Fertility issues - any ideas welcome

[SpotlessMind]

Hi everyone!

It has been a LONG time since I've been on here, but you're all who I thought of when a friend of mine has had some trouble getting pregnant

She is 21, and had been trying for 6 months when she called the doctor. They wouldn't see her until she had been trying for a year, and she began the process of testing this cycle. The test results are attached; would you mind taking a look to see if you notice anything you're familiar with?

Semen analysis: only thing brought up was that his morphology percentage is about half of what is normal; doctor does not think this is the issue

Fsh: 5.6 on CD 4 & Anti-Mullerian Hormone (Amh): 5.56 on CD 4; doctor does not think this is an issue

Progesterone: 8.3 on CD 22; has not talked to doctor yet

Thanks so much!

 

[jcleary10]

To me, the AMH seems a little high. I thought anything over 3.0 indicated PCOS? I did find this:

High (often PCOS) Over 3.0 ng/ml
Normal Over 1.0 ng/ml
Low Normal Range 0.7 – 0.9 ng/ml
Low 0.3 – 0.6 ng/ml
Very Low Less than 0.3 ng/ml

 

[CaliDreaming]

The piece of advice I would give your friend is not to blindly trust doctors when it comes to sperm issues. OBs and REs usually concentrate on women's issues and are not as well versed in sperm. Realize, they make a ton of money on IUI and IVF which fixes a lot of men's fertility problems, so they don't usually have to be concerned with it. If your friends' goal is to conceive naturally, then she should look deeper into her hubby's sperm and have him see a urologist if possible.

Her numbers look really good to me. The AMH is high but it is in range for a 20 year old. In any event, PCOS is easy to diagnose on ultrasound or through symptoms such as delayed/lack of ovulation.

The hubby's numbers are problematic. His morphology should be fine. The thing that jumps out at me is his sperm volume. It is less than half of what is needed for reliable conception. His sperm concentration is passable at 50 million/mL, but with a total volume of less than a mL, he is not producing nearly enough sperm to guarantee conception from cycle to cycle.

Another potential problem is that the motility is barely passing. His score is considered "normal", but when you consider that lots of men have 75% or more motility it doesn't look as great. It would be one thing if this were the only parameter that were off, but he has a bunch of "passable" numbers and one that is extremely low.

Are the docs assuming that he did not get all of the sperm in the container when he provided the sample?? I am not sure why they are not looking at this or at least advising that he get another sample. These doctors are quick to assume that there's a problem with the woman, but it's equally likely that he could be the problem. If his results are accurate, it could indicate that he could have a blockage or something.

The good news for your friend though is that if her hubby's sperm is the problem, that is usually an easy fix--or if it's not fixable, it's easy to diagnose and determine next steps. Men are usually very sensitive about it, but medically their problems are not as intricate as ours.

 

[broodymrs]

Adding to what the others have said day 21 progesterone should be over 30. Lower can be ok but With her reading I'd say she either ovulates late so hadn't ovulated on day 22 or isn't ovulating

 

[SpotlessMind]

Hi ladies,
Thank you so much for your responses. I also feel this doctor isn't doing all he can for her, and she already had to wait a year to go because she's young, and now he is retiring so she's going to have to switch GYN doctors in 2 cycles. I am honestly thinking she should think about switching sooner.

If she calls a new doctor, what are some of the fertility treatment options she should discuss with them? Maybe if they plan on addressing the issues talked about above rather than ONLY her low progesterone and putting her on clomid, switching would get her pregnant sooner.

Thank you again!

 

[Swimming]

I am super new here, and new to fertility, but I had to reply because her AMH is like mine (mine is 5.2)... I wanted to share my experience thus far... It was my impression also that over 3 (I thought 4, but trust PP because they probably know more than me) indicates PCOS. The lab I went to categorized it as "normal", but there are clinical journals that indicate PCOS with higher AMH levels.

I brought my RE a journal article with the parameters to my RE, to discuss my high AMH level. He was not concerned since it appears I am ovulating, but gave me femara for backup.

I hate that they make us wait a year, no matter the age. So I can empathize with your friend. If the RE really has one foot out of the door, it cant hurt to go to someone else who may scrutinize the SA as recommended by PP and give more attention to lab values that are slightly off.

Just my opinion, I hope your friend gets answers soon!

 

[SpotlessMind]

Thank you Swimming!

For anyone who may be watching this or have similar issues, it turns out not only is my friends hubby's motility very low, but her numbers are no good either. She got a new doctor who also tested her prolactin, and after a very high test result, she had an MRI. It showed prolactinomas (noncancerous tumors on the pitiitary gland that can cause fertility issues), which can be treated with medication, surgery, etc. Either way, now that she knows the combination of causes, she's doing IUI and will hopefully be pregnant by march! Thanks ladies for all your suggestions ��

 

[Swimming]

Thank you Swimming!

For anyone who may be watching this or have similar issues, it turns out not only is my friends hubby's motility very low, but her numbers are no good either. She got a new doctor who also tested her prolactin, and after a very high test result, she had an MRI. It showed prolactinomas (noncancerous tumors on the pitiitary gland that can cause fertility issues), which can be treated with medication, surgery, etc. Either way, now that she knows the combination of causes, she's doing IUI and will hopefully be pregnant by march! Thanks ladies for all your suggestions ��

Ahh thank you for this update! I hope your friend has a speedy recovery that slides her right into pregnancy ! I know I had my prolactin tested but when my doctor called for the results she didn't say anything about it. I really hope that is a good thing

 

[CaliDreaming]

Oh wow sorry your friends are dealing with so many issues but the good thing is now they have identified the likely problems and they all seem easily fixable. That is most of the battle with infertility.