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What the heck does “Morphology” mean on a Semen Analysis and why should I care?

What the heck does “Morphology” mean on a Semen Analysis and why should I care?

Early in the evaluation of a couple undergoing a fertility evaluation, the male partner will usually have a semen analysis.  Most men dread this, but it is important.  It is the best “snapshot” your healthcare team has to predict a man’s fertility potential.

Paying close attention to how to collect and most importantly, how NOT to collect can make the difference between a test that can be properly evaluated and the dreaded “you have to do this again”.  Ask your healthcare provider if you have questions. Most centers, including ours here at Louisville Reproductive Center, provide helpful instructions to make this test as valuable as it can be.

Interpreting the semen analysis is also important.  The important numbers on the analysis are the count, motility, and morphology.  The count and motility (also called mobility) are fairly self-explanatory, but the morphology is complicated.  We get the most questions in our practice about this one aspect of almost any test we order!  It is confusing—even to healthcare providers that don’t deal with fertility day to day.  So, let’s try to sort some things out.

Morphology simply means how the sperm look—how they are formed.  Are they normal or not?  From the start, let me emphasize that the majority of all sperm are abnormal.  A female fertility expert once mused that this is why most men don’t stop to ask for directions—we inherently know where we are going, even if clearly we don’t!

But seriously, the judgment of the shape of sperm under the microscope is what determines the morphology score.  The Andrologist studies the overall size of the sperm, the size and shape of the head of sperm, neck or midpiece, and tail.  The newest classification scheme, Kruger analysis, is used almost universally now.  Scores of only 5% or above are considered normal. That means again the vast majority of sperm have a spectrum of abnormalities ranging from mild to severe.  The analogy I use to explain this to women that they immediately grasp is like looking at diamonds. They come in all sizes and shapes with all kinds of grades of color and flaws. When analyzed, they are all diamonds.  But very few are “normal” or perfect.

At that point in my discussion of abnormal morphology score with the man, he is bewildered. All he hears is there is something wrong with his sperm.  Men are very sensitive to this. Men are usually “do-ers” and “fix-ers” of problems. They want to know “why” and “how to fix it”.

What causes these abnormalities in morphology?   The list is long and has to be considered by the healthcare team.  That is why we ask those probing questions early in the couple’s evaluation—things like age, smoking, drinking, drug use (prescribed or otherwise), occupation, sports endeavors and injuries, obesity, lack of exercise, poor nutrition,  exposure to known sperm toxins, medical history.  So be honest when you answer those questions. They will give insight into possible causes and corrective action to improve morphology.

Many men have no identifiable reasons for abnormal morphology.  In these cases, referral to a Urologist with experience in infertility is important to rule out hidden factors or other medical conditions. Things like congenital abnormalities, varicocoele, cystic fibrosis carrier state, epididymitis, prostatitis, and even testicular cancer may contribute to abnormalities in morphology on the semen analysis.

So the man has done all the right things and had the appropriate evaluations, and still has abnormal morphology, what then? Sperm are highly sensitive to injury during formation and storage in the male reproductive tract. This injury is often caused by a process called “oxidative stress” caused by things with ominous names like “free radicals”.  No guys, this is not a new episode of Star Wars!

A new era of treatment arose with the discovery that vitamins and better nutrition can help with oxidative stress.  It has been shown that zinc, folic acid, vitamin B12 improve sperm maturation and function. Supplementation of selenium, CoQ10, Vitamin C, Zinc and
Acetyl L-Carnitine may protect sperm from free radical injury.   Supplementation of vitamins C and E can also help as major anti-oxidants.

So just pop any vitamins?  Men’s formulations of vitamins have proliferated.  The best formulations combine the supplements known to be helpful for male fertility into a convenient, once-a-day supplement—examples are Proxeed, Proxeed Plus, or Fertile One.  Yes, they are pricey, but they may help!  Remember also, the sperm produced today were made 2-3 months ago and stored in the reproductive tract.  So stay with the program—take the vitamins regularly and repeat the semen analysis in 2-3 months to see if the morphology scores are improving.

Let’s sum it all up. Understand if all sperm are considered abnormal, it does NOT mean conception cannot occur.  It also does NOT mean that if conception occurs that the child will have birth defects. This is the most common concern of every couple.  However, if all sperm are abnormal, it does mean that conceiving may take longer and in many cases, may need to be assisted with insemination or In Vitro Fertilization.  If these techniques do not help, the couple should consider donor sperm insemination if that is acceptable.

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