Spoiler: It’s not the full story.

Did you know that sperm counts have dropped by more than 50% in the past fifty years, and that male infertility plays a role in over 30% of fertility challenges?

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While fertility conversations often center around egg quality and ovarian reserve, sperm health is equally important. One measurement that often causes confusion and stress is sperm morphology, a term that refers to the size and shape of sperm. If you or your partner has been told there’s an issue with morphology, you’re not alone, but it’s important to understand what that really means.

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One of the most common questions we hear from male patients is about low sperm morphology. The good news? Most men with low morphology alone can still conceive, either naturally or with the help of intrauterine insemination (IUI).

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Here’s the truth: Low morphology doesn’t mean infertility. Total motile sperm count (TMC), the number of healthy, moving sperm, is often a better predictor of fertility potential, especially in the context of assisted reproduction.

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Here at our East Bay Fertility Clinic and IVF lab, Collab Fertility, we take an integrative, science-backed approach to male fertility testing. In this myth-busting post, we’ll break down what sperm morphology is and how to interpret your semen analysis results in the broader context of your fertility journey.

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What is sperm morphology?

Sperm morphology refers to the size and shape of sperm cells, including the head, midpiece, and tail. A healthy sperm typically has an oval-shaped head and a long, straight tail that helps it swim efficiently. Abnormal sperm may have defects like a misshapen head, double tail, or a crooked midpiece.

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At Collab, we include a detailed semen analysis as part of our same-day joint testing and comprehensive fertility workup. We assess the key factors related to male fertility, including sperm count, motility (how well the sperm move), and morphology, or the percentage of sperm with a normal, healthy shape. While morphology is one piece of the puzzle, low morphology alone is rarely a cause for major concern. Instead, we focus on total motile sperm count, which offers a more accurate picture of fertility potential.

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Total motile sperm count (TMC),  not morphology, is the strongest predictor of fertility potential. Studies show that TMC thresholds are far more informative than morphology alone.

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Curious about how sperm testing works? Want more information on TMC? Read our article on male fertility testing to learn what to expect and how we evaluate sperm health at Collab.

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What is a normal range for sperm morphology?

The definition of “normal” can vary depending on the lab and testing method. At Collab Fertility, we follow WHO guidelines, where a normal morphology range is 4% or more using strict Kruger criteria. That means at least 4% of the sperm in a sample have a healthy, typical shape.

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While this number may seem low, it's important to know that even men with low morphology scores can still conceive, especially if other parameters like count and motility are within normal range.

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How do you make your sperm healthier?

Improving sperm health and morphology often starts with lifestyle and environmental changes. Because sperm take about 72–90 days to develop fully, changes you make today can improve sperm quality in just a few months.

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At Collab Fertility, we guide our patients through personalized recommendations, including:

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• Eating a balanced, antioxidant-rich diet
  
• Reducing alcohol and avoiding tobacco or marijuana
  
• Maintaining a healthy weight
  
• Exercising regularly (but not excessively)
  
• Wearing looser-fitting underwear
  
• Avoiding excessive heat exposure (like hot tubs and saunas)
  
• Limiting exposure to endocrine-disrupting chemicals and environmental toxins such as BPA and Phthalates
  
  

Causes of abnormal sperm

Identifying the underlying cause of abnormal sperm is key to choosing the right treatment path. Sperm can be influenced by a range of factors, including:

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• Genetic abnormalities (i.e. Globozoospermia, Y chromosome microdeletions)
• Varicocele (enlarged veins in the scrotum)
• Hormonal imbalances
• Infections or STIs
• Exposure to environmental toxins such as plastics (BPA), fragrance (phthalates), chemicals, and radiation
• Lifestyle factors (diet, alcohol, smoking, stress, heat exposure)

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What vitamins are good for sperm health?

Several vitamins and antioxidants have been shown to support overall sperm health, including count, motility, and morphology. These include:

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• Vitamin C and E – Help reduce oxidative stress
• Zinc – Supports hormone balance and sperm development
• CoQ10 – Enhances sperm motility and morphology
• Folate – Essential for DNA synthesis
• Omega-3 fatty acids – Support membrane structure and motility
• Selenium – A mineral with antioxidant properties. The highest concentration is found in the testes, and it is required in sperm development.

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Can I get pregnant if my partner has poor sperm morphology?

If your partner has been diagnosed with low sperm morphology, you may be wondering what that means for your chances of conceiving. The reassuring news is that many people with low morphology still achieve pregnancy, sometimes naturally, and often with the help of IUI, especially when total motile sperm count is within a healthy range.

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That said, sperm morphology does matter in certain situations, particularly in cases of recurrent pregnancy loss or during IVF treatment, where fertilization success is critical. In these cases, our team often recommends IVF with ICSI (intracytoplasmic sperm injection) to give each egg the highest chance of being fertilized by a healthy, functional sperm.

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At Collab Fertility, we provide comprehensive, on-site care for male fertility. Our specialists develop personalized treatment plans that go beyond the numbers, taking into account your full health history, fertility goals, and timeline. Whether your journey calls for lifestyle changes, high-tech support in our IVF lab, or both, we’re here to guide you every step of the way with clarity and confidence.

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Our services include:

• Semen analysis – evaluates sperm count, motility, morphology, and volume
• Lifestyle and nutrition support –  improves sperm quality, including how to limit exposure to environmental toxins
• Surgical sperm extraction or aspiration – includes the option to freeze sperm for future use or move forward with treatment with our partner urologist Dr. Shu Pan.
• Intrauterine Insemination (IUI) treatments – during IUI, sperm are washed and concentrated to isolate the healthiest motile sperm, which are then placed directly into the uterus. This method can bypass mild morphology issues
• In Vitro Fertilization (IVF) with Intracytoplasmic Sperm Injection (ICSI) – eggs are retrieved and combined with sperm in a lab setting. When morphology is compromised, our expert embryologists select a single healthy-looking sperm and inject it directly into a mature egg with a procedure called ICSI.
• Fertility after vasectomy – Studies show that surgical extraction of sperm is more effective than a vasectomy reversal, especially if the vasectomy was 10 or more years ago. → Learn more about fertility treatment after a vasectomy

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Personalized, patient-first fertility support

The first step to overcoming fertility challenges is meeting with a team that takes the time to listen, understand, and care about you. At Collab Fertility, we care for the whole person. Through The Collab Way—our evidence-based, integrative care model—we combine advanced medical treatment with nutrition counseling, clean living guidance, and personalized education to support every aspect of your fertility journey.

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Whether you’re exploring fertility options, managing a diagnosis, or simply looking for answers, we’re here for you. Our experienced physicians, embryologists, and compassionate nurses will support you every step of the way.

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Proudly Supporting Local Communities
Collab Fertility is honored to serve families in the East Bay like Danville, Alamo, Orinda, Lafayette, Moraga, Piedmont, and Walnut Creek, as well as many other communities in the Bay Area and beyond, including Oakland, San Ramon, Concord, Pleasant Hill, Santa Rosa, Novato, Napa, Sonoma, and more.

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