@joscar Hey there. I'm an embryologist at a fertility clinic and do a lot of semen analysis! I'm happy to help. And I'm sorry that your clinic has distributed these results to you with no explanation - that's not great practice on their part!
Let's break this down...
The volume is fine. Anything between 1.4ml and 5.0ml is considered normal.
"Number of sperm: 13.3 million/ml" refers to the concentration of sperm cells in the ejaculate. This value is about many sperm, moving or not, are present in each milliliter of ejaculated semen. Your husbands result is slightly below the lower limit of 16 million/ml.
HOWEVER, your total number of sperm ejaculated (55.9 million) is normal. This value refers to the total number of sperm cells, moving or not, in the entire sample your husband provided. It is calculated by multiplying the concentration by the volume and anything above 39 million is normal. In your case, while the concentration is low the highish volume compensates for that.
In short - you have a fair number of sperm, they're just spread out over more semen, which is why the concentration appears low if that makes sense.
pH is the measure of how acidic or alkaline something is. Semen is meant to be slightly alkaline, so anything between 7 and 8 is fine. pH7.7 is normal.
Viscosity refers to how "gloopy" a sample is. With samples which are highly viscous the sperm can struggle to move out of it, and into your cervix. His has been marked as normal so that's good.
Colour is an arbitrary thing. Saying the colour is normal is just shorthand for saying "there's no blood in this sample and it doesn't look infected either".
Now onto his motility. Motility is divided here into four categories: "null" means not moving. "In situ" means they are twitching on the spot, but not going anywhere. "Slow progressive" means that they are moving in a forward direction, but they're being a little slower about it than is optimal. They have fertilisation potential but are more likely to become stuck in the cervix and will be outcompeted by faster sperm. "Fast progressive" means that they are moving in a forward direction at a good speed and have good fertilisation potential. Your clinic has given you results in percentages, to indicate what proportion of sperm are moving well, not so well, or not at all. It seems like your husbands sperm are a little on the sluggish side, with only 4% of sperm being fast progressive. However your total progressive motility (which accounts for fast and slow progressive sperm) is 39%, and I believe the guidelines say it should be over 35%, so I would consider this borderline [
EDIT i checked, its 30%, this isn't a borderline result] Your total motility (accounting for progressive and in situ sperm) is 54% which is normal - the guidelines say it should be above 42%.
It's not that you don't have motile sperm, it's just that they're a touch on the slower side! BUT they are still swimming and therefore still capable of fertilising an egg.
Something they haven't included in your results is something called the "Total Effective Count". The TEC refers to how many motile sperm there are in the whole sample. It is calculated by multiplying the total number of sperm in the ejaculate (55.9 million) by the percentage of progressively motile sperm (39%). In your case this would be 21.8 million. So there are 21.8 million sperm in your husbands ejaculate that are swimming. The guidelines state that this value should be above 20 million, and anything between 20 and 25 million is considered "borderline", so your results would fall into the borderline category.
Vitality refers to how many sperm are alive. Sperm can be alive even if they can't swim. 78% is a normal vitality rate.
Leukocytes are white blood cells, they indicate either infection or some other sort of inflammation in the testicles. There shouldn't be more than 1 million, but your husband doesn't have any, so that's good.
Now lastly morphology. As you said 1% is a low result. With morphology, anything over 4% is considered normal. What I will say about morphology though, is that it's relevance is highly contested. The theory is that abnormally shaped sperm are more likely to get trapped in the cervix, targeted by your uteruses immune system, or fail to fertilise an egg because they can't "fit" with the receptors. There's also some discussion around whether poor head morphology correlates with high DNA fragmentation - which can cause issues with the embryos leading them not to implant etc. However, some research shows that even sperm with 0% normal morphology can go on to produce healthy pregnancies and live births, so you can see why it's contested. Even where I work we all have different opinions! But we do say that of all the parameters that are measured in a semen analysis, morphology is the one you should worry about the least. 1% of 20 million is still 200,000 and it does only take one!
(Ignore the rest of it, teratozoospermia is the scientific name for low sperm morphology, and the last 4 items on the list there are varying degrees of sperm immaturity. It doesn't look like they saw many immature sperm which is good)
In conclusion, yes, there could be a mild male factor fertility issue here, but if there is, then it's definitely very mild. It would be good practice to have a repeat semen analysis to confirm the results. There are so many temporary factors that can affect it and cause results to be borderline or low as a one off - for instance being unwell even with a cold, being very stressed. Also, things like taking hot baths or using saunas can affect motility. And chances are if you do a semen analysis on the same guy once a month it would vary significantly.
I want to reassure you that semen analysis is not an exact science. Apart from total azoospermia obviously, there is no cut off point or features that allow us to say "yep you'll never concieve naturally". Its not like that. An analogy I've learned from others in this thread, is that conception is a crap game of luck. It's like rolling a dice. You need a 1 to concieve. For most people, they're rolling a normal dice with 6 faces. When people start adding in things that make conception more difficult - like low morphology or low concentration or low motility - it's like adding more faces to the dice. Instead of rolling a d6, you're now rolling a d12 or d20. It's still absolutely possible to roll a 1, and hey, it may even happen quickly. But chances are it will take you more rolls to score the jackpot. Whilst there is a correlation between certain results and increased time to conception, its definitely not an absolute.
Personally, I've seen plenty of mild MFI patients go on to concieve naturally or with IUI (I've actually seen someone with a TEC of less than 0.1 million concieve naturally twice so nothing is impossible). Whilst these numbers indicate likelihood of conception, or time until conception, as long as there are some moving sperm the possibility of conception cannot be excluded. It just might take longer.
Your clinic will be able to advise you better on what the best next steps are for you, in light of your full history. I'm not really in a position to make that recommendation, I'm just sharing what I've personally learned and observed through work.
They will likely recommend that your husband should have a repeat semen analysis done in 3 months (takes 3 months for the testicles to go through a whole cycle of producing sperm, so it's good practice to compare after a whole cycle has completed). With the low morphology and in particular, the high incidence of head abnormalities noted, it might be worth asking your clinic if a COMET Assay would be available for you. COMET Assays measure the rate of DNA fragmentation in sperm, which I mentioned earlier.
I hope you've found this helpful and please do let me know if you've got any questions!
