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#1 Wilbur

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Posted 11 July 2017 - 07:06 PM

Wife and I are previously married. I have children from my first marriage, but they're in their teens now. Wife  does not have children. We had the discussion about having children prior to getting married, and decided we would like to have at least 1 child together, it is something that is very important to both of us. She's in her late 30's and I'm in my late 40's.

About 5 years back, prior to meeting my wife, as part of my regular physical, my doctor ordered some blood work, and I was diagnosed with low T levels and put on a T replacement therapy, which worked exceedingly well. The urologist I was referred to for the T therapy did tell me the T replacement would affect my sperm count, but at the time it didn't matter since I was single.

Fast forward to when my wife and I got married 2 years ago. Knowing we wanted children, I talked to my urologist and discontinued T replacement therapy. On my 6 month follow-up, she ordered another T test and a SA at my request to make sure my swimmers came back.

My T test came back as "normal" but just barely (e.g. 5 points less and it would have been considered 'low'). The SA showed a very low count (~2 million/ml) with poor motility, forward progression, and morphology. She then ordered another series of tests (FSH, LH, and a few others), all of which came back as "normal". She also did a physical exam to check for varioceles(?) and other physical causes, all of which were negative. So I ended up diagnosed now with idiopathic (some long name denoting poor sperm count, motility and morphology)-spermia. 

Given my low T levels and low sperm count, I asked my urologist if another form a T replacement might help boost my sperm production levels. I asked about Clomid and other therapies. She said she did not believe, based on my numbers, there would be any appreciable difference, because it did not appear that I was suffering from some form of testicular dysfunction (e.g. my FSH and LH numbers were all within normal ranges, and even my T level was, technically, although barely). I asked about supplements and specialized vitamins, which she dismissed as 'quackery' (placebo effect was the phrase she used). She recommended my wife and I speak to an RE about ART.

Wife and I went to the IVF clinic and met with an RE, who agreed we had an almost nil chance of natural conception, and recommended ICSI.

We went through 1 fresh cycle and they got 15 eggs, of which 5 fertilized. Over the past 5 months we did 3 transfers (1 fresh, then 2x2 frozen) all of which were BFN.

The RE said the embryologist had a difficult time finding good sperm in the sample I provided that day and that likely contributed to the poor rate of fertilization. Due to my counts, for the next cycle the RE wanted me to bank sperm ahead of time, while my wife started a round of stiming for egg retrieval. I also had a DNA frag test which came back "normal" but just inside at the "high" end of the scale. My other DNA tests (chromosome count and something else they did) also came back negative.

I had my first visit to the lab three weeks ago, and they collected 2.1m/ml sperm which they froze (I've had 4 SAs done since coming off the T replacement and all put my counts at 1.4m/ml to 4m/ml so this seemed to be within what I've experienced in the past).

The lab asked for me to come back a 2nd time so they would have more sperm. The 2nd time I went, I only had .6m/ml sperm in my sample(!).

So, they asked me to come back a 3rd time yesterday so they could process my sample via a different method, and today they called with the results... only .4m/ml sperm, with .8m/ml "round cells". The lab also said the pH of my semen sample was elevated at 8.5.

The RE's office called late this afternoon has now placed my wife's stim cycle on hold for the time being (she was due to start next week).

I'm a bit frustrated. I'm not sure what is going on, why my counts are decreasing so much. I always have ~3 days abstinence prior to going in for my visit (the lab says 2-3 days, anything over 4 days will degrade the quality).

When I google around about the higher pH level and round cells, everything I read says it could indicate an infection... I have no idea why I would have an infection down there (both my wife and I have been tested for STDs as part of the IVF process).

I have a follow up appointment with my urologist in 2 weeks. I'm not sure if I should demand she put me on Clomid, or another type of therapy, in an attempt to get my counts to go up. In a sense, I figure "what do I have to lose"?

Frankly, not sure what else to do. I'm frustrated because this experience is very emotionally tasking on my wife and that pains me a great deal. I have children from my 1st marriage so I'd be "okay" if we didn't have at least one child together (although certainly disappointed), but for her given she's in her late 30's with no children and wanting children, I feel as if I am letting her down. That more than anything else causes me great pain.

Anyone have any thoughts/ideas? I guess more than anything else I'm just looking to touch base with other people who have had similar issues and see what things they've done, ideas, etc.

Thanks for taking the time to read my post.



#2 SunshineTTC

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Posted 11 July 2017 - 10:35 PM

I don't know anything about male factor, but have you considered getting a second opinion? Many REs at reputable clinics across the country will do consults by phone or Skype. It may cost you $2-300 dollars, but worth it if you can get another perspective on your lab results and possibly some treatment suggestions. Getting a 2nd (or 3rd, 4th) opinion doesn't commit you to anything with another clinic, many do it to gain insight or increase their confidence that they've made the right clinic choice. I'd suggest Dr. Hudson in Victoria to have a look over your lab results, or there are several reputable clinics in Toronto also. One of the REs from Trio in Toronto responds to Qs on this forum ("Ask the RE" section), but your case is likely too detailed/complicated to just be answered on an open forum. Others here might be able to give more insight on the Toronto clinics, and also on which supplements may help you.

Me: 40 41 42 43 44 45, single, FSH 6, LH 2 (FSH not high, but exceeded 2:1 ratio), DOR (AFC 5-7, v.low AMH), all else normal/healthy.

After a difficult 6 year journey of everything going wrong, amazing baby boy born Dec 2018.  Donor sperm + DEB-USA donor eggs.  Detailed journey in 'about me'.

 


#3 HelenM

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Posted 12 July 2017 - 12:06 AM

I'm sorry you guys are going through this Wilbur. It sounds like a similar situation to me and my husband. Same deal for him, low counts, low morphology, low motility just generally crappy sperm.

We've done two rounds of IVF with ICSI, the doctor at our clinic didn't recommend any treatments for him (vitamins etc). Even though she said it was a waste of money we figured it couldn't hurt, so he was on the clinic vitamins 3 months prior to our last IVF cycle (May 2016).

After our two failed cycles we got a referral with Dr. Jarvi in TO who is supposed to be an excellent reproductive urologist. He put my husband on fertility vitamins and COQ10, and on Clomid to see if it would make a difference. We had his 3 month semen analysis May 2, which didn't see much difference, although a slight increase in motility so we were hopeful, but just had another one on Friday which was I think one of the worst yet. Our doctor at the fertility clinic suggested that any variation in his results is likely just normal variation. We are waiting on Dr. Jarvi to get back to us to discuss these last two analysis since he's the expert and she differs to him.

I think we will be turning to embryo donation at this point as for us we just want to be parents at this point, and this may be a great option for us.

I'm sorry if that isn't a great answer for you, but I would recommend getting in with a good urologist, I think there's one at one of the Montreal clinics, I just can't remember which one! I think he was a specialist in male factor infertility. Maybe call around. 

Good luck and I'd love it if you kept me updated since it seems you're in a similar situation to us.


TTC since Oct 2013

IVF  w/ ICSI #1 Jan 2016

-15 eggs retrieved, 12 mature, 7 fertilized. Transferred 2 day 3 embryos. Nothing to freeze.th_abfn.gif

IVF w/ICSI #2 May 2016

-24 eggs retrieved, 16 mature, 6 fertilized. Transferred 3 day 3 embryos. Nothing to freeze. th_abfn.gif

 

 


#4 Wilbur

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Posted 12 July 2017 - 07:29 AM

Thanks for the replies.
 

I don't know anything about male factor, but have you considered getting a second opinion?

 

Yes. In a sense I've had two opinions, the first being my own urologist, the second being the RE my wife and I see at the clinic. I've provided copies of all my prior exams/tests to the RE at the clinic and I've asked the RE if there is anything else I should do/test/etc. The RE is the one who recommended the DNA frag and the chromosome test (I forget exactly what it was called) which I had done back at our final meeting prior to the starting of the stim process for our first fresh cycle, but the test results didn't come back until after we had gone through the fresh cycle and transfer.

My wife and I met with the RE mid June to discuss this coming fresh round, and I specifically asked if there were any other tests I should have, the RE just suggested the banking process so the day of egg retrieval they wouldn't have to go on a sperm hunt. I asked the RE about surgical extraction at that meeting and the RE indicated it wasn't necessary since I do have sperm, although crappy, in my ejaculate, going in surgically wasn't going to make much of a difference in quality.

I have a regular follow up scheduled with my urologist in two weeks - i emailed the office yesterday asking if they could pre-order blood work for me (T, FSH, LH, etc.) so I will have the results at my appointment to discuss with the urologist.

I suppose I could seek a "3rd" opinion, but to be honest I would not expect any difference in the analysis, and I would be suspect that I would just "be told what I want to hear", sort of like how terminal cancer patients will seek out any opinion from a doctor that will give them hope.

My wife has likewise had a full battery of tests. She has an excellent egg reserve and zero issues, so this problem is entirely on my end. The RE in June indicated she did not feel our 3 BFNs were statistically significant to suspect RIF, but she did a few additional tests (blood clotting, some DNA tests I forget specifically what they were, and a endometrium cell culture) all of which have so far come back completely normal on my wife.
 

 

I'm sorry you guys are going through this Wilbur. It sounds like a similar situation to me and my husband. Same deal for him, low counts, low morphology, low motility just generally crappy sperm. [...] Our doctor at the fertility clinic suggested that any variation in his results is likely just normal variation. [...] I think we will be turning to embryo donation at this point as for us we just want to be parents at this point, and this may be a great option for us.

Thanks Helen. Sorry to hear you and your husband are in the same boat.

I've always seen my levels in that 1.4-4m/ml level. Honestly I was shocked a week ago when the lab called to tell me they only had .6m/ml in my sample (but I figured okay maybe it was an off day) and shaking my head in disbelief when I found out my levels were .4m/ml in Monday's sample, a week later. I'm at a complete loss to understand why my numbers are dropping off so substantially.

It is probably too soon for us to consider alternatives, such as donor sperm, although I did broach that subject with my wife. It is a discussion I will likely have with the RE at the end of this cycle (assuming we can go forward with it, wife has to call the RE's office this morning to find out what they want me to do next), if we have another series of BFNs. Because I have biological children with my first wife, I am "okay" with the concept of donor sperm (I know a lot of men have a difficult time with that idea - how I rationalize it in my mind, it really is no different than had I married a woman with children from a first marriage, the same as I had). However, too soon to go down that path.

More than anything else, I guess I feel like I'm letting my wife down in this process.



#5 RosySkies

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Posted 12 July 2017 - 05:36 PM

We haven't started any IVF cycles yet, but it sounds like your SA results are similar to my husband's. Two years ago his results were about 2 million/mL (can't remember the motility but it was below normal). Now that we want to go forward with IVF, he went to the lab for a new SA last week (a provincial-run lab, not at our clinic). We can see the lab results online show <1 million/mL, 7% motility, and 3% progressive motility. sad.png Annoyingly, there was a note that says the analysis was done 110 min after collection when it's supposed to be done in less than 60 min after, which may affect the motility results. We waited over a month for that appointment with the lab...

 

He's going to see a urologist on Monday to check for variceole, I'm hoping the urologist can tell us more details about the results (are we talking 900,000 sperm or 100??). I'm not sure why there is a drop in his count from two years ago. I'm hoping it's just normal variation and that it isn't too far below the 1 million/mL mark. We'll ask if we can get his hormone levels tested too.

 

I found this study online that was done in China (published last year). They looked at the effect of low numbers of motile sperm on ICSI success rates: http://journals.plos...al.pone.0163524

 

It's reassuring to see that, on average, even the group with <10,000 motile sperm per mL had fertilization rates that weren't too far below the control group (75% vs. 82% in the control group that had >2 million motile sperm per mL). There was some also some difference in the number of good-quality day-3 embryos (51% of embryos were good quality vs. 57% in the control group). The women in the study were all under age 35 though, so I'm not sure what impact your wife's age would have on expected fertilization rates.

 

It sounds to me like you should still be able to try another fresh cycle with your own sperm. I'm not sure what % motility they were, but I would think they would have enough to work with even just from your frozen samples.  

 

I'm hoping to start our first cycle next month. I hope we will be considered to have enough motile sperm to work with, we'll talk to our RE about banking some frozen sperm like you did. 


Me - 33   DH - 35

Started TTC Jun 2013

Diagnosis: Low sperm count & motility

 

IVF #1 - Aug 2017 - Antagonist Protocol

    18 eggs retrieved all mature  ICSI'd 16 eggs → 12 fertilized  10 blastocysts

     froze 9, transferred 1 fresh embryo - BFN

 

FET #1 - Oct 2017 - transferred 1 embryo - BFP!! 

    our son was born July 2018 babyboy.gif

 

FET #2 - Mar 2020 - transferred 1 embryo - chemical (beta = 5)

 

FET #3 - Jun 2020 - transferred 1 embryo - BFN

 

FET #4 - Oct 2020 - transferred 1 embryo - BFN

 


#6 Highest hopes

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Posted 12 July 2017 - 05:52 PM

RosySkies, I feel badly for you that the lab waited that extra 40 min. -- If you had to pay for that, then I feel that they should redo it for free if the results weren't reliable...   How frustrating.

 

Wilbur, my partner's DNA frag sounds exactly like yours, though he comes up good on everything else so it's kind of a mystery.

 

Because of this, they recommended TESE which we did, but we had BFN. Hard to say if that is why as we have other issues on my side.

 

I asked if they could freeze some (since it was ~$2000+) but they said they don't do well frozen. I'm not clear if this is true as others have talked about freezing them. 

 

Now my partner says he never wants to do that again because it didn't work.  He kind of thinks it's BS. 

 

I wish there was a way for them to weed out the bad ones. Because we do ICSI, if they choose a badly fragmented sperm then we have no chance :( 


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#7 HelenM

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Posted 12 July 2017 - 10:42 PM

Highest hopes,
I did some research on my own about just what you said, whether there was a way to pick the "right" sperm, since you can't visually see if they're fragmented.
I had found out about Picsi which is supposed to pick the good ones out but our clinics embryologist and our doctor both were very dismissive of it. Maybe bring it up with yours and see what they say?

TTC since Oct 2013

IVF  w/ ICSI #1 Jan 2016

-15 eggs retrieved, 12 mature, 7 fertilized. Transferred 2 day 3 embryos. Nothing to freeze.th_abfn.gif

IVF w/ICSI #2 May 2016

-24 eggs retrieved, 16 mature, 6 fertilized. Transferred 3 day 3 embryos. Nothing to freeze. th_abfn.gif

 

 


#8 Wilbur

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Posted 13 July 2017 - 09:40 AM

We haven't started any IVF cycles yet, but it sounds like your SA results are similar to my husband's. Two years ago his results were about 2 million/mL (can't remember the motility but it was below normal). Now that we want to go forward with IVF, he went to the lab for a new SA last week (a provincial-run lab, not at our clinic). We can see the lab results online show <1 million/mL, 7% motility, and 3% progressive motility. [...] It sounds to me like you should still be able to try another fresh cycle with your own sperm. I'm not sure what % motility they were, but I would think they would have enough to work with even just from your frozen samples.  [...]  I'm hoping to start our first cycle next month. I hope we will be considered to have enough motile sperm to work with, we'll talk to our RE about banking some frozen sperm like you did. 

 

We're waiting for a call back from the RE's office to indicate what we should do next. I should hear something today, hopefully. My wife was scheduled to start her stim cycle this week but the RE delayed it a week. My prior physical exam indicated I do not have a variceole so thankfully that is not an issue. The only physiological difference I can think of between fathering children with my first wife vs. my current wife is my age and T level, and, since I know T levels have a direct effect on spermatogenesis, this is the only thing I can think of addressing which may help.  
 

 

Wilbur, my partner's DNA frag sounds exactly like yours, though he comes up good on everything else so it's kind of a mystery.

 

Because of this, they recommended TESE which we did, but we had BFN. Hard to say if that is why as we have other issues on my side.

 

I asked if they could freeze some (since it was ~$2000+) but they said they don't do well frozen. I'm not clear if this is true as others have talked about freezing them. 

 

Now my partner says he never wants to do that again because it didn't work.  He kind of thinks it's BS. 

 

I wish there was a way for them to weed out the bad ones. Because we do ICSI, if they choose a badly fragmented sperm then we have no chance sad.png

 

Highest, our RE discussed chromosome testing of embryos at our meeting in June. The RE felt the science is inconclusive as the experience in their clinic has gone both ways: chromosomally-normal embryos have BFNd and abnormal ones have resulted in live births, as the section of the embryo they cull cells from to culture is different than what develops into the fetus. Although my DNA fragmentation was "normal" it was barely inside the "normal" range at the high end.

I'm not sure why they said they cannot freeze sperm obtained surgically, I believe they can. Granted, some sperm will not survive the freezing process, but I do think it is possible. Obviously if they do the surgical extraction on the same day as egg retrieval I do not think they can freeze, since they will not have time to do it.

There is a process known as "Intracytoplasmic morphologically selected sperm injection" (IMSI) which involves cherry-picking sperm using an electron microscope at 6000x power, rather than the "normal" 400x power scope used in many clinics. The difference being rather than seeing a dot which looks like it is moving, the clinic can actually examine the morphology of the sperm to pick the ones which look the most 'normal'. I intend to ask about this process at our next meeting.

I had asked about surgical extraction at our meeting in June, but the RE didn't feel it was necessary. That opinion may change based upon these banking results. I've watched videos about the process on YouTube (sometimes a mistake lol) and I can live with it though I have a natural cringe-reaction at the thought of someone getting near the family jewels with a scalpel. Can't be any worse than people who go through vasectomies and I've heard that process isn't that bad.
 

 

Highest hopes,
I did some research on my own about just what you said, whether there was a way to pick the "right" sperm, since you can't visually see if they're fragmented.
I had found out about Picsi which is supposed to pick the good ones out but our clinics embryologist and our doctor both were very dismissive of it. Maybe bring it up with yours and see what they say?

 
I have not done any extensive research on PICSI, as a cursory review of the process seemed to suggest sperm were cultivated chemically on their ability to successfully bind to an egg. Not sure why that is necessary in the ISCI process, given you're not just dumping a bunch of sperm in a petri dish with an egg and seeing who wins first, but physically injecting a sperm into an egg, thus negating the necessary of such a "binding" in the first place.



#9 Highest hopes

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Posted 13 July 2017 - 01:01 PM

Thanks for the reply Wilbur.

 

Just to clarify, they didn't say they can't freeze them, they just said the frozen TESE'd sperm aren't good quality. I'm just not sure if that is true as I believe I've heard other people say that their clinics did freeze their TESE'd sperm. What I had hoped is that they would have taken some for the procedure that day (as they did) and froze some for later, since it was so expensive so we didn't have to go through that again. I still wonder if that would have been a good approach.

 

Can I ask, when you mention "banking results", what do you mean? When you are giving samples and then they freeze them, are they able to tell you any information about the quality before they freeze the sample?

 

Thanks for the IMSI info, and Helen for the PICSI info.

 

PICSI: "Research shows that sperm that bind to hyaluronan have a lower probability of chromosomal abnormalities and higher DNA integrity. Sperm that express a positive reaction are selected for injection."

http://www.repromed....tion PICSI.html

 

They both sound great but I always end up finding that my clinic doesn't have many of the new bells & whistles (i.e. technologies) and if your clinic doesn't have those things, it's kind of a moot point. (i.e. If you have frozen gametes there then yes you can ship them elsewhere but that makes me nervous.)
 


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IUI & IVF & FET = BFN
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#10 Wilbur

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Posted 13 July 2017 - 01:21 PM

Thanks for the reply Wilbur.

 

Just to clarify, they didn't say they can't freeze them, they just said the frozen TESE'd sperm aren't good quality. I'm just not sure if that is true as I believe I've heard other people say that their clinics did freeze their TESE'd sperm. What I had hoped is that they would have taken some for the procedure that day (as they did) and froze some for later, since it was so expensive so we didn't have to go through that again. I still wonder if that would have been a good approach.

 

Can I ask, when you mention "banking results", what do you mean? When you are giving samples and then they freeze them, are they able to tell you any information about the quality before they freeze the sample?

 

Thanks for the IMSI info, and Helen for the PICSI info.

 

PICSI: "Research shows that sperm that bind to hyaluronan have a lower probability of chromosomal abnormalities and higher DNA integrity. Sperm that express a positive reaction are selected for injection."

http://www.repromed....tion PICSI.html

 

They both sound great but I always end up finding that my clinic doesn't have many of the new bells & whistles (i.e. technologies) and if your clinic doesn't have those things, it's kind of a moot point. (i.e. If you have frozen gametes there then yes you can ship them elsewhere but that makes me nervous.)
 

I've heard of TESE'd sperm being frozen, but I think it would have to occur before egg retrieval. In some clinics I know they schedule the TESE procedure at the same time as the egg retrieval so the sperm is "fresh", so my thought is after using that fresh sample for fertilizing whatever eggs are retrieved they likely have no time to freeze what is left. Maybe it also has something to do with the quality of what they retrieve. I'm only guessing based on what I've read online though. To be honest I haven't found many posts from men about going through these processes though, just 2nd hand info from women posting about their partner's experiences.

 

By "banking results" I mean whatever report is generated by the lab and sent to the RE. I believe the lab I went to creates a report which is sent to the RE above and beyond what they tell me on the phone, but I'm not sure what it contains. I imagine someone, somewhere, has to make the decision "this sample is good enough to proceed with the fresh cycle" or "we need him to come back again" or "he should undergo a surgical extraction to see if we get a better quality sample" (no word yet from our RE.)

Thanks for the PICSI info. Now it makes sense - they are using the ability to bind as an additional method of sorting which sperm they will use to inject. Maybe someone, somewhere, has PIMSI and combines the best of both worlds :)



#11 Highest hopes

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Posted 13 July 2017 - 02:24 PM

What I had hoped when we did TESE is that they would have used half that day for example, and then half to freeze for a future cycle. Or, if they truly needed that entire vial for that day, then why not fill 2 vials, one to use that day and the other to freeze.  But I don't think any of these logistics were the reason that they didn't. It was because they claimed that the quality of the frozen TESE'd sperm would be no good. I've just heard otherwise from other patients who did have it frozen so I can't figure out if our doctor was lying to make more money next time, or if he is misinformed, or if other people's doctors are misinformed by freezing theirs. So confusing!

 

We also froze a regular sperm sample on a previous occasion. We didn't receive any report about the quality at all, in fact, I didn't even know they had tested it (if they did). But your comments make me think that maybe they did and that maybe I should ask for those results. Thanks for the info.

 

Yes, let us know if you find clinics that offer PICSI & IMSI!

 

Our clinic was also doing a study using MACS which they considered putting us in put the study was on a hiatus at the time so we didn't get to try it.

 

Here is a summary I just found of some of these:

http://www.pragueivf...-sperm-sorting/

 

(This isn't our clinic but looks like a good chart at the bottom)


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#12 Wilbur

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Posted 20 July 2017 - 06:36 AM

Here is but one study performed on frozen TESE sperm:

https://www.ncbi.nlm...les/PMC3719314/

Based upon the study, it seems freezing sperm obtained via TESE procedures is viable and preferable in some cases.


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#13 Wilbur

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Posted 25 July 2017 - 11:12 AM

My wife and I finally had an opportunity to speak to our RE early last week. I had series of blood tests to test my hormone levels to make sure nothing was out of whack. Everything came back within normal ranges, there was one (FSH I think) which the RE indicated was a "little low" but nothing overly concerning. My T levels were perfectly normal in the mid range. No testicular dysfunction indicated on my hormone panel.
 

The RE also consulted with a urologist and they both concluded doing a TESE procedure was not likely to retrieve better quality (morphology/motility) sperm than I already have in my "fresh" samples. They indicated there are studies which indicate men with idiopathic oligoasthenoteratozoopsermia (the technical term I have) are unlikely to yield better quality sperm for IVF via a TESE procedure. Pre-extraction TESE to "bank" sperm is not a good option for me, due to my counts, the % of  sperm which would survive the freezing process and have motility after thaw is not likely to be very good (apparently what they look for is the motility of the sperm after thawing, perhaps this is why some people cannot have TESE-frozen sperm, if they have low motility.)

Since I do have sperm in my ejaculate, and we did have "success" with fertilization in our first fresh cycle, the RE indicated we should just proceed with another fresh cycle and they'll go on a 'sperm hunt' the day of extraction. The RE also sent all the paperwork over to my own urologist for a discussion about "trying" clomid for a 3 month period, purely experimental, to see if it makes any difference at all.

 



#14 RosySkies

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Posted 29 July 2017 - 06:06 PM

Wilbur, I guess on one hand it's good they didn't find any issues but also kind of frustrating that they haven’t found a cause. Hopefully this next fresh cycle will be successful for you! Let us know how it goes and if the clomid is beneficial.

 

It’s too bad more clinics don’t use PICSI or IMSI. I think there might be some in Ontario that offer PICSI, but outside of Ontario I’m not too sure. They would be great options to have, even if it meant paying more money for the cycle.

 

As for us, the urologist didn't find a varicocele but he sent DH for blood tests for hormones, karyotypes, and genetic testing (6-8 week wait for the results on the genetic test). The hormone test showed he has low testosterone. We asked our RE if we can do anything to boost his testosterone and sperm count and he said he didn't think so, but to ask the urologist about it. From reading online it looks like clomid could potentially increase both testosterone and sperm count. DH will ask the urologist about trying clomid when he has his follow-up appointment in September. But really, even if clomid doubled his sperm count it probably wouldn’t be enough to conceive with anything other than ICSI.

 

DH banked some frozen sperm on Monday at the urologist’s recommendation. We don’t have the clinic’s analysis of the sample yet. Our RE also didn’t have any more precise numbers from the SA done by LifeLabs a few weeks ago so all we know is that it was <1 million. But he seemed to be confident we’d have enough for ICSI since the lab was able to calculate a motility number.

 

So, we’re forging ahead with IVF/ICSI. I started my first BCP today and I'm guessing our egg retrieval will be sometime in September 

smile.png

Me - 33   DH - 35

Started TTC Jun 2013

Diagnosis: Low sperm count & motility

 

IVF #1 - Aug 2017 - Antagonist Protocol

    18 eggs retrieved all mature  ICSI'd 16 eggs → 12 fertilized  10 blastocysts

     froze 9, transferred 1 fresh embryo - BFN

 

FET #1 - Oct 2017 - transferred 1 embryo - BFP!! 

    our son was born July 2018 babyboy.gif

 

FET #2 - Mar 2020 - transferred 1 embryo - chemical (beta = 5)

 

FET #3 - Jun 2020 - transferred 1 embryo - BFN

 

FET #4 - Oct 2020 - transferred 1 embryo - BFN

 


#15 Wilbur

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Posted 30 July 2017 - 07:26 AM

Good luck, Rosy. 

My wife started her injections for this fresh cycle on Friday (she's was on BCP all July since our meeting w/ the RE in June), so we're now into her 3rd day. She's doing a slightly different protocol this time around compared to the first, she has a nitetime gonal injection and a morning fsh/lh injection. She had her base ultrasound Thursday morning and they say she has 10 follicles. This is about on par with where we were the first time around. If things go the same way as the first cycle, I imagine they'll be doing an extraction a week from tomorrow, but they start daily monitoring of her follicles and blood levels on Wednesday this week so could be any day thereafter.

I see my own urologist later this week so will see what she has to say about my bloodwork and trying Clomid for 3 months to see if it makes any difference.

Although it may not make a difference for natural conception or IUI, it may make a difference for the lab on the day of egg extraction, it may be a little easier for them to find viable sperm for the ICSI process, so its worth the effort for a few months at least.



#16 Wilbur

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Posted 07 August 2017 - 09:16 AM

Wife's Estradoil level was 1200 on Friday, 4 follicles on the left, 5 on the right nice and plump. She has another test today and we should get our extraction date this afternoon for this fresh cycle.



#17 Awoyt

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  • Dx:Male Factor
  • My Clinic:Victoria Fertility Clinic

Posted 29 August 2017 - 08:53 PM

Just wanted to say that you sound like an amazing husband wilbur!

 

i think male factor is so frustrating compared to female factors. Our clinic told us that there really isn't enough research and treatments avail for male factor. my husbands sperm count has always been below 4 mil. the Dr.s told us that IVF with ICSI was basically our only option.

 

have you tried any of those "quacky" treatments? (i can't believe your doctor actually said that lol) There is a book called "the infertility cure" it has a whole section on male factor. not saying that it is going to fix everything... but it is worth the read. simple good health goes a long way... and as quacky as it may seem, i think most people here are willing to try just about anything.


TTC since Oct 2014

Feb 2016 - Dx MFJun

2016 - DH underwent surgery - no change

Dec 2016 - ER, 21 retrieved ICSI 8 fertilized 5 day embryos

Dec 2016 - first fresh ET BFN

Feb 2017 - 2nd FET BFN - clinic testing for auto immune - test all good

May 2017 - 3rd FET Beta came back 75, follow up BFN-chemical

Jun 2017 - 4th cycle cancelled due to cramping *Dr. thinks this could be the cause of failures*

Jul 2017 - natural cycle started *fingers crossed* transfer scheduled 2 Aug 2017

 

Positive Beta 14 Aug 17 - trying not to overthink everything!


#18 Wilbur

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Posted 05 September 2017 - 01:45 PM

Thanks.

 

Its been a while since I posted. Unfortunately, no good news to share. My wife went through her stim cycle, and they retrieved 16 eggs, of which, only 5 fertilized and 4 survived to day 5. We did a day 5 transfer of 2, but 5 days post transfer my wife started bleeding, and her 10 day post transfer hcg level was 30, which is now down to zero, so this fresh cycle is another bust. We have another appointment in October with her RE to review the cycle and schedule the next frozen cycle of the remaining two embryos we have on ice. I know very little at this point about the embryo quality, etc. as my wife's RE did not do either the extraction nor the implantation this round, it was different doctors on staff that day.

Right now we're batting 0 for 4, two failed fresh and two failed frozen cycles.

 

I had my appointment with my urologist and discussed clomid with her. She agreed to do a "trial" for 4 months to see if it makes any difference in my numbers. I also picked up some MotilityBoost off Amazon and have been taking that. I will continue to take it through the time I take the Clomid. My T numbers at this point do not warrant replacement therapy (since they are low "normal") so I have to pay for the Clomid out of pocket since it is not considered "medically necessary".

 

At the end of 4 months we're going to do another SA to see if my numbers have changed at all; if they have, then I will probably try and bank some sperm for future IVF fresh cycles, or see if my urologist will continue the clomid through our next fresh IVF cycle (assuming the frozen transfer sometime in November fails). Even though my urologist thought it would make no difference to use MotilityBoost, I figure I have nothing to lose at this point except a couple hundred dollars.

 

Nothing else to report on my end. My wife continues to be in good spirits but each failed cycle adds accumulated disappointment to the overall process.



#19 Abrianna

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Posted 06 September 2017 - 09:34 PM

I hope the clomid works for you. We also are dealing with male factor issues causing repeated ICSI failure. We also have found MFI very frustrating as it has taken 3 IVF cycles and a change in clinics to figure out what is going wrong. My DH has low testosterone due to primary testicular failure so unfortunately there are not medication options for him.

We finally had better fertilization rates with PICSI (3 of 8) with our last cycle but all embryos arrested day 5/6. Through that cycle they have figured out that there is a rare underlying sperm issue that is causing egg activation failure. We are going to attempt to fertilize the last 6 eggs that we have frozen from that cycle with a combo of PICSI and AOA with Calcium ionophore to trigger egg activation. Fingers crossed that AOA works and we get an embryo to transfer.

Me:33 DH:37 Dx MFI

Ottawa Fertility Centre:

IUI#1 Feb 2016: gonal-f/centrotide
1.5mil post wash BFN

IUI#2 April 2016: gonal-f/centrotide
400,000 post wash BFN

IVF#1 July 2016:long agonist protocol(bcp/suprefact, gonal-f 150iu, Ovidrel)

AFC 28, 12 retrieved 8 mature, 1 fertilized with ICSI BFP ended in CP

IVF #2 Nov 2016:long agonist protocol(gonal-f 125 iu and luveris 75 added)

AFC 18, 3 eggs retrieved 2 mature, total ICSI failure

Hannam Fertility:
IVF#3 July 2017: Antagonist protocol( gonal-f, menopur, centrotide, double lupron trigger)

AFC 32, 17 eggs retrieved, 14 mature 6 eggs frozen as back up, 8 PICSI 3 fertilized and arrested at morula/stage 2 blast.

IVF#3.5 Thawed 6 eggs for fertilization with PICSI and AOA. 2 out 6 thawed, 1 fertilized and arrested day 3.

Final diagnosis of severe male factor with sperm head defect and unexplained egg cytoplasm dysfunction. Moving onto known embryo donation!

 

Create Fertility (Donor Embryos):

FET#1: December 2018 BFN

 

FET#2: February 2018 BFP


#20 Wilbur

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Posted 10 January 2018 - 01:59 PM

Followup after several months.

I've been on Clomid for 4 months now. 

The Good News: My sperm count skyrocketed, as I expected it would, by a gazillion percent. My count was 16 mil per ml, with a total count of 64 million!

 

The Bad News: Motility was measured at 0%. Morphology didn't change at all.

So, while I now have millions of swimmers, none of them are actually swimming. :(

To be honest, I expected the Clomid to increase my counts, based on my history. I am disappointed there was no increase in motility or morphology.

I have not noticed any real side-effects from the Clomid. My estrogen levels are elevated slightly above "normal" but my T levels are good and high. I have had some minor weight gain from the Clomid, nothing huge but I definitely need to be careful. No man-titties yet :)

In further depressing news, in the interim my wife finished her stim cycle and we went through another fresh cycle, which was BFN, in late November. We still have several embryos on ice so we're in the middle of gearing up for a frozen cycle probably sometime later this month. Hopefully that will be positive.

I'll probably continue the Clomid through another fresh cycle, if we need it, to see if it makes any difference in the fertilization rates we get out of the fresh cycle.



#21 Wilbur

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Posted 27 March 2018 - 07:51 AM

2 month followup.

Wife and I went through a frozen cycle, which failed at the 6-week mark. No more embryos on ice, they used the remaining for this failed frozen cycle. We see the RE in May to see where we go now.