Many patients i see for the first time have had their initial fertility treatment decisions based on a semen analysis done at a regular medical reference lab. That's the same place that does your blood count, cholesterol and all the other medical tests that your general doctor orders. Their semen analysis consists of a check of semen volume, sperm concentration (count), motility (movement) and standard (WHO) morphology (an estimate of those normally shaped).
When reproductive labs do a semen analysis we do a more detailed examination of motility than reference labs generally do and, more importantly, look at strict (Kruger) morphology. Strict morphology applies rigid criteria to call an immobilized, stained sperm perfectly normal. Normal values for strict morphology are in the 12-14% range while most reference labs use up to 80% as "normal." The difference is very important because we think that only perfectly shaped sperm are capable of fertilizing an egg.
The importance of performing a strict morphology in a semen analysis was emphasized in an article in the September 2010 issue of Fertility & Sterility. They contend that abnormal morphology by Kruger's strict criteria cannot be predicted reliably by the presence of other abnormal parameters on semen analysis. So even a normal count and motility along with a normal standard morphology does not assure that morphology by strict criteria will be normal. Many couples are lulled into a false sense of securrity and base their early treatment on the assumption that the male's morphology is normal, only to find that there are significant issues with his strict morphology when they fianlly come to have the semen analysis done at a reproductive lab. I see this scenario frequently.
I agree with this article's conclusion that assessment of Kruger morphology is a "necessary component of a complete semen analysis in the workup of the infertile couple." To this end we offer our referring OB/GYN's the opportunity of sending patients in their care to our lab for a truly complete semen analysis so that they have a better chance of getting the proper treatment earlier in their fertility journey.