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Fertility FAQ – Male Infertility

My wife and I have been trying to get pregnant for over a year. My doctor tells me my sperm are moving fast and have a “morphology” problem. So far, my wife’s test results have been normal. What do we do about my issue and can we still have children using my sperm?

Morphology refers to the size and shape of the sperm and is an area that is commonly abnormal in infertile couples. Normally, sperm have an oval-shaped head, a thickened midpiece, and a long, thin tail that beats back and forth. Sperm with abnormal morphology may have heads that are too large or too small, two heads, two tails, long tapered heads, or broken midpieces and tails. The abnormal sperm do not lead to abnormal children, they simply do not seem to fertilize eggs normally. Causes of morphology defects such as infection, environmental toxins, and exposure to high heat have been researched, but no consistent connections have been proven. Still, there is no absolute level of normal morphology below which pregnancy does not occur.

According to the World Health Organization’s criteria for judging sperm shape, only 30% of sperm need to be normal for a semen analysis to be considered normal. Most fertility centers use a stricter set of criteria called the Kruger criteria by which only 15% of sperm need to be normal. Despite this 15% cut off level, many men with lower morphology scores may still be fertile, albeit sub fertile.

Many dietary supplements and medications have been prescribed for men with low sperm morphology, but none have made significant differences for all patients. Still, it makes sense to practice a few preventive measures and healthier lifestyle choices. Avoiding exposure to high heat and chemical solvents, eating a balanced diet, and supplementing with a good multivitamin are reasonable, low cost ideas.

While intrauterine insemination (IUI) is a first line treatment for male factor infertility, it really does not compensate for fertilization problems associated with low morphology. Modest decreases in morphology may still be treated with IUI, but more profound abnormalities are usually treated with in vitro fertilization (IVF) combined with intracytoplasmic sperm injection (ICSI). ICSI involves selecting the most normal looking sperm under a microscope and injecting them into eggs in a laboratory. The embryos that develop after ICSI are perfectly normal and lead to normal IVF pregnancy rates.