Male and Female Infertility - The Double Whammy

[saphrons]

On top of my fertility issues, my husband's SA came back and the results were not positive. My husband's results showed low motility (13%) and morphology (1%). His count was 16 mil. He is getting re-tested within the next few weeks, but at this point I am feeling pretty down since this is an added challenge to my PCOS and endo. Is anyone else here in the same boat or have any of you experienced similar results on the male side?

[oceane]

I am sorry to hear that. We have not started any testing (2.5 years of ttc now), but I have hypothyroidism and short luteal phases while my partner has been diagnosed with autoimmune issues, so we are both (maybe too pessimistic) assuming that we're dealing with more than one issue.

[saphrons]

The interesting thing is that even though we have been TTC naturally for more than 4 years, we were still optimistic even though we knew about my issues. We figured that once my cycle was regulated and we were on Clomid, everything would be in order. This has certainly been a shock to us. My fertility doc is no longer going ahead with the Clomid at this time. I have a gut feeling we are going to be guided into more serious procedures from the reading/research I have done on my husband's results. So I guess the point is that, in my mind, it's better to be pessimistic so that you aren't caught off guard like we have been. 

[Keria]

We kind of dealt with hte same thing, I have a lutheal phase defect (start spotting really early) and don't respond well to stim drugs but DH's issues are so severe that we mine didn't seem that important,  IVF was our only choice and we were successful on our second try.

[saphrons]

Keria, it's encouraging to hear that while both of you had fertility issues, you were able to get pregnant through IVF. Was it regular IVF or IVF/ICSI?

---

Fertility blog/background: www.burnedsugar.blogspot.com

[Laurucha]

I don't know that it makes much of a difference that your husband has a low sperm count if you are doing IVF. (I'm assuming that you are planning on doing IVF.) You only need millions and millions of sperm if you are doing it the old-fashioned way. With ICSI, they really only need a few good sperm.

[RosieL]

When I got DH's SA results back I thought IVF was the only option. We met with an RE who recommended doing another SA, but this time with an IUI prep. Meaning they would take the sample, "wash" it like they do for IUI preparation, then do the semen analysis. She said this will tell us whether we are candidates for IUI. I had no idea that this test would be an option because I hadn't read about it anywhere. It makes me feel better, because on the one hand IUI with bad morphology makes no sense (sperm can't get INTO the egg, so putting the sperm closer isn't going to help), but a lot of people will try it anyway, and occasionally it works. The SA test with IUI prep is a way of getting more information about that out ahead of time. 

I asked *how* the wash might separate the abnormal sperm from the normal ones, and the RE didn't really answer. She said there is no way to predict who will get good results from IUI prep SA and who won't. I'm guessing that means our chances are low, but I'm happy to do this $150 test, covered by insurance, before contemplating IVF or IUI, not covered!

HTH.

[saphrons]

Interesting. I'll let you know what my RE recommends after the second SA (which happened to be today).

Do you know exactly what your husband's SA results were?

[RosieL]

Abnormal morphology: 2% are normal, 40% Large heads. Second analysis showed 3%. All else normal.

[saphrons]

Rosie, we got the results of the second SA back today and they are similar to the first results. My husband has been referred to a Urologist. Was yours?

[RosieL]

Not yet. The RE asked us to do the third SA but with the IUI prep and some more tests for me, then we sit down and talk about the plan forward. I *assume* that either we wi be a good IUI candidate or not, and if not we will be referred or IVF will be recommended.

I've read a lot about surgery for varicoceles, which DH has, but apparently results are quite mixed regarding post-surgery fertility outcomes. I should see the RE again and have test results within a few weeks, and I'll let you know. I'm curious to hear what the urologist has to say.

[kellenjane]

My DH and I are in a very similiar situation so I can certainly relate.  I just started Clomid yesterday so next week is our first time trying when I might actually be ovulating!  We shall see.  But I did want to tell you that while our chances are low, and my DH has similiar problems like yours, our doctor seems really confident about IVF.  Her plan for us it to try Clomid for 2-3 months, go straight to artificial insemination for 3-4 cycles and then directly IVF.  I have a problem that they are concerned that if I don't get pregnant in the next year I may not have a chance at all to conceive.  So anyway, hang in there!  There is always hope and from what my doctor tells me if your husband has a few good ones, IVF can certainly work for you!  God Bless!

[Keria]

We did ICSI it was our only choice but on DH's last Sa he only had like 9 normal sperms.
 

Originally Posted by RosieL 

Abnormal morphology: 2% are normal, 40% Large heads. Second analysis showed 3%. All else normal.

Rosie is that strict kruger? in that case 2% it's actually normal.

[RosieL]

Originally Posted by Keria 

We did ICSI it was our only choice but on DH's last Sa he only had like 9 normal sperms.
 

Rosie is that strict kruger? in that case 2% it's actually normal.

Would you mind letting me know how you learned that? Apparently there is a LOT LOT of controversy about the cutoff level for normal/fertile/average/subfertile levels of abnormal sperm. The original Kruger criteria was 14%, then more studies were done and the official (WHO) cutoff was changed to 5% (pretty recently). That's not the "average" or "normal", but rather the percentage that statistically is a cutoff for subfertility. There are no extant studies that have established a "normal" or "average" percent normal forms. Based on the available research (as far as I've found), the expected rate of spontaneous pregnancy is very low under 5%. 

The studies, admittedly, are few, small, and limited in their statistical power due to the nature of how the groups are formed and compared. However, from all I've read so far, the chances of spontaneous pregnancy with consistent numbers below 5% is really low.  I would LOVE LOVE to be proven wrong in this assessment...I'm sure there are studies that haven't turned up in my google scholar and pubmed searches. I have pretty much given up on conceiving naturally. 

[Keria]

Rosie sorry I looked it up on Dh's SA  results and it says normal results above  3% no 2% maybe it depends on the lab?,  but If your DHs count and motility are good I wouldn't give up on a natural conception kruger is really strict and 2% out of millions is still a lot of good sperm.

[RosieL]

Haha, I'm AMAZED that the "cutoff" for normal can very so much! Man I wish there was more research. Thanks for letting me know there's a lab out there who'd consider my DH normal. I wonder if they have a different method of counting? I know that there are computerized SAs now, but they're not standard. I wonder if those are even more exacting.

[saphrons]

Rosie, in my blog I posted a chart of what is considered fertile on the WHO and Kruger scales. www.burnedsugar.blogspot.com and it's a few posts down. My husband's (and your husband's) morphology is not normal using either scale.

[RosieL]

So, I guess the prevaling language on the RESOLVE site is that (for Kruger strict) 14% is normal, anything below 4% is a risk for infertility. http://www.resolve.org/diagnosis-management/infertility-diagnosis/the-semen-analysis.html

[Vegan Princess]

Same boat here. I have diminished ovarian reserve (even though I'm only 32) and DH has a low count. We have a 2.5 yr old, concieved naturally after 6 months of not preventing. We didn't realize until lately how much of a true miracle she is! Once we started trying for #2, I knew my cycle was off. My progesterone was low so I took clomid 1 month. Doc wanted DH tested before upping my dose. I thought "ya ya, I'm sure he's fine". Turns out he has a count of 6 million and a 35% motilillity. While waiting to see the RE, I unexpectedly got pregnant! No clomid, just taking prometrium after O on the off chance I might conceive. I ended up losing the baby at 10 weeks. Now that we know I have poor egg reserve and probably lower egg quality, we want to speed things up and are going to start IUI in august. But DH has succeeded in getting me pregnant 3 times (also had a chemical pregnancy last year), despite his low numbers. And I have a good friend who's hubby has a lower count and lower motility and she has egg quality issues. He has gotten her pregnant 4 times (3 were miscarriages) and she just gave birth to a baby conceived on their first try with IUI. So don't give up hope!! It definitely makes things more complicated and harder to digest, but it is not insurmountable!! (Now I just need to keep reminding myself of this :-))

Cindy

[RosieL]

VP - Thanks, that give me hope. :)