including ones for infections, as there are occasionally patients who have infections causing the morphology issues, and these can be treated with antibiotics. All his tests came back clear, and at this point, he said that we have to accept it is never going to improve. He also tried all the 'heat avoidance' things like baggy pants, no laptop on the lap, and even giving up running because it made him really really hot and sweaty. None of it worked for us, but it is probably worth trying. Bear in mind any change needs to be kept up for 3 months as that's how long it takes for the sperm to be produced...

However, we did also do a DNA fragmentation test, which looks at whether each sperm has normal DNA. This is obviously essential for a pregnancy. Ours came back very good, and Dr Ramsay said we basically have a packaging issue. The contents are fine but the packaging is dented. This did mean that we could do ICSI without too much worry that we wouldn't create normal embryos, and have had above-average fertilisation rates with our cycles.

Some clinics have better track records with male factor issues than others, because a lot of it comes down to the embryologist's skill and ability when injecting the eggs with the sperm (this is what ICSI is, and what you'll pay the premium for on top of the IVF cycle fee...)

A blunt instrument for spotting good male-factor clinics is to look for the ones that offer 'top up' treatments such as IMSI (ICSI with an extra-strong microscope) and PICSI (ICSI where they select the sperm by watching which ones swim towards a spot on the petri dish which is coated with the same chemical that eggs release to guide the sperms towards it)

Dr Ramsay told us he rated The Lister, but he works there so obviously would say that! We have also had cycles at Create and Chelsea & Westminster (the latter being our NHS round) and had more or less the same fertilisation rates at all of them.

If you want to PM me, please feel free...

Thank you so much sparechange for sharing this. It amazes me how much complete strangers can be willing to help each other like this.

This Dr Ramsay sounds like a bit of a hero. The DNA test sounds worthwhile I wonder if the NHS will offer that?

So worth knowing about those extra techniques too thanks for explaining those. So many acronyms it's like a different language...

Thank you

If you have medical insurance, some medical insurers will pay for testing (ours did including immunological testing) obviously they don't pay for treatment but the costs of some of the tests csn really add up so every little helps.

Dr Ramsay does see NHS patients, but your eligibility to be referred to him will depend on where you live. I think being in SW London is 'in catchment' for him but I don't know about other areas

We saw him privately, which cost £400 for the initial consultation, then £1200 for all the tests, then another £400 for the follow up appointment.
So not cheap but sadly nothing in fertility ever is.
Even if you can get the appointments as an NHS patient, it would be useful!
The DNA fragmentation test can be done by any clinic, and the results will come back as a percentage which are DNA normal.
There are ranges for what is excellent, good, bad and terrible. Any doc can give you those results so you don't need to see Ramsay for that
But Ramsay seems to be the undisputed leader for all the other tests to see if there is anything else that can be done.

And one other thing I didn't cover in my first post... Another cause of morphology issues is having varicose veins in the testicles (called varicoles)
This can be diagnosed by a urologist having a good feel so an examination will be a standard part of the appointment
If this is the cause, it can be repaired but it isn't a very reliable cure so most docs still recommend going down the ICSI route rather than having the surgery

Hi girls DH had his follow up appointment today so thought I would update. He saw the 'fertility specialist' at our practise. She wasn't overly concerned by his results, as everything is normal apart from morphology. She said when 4% is normal 2% is not that bad / concerning. She has ordered a repeat test so let's see what that says. She also wants to see me and start investigations so I've made an appointment - 20 October was the soonest I could get! Annoying.

I'm torn between feeling relieved she thinks we don't have a problem, and concerned that she's not doing more about it. But then it wasn't really realistic for her to refer us straight for intervention when I'm not fully assessed.

That's great news London and glad you've got an appointment too. Hope your OH is feeling better about things.

I think he's feeling a lot better about it, thanks geeup. Fx his next results come back better.

I think he's feeling a lot better about it, thanks geeup. Fx his next results come back better.

I think he's feeling a lot better about it, thanks geeup. Fx his next results come back better.