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surprise-surprise sperm parameters


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#1 Leeloo

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Posted 17 April 2015 - 10:31 AM

Hi Dr. Said and interested readers,

 

Since we started fertility investigations in January 2012, and until my successful transfer in March 2013. My husband must have had about 10 complete or short sperm analyses. By "short" I mean the simple analysis of concentration and motility that they do on embryo retrieval day. They would all come back with remarkably similar results: 5 to 8M/ml concentration, motility just around the normal threshold and very poor morphology with 0 to 1% normal sperm. Varicocele surgery, vitamins, weight loss, and switching from briefs to boxers did not change a thing over that time. 

 

When we came back for a 2nd baby and did a complete analysis in January 2015, we were not told the results in details but we were informed that they were "similar" to the 2013 results. We were approved for PICSI.

 

On embryo retrieval day (March 2015), we were told that the sample had 70M/ml and 75% motility. We had to mention our history of really bad morphology to make sure that they would stick to the PICSI plan. 

 

Now my questions are as follows:

 

- Is it more likely that this was a lab mistake than an actual drastic improvement in sperm parameters?

- How likely is it that morphology has improved with concentration?

- What could explain such an improvement?

- Should we freeze a sample now for maybe IUI use that would cost way less that IVF in case parameters come down again?

- How likely is it that the parameters will remain high?

 

Thanks!


Me 30: All seems OK, however I don't do well with stimulation.
DH 32: low count (moderate) and morphology (severe), normal motility.

 

Baby #1
Natural-IVF + ICSI #1 - gr.2 day2 transfer - Chemical pregnancy
Natural-IVF + ICSI #2 - Egg did not fertilize - no transfer
Natural-IVF + ICSI #3 - Abnormal cell division - no transfer
Natural-IVF + ICSI #4 - gr.2 day2 transfer - BFN

Stimulated-IVF + ICSI #1 - Antagonist -
- 12 retrieved, 3 mature(?!), 2 fertilized, poor quality - no transfer
Stimulated-IVF + ICSI #2 - Short -
- 7 retrieved, 5 mature, 2 fertilized - 1 lovely gr.1 9 cells day3 transfer - Positive!

- Nothing to freeze

- December 2013: Our wonderful DD was born!

 

Baby #2

Stimulated-IVF + PICSI #1 - Short -

- 16 retrieved, 12 mature, 8 fertilized - 1 lovely gr.2 8 cells day3 transfer - Positive!

- 4 frozen embies (3 x day 3 and 1 blast)

- Expecting in December 2015


#2 annagon24

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Posted 13 May 2015 - 02:41 PM

Hi Cyclebase, you mention your husband had a varicocele surgery? My husband was just diagnosed with varicocele and I am wondering whether you can provide me with more details on your DH experience with it? What procedure did he do? Did his count improve? How was the recovery time? We are concerned because we were told there is a possibility of my DH count going down to zero after the surgery (his current count is 1.5M/ml). Thank you!



#3 Leeloo

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Posted 14 May 2015 - 07:45 PM

That's strange... We were never told that the count could go down! The surgery is called "varicocelectomy" and is done in ambulatory care settings, which means that DH does not stay in the hospital overnight. Just in an out for surgery. I think it was under general anesthesia but can't quite remember. He had to put ice on it for a few days after. I believe he took 2 days of work for an extended week-end, then didn't do sports or heavy lifting for 2 weeks. I think the pain and recovery is pretty similar to that of vasectomy. 

 

The doctors expected a maximum of 30% increase in parameters which in our case, and in yours, would remain territory for IVF and ICSI. We only did it hoping that it would increase our chance with IVF. Expectations must be kept realistic... The expected improvement was supposed to show between 3 months and a year. Morphology did go up from 0% to 1% but the urologist really wasn't sure that it was attributable to surgery. Concentration and motility remained the same.

 

So all in all, I am not sure I recommend surgery. For us is was a fair bit of trouble for little or no gain at all. I think it's probably worth it if you are just below normal and a 30% increase can get you within normal limits, but that isn't the case for 1,5M/ml... Although I'll always have doubts whether that 1% increase was attributable to surgery and made the difference... With "normal" being set at 4%, going from 0 to 1 is quite significant! 

 

How are motility and morphology? If there are some good guys in the lot, I would just stick with that and find a clinic that does PICSI or IMSI in order to better select the best guys, because really all you need is a dozen good guys... 

 

Good luck!


Me 30: All seems OK, however I don't do well with stimulation.
DH 32: low count (moderate) and morphology (severe), normal motility.

 

Baby #1
Natural-IVF + ICSI #1 - gr.2 day2 transfer - Chemical pregnancy
Natural-IVF + ICSI #2 - Egg did not fertilize - no transfer
Natural-IVF + ICSI #3 - Abnormal cell division - no transfer
Natural-IVF + ICSI #4 - gr.2 day2 transfer - BFN

Stimulated-IVF + ICSI #1 - Antagonist -
- 12 retrieved, 3 mature(?!), 2 fertilized, poor quality - no transfer
Stimulated-IVF + ICSI #2 - Short -
- 7 retrieved, 5 mature, 2 fertilized - 1 lovely gr.1 9 cells day3 transfer - Positive!

- Nothing to freeze

- December 2013: Our wonderful DD was born!

 

Baby #2

Stimulated-IVF + PICSI #1 - Short -

- 16 retrieved, 12 mature, 8 fertilized - 1 lovely gr.2 8 cells day3 transfer - Positive!

- 4 frozen embies (3 x day 3 and 1 blast)

- Expecting in December 2015


#4 annagon24

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Posted 15 May 2015 - 08:36 AM

Hi Leeloo,

 

Can I ask what doctor performed your DH surgery? We saw Dr. Lo at Mount Sinai (Toronto) and on our initial appointment he missed varicocele completely! It was on our insistence for my DH to have u/s done that he found this on our follow up visit.

 

My DH does have low motility (around 5% post-wash) and also a high DNA fragmentation of 65% but he does have enough good guys for IVF with ICSI so the only reason to do a surgery is to relieve discomfort. However, we will hold off until we are expecting or have enough frozen embryos.

 

I see from your signature that you are expecting #2 - best of luck in your pregnancy.

 

I just finished my first IVF cycle and have 1 day 5 embryo frozen and waiting for PGS results.

We are preparing to do another fresh retrieval cycle mid June (sitting this one out) to see whether we can end up with my embryos.

Out of 12 follicles, 9 eggs were retrieved. Only 4 were mature enough for fertilization, 2 fertilized - on day 3 we had grade 2 embryo and grade 3 embryo. Since we are doing PGS, we had to wait till day 5 so we ended up with only 1 embryo who made it which has been frozen. 

 

My RE will be tweaking my meds and allowing follicles to grow larger to ensure that I have more mature eggs next time around.



#5 Leeloo

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Posted 15 May 2015 - 10:33 PM

Dr. Zini in Montreal (St. Mary's Hospital)

That's funny dh's varicocele never caused any discomfort but was quite visible upon visual exam.

I think it's good that you are covering all the possibilities by going for ivf prior to surgery.

So you will do a second ivf before transferring your embryo, no matter the PGS results?

4/9 mature is pretty low. Did your doctor consider growth hormone to help with that? That's what we did after getting 3/12 and we got 5/7 and 12/16 with growth hormone. It's about an extra 1000$ for the cycle and is not covered by insurances.

In this last cycle, we also pushed an extra day of stimulation compared to normal practices given the immaturity history. Normally 4 follicules >18mm will qualify you for trigering the same night, but we waited an extra day and It turned out perfectly!

Me 30: All seems OK, however I don't do well with stimulation.
DH 32: low count (moderate) and morphology (severe), normal motility.

 

Baby #1
Natural-IVF + ICSI #1 - gr.2 day2 transfer - Chemical pregnancy
Natural-IVF + ICSI #2 - Egg did not fertilize - no transfer
Natural-IVF + ICSI #3 - Abnormal cell division - no transfer
Natural-IVF + ICSI #4 - gr.2 day2 transfer - BFN

Stimulated-IVF + ICSI #1 - Antagonist -
- 12 retrieved, 3 mature(?!), 2 fertilized, poor quality - no transfer
Stimulated-IVF + ICSI #2 - Short -
- 7 retrieved, 5 mature, 2 fertilized - 1 lovely gr.1 9 cells day3 transfer - Positive!

- Nothing to freeze

- December 2013: Our wonderful DD was born!

 

Baby #2

Stimulated-IVF + PICSI #1 - Short -

- 16 retrieved, 12 mature, 8 fertilized - 1 lovely gr.2 8 cells day3 transfer - Positive!

- 4 frozen embies (3 x day 3 and 1 blast)

- Expecting in December 2015


#6 annagon24

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Posted 20 May 2015 - 10:17 AM

Leeloo,

 

Yes, we have decided to do the 2nd IVF retrieval but it will be done on my mid June cycle and our PGS results should be coming in before the end of May (these waits are excruciating!).

 

My RE will amend my retrieval protocol for our next round and will keep me on the retrieval meds for an extra day or so.

 

Thanks for sharing your experience and I definitely hope we will have more mature eggs in our next round.

 

I really hope we'll be ready for implantation after our 2nd retrieval...



#7 smurfette_w

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Posted 20 May 2015 - 11:22 AM

Leeloo,

 

Yes, we have decided to do the 2nd IVF retrieval but it will be done on my mid June cycle and our PGS results should be coming in before the end of May (these waits are excruciating!).

 

My RE will amend my retrieval protocol for our next round and will keep me on the retrieval meds for an extra day or so.

 

Thanks for sharing your experience and I definitely hope we will have more mature eggs in our next round.

 

I really hope we'll be ready for implantation after our 2nd retrieval...

 

My DH also had very low sperm counts (1mil/mL) and very low motility and normal forms.  He had to have two varicocele surgeries to correct everything (he also never felt any discomfort either), but things barely improved, went up to 5mil/mL, but still very low motility and normal forms.  We froze extra sperm samples for IVF/ICSI, but were informed both of those times that the samples were pretty low quality and it's best that we use a fresh sample for IVF/ICSI, and we did.

 

As for normal forms, our RE told us not to worry too much about it because it just means that the shape does not conform to the "standard" but doesn't mean that the sperm is not good to be used.

 

We are also expecting our second DD in July.


  • annagon24 likes this

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Me: genetic issues
DH: genetic issues, MFI

TTC since Summer 2009

See my profile for details


#8 Leeloo

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Posted 20 May 2015 - 02:37 PM

Well from 1M/ml to 5M/ml is a pretty great improvement! That's 500%! Much more that the expected 30%... That leave you in IVF-ICSI territory but your odds but were probably improved. Yeah morphology is pretty much just a beauty contest.

 

Congrats on the pregnancy!


Me 30: All seems OK, however I don't do well with stimulation.
DH 32: low count (moderate) and morphology (severe), normal motility.

 

Baby #1
Natural-IVF + ICSI #1 - gr.2 day2 transfer - Chemical pregnancy
Natural-IVF + ICSI #2 - Egg did not fertilize - no transfer
Natural-IVF + ICSI #3 - Abnormal cell division - no transfer
Natural-IVF + ICSI #4 - gr.2 day2 transfer - BFN

Stimulated-IVF + ICSI #1 - Antagonist -
- 12 retrieved, 3 mature(?!), 2 fertilized, poor quality - no transfer
Stimulated-IVF + ICSI #2 - Short -
- 7 retrieved, 5 mature, 2 fertilized - 1 lovely gr.1 9 cells day3 transfer - Positive!

- Nothing to freeze

- December 2013: Our wonderful DD was born!

 

Baby #2

Stimulated-IVF + PICSI #1 - Short -

- 16 retrieved, 12 mature, 8 fertilized - 1 lovely gr.2 8 cells day3 transfer - Positive!

- 4 frozen embies (3 x day 3 and 1 blast)

- Expecting in December 2015


#9 annagon24

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Posted 20 May 2015 - 04:29 PM

Smurfette, thanks for letting me know about the outcome of your DH varicocele surgeries.

At this time, we are just going to stick with IVF/ICSI and then DH will decide on whether to address his varicocele due to the discomfort he feels at times. 



#10 smurfette_w

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Posted 25 May 2015 - 01:25 AM

Well from 1M/ml to 5M/ml is a pretty great improvement! That's 500%! Much more that the expected 30%... That leave you in IVF-ICSI territory but your odds but were probably improved. Yeah morphology is pretty much just a beauty contest.

 

Congrats on the pregnancy!

 

I guess a 1 mil to 5 mil improvement is great, but it's disheartening when the lab says the sample to be frozen was still poor quality and asked us to make sure we have a fresh sample on ER day.  I don't even know what the minimum IVF/ICSI territory is, we were okayed for IVF/ICSI even at 1 mil.  And congrats on your pregnancy!!!


___________________

Me: genetic issues
DH: genetic issues, MFI

TTC since Summer 2009

See my profile for details


#11 GraceM

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Posted 18 July 2015 - 08:31 PM

Annagon - Dr. Lo did my DH's surgery and his counts are completely normal now.  We had a great experience.



#12 annagon24

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Posted 23 July 2015 - 10:44 AM

GraceM - what was your husband's count prior to his surgery?