Severe Morphology

Hi, my husband and I have been TTC for 15 months now.  I've had some tests done for myself and my pap and bloodwork comes back good.  We did a post-coital test and Dr. only found one dead sperm in the sample.  My husband then had a SA done and the count was about 250 million with 157 million living.  Although his morphology is horrible, only 1%.  We're having a Sperm Chromatin Structure Assay done, although its not back yet.  Is there usually a tie between poor morphology and poor DNA structure?  If so what are our options?  If the DNA is normal, can morphology be improved?  If not then what?  I'm so confused and want to know our options.  I'm sure that either IVF or something of that nature is in our future right? Help!

[Elaine Brown, MD]

Hi!
It is possible that the chromatin structure may correlate with the poor morphology, but it will be better for you two if it doesn't.  

Bad chromatin structure is usually correlated with miscarriage. I don't know if it can be repaired. (This a fairly new area).

Poor morphology can be worked around in a couple of different ways; I have seen some urologists use clomid on men to increase their counts, and therefore the numbers of normals (a low percentage of a higher number is a  higher number!)  I have seen some men undergo surgery for varicoceole if this is felt to be a contributor.  I have also very commonly seen Intra uterine insemination used--this concentrates and gives the advantage to the good guys.  Finally there is the option of ICSI-- or intracytoplasmic sperm injection--and yes, this is when you come to IVF--but it works!!!

There are lots more options with sperm than eggs, because there are so darn many of those guys, and they just keep coming--so your chances are pretty good!

Hang in there!
Dr B