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michelle A - February 27th, 2006 11:53 AM

Hello Dr Smith,
We have done two IVF cycles with the fert from 0-3.With our 1st IVF cycle from
20 eggs to just 3 fertalized and one made to blast and we had chem pg. With the
seoncd IVF no fertlization happend. Our Diagnose is MF; 800 thousand - 11 million count,
0-3% motility and 0% morphology. Due to low sperm counts, exception of DNA fragementation,
we have done all other genetics test. We have seen the urologist and the only diagnose
was low level of Testostrone. Urologist has given my husband femera but that made his
health worse. To maintain his hormone level he is taking some supplements and herbs. His last
SA was 5 million count, with 1-2 progression motile sperms, but still 0% morphology. The
lab result also stated he have Amorphous heads sperms. We are pursuing toward
third IVF. Is there any successful pregnancy with the Amorphous heads sperms?
Thanks,
Michelle

Dr Smith - February 27th, 2006 12:08 PM

When performing sperm morphology with strict criteria, there are two classifications of amorphous heads: sightly amorphous and severely amorphous. Pregnancy is possible with both types of sperm morphology, but when severely amorphous sperm are used for ICSI, the chance of a live birth ranges from 10-20% for women under 35 years old. If you are older than 35, the chances of a successful term pregnancy are even less.

michelle A - February 27th, 2006 12:31 PM

Thanks Dr smith. I am 31 will be 32 in april, and husband is 35. They have not specify it whether it is severe or slightly amorphous heads. But they said with ICSI pregnancy is possible. Can you tell me why so little fertalization rate in our case. I am good responder to med and with my eggs there is not problem they have seen. What are the cause for fertalization rate to be so low?
Thanks again for your help,
Michelle

Dr Smith - February 27th, 2006 12:44 PM

Severely amorphous sperm do not always undergo a process called "decondensation" or another process called "pronuclear development" after they are injected into the egg cytoplasm. In other words, you can put the sperm inside the egg with ICSI, but, once inside the egg, the severely amorphous sperm does not undergo the necessary changes to initiate embryo development. This is the most likely cause of the decreased fertilization rate.

Alternatively, your eggs may also have problems. You can't tell much about the developmental capability of the egg by just looking at it. So, even though they tell you that the eggs "look fine" they may not be fine. If the cytoplasm of the egg is immature (from a short stimulation , 9 days), then the egg does not have the ability to initiate development, even when a sperm is put inside with ICSI.

Finally, if the embryologist does not perform the ICSI procedure properly, the sperm can remain on the outside of the egg and fertilization fails.

michelle A - February 27th, 2006 1:02 PM

Hello Dr Smith,
Thanks for the response. Is there something we can do or take to fix the Amophous heads? What cause the Amorphous heads? Is this genetic issue or its cause by something else?
Thanks,
Michelle

Dr Smith - February 27th, 2006 1:33 PM

There is no "cure" or treatment for abnormal sperm morphology. Although excessive heat to the testicles and exposure to nasty chemicals can cause sperm morphology problems, it is usually genetic in origin. ICSI provides the only work-around that we have.

michelle A - February 27th, 2006 1:59 PM

Thanks for help Dr Smith. If we even go surgical routs to reterive the sperm, would that make any difference?
Again thanks for the reply,
Michelle

Dr Smith - February 27th, 2006 2:05 PM

No, it would be worse. Stick with the ejaculated sperm and ICSI. Even if there are very few sperm in the ejaculate, they will be better quality that sperm retrieved from the epididymus or testes.

michelle A - February 27th, 2006 2:11 PM

Thanks for all the Information. You have been a great help. Please pray for us.
Michelle

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