Today we talk about sperm shape, why it matters, why it might not, and whether teracospspermia is truly a fertility roadblock or just a misunderstood number. I'm Dr. Mark Amols and this is Taco about Fertility Tuesday. So let's start with the basics. Sperm morphology. It sounds like a fancy medical word, but really it just means what does the sperm look like? See, under the microscope, we're looking for the sperm that are perfectly shaped, smooth, oval heads, intact mid pieces and long straight tails. Seems simple, right? Well, not quite. The first thing you have to understand about the number is'not a raw number, it's a percentage. Which means potentially you could have a lot of normal sperm but have a low morphology. Because the ratio of your normal sperm compared to the abnormal sperm may be represented, but the absolute number is not. An example would be if you had 4% normal sperm and had 100 million sperm, you would have 4 million total moving sperm that are morphologically normal. But if you only had 10 million sperm and even 10% of the sperm were morphologically normal, you'd only have 1 million morphological normal sperm. And that's a really big difference between those two. Even though the number sounded better in the second situation. The other issue with morphology is it's somewhat subjective. Between different labs and different technicians, there's going to be stringent criteria. That's basically like, my wife looks like the most beautiful woman on earth and someone else may not think that, although I should point out they are wrong. She is the most beautiful person on Earth, also the sweetest. But morphology doesn't have the absolute look. It's in the eyes of the beholder. Now, there is some general rules to it, right? No one's going to say I'm on the same level Brad Pitt, although I wish. And this grading has changed over time. Back in 1980, someone who was called normal then would not be considered normal now. The criteria we use currently is called the Kruger strict morphology. When I say strict, I mean strict. Think of it like the Olympic gymnastics of sperm. Only the flawless form scores anything even slightly off. Big heads, small heads, double shells, bent necks, they get tossed in the abnormal pile. But the real question comes, does it matter if you find out you only have 2% normal sperm? That's a scary thing to be told. A matter of fact, a lot of people get very worried about it and there are some clinics that'even push you into treatment saying this is the cause of your infertility. But the question is, is it? And this is the point of this episode. The simple answer is no, it doesn't matter. But it'always not that simple. See, most fertile men do have morphologies below 4% and most studies show that there is no consistent correlation between morphology and the ability to conceive naturally. Even men with zero percent morphology have fathered children naturally. But the important part to understand is that the rest of the SEME analysis is also normal. So isolated terracospermia mean isolated sperm morphologyg issues in a situation where the rest of the analysis normal does not have really any effect on your fertility. And so if you have a doctor telling you oh this is the cause of infertility, they are likely wrong. Unless the men have a specific problem with all the sperm. If someone has zero percent morphology and they have globosospermia where they'rounded headed sperms with no acrosomes, they will not be able to fertilize normally. When someone has trachospermia and has lots of abnormal sperm, it's polymorphic, meaning there's multiple different types of issues there. But if it's only one issue that's happening, it may create a problem. So the point is, if you have a morphology issue and the rested count is normal and it's not a monomorphic issue, meaning the same issue in all the sperm, but polymorphic, meaning there's multiple issues, it doesn't appear to affect your chance of getting pregnant. But if you do have a low sperm count such as olgoosinospermia and you also have tatospermia, now you have olgoacenot terracospermia and that can be a bit of a problem. But this is beyond isolated trospermia, meaning isolate abnormal sperm. And this isn't just my opinion. This has been proven by studies. In a 2024 study by Pelzman, they did a large meta analysis that failed to show an association between sperm morphology and natural fertility outcomes. Now it's important to understand that a meta analysis doesn't prove anything. It just shows that taking a bunch of studies that they maybe didn't actually show what they originally thought they did after seeing multiple studies showing different results. So what about IUIs? If you have abthall morphology, are IUIs going to be the best thing for you? You would think it'd be better. In reality, it's still ineffective. Now when I say ineffective, I'm not saying that IUI doesn't work. IUI does work. No matter of fact, if you have low modile count or if you have other issues with the sperm, IUIs are great. But what the stud have shown that when you have a total modal count of at least 10 million or more, even with a morphology under 1%, it did not affect the success rates. Now, remember, there's that situation where you may have a monomorphic issue that affects all the sperm and then it would affect it and you'd be going on to IVF at that point. But for everyone else with isolated tratospspermia, it does not affect your success. So if someone tells you you need to go to IUI because of tatospspermia, they are wrong. Now, if you have other problems with your sperm and you have tractosperrmia, yes, IUI may be a great option for you. So then it's clear if you have tatospspermia, then you need to go on the ivf, right? That's what I'm saying. Well, I'm not saying that either. Unless you have sperm that has a monomorphic issue that affects all the sperm, IVF may not be what's needed. Now, if you do have a problem where the acrosome are messed up, that's the part that gets into the egg, or if the way it moves are messed up, then you probably won't get pregnant. With normal conventional treatments, you might need ivf. But then that brings us to the next question. Does that mean the sperm won't get in? Will the fertilization be lower? Well, if you were with me in training, you would think that absolutely. You must do icsi, intracyoplasmic sperm injection, where we inject the sperm into the egg. Because when I was trained, if your morphology was 4 or less, you always did ICSI. And that actually stuck around for a really long time until people started actually looking at the data. Now, I'm not saying that ICSI doesn't benefit some people who have tatospspermia. There are studies that show lower fertilization rates when you have poor morphology. But the weird thing was, if you're just looking at, let's say, the live birth rates, they were similar. So the fertilization rates went down, but the live birth rates were similar. Meaning in the end, if you're just looking at who gets pregnant, it didn't really affect it that much. But the thing is, the stakes are high. And because of that, no one wants to have a patient that doesn't get fertilization or has low fertilization. Doesn't matter. If you get pregnant, you're still going to be disappointed if only half of them fertilized. And for that reason, we tend to use ICSI a little bit more defensively, not because it's always needed, but because if, if fails to fertilize, the cycle is lost. The stakes are high. And for that reason, in the industry, we have seemed to push more for icsi. Now, in other countries where maybe it doesn't coste anything to do ivf, they're not going to do ICSC because if it doesn't work well, you didn't pay for anything, they don't care. But in the United States, it's different. It does cost a lot, sometimes a whole bunch. And so the stakes are high. And for that reason, ICSI neutralizes the effect of having poor fertilization. Now, I'm not seeing ISI is better than standard insemination. My fact, standard insemination usually has a better fertilization rate. But if there's concern about the sperm, such as morphology issues being the shape, it may not be worth the risk of using standard insemination. And for that reason, a lot of people will go to icsi. But what's interesting is that number has decreased over the years. Even at our clinic, when we first started, because of my training, if you had a morphology of 4.5, you ended up having XC. Now we use that. You have to be under 3. The use XC. And ever since making that switch, we haven't seen a single decrease in fertilization. Now, yes, if your morphalology is only 2.5%, you're going to get it. XCR clinic. Why? Cause, yes, I'm a little bit scared. I don't want to take the chance of you not having fertilization, but realistically, what do I know? Unless it's a monomorphic issue that affects all the sperm, it'not really going to matter. However, I'm still scared and I'm going to do ici. The point is, studies show there is little to no predictive value for pregnancy outcomes when it comes toachospspermia. Yes, it may affect fertilization a little bit, but it's not going to normally affect the pregnancy outcomes. Even the American Society of Reproductive Medicine recommends not basing treatment decisions on morphology alone. I can't tell you how many times I see patients or coming for a second opinion and the doctor told them, oh, your morphology, that's the reason you guys aren't getting pregnant. And then they get pushing the treatments that they don't need. It doesn't mean morphology doesn't have a time and place. But, most of the time, if it's an isolated issue. It doesn't seem to affect things. So if you're sitting there with a report that says 1 or 2% morphology and you're panicking, take a deep breath. A low number on paper doesn't always translate until a low chance success. Think of it this way. Sperm morphology is kind of like checking the trends on your tires. Sure, wall tires aren't ideal, but the engine, the transmission, and the brakes are working. The car still drives. You got to look at the whole vehicle, not just one worn tire. So what's the takeaway today? Morphology matters in context. You have a low count, low motility, and low morphology. Yeah, we're going to take that seriously. But isolated tatzospspermia, especially when everything else is normal, that's not cause to jump straight to IVF or to panic. It's a variable, not a verdict. Don't let a scary sperm shape score shape your future Morphology might look uglyee under a microscope, but the data says it's often nothing to worry about, especially when everything else looks good. Now always. As I say, talk to your doctor. Look at the full picture, but just dont let one scary number define your journey. Maybe youe one of those patients who were told that your infertility was due to sperm morphology issues or even told to go on to IVF when you didnt need it. Maybe you have a friend who has been told this this is true. Hopefully you liked this episode. Maybe it will help your friend. Now you can tell them that yeah just learned from Talk about Fertility Tuesday that it actually doesn't matter. Regardless if you love this show and especially this episode, give us a five star review on your favorite medium but always keep coming back. I look forward to talking to you again next week on TALKAC about Fertility Tuesday.