IVF can be an extremely confusing treatment, especially for patients. And medical professionals love using jargon and complexifying things to make it appear that what they're doing is very complicated. And perhaps, obviously, if it's complicated, it's got to be expensive. Unfortunately, in India, patients don't ask too many questions and they don't do enough homework to find out what's happening. And in this article, we are going to talk to you about teratozoospermia. And if you want to find out what teratozoospermia means and what to do about it and what the treatment options are, please read this entire article and you will learn enough so that no doctor will be able to take you for a ride. Now, the first test for an infertile couple is the man's sperm count. Remember, always test the man first because it's a simple, cheap test. The woman's testing should be done afterwards. Now, a semen analysis is a simple test and it's not very expensive. But because it's so simple, it's very simple to do badly. And tragically, lots of labs will do it badly. A lot of these labs don't even know the basics, like what a normal sperm count is. They still write reports normal and in brackets between 60 million to 150 million. Ridiculous. Everyone knows that a normal sperm count is more than 50 million, but obviously no one has told these labs that. But when you look at this form, the sperm analysis report, you will notice that the lab technician is supposed to check the count, the mortality and the shape of the sperm, what's called the morphology. And it's very common to have abnormal sperms. And that's absolutely fine because there are just so many sperms constantly being produced in the testis that even in a fertile man, the majority of sperms will be abnormally shaped. But when the number of abnormal forms is extremely high, the medical word for that is called teratozoospermia. Terato means monster. You may have come across this word when you remember that a drug which causes birth defects, for example, thalidomide is called a teratogen, which means it creates a birth defect. That's where the word terato here means that it's a defective shaped sperm. Lots of sperms are defectively shaped and that's fine. And even if 60, 70 percent of sperms are abnormally shaped or formed, that does not affect your fertility. But that's not something most patients know. So, when they read a report, oh, I've got 60 percent of normal forms, they get petrified. Oh, that's the reason I'm not getting pregnant. And sadly, the doctor, the treating gynaecologist doesn't know any better at all. And he will reinforce that opinion. And to add insult to injury, he will then end up treating these actually fertile men for their abnormal sperm forms. The root of the problem is actually the lab. The lab technician does not know how to check sperm morphology. It's not easy to test for sperm morphology. Ideally, what you need to do is you need to stain the sperms on a slide using special stairs and then check the shape of each individual sperm so that you counted 100. And then you can check the tails, the shape of the head, whether it's oval and so on. It's fairly detailed, but most labs don't know how to do this. It's time consuming. It's expensive. So, a lot of them will take shortcuts and just write whatever they like. And this obviously hurts both ways, because then there are guys who actually are infertile because of teratosis permea, but because the lab hasn't done the sperm morphology test properly, they miss that diagnosis. But much more commonly, they misreport a sperm sample as having abnormal forms when actually it doesn't. Now, because it's been such a complex problem, there have been special criteria laid down. For example, there are called Kruger criteria for strict morphology, which means only a perfect sperm with no abnormalities is considered to be normal forms. And in this situation, fertile men will have as low as just 4% normal form, which means it's perfectly OK for a man to have up to 96% abnormal forms when you're using strict morphology. But most technicians don't know what strict morphology is. Most of them don't bother. Most of them are just very casual and write anything. You can't even trust these reports. And that's a bit of a mess. The bottom-line is don't go to an unreliable lab. At Medline Academics, we believe that good fertility outcomes begin with good foundations. Our embryology courses in Bangalore are designed to close the gap between theory and practical clinical work, emphasizing evidence-based diagnosis, sound interpretation of investigations such as semen analysis, and sound decision-making in infertility practice. By educating clinicians on why a diagnosis such as teratozoospermia truly counts, and when it really impacts fertility, our goal is to minimize misdiagnosis, ineffective treatment, and patient anxiety in favor of sound, patient-centered reproductive medicine. Don't take shortcuts. Don't go to a nearby lab just because he happens to do a semen analysis. Go to a reliable lab if you want your testing done. And if it's been reported as abnormal, insist that they do a morphology test with a stained slide so that you can actually reconfirm whether this is correct or not. Now, most of the time, occasional abnormal sperms will have no impact whatsoever, but there will very rarely be men who only have 1% normal sperms or 2% normal sperms. It's this very small group which is called teratozoospermic infertility. It's not very common, but when it's picked up, it's really important. But the trouble with these abnormally shaped sperms is they don't function properly. They're not capable of fertilising the egg in the IVF lab. They can't get their wives pregnant after IUI. And this is a diagnosis which is easily missed because their count is normal and the motility is normal. But it's the morphology which is abnormal, but it's not being tested properly. And this is often the couple where you have total failed fertilisation. Even with IVF, the sperms don't fertilise the egg because they're abnormally shaped. And you only find this out the hard way. And the perfect treatment for men with abnormally shaped sperm or with teratozoospermia with less than 4% less than 4% normal forms by strict morphology is called ICSI or intracytoplasmic sperm injection, where we do in the IVF training lab what the sperm is not capable of doing for itself, which means the embryologist takes the eggs we give after the egg collection, strips them so you can hold the egg under a micromanipulator, very large instrument which magnifies it, holds the egg and then takes a single sperm and puts that single sperm inside the egg to fertilise it. And the good news is we can see the fertilisation rate with teratozoospermic sperms is very, very high. As long as the wife is young and she has good quality eggs. Now, even within teratozoospermia, there are lots of different varieties and there is an uncommon form, which is called globozoospermia. Now, this is actually very easy to diagnose, provided the test for the sperm morphology is done properly, because what happens is in these people, the sperm head doesn't have an acrosomal cap, which means it's no longer oval and it's round and that's why it's called globozoospermia. Now, for these men, even if you do ICSI, you still have total failed fertilisation after ICSI. And in fact, often the diagnosis is made only when the doctor realises, oh, we didn't get any fertilisation at all, even after doing ICSI. And that's when they go back and check the slides and check the morphology and find out that the man had globozoospermia. And that was the reason. The good news is it's possible to treat these men with doing ICSI with assisted oocyte activation. Assisted oocyte activation means we add a special chemical called a calcium ionophore, which allows us to then do the ICSI in such a way that even though the sperm does not have an acrosomal cap, we can still achieve fertilisation. We all have doctors, but what really makes a good one? It's not just about knowing a lot. It's about how they listen, how they explain things, and how they make you feel. Sometimes finding the right one takes time, but it's really worth the effort. Dr. Kamini Rao Hospitals is a top IVF Centers in Bangalore. They really focus on getting the right diagnosis from the start, making sure everything is ethical, and creating a treatment plan just for each person. We've got a lot of experience helping people with both male and female fertility issues. We follow clear, evidence-based methods for things like teratozoospermia, making sure that advanced treatments like IVF and ICSI are suggested only if they're really the right path for you. When you prioritize good lab work and straightforward talks with patients, the center helps couples skip extra steps while also improving their chances. Please understand… you're a patient and you'd rather not care about these details, but you can't afford to leave everything up to the doctor. As long as you have a good doctor, you're fine. But if you end up with a bad doctor, you're in serious trouble. You'll end up wasting time, money, energy. And by the time your wife will be so old, that even if you go to a good IVF doctor like me, you know, very, very little we'll be able to do for you. So the moral of the lesson is do your homework. Don't assume you're not going to understand anything. If the doctor refuses to explain, that's a red flag.