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Old May 10th, 2016, 10:16 AM   1
WishnandHopn
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Sperm analysis results: keep trying or seek help?


My husband (38) and I (37) have been TTC for 5 months. I was on the pill for 20 years before we started trying but I have regular 27-28 day cycles and I think we are timing intercourse well around ovulation. My husband *volunteered* to go and have a sperm analysis done last week and when he got the results he said the doctor said they were fine and he didn't need to see him. (he seemed pleased that his hot baths and 150 km of biking per week hadn't hurt his swimmers) I asked to see a copy and I'm not so sure we should be celebrating. His count (24 mil/mL) and motility (38% progressive) seem ok, but morphology is only 3% normal (4% is the cut-off) and there is also a note that there were a large number of immature cells. I won't say I freaked out, but I probably could have reacted better! And of course I've been obsessing about it ever since.

I had my day 3 LH/FSH/estradiol blood test done a couple of days ago so we're waiting on those results now.

So here's my question: if you were me, would you ask to be referred to a fertility specialist now, or keep trying on our own for a few more months? Part of me would like to just enjoy the summer without being poked and prodded. The control freak side of me wants to KNOW what is going on with us, and worries about delaying getting help any longer.



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Old May 10th, 2016, 10:44 AM   2
Cowgirl07
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Ttc for 35+ here is 6 months before seeking help. So I say your right around where you should be to start looking for a re. Did your ob say anything about the results?



 
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Old May 10th, 2016, 11:33 AM   3
WishnandHopn
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Thanks, it's the same here too, 6 months if over 35.

I guess I could take my husband's sperm results to my own doctor for an opinion...unfortunately he's kind of a jerk. I practically had to beg to get him to send me for the day 3 hormone blood work. I definitely felt like I was being brushed off since we'd only been trying for 4 months at that point. He actually told me to 'relax and it will happen'. I have an appt in July with him and I fully intend to bring him the fertility clinic referral form if we aren't pregnant by then!



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Old May 10th, 2016, 13:38 PM   4
CaliDreaming
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If it were me I'd seek out an RE now, especially if you have been using OPK's and timing intercourse.

At the same time, if your hubby is willing and your insurance will pay for it, I'd also have him seen by a urologist and have him start taking supplements. RE's really don't specialize in male fertility and you will get wildly different conclusions about his sperm depending on who you go to. In general, medical professionals don't spend a whole lot of time on male fertility since IVF is the go-to solution for all fertility problems. Don't be afraid to ask probing questions or seek second opinions. Men can be *really* sensitive about this so be careful about how you approach all of this with him.

When the doc said that your hubby's numbers were "fine", what he really means is that they met the *minimum* parameters necessary for conception. So with those numbers, you could get pregnant next months or it could take up to two years. For "reliable" conception, which is what any TTC couple is concerned with, you really need those numbers to be higher. Take into account that men without fertility issues can have up 300 ml/L sperm concentration and 75% motility. Some practitioners believe you really need the counts to be around 75 ml/L to have a reliable chance of conception from month to month.

I am pretty passionate about this issue because I wasted two years of my life in depths of depression and tons of $$$$ trying to conceive our second child when there was an easy fix for our problem. My hubby's numbers were only slightly worse than yours and we did not get pregnant for almost 2 years. The first RE we saw thought his sperm was fine (He was at 20 ml/L concentration 30% motility and 0.5% morphology). We saw a second RE who thought his numbers were horrible and said my hubby would likely never be able to get me pregnant if they didn't improve. He wanted us to see a urologist, but we were hesitant thinking the problem was with me because I was 38 years old. After 2 years of invasive tests, a exploratory laparoscopy, and 3 failed rounds of fertility drugs, I still had not gotten pregnant, so they kept chalking it up to age even though my hormone levels and AFC counts were excellent from month to month and I had no other problems that should have prevented conception.

I was starting to lose hope and then we decided to focus on hubby's sperm. We didn't see a urologist, but we had him take some supplements. He had been taking them almost a month when we conceived. I don't know what his numbers were after he took the supplements, but obviously it was enough of a boost to make a difference.

Looking back, my hubby was a classic case of age related decline in sperm. He was 41 at the time and had not had the best diet most of his life. He had been taking meds for high blood pressure and cholesterol. He was a mild case and I'm still angry no doctor suggested that he take supplements. I understand that supplements are not a quick fix for everybody, but they are cheap and much less effort than all the stuff they had us trying. They can only help and not hurt.



 
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Old May 11th, 2016, 14:28 PM   5
WishnandHopn
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Thanks for sharing your experience CaliDreaming...this is really helpful and I'm glad to hear you did eventually get pregnant!

My husband actually just went back to the doctor today to discuss his results and was reassured that they are "fine" and we should keep trying. From what I've been reading his numbers are well below average, and certainty not optimal for natural conception.

Can I ask what supplements your husband took? I am looking at getting something called Fertil Pro for him, which has L-carnitine and zinc among other vitamins.

Maybe we will try that for two months before getting a referral to the fertility clinic (they do have a urologist there). That would make a solid 7 months of trying on our own.



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Old May 12th, 2016, 15:13 PM   6
CaliDreaming
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My husband took all three supplements for men made by Fairhaiven Health-- Fertilaid for Men, Countboost and Motility boost. The downside is that there are seven large tablets to take a day, which is a major pain. The Fertilaid trio has just about every vitamin/herb that has been shown to improve male fertility. I'm pretty sure some of the ingredients are pretty useless but at least you cover all of your bases.

I'm not sure which of the ingredients did the trick for us, but from my reading any good male fertility supplement should have large amounts (@2g or so each) of L-carnitine and Vitamin C. The studies I've seen on Vitamin C are pretty impressive so if I had to guess I'd say it was the vitamin c that made the difference for us. Folic acid and zinc are also good ones.

I think you have a great game plan and you're so fortunate to be seen at an office that has a urologist. In two months, you could get a bfp or if not, at least enough time would have passed to see if your hubby's numbers have improved.

Good luck!



 
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Old May 12th, 2016, 17:03 PM   7
penelopejones
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My husband had poor numbers (much worse than yours though) and we ended up doing IUI. I agree with seeing a urologist and an RE. Why wait if you can get help?



 
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Old May 14th, 2016, 00:57 AM   8
Sweetkat
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My OH is on strong medication (immunosuppressant) which he gave up for a year before our daughter was born but which he can't give up again (he tried and his condition deteriorates). I fell pregnant with number 2 straight away but had an MMC in November. He then had a SA done, two actually. His numbers were all within range but morphology was only 6% and then 7% two weeks later. He is 1.5 on the teratozoospermia index.

When I read about it there are mixed opinions. World Health Organisation normal numbers were actually 15% until 2010 I think and anything below 4% is severe teratozoospermia. My OH has medium teratozoospermia.

This is apparently linked to DNA splitting in the sperm which is in turn linked to miscarriage, but nobody knows for sure.

Anyway, I asked all the drs I saw for ultrasounds after my miscarriage and they all said unhealthy sperm just won't fertilise the egg. So we decided to try naturally again. I got pregnant first cycle and again things went wrong really early on. I went for a scan at 6.5 weeks and was told baby measuring 4-5 weeks and enlarged yolk sack (apparently marker for chromosomal abnormalities).

Now I am pregnant for the third time in 7 months and I am petrified this is going to end up in another MC. It seems that nobody really knows what role morphology plays and whether lack of fertilisation/ MCs are linked to it.

My OH has head defects, tails are normal. So they swim up to the egg fine but looks like genetic material in some of them in the head is damaged.

Other thing that worries me is that other than supplements and IUI/ IVF there is little that can be done about morphology.

Anyway, let me know if you find out anything about how to treat it. There is lots of information online about supplements and lifestyle changes (no hot baths, no tight cycle shorts, no alcohol, smoking etc). My OH doesn't do any of the above.

I also found a discussion online were several ladies went to top fertility specialists just to be told that they do not know what role morphology plays and whether it can be linked to miscarriage/ not getting pregnant.

So I would say carry on trying, do some simple lifestyle and diet changes and also go see a specialist. They may recommend IUi/ IVf but at my age (35), they are sth like 20% chance of success per cycle so I figured I have nothing to lose (other than my sanity through miscarriages) if we try again naturally.

Also, I found loads of stories online of ladies whose OHs had 1% morphology who got pregnant naturally and had no issues!!!

Good luck



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Old May 14th, 2016, 01:04 AM   9
Sweetkat
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Just had a look and my OHs count is 28 and progressive motility is 38. As you can see I am getting pregnant straight away but then sth goes wrong



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Old May 15th, 2016, 11:10 AM   10
CaliDreaming
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Sweetkat,
I'm so sorry about your miscarriages. I hope that this pregnancy is a healthy one.

As for supplements that can help for morphology, poor morphology is thought to be caused by oxidative damage, so antioxidants may help in addition to lifestyle changes like avoiding hot baths, cycling, etc.

However, in reading your post I think we are talking about apples and oranges. In a sperm analysis, the point of the testing is to determine whether the sperm has the ability to make it to the egg and fertilize it. Sperm is nothing but a sack of the man's genetic material, so once it has deposited the man's dna in the egg, its job is done.

Morphology is only significant as a way of determining if the sperm is shaped appropriately so that it can swim fast and straight or to ensure that the head of the sperm is shaped such that it is able to penetrate the egg. Morphology says nothing about the state of the DNA contained inside of the sperm. If the sperm is able to get to the egg and fertilize it, it does not matter what the morphology is or how pretty they look under the microscope.

IVF with ICSI is often recommended for couple's where the sperm's morphology is thought to be rendering the sperm unable to fertilize the egg. That procedure is where they manually inject an egg with a sperm and then the pregnancy proceeds normally from there.

In your case, your husband's sperm is strong enough easily able to travel to and fertilize your eggs, so the standard measures of sperm are pretty irrelevant at this point.

In the past, it was thought that the man's sperm had nothing to do with any subsequent miscarriages, but new research suggests that it might, but nothing conclusive has been found. However, in those studies, a special test was used to evaluate the DNA inside of the man's sperm and not the usual sperm analysis. The tests that your hubby would need would measure the level of dna fragmentation in his sperm. Antioxidants are thought to reduce the level of dna fragmentation, but if they don't, IVF with IMSI is recommended. In IVF/IMSI, they analyze the sperm under a microscope and then select the sperm with the least amount of DNA fragmentation to inject into the egg.


I understand that they tend to wait until after the third miscarriage to do any genetic testing. It might be that one or both of you has something going on with your genes, but that's probably not the case since you have a healthy daughter. Or maybe the medication is causing a significant amount of fragmentation, but my understanding is that when there's a high amount of dna fragmentation, the miscarriages occur at a very early stage.

In your case, I think it's probably jumping a little ahead to worry about your hubby's sperm. In the vast majority of cases, recurrent miscarriage is due to an issue either with the egg or the conditions in the woman's body affecting the development of the egg, even for women who have had healthy children. The research into the role the husband's sperm plays is still in its infant stages and the issue is hotly debated.

Whatever the case, my heart goes out to you and I hope this pregnancy makes it. I hope that what I've written here does not offend you in any way. I've never had a miscarriage and can't imagine how painful they must be.



 
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