Help interpreting SA, please and thanks?

[ka__f]

@teadrinker Sorry to drag you back into tfab. I hope you and your wife are doing well.

 

[teadrinker]

@ka__f Trigger Warning

Oh, you definitely shouldn't feel the need to apologize! I really like helping people. Once we finally got a BFP, I just had to take a break since I was stressing too much about the pregnancy, and reading all the posts in TFAB, ST, and IF were just making me worry even more. Yes, wife and I are doing much better now, thank you for asking.

Now that we are on the other side of it, I feel better about it, so I don't mind helping out where I can. It's hard to find SA resources, so always feel welcome to tag me if you see anything that you think I can help with. I just don't frequent the board as much as I used to, at least not right now, but I still see tags and am happy to help.

 

[ka__f]

@teadrinker

 

[num1isjesus]

@teadrinker Thank you so much for commenting, I really appreciate it! And totally respect the need to take some space away from these posts - thank you for helping me, I'm really grateful.

You clearly are a sperm expert - I'm trying to figure out where you got some of the numbers and I'm having a hard time. Math never was my strength, but this shouldn't be so hard! When you say total motile is over 20 million, are you referring to the sperm count being 26? And for total motile normal being 200k, where does that come from? It looks like sperm motility is 40% - is that 40% of the 26 million? That doesn't come up as 200k by my (shitty) math. i also need to learnt the difference between progressive and total motility... So much more to learn!

The morphology tests looks grim to me - it looks like the normal forms on the morphology came back as 1% when it should be at least 4%, and immature forms are 5% when they should be less than 3%. But I could be reading it totally wrong.

He stopped smoking weed entirely after the first SA results were in, and is committed to sticking with that for as long as it takes for us to conceive. I need to ask more about the morphology being sent out - that might indicate that we only have lab techs and not even an andrologist here. We're in a remote place and our town of 30,000 people is the biggest in our region, so it wouldn't be too surprising if we only had a gyno as far as specialists. Might have to get on a plane to see an RE, andrologist, or urologist - I'll find out.

Again, thank you SO much. Sorry for my math questions - this is all new to me and the way the results are laid out isn't what I was expecting. No pressure to respond - you don't need to knock the dust off for a total newbie, and you've already been super helpful.

 

[teadrinker]

@num1isjesus No worries. It takes time to understand all the numbers and calculations. As I commented above, they listed the concentration, not the TC. Therefore, his TC on the second would be 52M. Total motile would be calculated by multiplying that by motility (usually total motility, but they only listed progressive, so I'm using that and adjusting my reference range on the WHO sheet). Therefore, 52M * 0.4 = ~21M TMC, well within the range for IUI, and some morph studies have shown that there isn't a difference in IUI success rates when TMC is that high and your age is less than 35.

You have morph correct. "Normal" morph is 4%, but that number has dropped for years. It's very likely the reference point will continue to drop the next time the WHO revises the guidelines. TMNC would simply be the ~21M * 0.01 (normal forms) = ~208k. That would be considered low for the metric, but its importance is debatable as others have said.

 

[num1isjesus]

@teadrinker Hm. Sounds like it is, overall, pretty grim then. Total count isn't awful (but isn't good), and there are not very many sperm that are motile. And based on the morphology, most of the sperm are abnormal. Well shit.

You mentioned IUI, which I'm also learning more about (I'm more familiar with IVF), and it sounds like I should do my homework - I'm getting the feeling, based on these numbers, that the odds of us conceiving are on our own are very, very slim. I can't ask for a diagnosis and don't want to break any rules here, but if you don't mind - would you agree with me on that statement?

Thank you again, so much. Even if the numbers are discouraging it is really helpful and encouraging to find so much information and support here.

 

[num1isjesus]

/@teadrinker one last thing, along with basically asking for a diagnosis (even though I shouldn't) above - for the morphology numbers, they reference 1% being normal forms and 5% being immature forms. So that's only 6% total... If the morphology test only considers the ~21 million motile sperm, and 1% of those guys are normal forms, and 4% of them are immature forms... Then are the rest of them a total write off?

 

[teadrinker]

@num1isjesus

are the rest of them a total write off?

No, not necessarily. The way a morph test works is they literally just select 100 sperm out of the millions in the dish and count them. Then they select another 100 in another area and count those. If the percentages are close to each other, they usually average the numbers and say that's the morph. If not, they might need to count more selections or something (I don't remember the escalation for that off hand without looking, sorry).

As you can see, it's a very imprecise process that relies on a very small sample and allows for a lot of variation in the result. While testing in multiple areas makes it less likely that there is a huge amount of variation in the sample, it's still testing an extraordinarily small number of sperm in the sample.

Regarding the morph itself, they are using Kruger/strict criteria. This means they are very strict as to what qualifies as a "normal form." Even the smallest deviation from a perfect looking sperm will disqualify it, even if that defect might not really be a huge deal. For reference, humans suck at making sperm, and the 50th percentile of fertile males (again, not all males) only have Kruger of 15%.

Something like the length of the tail will disqualify it even if it's motility is fantastic. This is far less damaging than something like a head defect (and unfortunately, that's the vast majority of morph problems). The better SA reports will actually break out where the defects are. We know that a perfect-looking sperm can fertilize an egg. We know that a sperm with two heads and a short tail can't. We don't really know much about that in-between area, so Kruger just disqualifies them all to be safe if that makes sense.

 

[teadrinker]

@num1isjesus Fair warning that I'm not doctor. I have zero professional medical knowledge, and everything I know is basically from Internet research. That said, with two morph tests at

 

[num1isjesus]

@teadrinker Thank you, again, for all this useful info. You have been so helpful and, by far, way more informed than my husband's doctor! He was taking a couple vitamins and we just added some supplements to the mix, so between that and giving up weed entirely I'm hoping that his numbers will improve in a couple months (which feels like a long time from now). In the meantime I'm hoping he can do another SA or two to see if the numbers are somewhat consistent with the second SA he did.

I'm also working on figuring out what resources are available to us here - as I've been referred to a gynaecologist, I have a feeling we don't have an RE or urologist, but I'm going to find out. And do more reading about whether it looks like IUI or IVF might be the only chance for us...

Anyway, feel free to send any other thoughts my way, I hope it's ok to have asked so much of you. I'm really, really grateful for your help - my husband and I went over his results for over an hour the other night, entirely using the info and numbers from you so we both got an understanding of where things are at. He was of course pretty bummed, but so appreciative of your help. I hope your journey in this TTC adventure is going as well as it can be.

 

[ka__f]

@num1isjesus Oh he hasn't been on his account in 8 months... Sorry. You'll probably have more luck with jyank (who devbio recommended).

 

[num1isjesus]

@mcg1102 Thank you!! i don't know, you're still a genius to me. I would love any insight from experts, this is all new to me and the total lack of info from DH's doctor has left me confused, and also extra grateful for help on the internet!