I have a general question- is it possible to have obstructive azoospermia when a couple sperm are found in semen? I've read online that it's mostly not possible, because some sperm are getting through, but what if the scarring/obstruction is so bad that only a couple can make it through? I really think my hubby should go for a 2nd opinion before we spend 15k on ICSI & IVF. Did your hubby's go to more than one urologist?
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Dealing with azoospermia?
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rdleela
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Nicole, my hubby was one of those with obstructive azoospermia and we decided to go with a surgery on him before IVF - but we did have zero sperm, none were coming through. If the wait time isn't crazy to get another opinion, and you guys feel it would be worth it, go see another urologist. But I would look for someone who specializes in male infertility - and vasectomy reversals - cause that is what we had done to "repair" my hubby (even though he'd never had a vasectomy)...
AuCa
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Did he ever get the imaging tests done to rule out obstructive azoo? If not, I'd definitely do that first before starting an IVF cycle.
He's had a general ultrasound (not internal), which just showed urologist he has a scrotal hernia. Doc said nothing else about ultrasound though, and didn't offer to do an internal ultrasound or imaging. If I bring this to the urologist's attention, is that what it's called? An internal ultrasound to look for blocking? Or imaging? Just want to make sure I'm asking for the right thing. We have full infertility coverage (excluding IVF), but it's with Kaiser Medical Center, and Kaiser can be very cheap when it comes to providing for their patients. You really have to be your own advocate.
Sharon99 - I have really been so busy with Christmas shopping and wrapping presents this last week, that I haven't really had time to just think about that. Ofcourse any cramp here and there, I think it might be because I'm pregnant.
I don't feel anything so I think it didn't take, but I just have to wait until the weekend to find out.
I have been watching that MTV show since the first episode. What I can see is that children born from a heterosexual couple are less likely to want to know about the donor. It seems that the one's that are missing the father figure are the one's interested in finding out, like something is missing. I also wonder about kids being bullies, even though I want to be open with the child I have to be very careful not to say too much at an early age, where they don't have a filter and can blurt it out to everyone.
I don't feel anything so I think it didn't take, but I just have to wait until the weekend to find out.
I have been watching that MTV show since the first episode. What I can see is that children born from a heterosexual couple are less likely to want to know about the donor. It seems that the one's that are missing the father figure are the one's interested in finding out, like something is missing. I also wonder about kids being bullies, even though I want to be open with the child I have to be very careful not to say too much at an early age, where they don't have a filter and can blurt it out to everyone.
AuCa
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That's the one they typically do (and that's what I meant with imaging 0 imaging is just an umbrella term for ultrasounds, X-rays and other fancy techniques like CT, MRI, you name it). If they didn't see anything on that I'd say it's highly unlikely you have a blockage. The only other imaging that can be done is a transrectal ultrasound. We specifically asked about that but were told that there is no point since if there was a blockage there we would for sure see a decreased ejaculate volume. So, if you don't have a low volume, you might want to think about if you really want to do that test...
I'm not aware of any other imaging test that is used to diagnose obstructive azoospermia.
Here is a good link explaining the two and when they are indicated:
https://www.biij.org/2007/1/e12/abstract.asp?ID=187
His first SA was only 1.5 ml volume. 2nd SA was 2.0 ml, and 3rd was 2.2 ml. So it's considered normal, but I'd still say on the lower side. Urologist doesn't think blockage is the issue because his FSH is slightly high (which indicates testicular failure)- but he has one undescended testicle, so couldn't this be the cause of the slightly elevated FSH? One of his testicles has failed, so I could see why his FSH would be high. But it still doesn't account for the good teste. He had multiple surgeries as a child, and I just think scarring is a high possiblity. But I would have to do some serious convinicing to get my husband in for a transrectal ultrasound, lol.
AuCa
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I don't think these are low volumes (I think we always get numbers a bit below and above 2ml). But maybe rdleela can give us some reference numbers from her experience
Well, I'm no expert but I'm thinking the undescended testicle is probably the cause of his fertility issues. And I'm also thinking that if there was a ton of scarring in his testes, they would have picked that up on the ultrasound they did on him (in our case for example they did see some "strange areas" and concluded that DH might have had an infection as a child). But then I'm not sure where the scarring would be exactly after the surgeries he had...
In the end I think it's always good to get a 2nd opinion.
rdleela
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Our samples are always less than 2.0, I think averaging around 1.5-1.7...and actually, they never picked up any scarring on any ultrasound - it wasn't until the surgeon went in and did the surgery that he found all the scarring!
But the repair didn't help the sperm count? Or it did? I see you're still going through with IVF & ICSI. I'm just trying to avoid this route at all costs, but I'm just kidding myself. I know this is what we'll end up having to do regardless.
rdleela
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Well, actually, I haven't done an official announcement on here yet, but here goes: just found out we are pregnant naturally, 14 months after DH's surgery...I was waiting on my period to call in to start procedures for IVF#2 in January, when, low and behold, AF never showed! Our last sperm count was at our failed IVF in October and it was 400,000 motile.
Looking back, I am SUPER happy we got the surgery, because even though Dh's sperm count is super low, he never had to have TESE's for our IVF cycle - he can provide a fresh sample - just need one, right? (I, too, was trying to avoid IVF at all costs - just ended up getting really impatient, losing hope and decided to do IVF anyways.)
And obviously now that we ended up with a natural pregnancy, I'm a bit biased and think a repair surgery is WELL worth it - I do caution though it takes TIME to get the surgery booked, time to see if successful, many many tries to get as LUCKY as we just did. So, I think in the end, it was great for us, but it may not be great for everyone. And you really don't know until you choose a path. I'm rambling but it's really not cut and dry with the path we decided to take.
Looking back, I am SUPER happy we got the surgery, because even though Dh's sperm count is super low, he never had to have TESE's for our IVF cycle - he can provide a fresh sample - just need one, right? (I, too, was trying to avoid IVF at all costs - just ended up getting really impatient, losing hope and decided to do IVF anyways.)
And obviously now that we ended up with a natural pregnancy, I'm a bit biased and think a repair surgery is WELL worth it - I do caution though it takes TIME to get the surgery booked, time to see if successful, many many tries to get as LUCKY as we just did. So, I think in the end, it was great for us, but it may not be great for everyone. And you really don't know until you choose a path. I'm rambling but it's really not cut and dry with the path we decided to take.
rdleela
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Lol thanks!!! ...I think I need to just go post it on my journal already, I'm having a tough time transitioning to the "other side" - I want to be very respectful to all the ladies still in the trenches - if anyone wants to wish me a congrats, come on over to my journal, I'll try to post the deets later tonight...
WOW, this just made my day! I'm soo happy for you! You just totally confirmed my decision to get a 2nd opinion and keep fighting for natural. Please post the link to your journal. I'm still trying to figure this blog out and not sure how to find it. I'd love to read through it!
This is the reply I got from his urologist today RE: an internal ultrasound...
Hi Kris,
There is no imaging study we can order that would rule out obstruction 100%. The structure is so small that ultrasound, CT, and MRI will not give us an answer. If you really want an answer to that, the best thing to do is a testicular biopsy, which can be done in the operating room. It would take about 1 hour under anesthesia and involve a 1 inch incision in the scrotum. Of course, to verify cost of this, you would have to call member services, the number on the back of your card.
Best,
Wayland
Do you guys recommend having him do the testicular biopsy? I've heard mixed reviews of this procedure. I've also seen girls post about a sonogram helping determine if an obstruction is a possiblity? And he didn't mentioned anything about the transrectal ultrasound. Hmm...
Hi Kris,
There is no imaging study we can order that would rule out obstruction 100%. The structure is so small that ultrasound, CT, and MRI will not give us an answer. If you really want an answer to that, the best thing to do is a testicular biopsy, which can be done in the operating room. It would take about 1 hour under anesthesia and involve a 1 inch incision in the scrotum. Of course, to verify cost of this, you would have to call member services, the number on the back of your card.
Best,
Wayland
Do you guys recommend having him do the testicular biopsy? I've heard mixed reviews of this procedure. I've also seen girls post about a sonogram helping determine if an obstruction is a possiblity? And he didn't mentioned anything about the transrectal ultrasound. Hmm...
rdleela
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My hubby had a testicular biopsy - that's how we confirmed that he did have sperm being produced and they were good - that's why we decided to go with they vasectomy reversal to repair. Click on "my infertility journal" below in my signature, it will take you to my journal, and if you read through my posts, you'll read all about the tests and procedures my DH had done.
I hope everyone can experience the good fortune we've been handed!
I hope everyone can experience the good fortune we've been handed!
Thank you! I think we're going to go ahead with the testicular biopsy. It's covered with our insurance, so why not? I think it's an important next step to rule out obstruction 100%. One other question- was your DH's FSH elevated at all?
rdleela
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I think the biopsy is a worth-while procedure. It was quick and hubby was only hurting for a day or two. It took us FOREVER to get the results back, that was torturous.
My DH's hormone levels were all normal. He had a lot of white blood cells in his sperm samples prior to his surgery, and like I said, low volumes, and of course, zero sperm. He had a scrotal u/s, which found nothing, then the biopsy which confirmed he was producing sperm, and then a transrectal u/s, which also showed nothing, but which confirmed for our urologist that the blockage was down in the testicular area, not anywhere after the prostate. So that's when we decided to go with the vasectomy reversal, which was $6000, but because he needed the surgery through no fault of ours, our provincial health care paid for the surgery. So that was a no-brainer for us, as free was a lot less expensive than IVF! I guess, to put it better, it was worth the gamble for us to put off IVF for a year and try the surgery first. IVF was always our "back pocket" treatment.
