We did a couple of IUI's that failed and switched to IVF. One of the tests that the RE requires before starting IVF is a Kruger morphology test. Although DH's SA was normal for count, motility and morphology under the WHO standard SA the Kruger showed signifcant abnormality with morphology. Our RE is convinced that is why we have been unable to get pregnant on our own and tells us with our Kruger count as low as dh's was, IUI is not recommended and we will need to do IVF with ICSI (sperm injection).

Even if dh's WHO SA is normal, you might consider asking your RE for the Kruger test. It is a few hundred dollars but was worth it for us.

Wow. I didn't know there were different tests. I'll have to talk to my RE about it if this IUI fails.

I agree with Rachel.....We also were unexplained after several failed IUIs, until my Dh took the SCSA which tested the DNA fragmentation. It turned out the my dh's results were very poor, so our RE recommended that we move straight to IVF with ICSI.....We are planning to start our first IVF in August when my natural cycle starts.

So Rachel, after reading some of your posts and info, I went to my RE's office and asked the NP there what was up with my DH's morph because it was 8% Kruger, and my RE had said the SA was 'fine' when we went to see him.
The NP admitted it was a little low on the morph (and numbers - it's 51.9mil), but that they try IUI on everyone with Kruger morph >5% in their clinic.
I'm a little concerned, but my RE said that if 2 IUI didn't work, he'd refer us to IVF anyway.
Still, doesn't sound like what your RE office said.

Thunderbird:

I've heard of people (on this board) getting pregnant with IUI and Kruger above 5%. Ours is 5% so we think our IUI's were a waste of time and wish we'd done the Kruger morph as part of our initial infertiility workup instead of just the WHO SA. There are so many costs and our insurance doesn't cover anything so sometimes you skip the "elective" tests. I won't make that mistake again.

8% is not as bad as 5% but you are right, it is below normal. Do you have insurance issues? Sometimes they require IUI before moving to IVF. We're also in a hurry ...
Best of luck to you,
Rachel

IVF would cost a lot more than IUI, but it'll cost us that much no matter what order we do it in.
I got lucky, and before my OBGYN referred me to an RE (on my first appt with her) - she suggested I get the SA with Kruger done ahead of the first RE appt, and even specified which lab would do a Kruger.

Is the solution to a poor Kruger number to do IVF? We're trying to see if there are anyother tests that could help us find out our "unexplained infertility". We are on for our first IVF next cycle and am wondering if we should ask for the Kruger test or the SCSA test.

If the "solution" to bad results for those tests is IVF anyway...then I guess there is no sense doing them now.

We had the same results. DH was tested using the WHO-ranges and semen analysis came out normal. But after 3 failed IUIs, we decided to swich REs. The new RE had DH test using the Kruger Strict criteria and his morphology was below the average. However, RE said that it's worthwhile to take the test again to confirm accuracy as sperm results can change from day to day. A recent study showed that sperm motility, and counts differed AMAZINGLY for monthly sampling over a year from the same guy. The only parameter that did not vary was the percent of morphologically normal sperm - the shapes.

All tests (HSG, FSH etc etc etc) were normal for me, although my lining is on the thin side, never above an 8. Dh's WHO SA was normal but Kruger was abnormal (5%). We were told with that Kruger #'s like that, IUI was a waste of time for us.

We are 30 weeks into a singleton pregnancy thanks to IVF/ICSI and a great RE at the SIRM clinic.

Rachel (38) & dh (35)
lining issues/mf
4 IUI's BFN
1st IVF BFN
2nd IVF ER but no ET (lining issues)
#1 FET BFP

Good luck to all the unexplained!

Hi all,
I just had my second FSH done and it came back at 5.5 which is DOWN from the 7.3 it was last year. Is this even possible? I thought the older you get the higher the FSH gets? Has anyone ever had this happen before? Do you think it's a mistake? Or do I have it backwards?
Thanks!

Karen

Karen:
From what I understand about FSH it can fluctuate from month to month. I think generally it correlates with age but I've known very young people with high FSH numbers and older people with very low numbers. Usually RE's tell you to go with the highest number as opposed to the most recent number..but neither of your numbers seem particularly high to me. I know that for IVF, antral follicle count is considered a "better" predictor of success.

There is a thread on "high FSH" and they might know the answer to those questions.

Good luck!

what is the Kruger test???

http://www.crozerfertility.com/maleinfertility.asp

You can have a normal WHO morphology but an abnormal Kruger...

What is Kruger morphology and how does it differ from WHO standards?

Kruger morphology is a rigid assessment of the sperm shape compared with the WHO classification which is very general. Based on the criteria established in the 1980's by Kruger, et al., the sperm head, midpiece and tail measurements are strictly assessed and equally contribute to the normal/abnormal classification scheme. Based on Kruger's original studies, the morphology of the specimen correlated to the fertilization potential in vitro. Although the original studies defined normal values as low as 14% as subfertile, as a general rule of our practice less than 5% morphology is an indicator for ICSI. However, the decision to ICSI or not will also rely on the percentage of slightly abnormal population in the sample, these sperm are nicely shaped but do not meet the tight range of size necessary to be classified as normal.

From the many, many articles, boards and internet data that I've read, a man who has normal sperm count on the Kruger scale is at 14%. 5% to 14% has less chance of getting pregnant, but not impossible. anything < 4% should consider ICSI/IVF. However, from what I understand, the Kruger scale is kinda TOO strict and it depends on the andrologist (the sperm guy) who counts the sperm. They take 100 or 200 sperm and see how many are "normal" based on Kruger's definition. But the andrologists keep eliminating any sperm that is not 100% perfect, therefore ending up with a very low number.

http://infertilityblog.blogspot.com/2006/05/sperm-morphology-mythology.html

the link is a blog written by an NYU fertility specialist. That's what he has to say about morphology. My DH's is 5% and since I feel that its borderline, I am going to see an RE next week to see if they'll let me try IUI, since the rest of his numbers are good. DH is also on a whole slew of supplements and vitamins and we'll see if that improves his numbers. I've heard that morphology does NOT change but the person counting it does (could explain variability). But then there are people who swear by these supplements. So we'll see.

FWIW:
Both RE's I saw said that IUI's were a waste of time with our morphology (5%). When I suggested supplements for dh to the RE he said they could work but that the literature indicated it didn't improve morph by more than 1% or so.

Good luck!