Tuesday, August 25, 2009

SA Results: Count, Motility, and Morphology Explained

In an effort to get my thoughts untangled before the urologist appointment this afternoon, I thought it might be helpful to write them down here. I plan to take this cheat sheet with us to the doctor tomorrow so that I can make sense of all of the numbers he throws at us. Because this post is likely to get long, I'll probably post two separate ones later this week or soon thereafter...one on morphology in more detail (the most concerning item for us since we currently have 0% normal morph) and possible "treatments"/remedies for MFI issues (though there seem to few and they seem to be mostly a crap shoot!)

The process of interpreting SA results or figuring out how to improve them begins with collecting the sample. With that in mind, this excerpt from Dr. Mark Perloe's "Miracle Babies" gives some great tips on how to make sure the best sample possible ends up at the lab. The exercept doesn't give too many specifics, though, so I'll direct you here for more specific instructions. Of course, if your doctor gives you different instructions, use those! The only tip that we were given that doesn't appear in those resources is that if your collecting at home and transporting the sample to the lab, be sure to keep the sample at body temperature (tip: keep the sample cup in DH's breast pocket, for example).

So, now the all important collection is done and your doctor calls with the results. Motility, morphology, volume and count...what the heck does all that really mean? Here are the "normal" ranges that I've been able to find. Keep in mind that the categorization "normal" seems to be somewhat subjective depending on the clinic/doctor.

Sperm Count/Concentration
Sperm count is the number of sperm typically found in a milileter of fluid.
Normal range: 20 million to 150 million. Average is 60 million.
Low: Greater than 10 million; Less than 20 million.
Very Low: Less than 10 million. This is otherwise known as oligospermia.

Motility is a measure of how many sperm are actively moving at certain times after ejaculation. The better the swimmers swim, the more likely they'll be able to reach the egg.
Normal: 50% moving at one hour post-ejaculation.

The WHO (World Health Organization) further categories motility into the following four categories:
Grade a (fast progressive) sperms are those which swim forward fast in a straight line.
Grade b (slow progressive) sperms swim forward, but either in a curved or crooked line, or slowly (slow linear or non linear motility).
Grade c (nonprogressive) sperms move their tails, but do not move forward.
Grade d (immotile ) sperms do not move at all.
More excellent information on motility here (the reference source for the above).

Volume is just the total amount of fluid in the sample. This measure is also why all of the SA instructions stress the importance of making sure that the entire sample is collected.
Normal Range: at least 2 milileters

Morphology is a measure of how the sperm or shaped. Normal sperm have oval heads, a connecting middle piece and long, straight tails. Anything not meeting those specifications is considered abnormal. The morphology measurement is the percentage of abnormal sperm in the sample. The more normally shaped the sperm are, the more likely they will be able to fertilize the egg.

There are two standards for categorizing morphology. You can read more about the WHO Criteria vs. the Kruger Strict Criteria here.
WHO Criteria
Normal>60% normally shaped

Kruger "Strict" Criteria (sperm must be perfect to be considered normal)
Normal>15% normally shaped

Particularly useful Kruger categories from fertilitydr.com:
>=15% normal: Normal range - Good prognosis
5-14% normal: Sub optimal range - Prognosis is fair to good, however, the lower the percent normal, the lower the chance of successful fertilization
0-4% normal: Poor prognosis - Will usually need IVF with ICSI

There is conflicting information about the importance of morphology, which is why I'm planning to talk about morphology in more detail in a later post. In brief though, if the count is high, 20% normally shaped may be more than enough to get the job done. 20% normal morph with a count of 100 million still leaves 20 million normally shaped sperm. That's in the adequate range. However, the lower the count gets and the higher the number of abnormally shaped sperm get, the fewer "good" sperm are left to do the job.

For us, for example, we have low count (number to finally be disclosed at this afternoon's uro appointment) along with 0% normal morphology. Even if we can get the count up, we've still got zero normally shaped sperm. That's obviously a big problem. We'll see where the urologist stands on the morphology controversy soon enough.

That's enough for now. More on treatments, morphology and possibly varioceles at a later date. I hope that this proves to be helpful for others who find themselves in a similar situation in the future! Please feel free to add any useful resarch that you've unearthed (or other blog posts you've found with helpful information) in the comments!

The rest of the resources used in this post can be found here:
IF Optimist, Then (kudos to my fellow blogger IF Optimist for some equally great research!)
Your Total Health (iVillage)
Bluegrass Fertility Center
Malpani Infertility Clinic


Brandy said...

This is a great post. Our last test showed 750,000 motile sperm, with 4% normal morphology (using Kruger). So we're looking at IVF with ICSI.

Our doc has DH taking supplements that help with morphology. If you want I can find out what they are and let you know.

Lisa RM said...

Good information, thanks!

Jenny said...

Interesting isn't it? Now if they could only do something about it...maybe someday. We too are faced with 0% morphology on two kruger SAs, and because of that we have low motility with no obvious cause, no varicocele, but probably genetics.

We've been told that the morphology doesn't always mean that the sperm cannot fertilize an egg and produce a healthy baby, it just may need some help getting in there. Even abnormally shaped sperm can penetrate an egg, it depends on the type of disfigurement, if you will, that the sperm has. So all hope is not lost with today's technology. They told us we have a 4% chance with IUI, we did four (because IVF is expensive)and they didn't work, so we are now doing IVF/ICSI and we have a 45% chance of success. Good luck at your appointment, I wish you well.

Anonymous said...

I wanted to wish you the best for your appointment this afternoon.
*Thinking of you*

Anonymous said...

I hope your appointment goes well and that you get good news. I think thats a great idea of bringing information with you to help you understand everything.

'Murgdan' said...

Excellent job. I hope you get some news and explanations. Although I generally find I don't have that many questions...because like you, I do all my own research first.


Jem said...

Very helpful post. I'm planning on showing this to my DH, as we have low count and not enough sperm to even judge morphology. We start IVF with ICSI in September.

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