Male factor infertility - Low Morphology

[Kitttycatt]

Hello
I haven't seen any recent threads about this topic so I thought I would create my own.
We have been ttc for about a year and have been referred to a fertility clinic. My tests have all come back clear but DH's semen analysis revealed he has an average count and motility but only 1% normal forms. This came as a bit of a shock and I could see straight away that we would probably be put through the IVF route and that's what our consultant has since recommended - since we are both 35. He is going to go for another follow up appointment in Sept to confirm and meanwhile I have bought him lots of supplements and making him wear loose boxers etc. He has a healthy BMI, doesn’t smoke and only drinks occasionally.
I'm just thinking is IVF a bit hasty seeing as DH hasn’t even had so much as a blood test? Conception is so women focussed, and the men only get a semen test. I would like to hear from anyone that has gone through this and whether the partner was referred for more tests or seen by a urologist on NHS?
Thanks

Hi

There isn't really any more tests they can give a man other than a sperm test or DNA fragmentation tests (only available privately) on his sperm. Blood tests aren't really relevant to men and a urologist isn't going to do anything either?

In my experience having done 5 rounds of IVF in 18 months - every month can be completely different - some months my DH has 1% and other months it's been as high as 6% - there is little pattern to it (the 6% one was after 8 weeks of Xmas and new year drinking and gluttony and the 1% was after months of healthy eating, living and supplements 🤷‍♀️)

Also it depends on how high his sperm count it as well - if its well over average then some NHS clinics will say this offsets the low morphology as if he's producing say 145 million sperm in any one "go" then 1% of this is still over 1 million "normal" sperm and it only takes 1 to make a baby.....

Hey,

We are in a similar situation, TTC for about 18 months now. We have both had tests (mine were fine) and DH SA was normal count and motility but 0% morphology/normal forms. We have been referred to NHS fertility clinic, just awaiting an appointment.

We have been seeing a private MFI urologist who seems optimistic at improving the morphology with supplements/lifestyle and perhaps some other medications. He is very good and gets fustrated at how female focussed the fertility services are!

Both the urologist and a private IVF clinic we had an appointment with encouraged us to continue to try naturally for a bit longer as it is not impossible to conceive if the other parameters are normal, so that is what we are doing whilst we await the NHS referral!

@Kitttycatt
I'm in a similar situation in that been trying for 10mths, and my DH morphology result was 2%, his count was 25million.

Consultants view was to give it to Christmas as it was still completely possible that we could conceive naturally. I'm 37, my DH is 44.

If by Christmas we haven't conceived her view was to start the IVF process then which would take around 3mths to get going.

She told us not to waste our money on supplements but he's just started proxeed plus today!

Hi,
My DH's SA came back with low everything and our GP arranged a blood test to check his hormones (which turned out to be normal though borderline). I don't know if he'll get offered any medication as we are still waiting to be referred to a fertility clinic. We have managed to improve the count a little bit and the motility a great deal with supplements, the morphology however is 0%. I have read that morphology alone is not the most important parameter though, so if your DH's count and motility are relatively good, you still have chances to conceive naturally!

Thanks, glad to know there are others in the same boat.

His count was in the normal range but not amazing - 22 million, 36% progressive motility. I might look into the private route for more investigations, I know hormones can play a big part in male fertility and these haven't been tested yet. We have our first IVF appointment in November so would like to use this time to try and get us in the best shape possible.

Hello @orchid10 how did you find your private urologist? I noticed there is one at our fertility clinic but he was not mentioned at our online appointment and i'm kicking myself that I didn't bring it up last week. We would be happy to pay for private tests while we wait for IVF

I actually found him on mumsnet comments- his name is Jonathan Ramsay. Not sure where you are based but he is in London.

thanks @orchid10 I have heard good things about him. I've moved to the North-East although originally from Lonson so there quite a bit. Good luck with it all.

@Kittycatt completely agree that its all very woman-focused.

We're in a similar position to you. Partners' tests came back with low morphology. Like you, we were told it could happen naturally so we gave it time but now we are starting our first round of IVF next month.

He's a healthy weight, eats a good diet, doesn't smoke, doesn't drink excessively.

Jonathan Ramsay is the guy for urology. The husband of one of the women on the BFN podcast went to him and did the DNA fragmentation test. I think it's a good route to go down if you can afford it but the test cost around £900 and I'm not sure there is much you do if they find fragmentation.

@orchid10 really interesting that your husband's best test was after a Christmas blow out. Mine is currently away with pals and I know there will be a reasonable amount of booze involved. He's been under strict instructions to go easy and not forget his vitamins but I've not been nagging as I wanted him to enjoy himself. Still, a bit worried as he'll need to give his sample soonish.

Agree with everyone who agrees about the female focus. Easily in the top 3 most frustrating things about going through fertility issues. I did an NHS round and they barely even mentioned looking into the male fertility side, so if you want to get investigations done you'll likely need to go private.

Myself and my partner went to see the aforementioned Mr Ramsay at the end of last year. He IS very popular in the forums for some reason! Good 'bed side manner' I think and seems very up on latest research, but he also works out of the London Urology Associates clinic in London so I'm sure he's not the only one there who would be helpful to see. He ended up recommending a varicocele embolisation, which I think is one of his 'go-to' suggestions if it seems a possible issue. He seemed to have a very positive hopes that it would help. I have to admit we have yet to have the followup test to see how results have improved (I ahem blame on my partner because I left it up to him to sort out, and well.. there we go!). But it will probably be in the next few weeks so I might come back and update here if anyone's interested to hear an example of how much a varicocele operation has helped.

@LennyFitz would be definitely interested to hear if the varicocele embolisation improves things if you don't mind reporting back!

Dr Ramsey does seem to be THE guy! @LennyFitz I would be interested to hear how your partner gets on. @peanutsandpinenuts did your partner end up going to Ramsey too? I’ve since noticed there is a urologist that works at our fertility clinic as well as privately, so I’m going to ask at our next appointment if we can see him.

@Kitttycatt no we've not been to Ramsey... or the urologist at our clinic. Our clinic seems to think IVF ICSI should work for us so we're gonna see how that goes. We want to see how we get on with our NHS treatment first, and if we can keep this simple/stress free with just the one clinic and set of appointments that would be ideal. One thing we are doing now is popping him on CoQ-10 with me until his sample (same time as my egg collection). Read in It Starts With The Egg that it's good for men as well. He should have been doing it for three months prior really but figure given my cycles we are 6 to 8 weeks off collection so it's worth a shot.

@peanutsandpinenuts we are both on Coq10 too, good luck with your egg collection, our consent appointment is booked for early November.

@peanutsandpinenuts do you mind me asking how long you have waited for your IVF appointment? My initial appointment with NHS keeps getting cancelled and I’m wondering how long the wait for IVF might be. I know it will differ depending on where you live but would be good to know!

@orchid10 That sounds really frustrating!

For us it was about six weeks. You're right though it really varies depending on where you live. We've got a decent enough clinic and there's not been too big a wait (outside of the whole covid thing) but down the road the CCG doesn't fund IVF at all.

One thing I've learned is that if you have been approved for funding then you might be able to transfer that funding to another provider. Have you been approved for funding yet? If so there might be other places in your area you could move your funding across to if the wait is very long.

@orchid10 so frustrating they are cancelling your appointments! Is that for the consent appointment? Does anyone know when you actually start the medication?

No it was for the initial appointment- luckily my husband is very persistent and kept badgering them so they gave us a cancellation for today (6 weeks earlier than the original they gave us) !! Just have to have a couple more tests now and then will be on list for IVF. Apparently we are very lucky in this area as no current wait for IVF.

@orchid10 oh I see, my fertility clinic did all our tests rather than our GP, they just referred us. We don’t have a waiting list either luckily.