Dealing with azoospermia?

[NikkiR143]

Wow, similar stories. Maybe both of his were undescended too. He only has a scar on the right side though, where the one we know was undescended. Does your DH have scars on both sides? Obv something is wrong with the "normal" testicle though, if he's only producing 2 to 5 sperm. I have no idea if they're even good sperm. I hate waiting...I have so many questions now. I read somewhere on this forum that scar tissue from the testicle surgeries is a possibility for zero count in semen too. Once the scar tissue is removed, sperm counts go back up to normal. Did they look into that at all? Oh no, I didn't know that. I thought I read that ICSI was cheaper, Maybe it's IUI I'm thinking of. I'm still trying to grasp all the terms and information. How much are you looking at, if you don't mind me asking? I'm praying for you. I hope all goes well in January!

 

[NikkiR143]

Here's what I found on FSH...

Instructions

1

Discontinue any medication which may affect your FSH level, such as clomiphene. Certain medications used to treat conditions like oligospermia, or a low semen volume, can increase the levels of FSH and cause an incorrectly high result on FSH tests.
2

Talk to your doctor about hormone therapy to decrease FSH levels. If your high FSH is due to a pituitary malfunction, the levels of FSH may be suppressed by treatment with synthetic hormones.
3

Have an examination performed to search for damage to the testicles. Men who have undergone trauma or damage to their testicles may not produce sperm correctly, which can raise FSH levels. An ultrasound examination may indicate the problem areas, allowing them to be repaired surgically. Once repaired, FSH levels and sperm production can normalize.


Read more: https://www.ehow.com/how_5730742_lower-fsh-levels-men.html#ixzz2miewOrPR

 

[melissaelaine]

Thanks for that info, Nicole! I bet my DH falls into category 3. I had heard that about scar tissue. At my DH's next appointment, he'll have a sonogram done to look for blocking, which may reveal scar tissue, I suppose. They can also do a biopsy (tese) to try to retrieve sperm, so that is another option. I have a journal with lots more infor about our journey. The link is in my sig if you want to stalk. Oh, and IUI is the one that is cheaper, by the way!

 

[sharon99]

Feeling very discouraged today! I missed my LH surge. It came early and I figured it was just starting up... but my tests have been getting lighter and lighter. I never got a really glaring positive, so I guess I couldn't have changed anything. I hate the pressure of trying to pinpoint ovulation, especially now that it involves doctors and lots of money. And it's possible/ likely that I'll miss next month, too, due to holiday travel. And by the next month I'll have turned 36! I know 2 months isn't a big deal in the grand scheme of things- just feeling a little sorry for myself today.

Good luck tomorrow, Olive! Happy weekend, everyone else!

 

[Mercury1]

To those dealing with undescended testicles - my husband had his repaired at age 11, and after going through what you're going through now with zero in samples, we now have a 2 week old daughter using his sperm.

His FSH was high, but that's to be expected as it shows his body has recognised that because sperm production has been damaged from the testicles being too hot it's working extra hard to produce any sperm. So he was given medication to try and get the FSH even higher which would then force his body to make as much sperm as possible. We were still getting mainly zero samples or occasional non-motile sperm, so planned an ICSI cycle with surgical sperm retrieval, but at the last minute good quality sperm were found in the samples (altho tiny numbers) so he avoided surgery.

At the beginning we had the additional tests like looking at pituitary function or checking for blockages and genetic issues, but the docs all felt that was a formality, and given his history of undescended testicles they didn't expect to find any other causes for the azoospermia. We also did the basic lifestyle changes (wearing loose underwear, avoiding sitting down for long periods, taking basic supplements etc)

If there's anything I can help with, please ask. I did lots of reading at the beginning, and was very lucky to be referred to doctors that really understood the issues. It seems there's lots of information out there - including from ' specialists' which isn't very accurate!

Good luck .... xx

 

[NikkiR143]

Thanks for your story Mercury1! Congratulations on your bundle of joy. Thanks for all the info as well- sounds very similar to what we're going through! How high was his FSH if you remember? My DH's is 900 and something. I think normal goes up to 800, so it's slightly high and I'm sure because of the undescended testicle. Did you end up doing IVF with ICSI when they found the good sperm? Do you mind me asking how much it cost? And did it work the first time? I'm sure this is the route we will need to take. Thanks again!

 

[Mercury1]

Hi nicole - glad to have helped! FSH must be measured in different units. His varied between 18-21, and I think around 10/12 was normal. But Dr Schlegel in New York (who seems to be the world expert at this) has found that the FSH level doesn't predict the likelihood of finding sperm, so is most useful just for confirming NOA.

Yes, we had ICSI. You need to have way more sperm than we had for straight IVF - I think at least a few million per ml. Our total cycle prob cost around £8,000, and we were very fortunate that it worked first time. We also froze some sperm for future use while it was there, as unfortunately with azoospermia it seems likely to get worse over time. If you are having anything in the samples, it may be worth asking about freezing now, as you don't want to start a cycle and have nothing on the day!

Are you seeing a urologist or a fertility clinic? I hope you're doing ok, it's such a roller coaster journey.

 

[NikkiR143]

We had an appointment to see a fertility specialist but I had to cancel due to a work ibligation. My hubby has had a phone consult with his urologist, and he goes in for a in-person appointment tomorrow. I'm hoping we'll know more after tomorrow. Fortunately, our insurance covers infertility- we haven't had to pay one cent so far for semen analysis' or blood tests, but unfortunately, in CA, IVF is not covered. I hope this isn't TMI- but my DH's good testicle swells really big sometimes, but it normal size in the mornings when he wakes up, and is lying down. I wonder if he has a hydrocele or variocele vein. I've also heard that the good testicle sometimes comepnsates in size when there's an undescended one. Looking forward to what the urologist has to say tomorrow after doing a physical. & yes, it's a total roller coaster. I burst into crying episodes from time to time. I just pray we have a successful outcome. Thanks for the support! This thread is a life saver.

 

[melissaelaine]

To those dealing with undescended testicles - my husband had his repaired at age 11, and after going through what you're going through now with zero in samples, we now have a 2 week old daughter using his sperm.

His FSH was high, but that's to be expected as it shows his body has recognised that because sperm production has been damaged from the testicles being too hot it's working extra hard to produce any sperm. So he was given medication to try and get the FSH even higher which would then force his body to make as much sperm as possible. We were still getting mainly zero samples or occasional non-motile sperm, so planned an ICSI cycle with surgical sperm retrieval, but at the last minute good quality sperm were found in the samples (altho tiny numbers) so he avoided surgery.

At the beginning we had the additional tests like looking at pituitary function or checking for blockages and genetic issues, but the docs all felt that was a formality, and given his history of undescended testicles they didn't expect to find any other causes for the azoospermia. We also did the basic lifestyle changes (wearing loose underwear, avoiding sitting down for long periods, taking basic supplements etc)

If there's anything I can help with, please ask. I did lots of reading at the beginning, and was very lucky to be referred to doctors that really understood the issues. It seems there's lots of information out there - including from ' specialists' which isn't very accurate!

Good luck .... xx

Thank you so much for sharing your story! I have so many questions.

- Was your DH still taking FSH when he got the ejaculate sample for IVF? Or had he stopped taking it by then?

- How far in advance of your IVF was the ejaculate sample taken? Did they freeze and thaw the sample?

- How many sperm did they get? Do you have a sense of how few is too few to do ICSI?

 

[Mercury1]

Hi melissaelaine - a few years ago (before we were together) he had a sample which had around half a million. Then 2 years ago when we were thinking of TTC it was down to zero. He was put on tamoxifen, which is supposed to get the FSH to go up. We got a few non-motile sperm only, so they tried a different drug called anastrozole, but SAs were back to zero. So back to tamoxifen, and after about 6/7 months in total on meds he had good quality sperm but small numbers in ejaculate when I was already taking IVF drugs. He was still on the tamoxifen and froze a few samples as back up, but on the day of EC he did a fresh sample and that's what we used.

I think it was still tiny numbers - some of the samples only showed sperm after centrifuging. They only count the amount they can see in a small bit of the specimen and then work out roughly what that would equate to in the whole sample, and I got the impression we were still only in double figures, but they were motile. You really do only need one sperm for each egg with ICSI, although it's preferable to have more so there's a choice for the embryologists. And even if they're non-motile it doesn't necessarily mean they're dead, so they may still be suitable for ICSI. Our fertilisation rate was a bit rubbish, though. Not sure if that was an egg or sperm issue.

Hope that answers your questions? Just ask if you have any more!

 

[tulip11]

Hi

I have question regarding centrifuge what I know the labs didn't do this in case of my hubby samples so now how can we asks them any suggestion?

 

[melissaelaine]

Tulip-

When I asked my RE, I asked him if they counted the sperm by spinning the sample or if they only counted what was in a smaller portion. Although it wasn't clear from the SA results we were given, the RE told me that they do spin the samples to count all of the sperm in the sample (at least with lower numbers, like my DH's).

 

[tulip11]

So it means they apply the same procedure for every SA. Thanks. On Thursday we have our first appointment with assisted fertility specialist as referred by our urologist idk what they will do as we haven't got genetic test result and still one SA is left. And even though what I think after so many zero sperms results we got what next they will do. Seems quite strange.

 

[AuCa]

Tulip - no, it depends on the lab. You should ask them if they do it or not.
Ours doesn't do it as a standard, only when they do the specialized analysis pre-IVF (for which we had to pay out of pocket).

 

[NikkiR143]

So my hubby just had his appt with his urologist. I wish I could've been there, because my husband is kind of lost with all of this (as am I really, but I've done a little more research and feel like I could be a better adovcate for him and ask better questions). He basically told him IVF is our only option, because his numbers are so low. He said the sperm they did find, was good though. But that he would do an incision on his testicle, extract the sperm, and then do IVF. He said IVF is our only option (besides donor sperm or adoption). He said he may have a hernia (causing his testicle to enlarge- but he has no pain, so I don't think this is it) or extra fluid in his scrotum- they're doing an xray on him today at 2:00. This will tell the doc more about his testicle (because due to the extra fluid, he wasn't actually able to feel it). The other one is undescended. I wonder what's wrong with his dropped testicle causing it to produce so little sperm? Hormones are all normal, besides FSH, so he didn't offer to do any hormone therapy to increase numbers or anything like that. He didn't say much about scar tissue causing a blockage either. I was thinking this could be a possiblity since he has surgery on his undescended testicle as a child. Hopefully the ultrasound can give more info on that as well. So basically we're looking at $1,000 to $2,000 for the surgery on his testicle to extract sperm (is this what ICSI is??) and another $10,000 to $12,000 for IVF. And what if it doesn't work? that money goes down the drain? And when we want a 2nd, it's another 15k? He said it can take 6 months to get us in for our IVF appt, so he said give him the go ahead and he'll refer us today. So much to think about...We don't have 12k just lying around. Have any of you women looked into funding for it? I want his baby, and I'll do anything I need to. Money doesn't mean anything, but it's still so stressful to think about.

 

[NikkiR143]

Hi Tulip-

I would definitely ask! I've read online that if labs don't centrifuge, it causes doctors to give the wrong diagnosis to their patients- as azoospermic instead of cryptospermic. This is a huge difference! At least with small numbers of sperm, IVF is still a possiblity. And proves to the doctor that your husband's testicle is producing some sperm. With Kaiser, my husband did two semen analysis's in which they didn't centrifuge at the regular lab. His urologist then sent him to a speciality Kaiser lab, where they did centrifuge it. Fortunately, we have really good medical insurance so this was all covered. I'm not sure what your insurance looks like, but I pray that the lab your husband has been going to would do that for him.

 

[Deb111]

Nicole - ivf is when they put an egg in a dish surrounded by a solution with sperm in and let things happen. Icsi is when they take a single sperm and inject it directly into a single egg. Wishing you all the best.

I miss you all girls and hope you are all making progress. Welcome to the newbies. Youve come to a great place for support x x

 

[NikkiR143]

Oh ok, thank you! So they're probably hoping that by extracting the sperm directly from his testicle that they'll have a larger sample to work with than taking it from his semen? So we only have to do IVF, not IVF with ICSI? However, if they take the sperm directly from his testicle, isn't it not matured yet? Wouldn't it be additional costs to mature the sperm, and then do IVF? Doc didn't say anything about ICSI to my husband, just the surgery on his testicle for extraction and IVF. Ugh, too much info at once, lol. As you can see, we're just beginning this journey. I'm sure I'll catch on to all these terms quick.

 

[Mikihob]

Hi ladies. Hope this info helps you understand what the doctor is telling your DH's.

My DH has very low testosterone, but normal FSH. My DH is using an FSH pen along with HCG injections in hopes the extra FSH will start sperm production. I do not know if the hospital spun my DH's sample. I am assuming not because in Alaska we have very limited doctor knowledge. We are working with doctor's in Seattle and will have to fly down their for almost every procedure.

Nicole, when the doctors take the un-matured sperm from DH testicle, they don't mature it. Since it can't swim they use ICSI and put that individual sperm into one of your eggs. If they have motility (can swim) they don't use ICSI unless the number of sperm is low. In case, they would remove the sperm around your egg retrieval and then immediately put the sperm in the egg and allow the embryo to develop. OR they will take those sperm and freeze them until the day of your egg retrieval. I have heard of this done in several different ways. It depends on where you are and what doctor you are using.

DH and I withdrew money from our 401K retirement fund for IVF. Without it we would have had to take out a fertility loan through our clinic or privately. We are looking at $13,000 for IVF, $5,000 for my meds, and about $3,000 for DH's surgical sperm retrieval. Currently his FSH and HCG cost $8,000 for every three months. It's so expensive and scary. If he doesn't produce sperm at all in the six month treatment period....that's $16,000 down the drain with nothing to show for it. It's VERY hard.

Sorry for the long post. Hope I helped a little with the information.

 

[Mikihob]

Deafgal how are you doing? I think today is your IUI test day, right? Have you tested yet? Hope all is well with you.