Male factor - low testosterone, questions

[airmide_m]

We just had our urologist appointment and he seems pretty convinced my husbands problems are due to low testosterone. Tomorrow we are going to get the tests done for testosterone, estradiol, FSH and LH.

I am wondering, has anyone else had experience with any of this? Do you know if insurance (We have BCBS) will most likely cover the tests? They say they cover infertility testing, but in reality they only cover testing if it's for another reason. I know I got these same tests done 2 years ago and insurance paid for it no problem, but I don't remember what diagnosis and CPT codes my old doc used. I think we're just going to go for it and hope for the best, and be prepared to fight with the insurance if it doesn't work out.

Does anyone know anything about treatment? Our doc mentioned clomid, or one other drug I can't remember. I've been reading very mixed reviews about the success of clomid. But the doctor seemed very optimistic.

My husband's problems are pretty severe, and are concentration, motility and morphology.

[RunnerDuck]

I'm not sure what you mean by saying they cover infertility testing but only of it's for another reason?? If they say they cover "diagnostic" testing, then it is covered. The thing is it is only covered if it's diagnostic - they will cover something while you are trying to figure out what is wrong and plan on a course of action, but they might not cover the same thing once you are actually in a treatment cycle. For example I could get an ultrasound of my ovaries and CD3 blood work to diagnose PCOS... but once I am in an injectables cycle to get pregnant, those same tests won't be covered.

So if you're not actually being treated yet - it should be covered.

I do not know a whole lot about the clomid for men thing. I do know of people who have done it and I have heard of success - but I don't know why it works or how well it works or anything like that.

There are ways to overcome MF, though... for less sever cases, IUI may be enough. Sometimes what people will do is store up several frozen samples and combine them with a fresh to get more live sperm at a single IUI. (You will lose a lot of sperm in the freezing - but still end up with more than in a single sample for the IUI) My husband had slight male factor - we used Fertility Blend for Men and saw some improvement but not enough to say for sure it was the pills and not normal fluctuation. IVF can help because it makes it a lot easier for the egg and sperm to find each other... and as a final course of action there is always IVF with ICSI where sperm and egg have no choice but to meet. But start with the clomid... see what happens... It can take ~3 months for new sperm to be produced so this is not a quick fix but hopefully your doctor will have some idea of how much improvement to actually see.

[quantumleap]

Hormone panels for men should be covered, and, in fact, treatment should also be. I say that because hormone levels that are out of whack affect everything from bone density, energy, strength, sex drive...especially in a younger man. Of course, I'm basing this off of my knowledge of how it has worked for a member of my family, and we are in Canada, but still. Your urologist should know how to bill this so that it is covered.
Sorry about the cruddy results.

[Dena]

We had BCBS when we went through IF testing and yes, they covered all the diagonistic testing. But none of the treatments. So, basically, they will cover tests to confirm you have a disease, but will not pay to treat it.

We also have a male factor issue - both our girls are from IVF - and originally it was thought that dh had low testosterone, when he was tested by a urologist. However, we later got in to see an endocrinologist and found out the urologist ran the WRONG tests - I think the test you want is called free testosterone, but it has been six years, so don't quote me. Unfortunately, we found out all this after a round of clomid had raised his testosterone and killed off what few swimmers he had. : So we are a cautionary tale about the possible negative effects of clomid for men. Yes, it works, unfortunately, it can be very effective birth control if the man doesn't actually have low testosterone. So I would highly highly recommend seeing an endocrinologist, unless your urologist is one, as most urologists will say they know all about male IF when they don't. You want to make sure that the test is done correctly. We went with the urologist where we could get in fastest, and that was a huge mistake, as the resultant loss of dh's swimmers actually set us back three months.

Oh, and not to put too fine a point on it, but the same urologist looked dh and I right in the eyes and told us he did not have a varicocile - the same one male IF specialist later spotted from across the room.

[airmide_m]

Thanks for the support! What I mean by BCBS will cover infertility diagnostics only if it is really for something else is this: They will not cover a S.A. - isn't that a test used to diagnose male infertility? Is there really any *other* test done to prove male infertility at all?

They will only cover tests if the coding is so that something else is suspected. For instance they will cover a thyroid panel if the coding says the doctor is using it to confirm/deny hypothyroid or Hashimoto's hypothyroid. But they will not cover it if the doctor uses an infertility code, saying they are looking for a cause of infertility.

The same goes for laproscopic surgery. If the doctor codes it as suspected endometriosis, they will cover it. If it is coded to find a cause for infertility, they won't.

If my husband went to the urologist for advice on infertility, to get it diagnosed that he has it or WHY he has it, that would not be covered. The same exam to diagnose scrotal pain IS covered.

Does all that make sense? It's hard for me to figure out but basically what I've been told is they technically say they cover diagnostics to diagnose infertility but really, they only cover diagnostics to diagnose anything *but* infertility. If the test cannot be used (or the doctor won't code) for anything other than to prove/disprove infertility, such as a S.A., the insurance will not cover it.

I'm wondering if they will cover these hormone tests. I think it will totally depend on what coding is used, but the doc didn't write the diagnosis and CPT codes on the slip he gave us, so maybe I'll try to call back Monday and find out. I know they were covered for me a year and a half ago when I went to a GP to get my low progesterone and Hashimoto's diagnosed.

Also I'm wondering how they will cover for treatment if it is discovered he has low testosterone. Aren't clomid and other medications which restore fertility *also* a treatment for the low testosterone itself? If that is the case, I should think they would have to go with what your doctor decides is best in your case. They shouldn't be able to say "Well these medications treat the same thing in slightly different ways, but you are only allowed to have the one that causes sterilization". But who knows when it comes down to it.

Our urologist is a fertility specialist. So I am hoping he has a clue what he's doing. He seemed like he did, but who knows.

He ordered the serum testosterone test. I will try to check out the difference between serum and free, and which is most accurate. I know that really saliva tests are the very most accurate, but I don't think this urologist would consider using them. Our main doctor's specialty is Functional Medicine, and he uses saliva tests, but I don't know how experienced/comfortable he is prescribing for infertility.