I was at a meeting this past weekend, and one of the hottest topics of discussion was sperm shape. We call it “morphology”, and it’s how sperm look under the microscope. A technician counts up the number of normal looking sperm, and reports the percentage of the total. Here’s the odd part: with fairly generous criteria, (like normal means one oval head with one tail,) only about a third of a man’s sperm look normal. That means, for most men, most of their sperm are funny looking.
Is that a bad thing? Well, we all managed to get here with fathers that had for the most part funny looking sperm. Was it the best looking sperm that found its way into the egg and made you? That’s the million dollar question, and one for which we don’t yet entirely know the answer.
There are two ways to measure the look of sperm. One is using the World Health Organization (WHO) criteria, which for the most part say that if a third of sperm look fairly normal, the whole lot are O.K. These criteria have been around for a while, about a half century. The new kid on the block is about twenty years old, and uses a much stricter definition to call a sperm ‘normal’. Thinus Kruger invented this stricter system, and so it’s often called ‘Kruger morphology’ or ‘strict morphology’. To calculate strict morphology, the technician takes measurements of the sperm, and if any are outside the normal range, the sperm is counted as abnormal. The usual cutoff for strict morphology is 4%, which means that 95% of your sperm can be funny looking, and you’d still be considered to have normal morphology. That should give you an idea of how oddly shaped most sperm are in the typical male.
One big challenge in assessing morphology is that even though it appears to be an objective way to describe sperm shape, it still includes a great deal of subjectivity on the part of the technician. The technician is like a referee. Sometimes he or she will let a sperm pass the shape test, sometimes not. From some labs, almost no sperm are called normal in shape. So the first thing you’ll want to do if you’re told that your sperm are especially strangely shaped is to have the test repeated, preferably at a lab that does a lot of semen analyses.
For as many scientific studies that say morphology predicts how sperm do, there are those that say it doesn’t. You might think, as I did, that if a man has especially odd looking sperm, it would affect the chances of sperm getting into the egg and be a good reason to have the sperm injected into the egg using intracytoplasmic sperm injection (ICSI). ICSI is a technique used in in-vitro fertilization (IVF) where the sperm is injected directly into the egg. But in 2007, Keegan and colleagues published a study which reported that there was no advantage to using ICSI for semen with an abundance of funny looking sperm, meaning they did just as well getting inside the egg by themselves as men with “normal” looking sperm.
What does this all mean? Well, it could mean that sperm shape counts, but we don’t yet know how to measure it correctly. Or it could mean that the sperm shape doesn’t have much to do with its function–in other words, the shape of the boat doesn’t say much about how good the captain is that’s piloting it. I don’t know which is right, and I don’t think anyone does yet. So if someone tells you that your sperm is funny looking, don’t despair. It might not be the thing keeping your wife from getting pregnant.
Hello Dr. Niederberger,
Do you have any knowledge of the effectiveness of acupuncture in improving sperm count/motility/morphology? For example, could acupuncture treatment possibly raise sperm count from 6 million to 10 million (to meet the standards for attempting IUI as opposed to IVF).
Rachel, that’s such a great question that I made it my latest post. Check it out!
Thank you very much for the posting! I appreciate your attention to my question. Let’s hope some more studies are done on the effects of acupuncture. I have found your blog extremely informative – especially in an internet sea of insufficient and confusing information. Thanks again!
If morphology is not an issue, why would people in “centile 5” have the least “Normal forms (%)” in the new WHO:
Does not the new WHO table imply increased chance for natural conception with “Normal looking sperms”.
Morphology probably does partially relate to outcomes, but with the caveats that the test be done in a way that creates an actual distribution (for many labs it’s so strict that every man has a morphology of 0%,) and for pregnancy with natural conception. Its use in ICSI is likely very limited, as the sperm is being inserted into the egg directly.
It’s been many years, and I’ve finally turned off comments for this WordPress blog. Why? Although it’s the first question in the FAQ, I still get comments (a bunch a day!) asking personal medical questions that I can’t answer. That’s sad and frustrating for me, because as a doctor, I really like to help patients. But this WordPress site was never meant to deliver personal medical care, and the University lawyers tell me that doing so would run afoul of State and Federal laws.
If you have specific questions about your own personal care, I urge you as outlined in the FAQ to use the American Urological Associationâ€™s Society for the Study of Male Reproductionâ€™s search engine
I also urge you to read through all of Maledoc.com and especially the comments. For the five or so years that it was active, A lot of excellent questions were asked, including by other healthcare providers. Chances are, if you have a general question, it’s been answered here and more than once.