Unexplained Infertility: Key Questions and Insights

Unexplained infertility issues?

Hello Doctor, my husband and I have been trying to conceive for two years.
All fertility tests have returned normal results, but we have been unable to conceive naturally.
We have undergone artificial insemination three times, with one successful pregnancy that ended in an 8-week miscarriage.
I would like to ask you:
1.
My husband's sperm morphology is at 12%, which exceeds the standard of 4%.
However, the Kruger study suggests that for normal sperm morphology, at least 14% is required.
If the normal morphology is between 5-14%, the pregnancy rate is only 11.4%.
The standard indicates that a 4% morphology is sufficient for natural conception, but the research indicates that a morphology of 5-14% has a low success rate even with artificial insemination.
Is my husband's sperm morphology (12%) too low? Are there any methods to improve it?
2.
Does artificial insemination reduce the natural selection process of poor-quality sperm, potentially leading to abnormal embryos after conception?
3.
When entering artificial insemination treatment, should the female partner select a cycle with lower FSH levels (indicating better egg quality) to increase the success rate?
There are many questions I couldn't ask during the clinic visit, and I am quite worried.
I sincerely seek your guidance on how to proceed in the future.
Thank you!

Miss Lin, 30~39 year old female. Ask Date: 2016/12/13

Dr. Cao Guotao reply Obstetrics and Gynecology

Hello, the normal morphology of sperm should be around 60% meeting the standards.
In artificial insemination, the selection of higher quality sperm is preferred.
If follicles are observed on ultrasound, artificial insemination can be performed.
If there are still concerns, it is advisable to consult the original obstetrician-gynecologist.
Wishing you good health.

Reply Date: 2016/12/13

More Info

Understanding unexplained infertility can be a complex and emotionally challenging journey for couples trying to conceive. In your case, it appears that you and your husband have undergone various fertility assessments, and while everything seems normal, you are still facing difficulties in achieving a successful pregnancy. Let’s address your questions one by one, while also providing some insights into the broader context of infertility.

1. Sperm Morphology and Its Impact on Fertility: You mentioned that your husband's sperm morphology is at 12%, which is above the World Health Organization's (WHO) lower reference limit of 4%. However, as you pointed out, studies like the Kruger criteria suggest that a higher percentage of morphologically normal sperm (ideally above 14%) is associated with better fertility outcomes. While 12% is technically within the acceptable range, it may still be on the lower side for optimal fertility. To improve sperm morphology, lifestyle changes can be beneficial. This includes maintaining a healthy diet rich in antioxidants, avoiding smoking and excessive alcohol consumption, managing stress, and maintaining a healthy weight. Additionally, certain supplements like Coenzyme Q10, Vitamin C, and Omega-3 fatty acids may help improve sperm quality, but it’s crucial to consult with a healthcare provider before starting any supplementation.

2. Impact of Artificial Insemination on Sperm Quality: Artificial insemination (IUI) does involve the selection of sperm, but it does not necessarily mean that only the highest quality sperm are used. The process can sometimes lead to the introduction of sperm with suboptimal morphology into the uterus. However, the body’s natural selection process is somewhat bypassed in this procedure. While it’s true that using lower-quality sperm may increase the risk of abnormal embryos, many factors contribute to embryo quality, including the health of the egg and the overall reproductive environment. Therefore, while sperm morphology is important, it is not the sole determinant of embryo viability.

3. Timing and Hormonal Considerations in IUI: When it comes to artificial insemination, the timing of the procedure is crucial. Some studies suggest that lower FSH (Follicle Stimulating Hormone) levels may correlate with better egg quality, but it’s not the only factor to consider. The overall hormonal profile, including estrogen and progesterone levels, plays a significant role in the success of IUI. It’s essential to work closely with your fertility specialist to monitor your hormone levels and determine the best timing for the procedure. They may recommend specific medications to stimulate ovulation and optimize your chances of success.

In conclusion, unexplained infertility can be frustrating, but it’s important to remember that many couples experience similar challenges. The journey may require patience and persistence. It’s advisable to maintain open communication with your fertility specialist, who can provide tailored advice based on your specific situation. Additionally, consider seeking support from counseling or support groups, as emotional well-being is a crucial aspect of the fertility journey. Remember, you are not alone in this, and with the right support and guidance, you can navigate through these challenges.

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