Help interpreting SA, please and thanks?

[num1isjesus]

My husband has had two SAs done, a couple weeks apart. I'm glad he did two because the first one seemed really grim - I think the second one isn't as bad but I'm having a hard time interpreting the results. His doctor couldn't tell him much, and couldn't explain his morphology results at all. Obviously a great doctor. I've been referred to a gyno and w'll both be able to get some info/tests from one doctor then (we have different doctors currently). But my appointment isn't until April - I'm hoping to get a better understanding of these results before then (via the kindness and knowledge of lovely internet strangers).

I'm having a hard time understanding the results because they aren't all percentages/the methods of measurement don't make sense to me compared to what I'd read online or seen in other's results online.

First SA:

https://imgur.com/a/LBmiq

Second SA:

https://imgur.com/a/gFucU

First morphology:

https://imgur.com/a/2IUcT

Second morphology:

https://imgur.com/a/u9U8R

Thoughts? Trying to figure out just exactly how bad it is - after the first SA (where some numbers are flagged with 'L' for low), my husband's doctor said his results were "at the beginning of that's considered low". But give it to me straight, friends - how bad is it?

*Edit: Forgot to black out the morphology doc's name - thanks for caching it! Edited to provide new links for the morphology pics with name blacked out. Was focusing just on blacking the local doctor's name and forgot about the lab doctor. Sorry!

 

[christfollowergift]

@num1isjesus Hey love, the SA isn’t that bad at all. It looks like the first one was a fluke. The second one is totally normal. My husband had similar samples (a “bad/ low” one and then one that was totally normal) the drs weren’t worried at all. They chalked it up to a fluke.
Think about it this way, it’s possible to have a bad day, but not really possible to have a good day if you have a low speed count. Hope this helps!

 

[num1isjesus]

@christfollowergift Thanks very much, good to know your DH had a similar experience. I assume more SAs are in his future - hopefully the first one was just a bad day.

 

[ka__f]

@num1isjesus I would discount the first SA. The 2nd one looks normal. Morphology is a controversial measure... They aren't really sure how much it matters (from what I have gathered in my research). Was there something different between the 2 SAs - length of time abstaining, sample given onsite vs offsite?

 

[num1isjesus]

@ka__f Both samples were given offsite and quickly delivered to the lab at our local hospital. They were given about two weeks apart, so not long enough for a new life cycle of sperm generation. After the first SA results were in and (poorly) reviewed with his doctor, DH (finally) quit smoking weed. He was smoking weed once or twice a week, and some weeks not at all. There's research that says it's fine and research that says it affects male fertility, so at least the first SA was inspiration to quit entirely... But a week of not smoking pot wouldn't have changed his numbers.

As far as abstaining prior to giving samples, he abstained for three days the first time and five days the second time.

 

[rooted]

@num1isjesus Oof... I think the second SA is what you should focus on. However, I do think the total count is still on the low side (52 mil?).

Morphology is a more controversial measure than the others - so don’t put a lot of stock into those results. It’s nice they gave you comments and details.

If you want to try and improve quality and quantity, I’d look at starting him on CoQ10 and a men’s multivitamin (if he isn’t already). There are other supplements to consider too, but I think these are an easy and inexpensive place to start. Additionally, you can look at lifestyle changes that may help increase those numbers (hot tub/sauna use, underwear selection, caffeine, smoking, other drugs, etc.)

Edit: also curious, what were the “conditions” for each SA? Such as time since last ejaculate, home or lab generated sample, time from sample to analysis?

 

[num1isjesus]

@rooted Thanks for the insight - question though - 52 million is coming from 26 x 10 to the power of 6, which is 26,000,000 and then multiplied by 2 because the sample volume was 2 mil, correct? Sorry if that's a dumb question, I just haven't seen an example of an SA laid out like this before and thought there would be more percentages. My mistake for not knowing what to expect/interpret!

Re: the conditions, the first test was done after three days of abstaining, the second test was after five days. Both samples were given offsite and taken to the hospital lab very quickly (within 15 minutes) so the SA was done right away. For the morphology tests, they had to be sent to a lab thousands of kilometers away because our local lab can't do it. In that case I assume they freeze the sample, or it doesn't matter how fresh it is for morphology.

After the first SA results were in and (poorly) reviewed with his doctor, DH (finally) quit smoking weed. He was smoking weed once or twice a week, and some weeks not at all. There's research that says it's fine and research that says it affects male fertility, so at least the first SA was inspiration to quit entirely... But a week of not smoking pot wouldn't have changed his numbers. He wear boxer briefs, so not tightey whitey undies, but not super loose boxers. More like somewhat fitted shorts - think that's ok? He's avoiding hot tubs, etc, doesn't consume a lot of caffeine (although this is a good reminder), doesn't smoke, doesn't drink much and cut that down anyway. He is overweight and that likely doesn't help in general.

I've got CoQ10, Maca, and Ashwagandha for him to start taking - just need to figure out dosage and he'll start that today. He's already taking vitamin C and zinc.

 

[rooted]

@num1isjesus Yep!! You’ve got your math correct. I haven’t seen results laid out quite this way either.

You’re right - one week wouldn’t make a difference. But it might be interesting to see his numbers if he doesn’t smoke for 3 months. I would personally err on the side of caution and ask him to continue to not use while TTC. But that’s just me!

My husband wears boxer briefs too. The urologist didn’t seem to think they needed to be changed. He’s also borderline healthy/overweight which we’re working on... he dropped 30 lbs last year which I’m super proud of him for! Now for just those pesky last 5-10 lbs.

You are ready to go with the vitamins!

Good luck! Hopefully you won’t need another SA, but if you do have him get another in ~3 months, I’ll be really curious to see the results!

 

[num1isjesus]

@rooted Thank you so much for your help, I really appreciate it. DH came home from the doctor super bummed because the numbers looked bad AND he didn't understand them - his doctor had him leave confused and disappointed, so the last couple days have been pretty rough. This is really helpful, even if his numbers are still bad... At least we can understand a bit better!

Thanks for the math help, I think I get it now. The morphology math is still weird to me - I think both the normal and immature forms numbers are percentages, and his don't look great.

That's really great about your husband's weight loss - mine needs to get motivated. If he could lose 30 pounds this year that would be amazing. I think there will be more SAs in our future, and I'll probably do an HSG test this spring once I see the gyno in April.

 

[rooted]

@num1isjesus Oh that sounds awful!! No one should leave the doctor feeling like that. I hope he is feeling more relieved after the second! Keep in mind his total number on the second SA isn’t bad, it’s above the reference!

I agree the morphology report is a little odd... but don’t get too worried about it!

 

[num1isjesus]

@rooted Thanks very much I posted this in another sub and someone there said the sperm count doesn't get multiplied by the sample size - so the results in the second SA are 26 million, not 52 million. I'm not sure, the way the results and measurements are laid out isn't clear. Hopefully we can see an RE or someone soon who can actually interpret the numbers with us.

 

[teadrinker]

@num1isjesus This report likely means "concentration" when they listed "count." You can tell because they list 15M as the cutoff, and that's the 5th percentile for concentration. The 5th percentile for count would be 39M.

 

[num1isjesus]

@teadrinker So if they did mean concentration, does that mean SilverBea's math was right and the total count in the sample would be 52 million?

And the fifth percentile - that means 39 million would put a man in the fifth percentile for count, which is quite low. Correct? Sorry - my familiarity with percentile is only in terms of people talking about their babies' growth, which is obviously a bit of a bummer reference in this case.

 

[teadrinker]

@num1isjesus Yes, that is correct. Total count is likely 52M. Yes, when I say "5th percentile," what that means is that the WHO collected a bunch of SAs from males who were able to get their partners pregnant within a year of beginning unprotected sex. When that data is normally distributed, only five percent of those males (not all males) got their partners pregnant with less than 39M total count.

However, this doesn't account for a lot of things, namely that someone with 20M count and 100% morph is likely more able to get someone pregnant than 40M count and 0% morph. They just have limitations in how they display the data.

 

[num1isjesus]

@teadrinker That makes sense, thank you! I understand the limitations with the data too - there would be so many different combinations that would lead to different results, and beyond that of course each couple is different.

 

[num1isjesus]

/@mcg1102 could I beg you for a minute of your most helpful insight here? I did post this in the /r/infertility sub too, but you know, you're a genius so...

 

[mcg1102]

@num1isjesus I am definitely not the right person to ask about sperm -- my knowledge has glaring holes, and most of sperm development is one of them.

It looks like you've gotten some good answers so far, but /@seekerofhope is our current resident sperm expert (though my apologies if I'm missing other current resident sperm experts!).

 

[ka__f]

@mcg1102 I haven't seen him in a bit but /@teadrinker is/was our other expert

 

[num1isjesus]

@ka__f Thank you! A sperm expert I am not, and would so appreciate any help! I posted this in the infertility sub too but TFAB is where I (all of a sudden) feel at home.

 

[teadrinker]

@num1isjesus Sorry, all. I took a break for a bit since I realized IF was really impacting my life and the life of my family. I promise I still get alerts if people like /@ka__f or /@mcg1102 tag me and I'm happy to respond, and I used to have a lot of conversations with them on these boards. I hope that someday I'll be able to respond more proactively like I used to. Just trying to reset, I guess. Anyway, I'll try my best here after I knock the rust off.....

I wouldn't worry about the first result. SAs are all over the map. Concentrate on the second one until you get a third (if you get to that point) so you can establish a baseline. Total motile (TMSC) is over 20M and looks fine. It looks a little worse if you look at total motile normal since that's around 200k. WHO 5th centile for that is around 500k and is usually the marker for concern. Do note, however, that they are likely using progressive motility instead of total motility since they are using 32% as the baseline and not 40%.

Like others have said, morph is controversial, and unfortunately it's the most difficult to change with diet, exercise, and other changes. That said, not smoking weed for a week isn't going to make much of a difference. You need around 74 days sperm to mature, so he really should stop smoking for at least that long before another SA. I'd recommend he go to an andrologist (a urologist will work if you simply can't find one) as they have a lot more experience with male IF issues than an RE. The fact that they refer out for morph is odd to me. A skilled andrologist should be able to do the entire SA themselves, so I'd try to get the third SA at the andrologist/urologist if possible. Let me know if you have other questions, and I'll do my best. Good luck!