12 replies to this topic

[Watermelon]

Hi everyone

I'm new to this forum and hoping you can share your advice with this newbie!

DH and I have been trying to conceive for about 2 years. I ovulate every month and I know we have been timing things bang on. I am 29 and all my investigations have been normal. As part of our fertility work up, we discovered that DH has a morphology of only 1% (confirmed by 3 repeat tests). His count and motility are great though.

We were referred to an RE by a colleague of mine who did part of her obstetrical training at a fertility program in Alberta. She told me that based on DH's poor morphology that we would need IVF with ICSI to conceive. She told us not to waste our time and money on IUIs or anything else. Based on this, we went in for our initial consult with an RE anticipating a discussion about IVF/ICSI. To our surprise, the RE said they don't really care much about morphology and that it was unlikely to cause an issue. Based on us having been trying for awhile now, he is suggesting we just try Femara for a few cycles or Femara with IUI. He told us that IVF/ICSI would be extreme.

I know I should be happy at the positive outlook, but I cannot help but wonder if morphology is really of no concern. It seems strange to me that two fertility programs could have such opposing opinions on poor morphology. I'd love to get pregnant as naturally as possible, but don't want to look back feeling like we wasted time and money on a pipe dream.

I would be so grateful if any of you out there with isolated poor morphology would share your stories. What were you told/what were you advised to do?

Thanks

[amp77]

I haven't had this exact experience but at our clinic, prior to IUI, the test for morphology is not even a standard test.  If we had gone that route, we would not have even tested it but not sure what the standard practice is at other clinics.  Since we are going the IVF route, we did have morphology tested and DH had 6% morphology so no ICSI required.  

 

A quick google search also shows that as long as there are lots of sperm, morphology is not as important for IUI as they will do a sperm wash anyway and will be selecting better sperm.

 

I am sure that others will have a better answer based on their personal experience.

 

Good luck!

[EMJ]

My DH's morphology is also terrible and we were told to go straight to IVF/ICSI (by the Calgary clinic). Anything else would be a waste of time and money. My understanding is that poor morphology means the sperm have difficulty penetrating the egg due to their abnormal shape and that's why they need the help from ICSI. When I didn't respond well to the IVF meds, one of the REs recommended converting to IUI. I mentioned DHs sperm issue and that IUI wouldn't work and his response was, "Stranger things have happened." It was a bfn as I had anticipated.

 

Some ladies on this forum have posted that they conceived naturally with poor morphology so it is definitely possible. Since age and health are on your side, you may want to try one or two cycles of Femara. However, my experience echoes your colleague's advice.

 

Good luck to you and your DH.

[hamiltwin]

My husband has 0.5-1% normal morphology. We were also told by our FS that IVF with ICSI was really our only option. We were told that IUI was a waste of time as abnormally shaped sperm cannot penetrate the egg properly. He also mentioned that they may be able to swim rapidly and block passage of normally shaped sperm to the egg, thus preventing fertilization with healthy sperm.   I'm not sure I totally buy his story though as other FS seem to think that morphology is the least important parameter. So long as count and motility are good, some FS feel that morphology plays a very small role in fertility.

 

According the WHO, normal SA parameters (aka a sperm sample deemed 'fertile') are:

Volume 1.5ml

Count 15 million/ml

Total count 39 million

Rapid Progressive 32%

Total motile 40%

Morph 4%

 

So you want to see a total of 624,000 normally shaped sperm that are motile.

 

My husband and I conceived naturally in April 2010 and now have a 3 year old son! Lots of women can and do get pregnant naturally so don't lose hope! IMO, teratospermia should be deemed sub fertility and not infertility. Baby #2 is proving to be a lot more challenging to conceive for us! We opted to go straight to IVF/ICSI as I had symptoms of endometriosis before I had my son. Unfortunately, that attempt failed due to poor egg quality. We attempted a 2nd IVF in March but I did not respond to stims so it was converted to an IUI. My  husband's post wash count was excellent as per the RE: 48 million/mL with 81% motile. I can't remember what the morphology was. I was told I had a 15% chance of success with those numbers, the same as anyone doing IUI! I think it's going to be a BFN but go for my official blood Beta on April 16th.

 

Good luck! I hope your stay here is short!

[Dudette76]

Definitely worth giving Femera a try.  We had 0% morphology, and combined with my issues were told IVF/ICSI.  We tried Clomid prior to our consult to see if we could resolve one of my issues (long cycles).  Natural pregnancy on third round, 2 weeks before IVF/ICSI consult.  Docs were totally impressed, and my husband put the money we saved to good use elsewhere.

[Watermelon]

Thanks for your posts ladies. It's so helpful to hear what others have been told.

We found out today that DH morphology is actually 0%...the lead andrologist actually spend 20 mins on the phone with us reviewing the slide. When we asked him if he would recommend IUI/superovulation he said that sometimes they try that with 1-2%...but that he strongly encouraged us to do IVF/ICSI as this was really our best shot.

We immediately tried to make an appointment with our RE to reevaluate our plan, but we're told the next available appointment was in 2 months!!?? What?! I thought after our initial consult that getting in would be better...what a joke. Especially given that his recommendations and his own andrologist's recommendations are so so different. This is not fair to patients to not even provide a venue to discuss!! I really don't know what to do...

[amp77]

So sorry Watermelon - that seems really odd.  Is there a different dr at the clinic that could discuss it with you?

[lisserb]

Morphology can change with each ejaculation. My husband routinely had between 0%-2% normal forms on each semen analysis. We did 10 IUI's with RFP, with clomid and ultrasound trigger monitoring for the last 8. I conceived 3 times, once with 0% normal forms. Unfortunately one was an ectopic discovered at 6 weeks, and the next two were losses likely due to my own undiagnosed clotting disorders.

I am currently 37 weeks along with a natural pregnancy, my second actually, as our 8 year old DD is also naturally conceived, although in those 8 years there were no other natural pregnancies. After 10 IUI's we were preparing for an IVF cycle, had paid and even purchased IVF medication, but we ended up with a bfp instead.

I would take the next appointment the clinic has and in the meantime start your DH on a regime of antioxidant supplements and vitamins, to see if that can make any difference for him. Sometimes it can work. I do think if I needed to do it all again, I would try at least a few IUI's before jumping straight in to IVF. Good Luck!

Good Luck!

[Watermelon]

Thanks for sharing your story lisserb. I needed that boost of hope. I think I just needed to vent my frustrations somewhere. I know that 0-2% is really neither here nor there. Variation is to be expected much like count and motility and there is a certain level of subjectivity in labelling a sperm "normal".

Hearing the recommendation for IVF/ICSI from the andrologist just sent me back to the land of frustration. I was already feeling so confused about the right course of action before... And now to get mixed messages from within the clinic...sigh. I will call my clinic again on Monday.

I took DH to a naturopath in January and he has been taking vitamins/supplements since, but so far no change. From my research it seems like morphology is something science doesn't fully understand yet....no clear cause found and thus no easy fixes.

Thanks again everyone. This forum is wonderful.

[laura02]

Can you try some femara cycles with TI while you wait? Morphology seems to be becoming less of an issue, than I remember it being when we did IVF/ICSI. My RE recommended some IUI's prior to IVF based on the fact that we had naturally conceived our DD#1. 

 

The other thing is that you usually need a hysteroscopy done prior to IVF, so if you could get this done early, it may increase your chances during a Femara cyle. 

[runner.girl]

My DH had morphology issues as well (1% normal if I recall) on multiple samples as well. I remember the RE felt it was a minor issue and the possible cause (varicocele) wasn't worth the surgical risk given my issues (only one tube, abnormal uterus).

We conceived with a super ovulation IUI so IUIs are definitely not a waste with morphology problems. I think counts are a bigger determinant of success with IUI since they 'process' the sample to get the best ones prior to the IUI.

[Watermelon]

Yes I will definitely give Femara and TI a try while waiting for another appointment. Who knows, we may get lucky! . Nothing lost that's for sure .

I've had an HSG, but not a hysteroscopy. My RE did not mention anything about one. Is a hysteroscooy considered pretty standard prior to IVF?

[laura02]

I think a hysteroscopy is standard for IVF. I know that I had an HSG done (clear) and my RE still wanted to do a hysteroscopy. I found it to be an easier procedure than the HSG - they fill your uterus with saline and then have a look around with a camera to make sure it all looks normal. Similar to the HSG, a hysteroscopy can increase your fertility for a few months.