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Morphology and Motility Issues

Problems with sperm morphology and motility (shape and movement) often relate to specific parts of the “manufacturing process” in the structures that make sperm; the Sertoli cells in the testes. The sperm fully mature later in seminiferous tubules, which include the sperm cell elongating to form a tail and the acrosome forming at the tip.

As a general rule, abnormal heads relate more to the testes and tails to the tightly coiled tubules. The semen samples article has information on how you can interpret semen samples. There are three basic reasons for sperm motility and morphology issues:

  1. The Sertoli cells don’t get the nourishment to create healthy sperm, or they’re poisoned
  2. Obstructions prevent healthy sperm from forming
  3. Infections disrupt the health and function of the testes, and sperm quality falls


The term for having abnormally shaped sperm is “teratozoospermia”, and there are various forms, which involve multiple or misshapen heads, tails and midpieces. Some of the shapes are diagnostic of the cause and indicate appropriate treatment


“Asthenozoospermia” is the term for poor sperm motility, and the WHO criteria measure two types of motility in semen samples:

  1. Total motility is the percentage of active sperm
  2. Progressive motility is the percentage of sperm that can move forward

When either less than 40% of the sperm move or less than 32% move forward, the man will be diagnosed with asthenozoospermia.

About half of semen samples with motility issues have anti-sperm antibodies, which makes it essential to check for ASAb if your sperm have low motility.


Poor sperm motility and morphology are sometimes temporary, which makes semen testing over a few months essential (it takes three months for sperm to form fully). There are a variety of potential causes, which are either:

  1. Pre-testicular
  2. Testicular
  3. Post-testicular


Pre-testicular factors prevent the man’s testis from making healthy sperm, although the testis themselves could be fully functional. In these cases, poor motility and morphology can be due to:

  • Genetic traits that alter the structure of tubes
  • Medications (including chemotherapy or radiotherapy)
  • Age as motility significantly falls after 45 years
  • Conditions such as diabetes mellitus or meningitis
  • Fever or extended exposure to high temperatures
  • Abnormal sex hormones and the formal diagnosis line is a man’s testosterone under 10.5 nmol/l and/or his luteinising hormone (LH) is below 9.4 IU/l
  • Lifestyle factors can be significant issues and include:
      • Poor diet and low nutrition
      • Smoking
      • Alcohol
      • illicit drugs
      • Environmental toxins
      • Endocrine-disrupting chemicals (EDCs)
      • Tight underwear


Testicular causes are due to changes within the testicles that make sperm production more difficult:

  • Trauma to the testicles or tubules
  • Incomplete descent of testicles after birth reduces fertility as the testis overheat and produce abnormal sperm. This condition should be checked for and resolved in early childhood.
  • Hydroceles involve fluid accumulations in the spermatic cord, which causes swollen but (usually) painless testicles and discomfort due to the heaviness of the scrotum. If there’s pain, it’s generally due to inflammation, and the swelling may be less in the morning and more later in the day.
  • Varicoceles involve impaired blood circulation due to dilation of the spermatic cord veins. They typically cause pain or heaviness in their scrotum, and large varicoceles involve a network of veins and have been described as a “bag of worms”.


These factors cause abnormal sperm development and motility concentration in semen. There are a couple of reasons this can happen:

  • Spermatic ducts abnormalities are often due to historical traumas or infections, and they can alter the final development of sperm
  • Infections in the tubules cause inflammation and alter the structure of the epididymis or vas deferens tubes, and disrupt normal sperm development
  • Anti-sperm antibodies are often a result of trauma or infections and are found in over half of men with poor sperm motility

The morefertile® PFPs predict different causes of poor sperm motility and morphology, as well as different paths to successful treatment.

The PFPs and sperm motility and morphology

PFP Motility Morphology Other semen issues Other Issues
Energy & Blood Low motility Abnormal heads to sperm Low semen volumes Tired, weak limbs, lack of strength. Palpitations, shortness of breath, anxiety, poor digestion
Energy & Fluids Low motility Abnormalities mainly in the body and tails Low semen volumes, possibly thick semen. Low libido, lassitude, heaviness in the body Loose stools, weak limbs, lack of strength. Low spirits, woolly-headed
Hot Low motility Heads are mainly affected; small and pointy or malformed Low semen volumes, liquefaction issues, high libido, premature ejaculation Hot and sweaty at night. Irritability that’s worse when tired. Over-busy mind, anxiety
Cold Low motility Heads are mainly affected; small and pointy or may lack a midsection Thin, watery semen, low libido, liquefaction issues Cold, weak lower back and knees, aversion to cold, apathy. Weak erections, coldness and dampness of the genitals. Frequent urination of pale urine, possible varicocele
Hot & Fluids Low motility Abnormal sperm Thick or cloudy semen. Low sperm count
Fluids Low motility Abnormal morphology Thick semen, liquefaction issues Sweaty, clammy or lumpy testes, high BMI, heavy limbs and lethargy. Nausea, feeling full in the chest, non-postural dizziness, woolly headedness. Loose stools (that may contain mucus) or mucus in airways
Flow Low motility Many abnormal sperm Low sperm counts Varicocele, history of trauma to testes, distension or pain in the genital region. Possible painful ejaculation, hard and tender lumps on the scrotum or testes