My husband has had one sperm test and it concluded that his sperm count was fine. However, the morphology was 90 percent malformed. I was wondering what might possibly cause this. --Tracey

Poor morphology is one of the least predictable numbers in the semen analysis. Morphology basically describes the percentage of sperm that look normal. There are two methods used to describe normal and abnormal sperm. One method, called WHO, provides a less critical analysis of the sperm. The other, known as Kruger morphology, involves a more in-depth description of what determines a "normal-appearing" sperm. While 60 percent should be normal by WHO criteria, the stricter Kruger definition finds as little as 15 percent normal sperm from couples with proven fertility. Unfortunately, both of these tests have little predictive value identifying those for whom fertility treatment will be effective.

Common causes of abnormal morphology include varicocele, drugs, heat, infrequent ejaculation, infection and smoking. If the man ejaculates on a regular basis three to four times each week, I advise taking antioxidant vitamins and a brief course of antibiotics. A repeat semen analysis will be performed in one to two months. If the problem persists, intrauterine insemination may be necessary. If a pregnancy has not occurred after three to six cycles, in vitro fertilization with ICSI (sperm injection) may be considered.