Welcome back to the As a Woman podcast. I'm your host, Dr. Natalie Crawford, and joining me today is Emily Whitlock for one of your favorite episodes.

This is fertility Q&A, where we answer your top fertility questions. Thanks, M. For being here. Happy to be here. All right. So the first one says her husband has a low morphology, and they tried IUI, and it didn't work. So they're moving on to IVF. Her doctor said that it isn't a concern, but his urologist said it is a concern. What are your thoughts on low morphology and how much does it actually matter? This is something that is actually debatable, which one of us might think that it shouldn't be, right?

Because it's an abnormal sperm parameter.

For people who don't know, morphology is shape of the sperm.

So most men actually have the majority of their sperm abnormally shaped.

When we use the strictest morphology called the Kruger on a semen analysis, the normal threshold is having 4% of your sperm normally shaped is the low end of normal. So that means

most men have highly abnormal sperm. What is this? Two heads, two tails, short tail, weirdly shaped head.

It's crazy to me when we know one of the founding principles of biology's structure equals function,

that we can sit here and say that abnormally structured sperm have

no impact on fertility or your success rates. The reason why this is nuanced is that there are some

normally shaped sperm, and so men with low morphology can get pregnant. But if you are trying to

do IVF, you want to optimize your outcomes, thinking about why the morph may be low and what you can

do about it is going to be really important.

Morphology is directly associated with environment.

Because the sperm grow across the course of the testes over those 72 days, they grow, develop, and are formed inside your body and a reflection of your environment.

So whether this is a chronic inflammatory disease, diabetes, autoimmune disease, smoking cigarettes, marijuana, sauna use, being overweight, eating a lot of sugar, not sleeping enough.

There's so many different things that cause inflammation and insulin resistance that can directly impact sperm parameters.

I wouldn't hold an IVF cycle for low morphology, but I would say start making the changes now so that you're

going into that cycle with the best sperm you can. Okay, the next one says she has a three-year-old

daughter and got pregnant on the first try with no issues. She's been trying now for two years

to conceive her second child and has had five losses. She's done the full RPL workup, which is recurrent pregnancy loss workup.

Her doctor is recommending IVF with genetic testing, but she's so scared to go through all of that and have another loss.

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