FertilityZone

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

Hi Osmond,

There is not a lot that can be done, sadly, other than steroids as you say. The problem is these usually don't work, and you never know this in advance. The sperm can remain much the same in appearance yet a pregnancy happens. And as with any fertility treatment, even if they are better it can still take 12 months or more to achieve a pregnancy. So you have to persevere with a difficult treatment, perhaps for up to a year, never knowing whether or not the sperm have benefitted from this.

The antibody seems to be deposited on the sperm in the epididimys, so occasionally very frequent ejaculation (2-3 specimens in one day - phew!) can reduce the antibody coating. It has been suggested that ejaculating directly into culture medium also stops them becomng to firmly coated, and then this coating can be washed off by several wash and spin downs with further fresh culture medium. Talk to the embryologist about his experience with these approaches.

Otherwise you are looking at IUI perhaps, or IVF, or being very lucky. It is reassuring that you still have a high %age and quality of motility, suggesting perhaps that the antibody is not that firmly bound; and a naturally pregnancy is still not impossible therefore. What might help to predict the likelyhood of this is to test your sperm against her best cervical mucus. Mucus is the point where most sperm are immobilised, and if survival in her EWCM is better than expected then you have a chance naturally. A good sperm against mucus interaction result was the single most accurate predictor of natural fertility, in my large series of couples in my Liverpool research. This test is the first one I do with each new couple I see therefore.

Good luck with this.

Paul

Hello,

My husband just got his results back and read as follows:
IGA antibody 47%
IgG antibody 2%

Volume: 4 ml
Viscosity: Slight
Concentration: 23.9 mil/ml
Count: 95.6 mll
Motility: 64%
Progression Rate: 2+
Motile: 61.2 mil
Normal Forms: 3.7
Ph: 8
Debris: Moderate

I just had a miscarriage and im worried that the antibody are going to keep making this happen. HElp. Is his sperm still doable for a successful pregnancy without assistance.

We have a healthy 4.5 year old already.