Dealing with azoospermia?

[Stinas]

Nicole if you do the biopsy or tese make sure
You freeze what you find just in case.

 

[Briss]

ladies, has anyone had DH's karyotype test coming back abnormal? what does it mean for men with low sperm count? is there any chance that with such results he can still have a biological child with ICSI/IMSi (or maybe also + pgd testing?) or is this the end of the road?

I am very confused and not sure I understand how karyotype testing explains low sperm count. we have been TTC for 3.5 years and no natural BFP. we had 2 IVFs and the first natural IVf resulted in chemical pregnancy; the stim IVf did not work because I have high FSh so did not respond to stim and the only mature egg did not fertilise. we are trying to see if we could get DH's numbers up but all the lifestyle changes did not help so the urologist suggested doing karyotype testing. how is it going to help?

 

[NikkiR143]

Thanks ladies! This is what the urologist wrote back...

"Well, if you absolutely want to rule out obstruction we should plan on a biopsy. The flip side of that argument is that if you decide to proceed with IVF, the testicular sperm retrieval technique is about the same invasiveness as the biopsy, so you would have 2 procedures instead of one. But if you absolutely need to rule out obstruction to have peace of mind to do IVF, we need to do a biopsy. Just let me know what you decide.

Wayland

Now I'm worried again! I know urologist doesn't think it's obstruction because he has a high FSH (but I still think this is because of his one undescended testicle, not because of his good one), and he had a couple sperm in his semen. BUT...I've read online even if there are some sperm in the semen, there can still be an obstruction. But I don't want the testical surgeries making his infertility even worse. Decisions, decisions. I have my first appt with the fertility specialist on January 10th. I may wait till then to her his/her advice. I know the urologist is the expert in the male infertility, but he/she may be able to give me good advice. And good idea, I will ask about freezing what they find!

 

[AuCa]

ladies, has anyone had DH's karyotype test coming back abnormal? what does it mean for men with low sperm count? is there any chance that with such results he can still have a biological child with ICSI/IMSi (or maybe also + pgd testing?) or is this the end of the road?

I am very confused and not sure I understand how karyotype testing explains low sperm count. we have been TTC for 3.5 years and no natural BFP. we had 2 IVFs and the first natural IVf resulted in chemical pregnancy; the stim IVf did not work because I have high FSh so did not respond to stim and the only mature egg did not fertilise. we are trying to see if we could get DH's numbers up but all the lifestyle changes did not help so the urologist suggested doing karyotype testing. how is it going to help?

I'm surprised they didn't do this beforehand. We had to have all the genetic testing done before they would even let us go for IVF (karyotype, Y chromosome microdeletion, cystic fibrosis).
Abnormal karyotype can cause male infertility, and men who have this have an increased risk of producing genetically defective embryos.

How is it going to help? It won't really "help" per se, but if it turns out your husband has a karyotype issue they might suggest you do PGD (I'm guessing it depends on what the issue exactly is).

 

[AuCa]

Now I'm worried again! I know urologist doesn't think it's obstruction because he has a high FSH (but I still think this is because of his one undescended testicle, not because of his good one), and he had a couple sperm in his semen. BUT...I've read online even if there are some sperm in the semen, there can still be an obstruction. But I don't want the testical surgeries making his infertility even worse. Decisions, decisions. I have my first appt with the fertility specialist on January 10th. I may wait till then to her his/her advice. I know the urologist is the expert in the male infertility, but he/she may be able to give me good advice. And good idea, I will ask about freezing what they find!

It's a tough decision. I think it is what he says - if you need to rule out obstruction 100% for your peace of mind, and your hubby is ok with doing a TESE twice, then maybe you should do it.

Personally, we opted against the mTESE as a diagnostic tool when that decision had to be made (and my husband doesn't even have high FSH).
I don't remember the exact numbers, but the percentage of men whose infertility is caused by an obstruction is quite low. But I know that you have a real suspicion due to all the surgeries he had....
My thinking was - the chances they will find obstruction are really low; if they do find obstruction, the surgery and recovery times will be significant and will delay everything by months, even a year maybe; even if his sperm count goes up, chances are high that we will still need IVF in the end (but then rdleela is an example that it is possible; however, I'm very pragmatic and think she got very lucky and this is not the norm).

But again, it's a very personal decision, and I think there is benefits and disadvantages both ways.

 

[rdleela]

I did get VERY lucky...but there are lots of men who get vasectomies, then get vasectomy reversals (same surgery we did) and also end up getting lucky like we just did. I'm not TOO much of a rare bird...BUT a lot of those couples end up doing IVF in the end anyways, too...

I would say, if you guys are young and can afford at least two years to see if a (potential) surgery to repair a (potential) blockage works, then go for the biopsy. If you aren't willing to wait two years, then I say go straight to IVF. I do like the way we did it, though, because even though we ended up trying IVF, we did have sperm in ejaculate after the surgery and we actually got to TTC every month; even though our chances were super low it would work, I was fully prepared to do IVF if it was taking too long or his sperm count never got high enough. Anyways, rambling again, but it is a very tough decision to make, and you don't even know yet if it is truly obstructive or not...and sounds like urologist is thinking it's non-obstructive, so you really gotta take that into consideration.

 

[Briss]

AuCa, thank you! our FS would not even refer DH to a urologist and did not ask him to do any tests except for SA so we had to go privately and mainly because our two IVFs failed. with my high FSH stim IVf is just not an option I am so hoping the urologist can offer a solution is we could rule out the genetic issues.

has anyone had PGD? I am wondering if there is any point doing PGD in a natural IVf where you only got one egg from the dominant follicle?

 

[sharon99]

Good luck, Olive!! I'll have my fingers crossed for you this week. Lots of distractions are good! And yeah, I noticed that too about the kids with a stable father already in their life- like they felt less of a void. I felt a little sorry for the kids feeling so guilty about their curiosity, though. It does seem pretty natural to be curious, even if you're not looking for a "father figure". Did you guys choose an open ID donor or a totally anonymous donor? (or are you using a known donor? I don't think I know). We went with an ID option donor, so when the kid turns 18 they can contact the sperm bank for contact information. This was threatening to me (and DH) at first, but hopefully in 18 years I'll feel more confident as a parent! I've also saved the pictures of the donor I downloaded, so I'll show those to the kid at some point. My husband didn't want to see those, and seeing grownup pictures also freaked me out at first.

Do you listen to podcasts at all? I listen to them ALL THE TIME (seriously, if anyone has any suggestions, I burn through them). Anyway, there's one called Creating A Family, and it's about infertility & adoption, and they have lots of episodes with tips on how and when to tell donor-conceived kids.

rdleela, congrats! I love hearing success stories, to know there is life outside the trenches!

AFM, AF came yesterday and I have never been so happy to see her! I am hoping that I won't miss ovulation this month. We are getting on a plane just after midnight on New Year's Eve, and by the calendar it's juuuuust possible that I could have my IUI that morning. It would be great to have it, and then spend a week relaxing in Florida afterwards!

 

[AuCa]

AuCa, thank you! our FS would not even refer DH to a urologist and did not ask him to do any tests except for SA so we had to go privately and mainly because our two IVFs failed. with my high FSH stim IVf is just not an option I am so hoping the urologist can offer a solution is we could rule out the genetic issues.

Wow, that's crazy that all you did was an SA. If you take it a step further, I'd have them run all the tests - also do the Y chromosome microdeletions, ultrasound, and check his hormones (hoping he did at least get that done?)
The genetic testing is simple (just blood/saliva tests), but it took a few weeks to get back to us.

Not sure about natural IVF and PGD....

 

[Briss]

the urologist did not think DH had obstructions, he asked for hormones and said they were fine. he said no need for Y chromosome microdeletions and only asked for karyotype test. I am so worried of what the result could be.

 

[NikkiR143]

Nicole if you do the biopsy or tese make sure
You what you find just in case.

Urologist actually just told me they can't do both surgeries at the same time- biopsy + surgical sperm extraction- so it will be 2 separate surgeries. I guess they can't freeze what they find during the biopsy. Maybe because it goes straight to lab for testing and it's not possible to save it? That's why he suggests only the surgical sperm extraction w/ ICSI + IVF, so avoid 2 surgeries when the possiblity of an obstruction is so low anyway. But I still want it, lol. Especially since it's covered with his insurance.

 

[Stinas]

My clinic wouldn't let us do the TESE and IVF/ICSI same day just in case they didn't find anything.
If anything is covered, DO IT! lol It sucks paying for all of this out of pocket! I am still getting septembers bills! lol

 

[NikkiR143]

Now I'm worried again! I know urologist doesn't think it's obstruction because he has a high FSH (but I still think this is because of his one undescended testicle, not because of his good one), and he had a couple sperm in his semen. BUT...I've read online even if there are some sperm in the semen, there can still be an obstruction. But I don't want the testical surgeries making his infertility even worse. Decisions, decisions. I have my first appt with the fertility specialist on January 10th. I may wait till then to her his/her advice. I know the urologist is the expert in the male infertility, but he/she may be able to give me good advice. And good idea, I will ask about freezing what they find!

It's a tough decision. I think it is what he says - if you need to rule out obstruction 100% for your peace of mind, and your hubby is ok with doing a TESE twice, then maybe you should do it.

Personally, we opted against the mTESE as a diagnostic tool when that decision had to be made (and my husband doesn't even have high FSH).
I don't remember the exact numbers, but the percentage of men whose infertility is caused by an obstruction is quite low. But I know that you have a real suspicion due to all the surgeries he had....
My thinking was - the chances they will find obstruction are really low; if they do find obstruction, the surgery and recovery times will be significant and will delay everything by months, even a year maybe; even if his sperm count goes up, chances are high that we will still need IVF in the end (but then rdleela is an example that it is possible; however, I'm very pragmatic and think she got very lucky and this is not the norm).

But again, it's a very personal decision, and I think there is benefits and disadvantages both ways.

Thank you for the good advice! It's difficult with Kaiser- because I always think they're just trying to save money, without having the patients best interest in mind. 2 surgeries will cost them a lot more, as opposed to 1. Whereas they'll make a lot of money off us if we go with IVF. But the obstruction repair (if there was one) is covered under his insurance. I'm 25, he's 30. I feel like we have time. If anything, it just gives us more time to save for IVF while still being pro-active in our search for the problem. Ya know? I def need to talk to DH more about it and see what he thinks. He's the one who has to go through all these surgeries- poor guy This sucks! How's everything going with you? Do you have a journal? I'm obsessed with stalking azoo journals now.

 

[NikkiR143]

My clinic wouldn't let us do the TESE and IVF/ICSI same day just in case they didn't find anything.
If anything is covered, DO IT! lol It sucks paying for all of this out of pocket! I am still getting septembers bills! lol

Biopsy and all obstruction repairs would be covered, if by some miracle there is an obstruction. But TESE, IVF, and ICSI are not. That's why I think it's worth it to do biopsy first, just to rule out obstruction 100%, eventhough urologist seems pretty confident that isn't the problem. But doctors are wrong sometimes too! I just don't want the biopsy to impair his inferility even more. & I know, the $$ is insane. My friend posted a funny quote on my pinterest today https://www.pinterest.com/pin/283867582736258975/

"I'm sorry I spend your entire college fund trying to conceive you".

lol

 

[NikkiR143]

I did get VERY lucky...but there are lots of men who get vasectomies, then get vasectomy reversals (same surgery we did) and also end up getting lucky like we just did. I'm not TOO much of a rare bird...BUT a lot of those couples end up doing IVF in the end anyways, too...

I would say, if you guys are young and can afford at least two years to see if a (potential) surgery to repair a (potential) blockage works, then go for the biopsy. If you aren't willing to wait two years, then I say go straight to IVF. I do like the way we did it, though, because even though we ended up trying IVF, we did have sperm in ejaculate after the surgery and we actually got to TTC every month; even though our chances were super low it would work, I was fully prepared to do IVF if it was taking too long or his sperm count never got high enough. Anyways, rambling again, but it is a very tough decision to make, and you don't even know yet if it is truly obstructive or not...and sounds like urologist is thinking it's non-obstructive, so you really gotta take that into consideration.

& you said your DH's undescended testicle surgeries are what caused the obstruction, right? Hmm...mine only had surgery on one side though. I highly doubt obstruction is the problem, but I still want to do biopsy regardless. I'm 25, he's 30. I feel like we do have time, although I have read that chances of a successful IVF go down even by your late 20's, so I don't really have that much time. So much to think about.

 

[Stinas]

Nicole lol thats a funny one!!…but soooo true!!!

 

[rdleela]

I did get VERY lucky...but there are lots of men who get vasectomies, then get vasectomy reversals (same surgery we did) and also end up getting lucky like we just did. I'm not TOO much of a rare bird...BUT a lot of those couples end up doing IVF in the end anyways, too...

I would say, if you guys are young and can afford at least two years to see if a (potential) surgery to repair a (potential) blockage works, then go for the biopsy. If you aren't willing to wait two years, then I say go straight to IVF. I do like the way we did it, though, because even though we ended up trying IVF, we did have sperm in ejaculate after the surgery and we actually got to TTC every month; even though our chances were super low it would work, I was fully prepared to do IVF if it was taking too long or his sperm count never got high enough. Anyways, rambling again, but it is a very tough decision to make, and you don't even know yet if it is truly obstructive or not...and sounds like urologist is thinking it's non-obstructive, so you really gotta take that into consideration.

& you said your DH's undescended testicle surgeries are what caused the obstruction, right? Hmm...mine only had surgery on one side though. I highly doubt obstruction is the problem, but I still want to do biopsy regardless. I'm 25, he's 30. I feel like we do have time, although I have read that chances of a successful IVF go down even by your late 20's, so I don't really have that much time. So much to think about.

Hernia repair in groin area as a newborn, AND one undescended testicle as a toddler. That testicle never ended up forming, and his one testicle only half-formed. The surgeon said it was a very difficult surgery because of this. We were amazed the surgery even worked at all and he had sperm return! So he's working with one-half of one testicle!

 

[NikkiR143]

I did get VERY lucky...but there are lots of men who get vasectomies, then get vasectomy reversals (same surgery we did) and also end up getting lucky like we just did. I'm not TOO much of a rare bird...BUT a lot of those couples end up doing IVF in the end anyways, too...

I would say, if you guys are young and can afford at least two years to see if a (potential) surgery to repair a (potential) blockage works, then go for the biopsy. If you aren't willing to wait two years, then I say go straight to IVF. I do like the way we did it, though, because even though we ended up trying IVF, we did have sperm in ejaculate after the surgery and we actually got to TTC every month; even though our chances were super low it would work, I was fully prepared to do IVF if it was taking too long or his sperm count never got high enough. Anyways, rambling again, but it is a very tough decision to make, and you don't even know yet if it is truly obstructive or not...and sounds like urologist is thinking it's non-obstructive, so you really gotta take that into consideration.

& you said your DH's undescended testicle surgeries are what caused the obstruction, right? Hmm...mine only had surgery on one side though. I highly doubt obstruction is the problem, but I still want to do biopsy regardless. I'm 25, he's 30. I feel like we do have time, although I have read that chances of a successful IVF go down even by your late 20's, so I don't really have that much time. So much to think about.

Hernia repair in groin area as a newborn, AND one undescended testicle as a toddler. That testicle never ended up forming, and his one testicle only half-formed. The surgeon said it was a very difficult surgery because of this. We were amazed the surgery even worked at all and he had sperm return! So he's working with one-half of one testicle!

Wow, that is amazing! Did they centrifuge any of his semen samples before the repair? I know you said no sperm was found, but just wondering if they spun the sample?

 

[rdleela]

Nicole - no idea! He had multiple counts done with a zero count, no idea if they spun the samples or not...

 

[tulip11]

Idk what to do ? whenever I feel something positive so somewhere news from other side makes me and my hubby upset. Since yesterday we got two news of two sister in laws who got their BFP'S one is expecting 2nd and other one 3rd baby. I try to control myself but somewhere i fail I want to cry ..... I just want to go away from all this stuff truly I badly want baby now but may be I cant be mom like others are .