3% morphology options?
3 Replies
jenisci - October 31

Hi Dr. Jacobs,

I am 39 and my husband is 36. My fsh is 5.6. DH has sperm issues. We have been working on improving his sperm motility and have improved that situation somewhat, his recent counts have had 32-25 million motile sperm. We had gotten major improvement in forward progression to 3 and 3.5 (was 1.5-2 before) but on the most recent count it was back to 2. We just had a strict morphology done and it was only 3%. Our RE says at their lab anything over 10% is really good, and under 4% is subfertile.

We have done 3 failed IUI's w/o meds, with low counts (4-10 million). We did 1 IVF and I hyperstimmed, producing 35 eggs, but only 10 mature and 8 semi-mature. Dose was 300 gonal-f /75 menopur 3 days, stepped down to 225/75 for rest of stims. We got 6 embryos at the 2pn stage and 6 more when they checked on day 3. We transfered 3 early blasts, 1 grade 1 and 2 grade 2 embryos on day 5. We had 3 extra grade 3 early blasts on day 5, on day 6 1 had progressed to blast and graded as 2 good for freezing. Estrogen level was high, 4,565 two days before retrieval.

I am now stimming at 112.5 gonal-f/day for a stimulated IUI cycle. We just got the morphology results and am wondering if we have much of any chance with IUI using my husbands sperm. We froze a sample to combine with the fresh to increase counts. Am also wondering if we our chances would be reduced with ICSI due to poor morphology. I read an answer from Dr. Smith regarding a woman whose husband had 1% morph, and he said that when morph is that low there tends to be excessive DNA fragmentation which causes embryos not to divide and grow properly, and they were best off using donor sperm. I don't know if that would still hold true for 3% morph though.

We were planning on doing another IVF w/ DH's sperm if this didn't work, but we don't want to if the morph means our chances are significantly reduced. Husband is very open to donor sperm and doesn't care much where the genes come from, he just wants a healthy baby, but I wanted to try to have his biological child if we could manage to. However we have limited financial resources and no insurance, and while I have great ovarian reserve for my age (asked my RE, I do not have PCOS) I know that doesn't mean that the quality is any better than average. The embryologist noted some of my eggs had thick zonas in the IVF. While I would like to have DH's biological child it is far more important to me that I have MY biological child.

I was wondering if you could shed any light on how morphology of 3% (in combination with other sperm issues) impacts our chances for IUI and IVF/ICSI. If it is a severe negative impact on BOTH we still have time to switch to donor sperm for this IUI cycle.

Thank you in advance for any advice or light you can shed on our situation.


B. Jacobs, M. D. - October 31

Since the lab I use has a bit more narrow definition of normal morphology, it is a bit difficulat to translate your 3% normal forms into our reporting system. Based on the information you have provided, if you cannot significantly improve morphology, in our practice, we would probably do ICSI.
Good luck.


jenisci - November 1

Thanks Dr Jacobs,

To clarify- our last IVF was ICSI, and we were going to do that again before we got the morphology results- so you are saying that a 3% strict morphology (Kruger) does NOT lower success rates with ICSI? Because if it does, we'd want to use donor sperm instead.



B. Jacobs, M. D. - November 1

We do ICSI for that grade morphology, and worse, to achieve pregnancies. Most of the time the morphology issue is a deterant to sperm penetration of the egg. ICSI provides the entry.
Good luck.



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