Sperm Morphology: Impacts on Fertility and Treatment Options

Q: Sperm Morphology: Impacts on Fertility and Treatment Options

Huang： Hello, the different standards for testing can lead to inconsistent interpretation of results. <br>Here’s a brief explanation to help clarify： Regarding motility, the test results from June 2 were categorized into different levels, which is a more detailed classification：

Sperm morphology

Hello Dr.
Hsu, my husband (the information is about his age) and I have been trying to conceive for a year without success.
On June 2, we went to Cathay Fertility Center for a sperm analysis.
The results showed poor morphology: semen volume 1.5 mL, pH 8.8, concentration 181 million/mL, sperm motility: 44% (normal is above 50%).
Grade 1: non-progressive motility (%) 23, Grade 2: slow progressive motility (%) 40, Grade 2 + Grade 3 32%, Grade 3: rapid linear motility (%) 37, sperm morphology %: 0 (L) 4% (normal is above 15%).
My husband mentioned that he was diagnosed with varicocele during his military service, so he went to the urology department at Ma-Jia for further examination.
The doctor confirmed that there is varicocele on both sides but suggested performing a semen analysis (on July 1).
The reference values were: Total Amount: 2.4 mL, Count 101 million/mL, Morphology Normal 91% (>70%), Motility(+) 79% (>50%), Motility index total score = 254 (>150).
The doctor said my husband's test results were excellent with no issues, and there is no need to treat the varicocele.
A few days ago, I returned to Cathay to ask the obstetrician about the initial test results, and he mentioned that the July 1 results were based on more lenient standards, and the results from the reproductive medicine department should be similar.
My husband used to run long distances (he participated in marathons in March and May, running over 10 km weekly), but after the June test, he has temporarily reduced his running distance.
Could this have an impact? The results from the two tests differ significantly; should we seek a third opinion? If the results are still poor, would surgery for varicocele be necessary? Thank you, doctor!

Huang, 30~39 year old female. Ask Date: 2015/08/20

Dr. Xu Weikai reply Urology

Huang: Hello, the different standards for testing can lead to inconsistent interpretation of results.
Here’s a brief explanation to help clarify: Regarding motility, the test results from June 2 were categorized into different levels, which is a more detailed classification: only those with better motility were considered acceptable (Category 3), thus the motility was only 40%.
In the report from July 1, the motility reached 79%, as it combined Categories 2 and 3, categorizing them both as having acceptable motility.
Therefore, the physician from Cathay would say that the two tests essentially show similar results, but the differences in standards and classifications make the results appear significantly different, when in fact they are not that dissimilar.

Now, you should have a clearer concept when looking at the quantity/concentration: 181 vs.
101 is indeed a substantial difference, which I believe is due to the method of sample collection.
The standard for semen analysis generally requires abstinence for 3-5 days before ejaculation.
Both too long or too short an abstinence period can lead to variations in quantity, motility, and other test results.
Note: Sperm, once produced, is stored in the seminal vesicles and is released during ejaculation.
The longer sperm is stored in the seminal vesicles, the poorer its motility becomes, although the concentration of sperm increases.
Running 10 kilometers weekly is not considered a long distance and theoretically should not have a significant impact.

As for marathon running, due to its high-intensity nature, there is greater stress, which may increase the need for muscle and nerve recovery, theoretically leading to a temporary rest of the reproductive system (though there are no reports on this), and I have not heard of marathon runners having poorer semen quality.
Note: Statistically, marathon runners have a significantly lower rate of cancer compared to the general population (the exact reasons are still under investigation).

Regarding whether varicocele surgery is necessary, I believe it would be prudent to conduct a few more semen analyses to assess the quantity of "motile sperm capable of fertilization" before making a decision.
Of course, considering both partners are getting older, which may reduce the chances of conception, it might be advisable to proceed with varicocele correction surgery, as the incision is small and can even be performed laparoscopically, classifying it as a minor surgery.
If there are any concerns, you can visit a nearby medical facility for relevant tests or further treatment.
If there are any unclear points, feel free to ask again, and we can discuss and research further.
Online responses can only serve as a reference; if necessary, it is best to seek medical attention at a healthcare facility.
The Ministry of Health and Welfare, Taitung Hospital, cares about you.

Reply Date: 2015/08/20

More Info

Understanding sperm morphology and its impact on fertility is crucial for couples trying to conceive. Sperm morphology refers to the size and shape of sperm cells, which can significantly influence a man's fertility potential. In your case, the sperm morphology results indicate a concerning situation, particularly with the initial test showing 0% normal morphology, which is well below the standard threshold of 15% for normal sperm shape.

Impact of Sperm Morphology on Fertility
1. Sperm Shape and Function: Sperm cells must have a proper shape to swim effectively and penetrate the egg. Abnormal morphology can hinder these functions, making it difficult for sperm to reach and fertilize an egg. The presence of sperm with abnormal shapes can lead to lower fertilization rates and may contribute to infertility.

2. Correlation with Other Parameters: While morphology is a critical factor, it should be evaluated alongside other sperm parameters such as sperm count and motility. In your case, the motility was reported at 40%, which is just above the threshold of 50% for optimal fertility. This suggests that while some sperm are moving, a significant portion may not be, which can further complicate the chances of conception.

3. Variability in Results: It's important to note that sperm parameters can fluctuate due to various factors, including lifestyle, health, and even the time of day when the sample is collected. The differences between the two tests you mentioned could be attributed to these factors. For instance, your husband's running routine could influence hormone levels and overall health, which in turn may affect sperm quality.

Next Steps and Treatment Options
1. Further Testing: Given the significant discrepancy between the two tests, it may be beneficial to seek a third opinion or conduct another semen analysis. This will help clarify whether the initial results were an anomaly or indicative of a persistent issue.

2. Addressing Varicocele: Since your husband has been diagnosed with varicocele, it is worth discussing this condition with a urologist. Varicocele can affect sperm production and quality, and in some cases, surgical intervention may improve sperm parameters. However, the decision to proceed with surgery should be based on a comprehensive evaluation of all sperm parameters and a discussion of potential benefits and risks.

3. Lifestyle Modifications: Encourage your husband to maintain a healthy lifestyle, including a balanced diet, regular exercise, and avoiding substances that could negatively impact sperm quality, such as tobacco and excessive alcohol. Stress management techniques can also be beneficial, as stress can adversely affect hormone levels and sperm production.

4. Consideration of Assisted Reproductive Technologies (ART): If sperm quality remains a concern despite lifestyle changes and medical interventions, you may want to discuss options such as intrauterine insemination (IUI) or in vitro fertilization (IVF) with your fertility specialist. These methods can sometimes bypass issues related to sperm morphology and motility.

5. Regular Follow-ups: Continuous monitoring and follow-up with a fertility specialist are essential. They can provide tailored advice based on the evolving situation and help navigate the complexities of fertility treatment.

Conclusion
In summary, sperm morphology plays a significant role in male fertility, and abnormalities can impact the chances of conception. Given the variability in your husband's test results, further evaluation and possibly treatment for varicocele may be warranted. Lifestyle changes can also contribute positively to sperm health. Consulting with fertility specialists and considering assisted reproductive technologies may provide additional pathways to achieving your goal of conception. Remember, fertility is a multifaceted issue, and a holistic approach is often the most effective.

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