Hi Osmond,
As you say you have a very high sperm count with very good motility. The morphology result is not too terrible either. There are two different criteria used to classify sperm morphology. The older, World Health Organisation (WHO) classification, and the newer Kruger Strict Criteria. The normal range for the former ranges from 25%-55% normal forms, whilst with the latter 8% - 18% normal forms is considered acceptable. Even values much below these figures do regularly go on to produce healthy normal babies as stories on FZ attest to.
Sperm autoimmunisation is not uncommon, and probably around 10% of men have some detectable antibody on their sperm. One effect of this antibody coating, which can be on the heads, the tails, the midpieces or all three, is to reduce sperm percentage motility and sperm speed, and antibody also causes the sperm to stick together (aggluntinate) in the semen specimen - this would have been reported if it was marked. The antibody coating also interferes with how well sperm swim through cervical mucus, the mucus causing antibody coated sperm to become immobilised. Progression through the remainded of the female genital tract to the egg is also reduced for antibody coated sperm. With head antibodies there can also be some inhibition of sperm binding to, and penetration into, the egg.
How much of an impact sperm antibodies make on your fertility depends upon the total number, of active sperm, in your samples, and how much this activity is affected. Fortunately you have a very high count of very good activity sperm and their motility does not appear to be suffering greatly. Despite the high percentage of sperm that appear to be antibody coated you still have a high number of good activity sperm many of which are free on antibody. You can work out that you have around 18 million good activity, relatively antibody free sperm, in that sample. This is a great deal more sperm than many, fertile, men have in their total sperm count.
The other factor is always how fertile your partner is and how well does her cervical mucus handle your sperm. Some women can have a mucus containing antibody that makes it hostile to sperm, even normal ones, and some couples will have a both a sperm antibody and a mucus antibody problem. So she needs to be investigated and her mucus tested against your sperm. This is a test that I do regularly on all couples I see as it gives a good picture of how well his sperm penetrate into, survive within, and move on through her mucus - the first real hurdle for sperm in their journey towards finding the egg.
Treatment to reduce sperm antibody is not easy. Steroids have been used in the same way as they are used for any other immune system disease. But these are potent drugs to have to take for many months, without perhaps any benefit. The sperm picture often does not appear any better even whilst on steroids, and you have to continue taking them, hoping that at some point a pregnancy will happen. Antibody coating gets worse the longer you abstain, and regular ejaculation every 2-3 days will reduce this, as well as improving other sperm parameters. As sperm survival in mucus may be reduced, regular intercourse 2-3 times per week will also ensure that you always have your best sperm around in your partner whenever ovulation occurs.
So the picture is not as bad as it seems and unless further tests indicate other problems in your or your partner then a spontaneous pregnancy, whilst perhaps taking a little longer than average to achieve, is still very likely. There is no increased likelyhood of birth defects, or of pregnancy problems.
Keep us in touch, and good luck.
Paul