When asked to interpret a Semen Analysis, one of the commonest variables that create a lot of confusion is Sperm Morphology or the size and shape of sperm. Morphology is usually reported as a percentage of sperm that appear normal when tested during a Semen analysis. Scientifically, morphology is one of the most predictive measures of fertility potential and therapeutic outcome. Ironically, is the most confusing to perform as a test and the most difficult to interpret.
Men who present to our specialty clinic are overtly concerned about the morphology section under Semen Analysis. The usual question is “Don’t we need all our sperms to look normal”. How do sperms look? Usually a sperm should have a head with a nucleus, a middle piece and a tailpiece. The nucleus has the DNA which is the genetic material required for fertilization.
However, this is not the norm. There are a lot of factors that could have an effect on the interpretation of morphology in the lab. The way one technician stains the slide and dries the slide may be different from the way another one processes it. If this does not cut it, then adding to the confusion is how do we employ criteria to differentiate a normal sperm from an abnormal one. Also does abnormal mean defect in the head, middle piece or tail?
Recently many labs have started to employ the KRUGER criteria for determining morphology. This is a good start as it establishes a guideline to compare lab results with. For an infertile couple abnormal sperm morphology done according to strict criteria in a specialized lab may suggest the next therapeutic step like IVF, ICSI or even a Varicocele repair.
It is important as always if a reason is not found for the abnormal sperm morphology to relax, adopt lifestyle modifications and consume antioxidants if needed and follow the specialist’s advice.