I am so mad at my doctor. Bad SA results

[CaliDreaming]

I visited an RE last October, and Dh had a SA done. The highlights: He had 3 ml total volume, 20 million concentration per mL, 30% total motility, and 0.5% morphology. She told me dh's motility was borderline and that the morphology was very low, but she very confidently told me that his sperm was o.k. and that she would have expected me to have gotten pregnant by now with his results.

In May I visited another RE for a second opinion before having a lap/hysteroscopy. He did not think the lap was a good idea and was very concerned about dh's results. He told me that his results were so bad that it could take years and years before I got pregnant if I was lucky. I really believed in my doctor so I decided to go through with the surgeries and dismissed the second doctor's opinion on dh's SA.

Now that I've had my surgeries and no bfps, I've done some research on SAs and it seems that hubby's sperm really does suck! Most docs would not consider dh's motility to be borderline by any stretch of the imagination. 40% is the lower limit and they really want it over 50%. The morphology is not a problem by itself, but combined with the low motility, it is definitely of concern. My doc didn't even mention dh's sperm concentration, but at 20 million per ml it is on the very low end of normal. Average concentration is over 60 million per ml. Combined with the low motility and morphology, and I really don't see how his sperm can impregnate me.

I am so mad that my doctor lead me to believe that there was no problems at all with dh's sperm. How in the hell could she have thought those numbers were okay and not recommend that he see a urologist or at least take supplements at the same time??? I've wasted all of this time looking for problems with me when I should have been focusing just as much on dh.

Just goes to show that just because a person has an MD behind their name it doesn't mean they can't be WRONG.

Thanks for letting me vent...

 

[PinkPeony]

Ah! Cali! Your DH's SA is pretty much exactly the same as my DH's except mine has 15% morph. I think that there are different scales to measure the morph because we were to,d anything above 10% is OK. I've had different things told to me by doctors about it too. The urologist told us our only chance was IVF, and our current doctor told us he's not so bad that we shouldn't have conceived my now so she diagnosed me as unexplained. It really does mess with your head. I never know whether there's something wrong with me or not. That's really frustrating.
Has he done an SA since then? They do vary pretty widely so it's worth updating.

 

[CaliDreaming]

Hi Pink! He's just started taking supplements so in 3 months or so he'll go get another SA. It is so frustrating because you think with all the study that doctors have to do that they would be consistent on all of this. Did your hubby take anything to improve his results?

Also, I see you got 2 blasts transferred. OMG, you must be so excited. With all you've done to get your body in tip top shape I am very hopeful for you. PUPO!!!

 

[PinkPeony]

Thanks Cali. I'm pretty happy with the IVF so far. Really hoping it works. Just at the start of the 2ww and I'm already going nuts.

My DH has been taking lots of vitamins for almost a year now and there hasn't been much of a change unfortunately. He also has a small varicocele. Now that I'm doing IVF he's suddenly inspired to make some lifestyle changes. I think it just sunk in now. Suddenly he's running almost everyday and eating well and he's really cut down on drinking. That's only been for the past month so we'll see if it changes anything in a few months... if he keeps it up that long.

A MF diagnosis is tough to come to terms with when you've been assuming you were the problem all along. Ultimately, you can't control what they do and how far they go with this stuff. It can be very frustrating. At least when it's you, you can trick yourself into feeling like you have some control.

 

[Briss]

Cali, I am sorry you feel so let down. I also had to go through lap unnecessarily while my DH's sperm is the problem and really upset with my doc cos it's been over a year since my lap we do not have any progress. I think you should do another SA because it could have been just one off. We had 5 SA and they varied a lot, motility particularly changed from "only occasional" to normal after my DH stopped drinking any alcohol. At the moment we also have morphology issue it's 2% so we are facing ICSI unless on the day his sample will have at least 4% in which case they can do normal IVF. My DH's sperm count was never above 12 million despite tonnes of vitamins, Chinese herbs etc etc so I reconciled with the idea of IVF after TTC for over 3 years.

20 million is not too bad and you can get pregnant naturally with this count. morphology is very controversial factor because some think it's not helpful at all as men with very bad morphology are still able to father children. From my experience motility can definitely be improved with lifestyle changes.

In case it's helpful here is the list of my DH's vitamins:

Wellman Conception
Vitamin B complex
1,000 Maca
1,000 Ginseng
200 COQ10
60 Pycnogenol
1,000 Flaxseed oils
1,000 Fish oils
1,000 L-Arginine
1,000 Carnitine
700 Horny Goat weed
500 tribilus
60 Zinc
50 Selenium
800 Calcium
1,000 Vitamin C
1,000 Vitamin B12
800 Vitamin E
4,000 Vitamin D

 

[CaliDreaming]

Pink, it's great that your hubby is now finally starting to see the light. I guess it takes longer for it to sink in for them because TTC is not front and center in their mind like it is for us.

You hit the nail on the head about how MF is so hard because it's out of our control. It would be so much easier if I could take the vitamins, but instead all I can do is prepare healthy meals and bring him his vitamins. I had a mini meltdown this weekend because I found one of his doses of vitamins on his nightstand. I can't believe that even with all I'm doing to make it easy for him to take them, he STILL forgets from time to time! So now I worry about whether he is actually taking them, or just forgetting or even just throwing them in the trash when he doesn't feel like it.

Briss, it's so good to be able to know I'm not alone in going through that surgery with no real results. I guess I needed it to rule out any problems with me, but at the same time I feel like it was a lot of effort for not a lot of gain.

Thanks so much for the advice on the vitamins. Are those each separate vitamins or are those all contained in the Wellman tabs?? Does your hubby take them willingly or do you have to struggle with it? My hubby takes a total of 8 tablets a day, and I feel like it is such an ordeal to get him to do it. It's not so much that he is resisting, but he doesn't take it nearly as seriously as I would like him to. My dh doesn't smoke or drink, but his diet is very bad and his work is extremely stressful. He is at his normal weight but has to take BP and cholesterol medications because of all the junk he eats. I just hope that since he was very fertile at one time that he can get his mojo back.

I guess 20 mil concentration is not so bad, and hopefully that means we'll see big improvements in his sperm. My problem with my doc's assessment of his sperm is that she seemed to be looking at each parameter by itself instead of the big picture. I agree that, leaving aside the morphology, he wasn't very low in any one factor, but it all adds up to one big ball of fail. Another thing is she based all of this on just one SA, and that was taken after 5 days of abstinence. I keep thinking that even after abstaining his counts were just barely normal. If he had abstained for only 2-3 days, they probably would have been even worse.

I read an article somewhere that even leaving out morphology, you need 80 million moving sperm to have a reasonable chance of getting pregnant naturally, and we aren't even close to that since he had only 18 million moving total. If you factor in morphology, they think that having at least 10 million normal moving sperm should be good enough for trying naturally, but dh had less than 1 million normal.

So I'm just hoping that we can keep up this vitamin and diet regimen long enough to see some improvement. Just hoping we don't get in a big fight or something and he decides he doesn't want to be bothered with it all anymore.

 

[Briss]

Cali, the vitamins in my list are in addition to Wellman tabs. Wellman are great but you need much higher doses of certain vits like zinc, b12 etc My Dh does not take anything willingly. it's a struggle every day, he makes scenes like I am trying to poison him, sometimes he flatly refuses to take any for days and there is nothing I can do. He takes much more than 8 tablets so they look quite scary. Last couple of days I feel so hopeless cos he went to the gym and did super intensive training for 7 hours every day and I am ovulating in 1-2 days, it's just so hopeless. He eats well but he cant stay away from beer for long cos it's part of his social life. even though he knows perfectly well how much alcohol affects his sperm.

I think 5 days of abstinence is OK, I do not think it would affect his result greatly. also, I do think your DH's results are not bad and you can get pregnant naturally but obviously he heeds to try and improve it to make it easier and faster.

 

[Serenyx]

Another thing is she based all of this on just one SA, and that was taken after 5 days of abstinence. I keep thinking that even after abstaining his counts were just barely normal. If he had abstained for only 2-3 days, they probably would have been even worse

Actually this is not necessarily correct, abstinence is actually bad for sperm. They longer you abstain the more dead sperm will be present in the sample.

My DH had a poor SA and they thought we would have to do ICSI (low count, poor motilty, poor morphology). He went on supplements, seriously reduced his caffeine intake and cut out all alcohol. When we came to do IVF his results had improved so much they went with normal IVF and not ICSI. On the doctors orders he only abstained for 36 hours prior to IVF instead if the 4 days it was last time he had to do a SA.

I'm not saying this would work for your OH but abstaining is not always good for sperm.

 

[CaliDreaming]

Briss, you must be married to my hubby's twin! It seems like the easier the task is that I want my dh to do, the more he fights it. It could be one tablet a day and I'd still probably have to fight him. Even the number of tabs your dh is taking does not sound that bad. It really is not hard to swallow pills so they need to stop being such babies about it.

I really hope you're right about dh's sperm since this is our only hope. I'm going to get him in to do another SA in January--that is if I can keep him on his pill regimen.

Serenyx, that is really interesting info about abstaining. I googled it and it seems like abstaining for that length of time really hurts the quality for guys with low sperm count. It would be comforting to think that his morphology might be better than 0.5%. But then on the other hand, if he had gone in earlier, we'd still have the problem of lower counts. I wish the docs would come to some sort of consensus on this, because my head is spinning.

 

[Briss]

Cali, definitely your hubby's twin LOL we usually go to work together with DH in the morning and you should just hear him complain how he woke up in excellent mood only to get it ruined by my vitamins and how now the whole day is ruined cos he is not feeling that well after taking them… and on and on and on

My DH agreed to repeat his SA and I checked again with the clinic they require abstinence of between 2-5 days. if you abstained for less than 2 or more than 5 days they wont accept your sample cos the result wont be adequate

 

[PinkPeony]

My Dh has a very overbearing mother so if I ever come off as nagging him in the slightest it majorly backfires. The only reason mine takes his vits (most of the time) is bc both the FS and the urologist told him to. I try and use guilt a bit and gently remind him here and there but generally I have to be hand's off with these sorts of things or it aint gonna happen. It's all very delicate.

Regarding the abstinance thing. Btwn regular testing, 5 IUI's and an IVF we've had loads of SA's. it's my experience that it's all pretty random but in general it's better to wait longer (like 3-5 days). We even had one that was a full 6 days wait and it was fine. But if we waited only 2 days or less it's really bad. So really, I know it says all over the internet waiting 5 days is bad but those were some of our best ones.

 

[CaliDreaming]

Briss, OMG your hubby is cracking me up with his whining over the vitamins, lol. I know you must want to hit him over the head with a frying pan when says things like that!

On the abstinence, my gut is telling me that dh's one SA is probably a pretty accurate reflection on the state of his sperm. Maybe the morphology would go up a tad, but I'm positive that the volume at least would go down because I notice a huge decrease when we bd on a regular basis.

I guess it's possible that he has a varicocele, but with his numbers is it safe to assume that he doesn't have any other problems physically that would cause those numbers? The studies on varicoceles seem mixed so I would not be pushing him to do it.

 

[PinkPeony]

I notice the same thing with the volume after bd-ing more often. My DH's varicocele isn't big enough to operate on or it wouldn't be worth it according to the urologist. It's so frustrating that there's not much to be done for sperm count. I kind of feel like there's a bias towards researching and treating female fertility in the medical community.

 

[Briss]

PinkPeony, I am with you on male fertility issues, if there is a male problem is seems like the end of the road, IVf is the only option and docs do not want to bother trying to improve things. TCM supposed to help. I put hubby on Chinese herbs but could not see any dramatic changes.

Cali, I also read somewhere that varicocele can be treated with an operation but whether it actually improves sperm count is unclear, in some cases it does in others it does not.

 

[CaliDreaming]

That is so true that doctors do not do enough to research treat male fertility issues. It's a shame because their procedures are not nearly as invasive or costly.

I wonder if doctors have the same frustrations with dealing with their male patients as we wives do in getting our hubbies to make necessary changes, and so they'd rather just refer to IVF or just work on the woman's issues than having to deal with a resistant male patient.

 

[PinkPeony]

My Dh's urologist: "just do IVF"

Oh ok. We'll "just" do that. Thanks bud.

 

[CaliDreaming]

LOL. These docs seem to have NO concept of how much $15-20K is. I would have told him, "BTW, can you lend me $20K? I just got some Cheetos from the vending machine and realized I might be a little short. Pay you back once I'm pregnant."

I know it must be frustrating for docs too, because in IVF they have this great procedure with such high success rates that so many people can't afford. In a perfect world they wouldn't have to alter their recommendations based on cost.

 

[hopefulfor1st]

He still has 60 million per load and it only takes 1 !

 

[lilmonkey86]

Hi Ladies,
DH and I went to the urologist 2 weeks ago and he seems to think DH has Varicocele he could feel it upon examination, from what the urologist said DH seems to have great volume, his count is low but not insanely low (the first urologist told us that threshold for low count is 60 million and he was way below that, this doc said low is 20 and he is at 19), apparently with motility there are different grades so 25% is good if it is all Grade A, but if you have 75% of grade D that's bad, so they have done an advanced SA where they test everything even PH, so on Oct 25 we drive an hour back to clinic for an ultrasound, then we go on December 5th to discuss the results of the SA and the ultrasound. we have only been trying for 13 months (I say only as if it hasn't driven me nearly to the breaking point). I am getting really tired of this.

 

[CaliDreaming]

lilmonkey, so sorry you haven't gotten a bfp yet. 13 months isn't so long in the grand scheme of things, but it still feels like a lifetime when you're going through it.

I think both of the urologists your dh saw were right in their own way. The WHO standards put the minimum for a "normal" count at 15 million/ml and men with those counts are capable of fathering a child. However, the lower the count is below 60mil/ml the more you can expect that conception will be significantly delayed. So I think of 15 mil/ml as being "normal" in the same way a C- is "passing". If you're trying naturally, you really want to see it at at least 60 mil/ml or more with adequate motility and morphology.

The good news is that since your hubby's sperm is not extremely bad that there is a good chance that it can improve. My hubby's sperm analysis results were very close to your hubby's and we conceived three weeks after he started taking supplements. I'm really curious about what his numbers are now but I guess we'll never know. Good luck!