Let's Talk About Sperm, Baby

BookishMomma

Going with the trend of the recent posts on male factor issues, I want to throw out a question about morphology. DH had an SA about a month before this last BFP. All his numbers were great except for morphology. Total count was through the roof (like 300 million or something). All the other numbers were well above average, too. But morphology was 1%. 

For those not down with the swimmer lingo, morphology is the shape of sperm. Even men with great morphology have a shockingly low percentage of "normal" shaped sperm. 4% or above is considered good morphology under strict standards. The other 96% might have 2 heads, 2 tails, weird-shaped bodies, or whatever.

When I asked my RE about DH's 1% morphology, he said he wasn't too concerned about it because his count was so high. He explained it as saying that even though the percent morphology is low, my DH probably has more normal sperm per ejaculation, in terms of sheer numbers, than most men. And obviously this has not prevented the little buggers from getting to the egg, since I've been pregnant 4 times in a year.

However, after this last loss, I am wondering if there's any connection between low morphology and miscarriage? My RE thinks it's not likely, but Dr. Google says maybe. Does anyone have any knowledge on this issue they'd be willing to share?

edit - clarity

PinkCamino

I can't commit about the potential of a link between morphology and RPL but I do think your doctor is likely right about the number.

Let's do a little math shall we.

3 000 000 X 0.01 = 30 000

2 000 000 X 0.02 = 40 000

1 000 000 X 0.03 = 30 000

So I think it does seem to "balance itself" so to speak.

BookishMomma

@pinkcamino Yeah, that's what my RE was getting at. And logically I sort of tell myself that it's the "better" sperm that are the ones likely to make it all the way to the egg. You know, natural selection and all that. But still... I can't help but wonder. 

Km380

I'm no expert here but my first thought was to do the math. 1% doesn't sound like a lot but given the total number- that's a lot of good swimmers! My second thought is do you trust your RE? If the answer is yes, I would take his answer over Dr Google.
But I also know that's easier said than done.
Sorry I don't have any actual advice. It seems to me the only way around morphology would be IVF - and that's not a route you want to take unless necessary

BookishMomma

Km380 said:

I'm no expert here but my first thought was to do the math. 1% doesn't sound like a lot but given the total number- that's a lot of good swimmers! My second thought is do you trust your RE? If the answer is yes, I would take his answer over Dr Google. But I also know that's easier said than done. Sorry I don't have any actual advice. It seems to me the only way around morphology would be IVF - and that's not a route you want to take unless necessary

@KM380 thanks for your input. I do trust my RE, but like so many of us with RPL, I feel like even great REs don't have the answers for us. We can get pregnant, so the usual approaches don't always fit.

Km380

BookishMomma said:

Km380 said:

I'm no expert here but my first thought was to do the math. 1% doesn't sound like a lot but given the total number- that's a lot of good swimmers! My second thought is do you trust your RE? If the answer is yes, I would take his answer over Dr Google.
But I also know that's easier said than done.
Sorry I don't have any actual advice. It seems to me the only way around morphology would be IVF - and that's not a route you want to take unless necessary

@KM380 thanks for your input. I do trust my RE, but like so many of us with RPL, I feel like even great REs don't have the answers for us. We can get pregnant, so the usual approaches don't always fit.





I know, and I completely get why you are wondering. I hope that didn't come across as not understanding where you are coming from or minimizing how you feel. Not having answers is shitty.

BookishMomma

@KM380 No worries, it didn't come across to me that way at all. 

BookishMomma

Amybunny30 said:

Also that it seemed like there wasn't a lot of research on this in general.

@amybunny30 Yeah, that's the impression I got, too. Or that the research sort of goes both ways or is inconclusive.

katib77

As a MFI couple (low count and motility but decent morph) I will say if it concerns you - and you are acceptable to costs - look into a IUI since then they will be taking the besst of the best sperm. But remember that there are so many reasons for m/c that it's not eliminating the known causes, just assisting one possibility. However - a medicated cycle can also help with other possible reasons (FSH drugs can strengthen your ovulation/egg), early monitoring can monitor hormone levels, supplimented progesterone etc.
That said - even with MFI being our main IF issue and nine treatments cycles I still ended up with m/c's and child free so nothing is ever guaranteed.

megrae12

I got nothing, love. Our IF issues are with me and me alone. I am sorry that things are inconclusive at best, but I do like Pink's math. I would trust your doctor. Y'all were planning on IUI right? Like Katib said, if you do that then you get the best of the best. ((Hugs)) 

BookishMomma

katib77 said:

As a MFI couple (low count and motility but decent morph) I will say if it concerns you - and you are acceptable to costs - look into a IUI since then they will be taking the besst of the best sperm. But remember that there are so many reasons for m/c that it's not eliminating the known causes, just assisting one possibility. However - a medicated cycle can also help with other possible reasons (FSH drugs can strengthen your ovulation/egg), early monitoring can monitor hormone levels, supplimented progesterone etc. That said - even with MFI being our main IF issue and nine treatments cycles I still ended up with m/c's and child free so nothing is ever guaranteed.

@katib77 Meds + IUI are likely our next step anyway, so this is helpful to hear and sort of reiterates what I've heard elsewhere. Thanks. 

Menrandes

I don't really have anything new to say. 
But I think that this is one of those cases that the documentary "The Great Sperm Race" might be helpful.
Everything that the sperm has to go through to get the egg..I don't know, I'm not a doctor and I really only know the smallest bit about reproduction, but it doesn't seem likely to me that the imperfect sperm would be able to make it very far. 
*hugs*

ellebelle2384

I don't have any experience but I know I would be wondering the same things too if I was in your shoes.  I would also tend to agree with your RE that most likely the "good" swimmers are the ones getting to where they need to go.  I know you had chromosome testing with your baby girl.  Did they tell you what origin the chromosomal anomaly was from? (Ours was maternal origin, and my RE told me most usually are, but if yours was paternal origin then maybe that leads more weight to your worries about the morphology).  I know the next step was IUI and that should help with the morphology concerns so I will be keeping my FX for you lady! (hugs)

BookishMomma

ellebelle2384 said:

I don't have any experience but I know I would be wondering the same things too if I was in your shoes.  I would also tend to agree with your RE that most likely the "good" swimmers are the ones getting to where they need to go.  I know you had chromosome testing with your baby girl.  Did they tell you what origin the chromosomal anomaly was from? (Ours was maternal origin, and my RE told me most usually are, but if yours was paternal origin then maybe that leads more weight to your worries about the morphology).  I know the next step was IUI and that should help with the morphology concerns so I will be keeping my FX for you lady! (hugs)

@ellebelle2384 With Turner's Syndrome (which is what our girl had), 80% of the time it is the sperm and 20% of the time it is the egg. So it is likely it was a sperm issue.

I did manage to "collect" some tissue that I passed (TMI) on Friday and brought it in immediately to my RE's lab in a special container, so I am hoping they will be able to find something out from testing that. 

ellebelle2384

Hmm based on that I would be wondering too.  I hope your RE's lab can give you some answers. (hugs)

BookishMomma

@ellebelle2384 you said that IUI helps with morphology & I've heard other people say that before, but do you know why that is? Is it because something happens when the sperm are "washed"? I guess I don't completely understand that part.

ellebelle2384

I think that's why but one of the IF ladies might know better or more in depth.  I would definitely talk to your RE about the plan though because I know that there is conflicting research with IUI and low morphology with AMA. (https://www.resolve.org/family-building-options/iui/intrauterine-insemination-will-it-help-me-conceive.html)

yellowcat10

We are MFI.  MH has good numbers, but the morphology is low (3%) and motility is all over (24%-60%).  With IUI post-wash it is believed the morph issue is fixed, but testing morph would compromise the sample so they never really have stats on it (at least not where I go).  My RE said that not a lot is understood about morphology and its affect on the sperm, but that your most motile sperm could have morphological issues.  Just because it is fast does not mean the "head" is right as he explained it.  We are moving on to IVF to get around the sperm issue.  My RE believes our losses are likely sperm related since all of our other testing is normal except morph and motility.  Have you had genetic testing?  Perhaps this is the issue? 

((HUGS)) I hope this helps.

BookishMomma

yellowcat10 said:

We are MFI.  MH has good numbers, but the morphology is low (3%) and motility is all over (24%-60%).  With IUI post-wash it is believed the morph issue is fixed, but testing morph would compromise the sample so they never really have stats on it (at least not where I go).  My RE said that not a lot is understood about morphology and its affect on the sperm, but that your most motile sperm could have morphological issues.  Just because it is fast does not mean the "head" is right as he explained it.  We are moving on to IVF to get around the sperm issue.  My RE believes our losses are likely sperm related since all of our other testing is normal except morph and motility.  Have you had genetic testing?  Perhaps this is the issue? 

((HUGS)) I hope this helps.

@yellowcat10, thanks, this is helpful. DH and I both have had karyotyping done, which came back normal. I'm talking with my doctor now about getting the Counsyl genetic screening exam done, or something similar. 

yellowcat10

@BookishMomma good luck!