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Poor sperm morphology and clomid
mrsrachie posted:
My husband (35yr old) had SA done and has 36% normal sperm with rest being abnormal (n.b.38% is amorphous). His sperm count is 21.3MM and motiltiy is 93%. All my tests (I'm also 35yr old) such as HSG, FH, LH, testosterone have come back within normal ranges. We have been trying for almost a yr and are frustrated. I went to see a fertility specialist today and I felt like he was trying to jam IVF at 15K a pop down my throat. I suggested Clomid since I have regular periods (26-29days) but don't always detect ovulation (and I have been testing for several months). He said there was no improvement of pregnancy w/ Clomid if we didn't do IUI too. He may be willing to do Comlid w.o IUI, but still wants all these crazy addt'l tests like ultrasounds and hCG injections. I feels like someone is trying to "snow me." Also, my hubby has 1 testicle (not sure if this is important). Any help or thoughts given our prediciment and my husbands "bad" sperm?? Will Clomid possibly help us?? Thanks
AmyAALC responded:
Depending on the type of morphology test/criteria used by the laboratory, 38% normal is great. Check the report for the reference intervals and if his 38% falls in the normal levels he's doing great. If they use a strict criteria as little as 6-14% normal is acceptable. His motility is off the charts (normal is 50% or greater) and sperm count is that 21.3 Million/ml volume??? If so the count looks normal as well (normal 20 Mil/ml or higher).

To make sure to optimize his sperm quality follow the sperm healthy lifestyle guidelines I've posted under discussions. If you still have concern make sure he has a full workup with a urologist. Male fertility evaluations are often overlooked. Clomid can be given to men to boost sperm production if their sperm counts are a little low. It has also been shown to improve quality of sperm.

Testing on the female side does get expensive and time consuming. Regular cycles are important but without further workups from a RE (reproductive endocrinologist) it is hard to say is you are in fact releasing an egg for a true ovulation. The will also want to check to see if you have any blockage in your tubes that could inhibit the egg from moving down the fallopian tube. This test is known as hsg or hysterosalpingogram. Some couples conceive naturally after the hsg test.

I would start your workups to check if everything is open and functioning on your side. If that checks out okay IUI would be a great place to start with time ovulations. They will be able to ultrasound and check for the release of your egg ensuring your insemination takes place at optimum time for fertility.

Best of luck and please keep us posted.

Amy R. Perkins, MS, TS
Laboratory Supervisor
Arizona Andrology Laboratory & Cryobank
International Center for Vasectomy Reversal
AmyAALC replied to AmyAALC's response:
For more information on morphology check my discussion post titled Morphology "Normal Forms"

mrsrachie replied to AmyAALC's response:
Hi Amy -

Thanks for yor response! I reviewed the discussions you listed above.

Just a couple of follow-up questions: 1) what do you mean about determining if I am "in fact releasing an egg for a true ovulation"? 2) Are there any other diagnostic tests I can have done? 3) Is the andrology lab we went to a bit too extreme?

Point#1: I had an HSG and blood work (TSH, FH, LH, estrodyle) and all were normal. I asked an RE about IF I am ovulating since I don't always detect on OPK. He said if I have normal periods (mine are every 26-29 days), I am ovulating. And then he tried to push me into IVF!! ( I kid not, so I am hoping you can provide unbiased, honest, info). I thought I read that NOT all women ovulate every month even w/ normal periods. Is this true?

Point #2: Any tests (not too drastic) I can do next to test issues on my end?

Point #3: Yes, hubby's sperm was 21.3MM/ml. Lab said this was normal as was motility. BUT his "normal sperm forms" were 36% - Lab says 35-39% is 'equivoval' and 40% is normal in this category. Of BIGGER concern is he has 38% "amorphous forms" and lab said over 20% is ABNORMAL.

What are your thoughts on my 3 questions: of other tests for me, is hubby's sperm really ok and how can I make sure I do in fact ovulate??

One last thing: when do you think it's 'time' for IUI? Of course this is personal, but we have been very actively (e.g. tracking, having sex at ovulation, doing OPKs) for 10 months. And before that we were 'trying' w/o all the extra stuff - i.e. just having unprotected sex. Hubby says I am too impatient, but I think we might need to 'step up our game...'

What do you think about the above (esp. the issue of IF I am ovulating)???

Thanks and bless you for helping us!!!
AmyAALC replied to mrsrachie's response:
It is true that women can have normal periods and not ovulate every month. The OPK kits don't work great for everyone so you might try add in the basal body temperature tracking as a second check. It could be possible that you are ovulating early or late compared to the normal day 12-15 and your timing is off a tad. I would also recommend a fertility blend vitamin and healthy lifestyle for yourself. What is your age? Do you battle weight problems? Any health problems?

Have you tried a couple months on Clomid with regular intercourse? Any ultrasounds yet to look at your ovaries and signs of ovulation? I think the ultrasounds might be very helpful to just confirm that ovulation is not a problem.

I'm amazed that they already want to just push you into IVF. Okay, not completely amazed since I hear it often but why not try to do a little more investigating and solving the problem. IVF should be your last option after you exhausted all other (less invasive) options.

Back to the male factors. Amprohous forms is usually the easiest to classify and could be why they rate those the highest. Has he had only 1 analysis? I would recommend a second and compare the results to each other. One analysis is hard to predict overall sperm quality. I would also start him on a fertility blend vitamin. If you are willing to give it some time, start the vitamin and take at least 3 months prior to the next analysis. This will give time for a new batch of sperm to be produced, released and seen in the ejaculation. You might also want to look into a male fertility trained urologist to discuss clomid to improve sperm count and quality. I would say investing in 3 months to try to improve a couple parameters on his end sure would be worth the try over just heading into IVF.

Is he overweight? A lot of new studies over the past 6 months linking overweight men and lowered fertility. Some of these studies show good sperm counts and motility but for some reason the sperm just aren't as good at creating a pregnancy when compared to healthy weight men.

I would focus on trying to improve that morphology a little and give it at least another 3 months before starting in on the IUI. Stress can have a big impact on fertility so keep that in mind.

mrsrachie replied to AmyAALC's response:
Amy -

You raise some great points! Now that I understand the ovulation question, I can ask about it intelligently. On my end, very healthy eating, living, etc. Very good weight and BMI (5'5" and 126-130 lbs). Rare drinking, (1-2x/mo), no smoking, etc. Hubby good on "healthy living" too, except he drinks a good amount of caffeine.

We're both 35.

He; however, struggles with weight and his BMI is not good. This is a struggle and he fluctuates quite a bit. He needs to lose at least 30-50 lbs. He had been dealing w/ lots of stress, so you're right this doesn't help. Also, I will try to get him on a fertility blend vitamin (he thinks I keep trying him to do one thing after another). He's had 2 SA's and both show alomist exact amount of "bad" sperm.

We have an appt scheduled for a urologist in a couple weeks and I will try another Dr. for the Clomid with just sex alone, Dr. I went to wouldn't do it (that's the IVF-pusher)! I heard fertility blend vitamins for women with "normal" periods might put your periods of track. Do you agree with this? We are also interested in exploring natural/Eastern 'alternatives.'

Thanks again and will keep you posted.
justpeachy68 responded:
My Husband and I are also having problems due to sperm motility bc he is a smoker, fixed by taking Vitiam C, and I was diagnosed with Endo in 10' and my doc is recommending Clomid and "natural". My doc has had a lot of success with Clomid.

I feel your frustration.
mrsrachie replied to justpeachy68's response:
Hi justpeachy -

After a very long time trying, I was able to get pregnant - but unfortunately I had a miscarriage. We are back trying again, so I pray all will work out in the end.

Good Luck to you!

AmyAALC replied to justpeachy68's response:
You get one thing figured out to just be faced with another... The Clomid and with trying on your own if a good place to start. Give it 6 months and if still nothing move onto IUI for 3 months and if nothing IVF is usually a nice approach.

AmyAALC replied to mrsrachie's response:
Give the vitamins a try! They've done amazing things for some couples and worth the try because some times it's just that simple of a fix to get that pregnancy to happen.


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