ICSI & poor morphology; count; and motility
10 Replies
kkr - January 3


My husband and I have been unable to conceive for 2 years. All my tests came back normal and my husband's sperm analysis came back abnormal with a count of 5 million; motility of 12%; and morphology of 1 %. My doctor has advised icsi.

Will the morphology abnormality affect my chance for a baby. I know that with icsi a majority of the eggs will fertilize, but will the abnormal sperm morphology impact the chance for a good embryo and ultimate implanation and pregnancy.

thanks for your help.



Dr Smith - January 8

When performing ICSI, the embryologist will do their best to choose a normal looking sperm. This does not guarantee the genetic normalacy of the sperm. Conversely, perfectly normal looking sperm may be geneticaly abnormal. The correlation between abnormal genetics and abnormal morphology is not absolute.

When morphology is poor (i.e. <4%), fewer embryos develop to the point where they are capable of implantation (blastocyst stage). Of the ones that do implant, there is a slightly higher first semester miscarriage rate. That being said, once a fetus makes it past the first trimester, development appears normal and there is NO higher chance of congenital abnormalities (birth defects).

So, to answer your question, yes, poor morphology will lower your chances of pregnancy, and to a lesser degree, a term pregnancy.


kkr - January 18

Thank you for responding. Given my husband's SA, are we wasting our time pursing icsi, or do you think we still have a good chance. We need to decide how to best utilize our resources.


Dr Smith - January 18

I think, with ICSI, your chances are still reasonable, provided you have enough eggs to compensate for the effect of the sperm. In my opinion, you will need at least 10 if you are going to transfer at the blastocyst stage. I would recommend this because when the sperm morphology is low, if pays to wait it out to see which ones develop into good blastocsts.


kkr - January 18

Thank you again for responding. One last question.

Assuming there are embryos which make it to 5 day blast, does this mean that we have overcome any sperm issues? Does this mean we would be okay transferring 2 good blasts? We do not wish to deal with selective reduction, but also do not want to transfer less than would be wise.

I appreciate all your answers!


Dr Smith - January 19

From all the available data, it would appear that there is no higher miscarriage rate from ICSI derived embryos. Yes, I would suggest transferring 2 good quality blastocysts.


Steve - January 25

Me and my wife have been married for 3 years now and trying for a baby since almost a year.
I recently went for a semen analysis and scrotal Ultrasound.
following were the result:
Concentration:10.0 X 10 Million/ml
Total count: 24.0 X 10 Million
Motility 25
Morphology: 11
and TZI of 1.95.

In such a case, do u see there is a possibility of conceiving naturally? or should we go for IVF/ICSI?

Most of the tests conducted on my wife has been found to be normal.

Any information is greatly appreciated.


Dr Smith - January 30

Semen parameters do go up an down, so there are "good" sperm days and "bad" sperm days. However, based on what you provided, even on a "good" sperm day, it is unlikey (notice I didn't say impossible) that you would be able to conceive through intercourse. You've been trying for a year and that has not been working. The next option would be IUI, but I think that's probably a waste of time and money too. Bottom line, yeah, go straight to IVF/ICSI. That's where you have the best chance.


nabila121 - November 21

Hi Dr. Smith


nabila121 - November 21

Hi Dr. Smith,

Me and my husband are trying for 15 years to get pregnant. We have been through 6 failed IUI and two failed ICSI. We are both 39. I had 21 and 15 eggs on my two respective ICSI cycles, however none of the embryos made to blastocyst stage. There was 90% fertilization with embryos growing good till day three and then slow down thereafter. My husband has 15-20 wbc's 1% mormphlogy, 20 million count and 25% motility on semen analysis. I was diagnosed with endometriosis and had two surgeries (7 year back and 4 year back). We are going for our third attempt for ICSI in January. I am thinking of using donor sperms this time because from day one we had the poor sperm uality issue and my husband have used all kind of antibiotics without any outcome. My RE is recommending a day three transfer for our next cycle. I am totally confused right now because we have limited resources. I will appreciate your expert opinion.


DSemcho - November 7

Hello Dr.

I was wondering if you think IVF with ISCI is good for me and my husband to attempt.

I had a HSG on 1NOV2013 and it revealed Right Tube was blocked and they had issues getting dye through the left tube. I have been told that if I am tense during the HSG it can cause similar results.

Also my husband had a spermiogram done, and these were his results.

Liquification Time: 20 Minutes
Volume: 4mL
Fluidity: Normal
PH: (left blank)
Aggulation: Positive
Concentration: 50 x 10^6
Motility: 20
Fast Motility: 15
Other Cell: 0.1 x 10^6

Morphological Evaluation
Normal Sperm Rate: 1 (normal value listed as 4% or more)
Head Anomaly: 77 Dominant Anomaly
Neck Anomaly: 10
Tail Anomaly: 12

And in the notes it says it was diagnosed as Asthenozoospermia and it says "big head abnormality and acrosomal vacuole were extensively observed". I do not understand any of this, and it's been almost a week since both tests were done and our doctor has not given us any answers. Please help!



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