Advice needed - just got results back - not good.

[furtivefeline]

We have only been TTC DC2 5 months but just had a feeling something wasn't right. Periods always a bit irregular but otherwise no real reason for this concern.

GP agreed to run tests which have come back today and results are really not looking good so I'm just hoping to hear from anyone else in this situation and to learn a bit more about what might lie ahead for us.

Results are:
Day 21 progesterone 5nmol/L (ovulation unlikely with

[lucieloos]

Furtive I replied to you on the pregtober bus but thought I would post here as well incase you don't see it...

Sorry to hear that furtive, we are also faced with low sperm motility so I know how it feels to get results like that. There is lots than can be done though. Get dh on a good multivitamin and 1000mg of vitamin C, zinc and selenium. Sperm count can be improved as can low progesterone. Don't give up hope. I am having acupuncture and she has also recommended it for DH too so that could be an option for you too. Also don't rely on just the one semen analysis. So many factors can affect the results, they always recommend getting a retest to confirm.

My consultant has recommend icsi for dh and I should we not have any luck by next year.

Big hugs to you

[furtivefeline]

Thanks lucie. He is taking a conception vitamin but only for the last month or so.

The 0% morphology is what's really worrying me and then there's the whole not ovulating thing too. Amazing that we have one DC already really.

Does anyone know how I research IVF/ICSI clinics? We're in London in case anyone can recommend a good one.

[lucieloos]

There are plenty of success stories about on google with 0% morphology. The vitamins really can help too but will take a few month to build up.

You can research clinics here guide.hfea.gov.uk/guide/ it gives success rates etc for each one

[Lindy2]

If I remember correctly the day 21 results are based on a 28 day cycle. If your cycle that month is not going to be exactly 28 days the results may not actually be very helpful as you are at a different point in your cycle. Things like clomid can also help boost ovulation.
Again, are the SA results the first time it has been assessed? SA results can vary according to diet, general health, etc. A bout of illness could effect results for up to 3 months. There are things like supplements, diet, not having too hot baths, wearing tight pants etc that can help improve results.

[furtivefeline]

Thanks lucie and lindy

Although I suspected we might have problems I'm just finding it really hard to get my head round the fact that things are this bad and that there's issues with both of us. Considering that the normal conception rate is, what, around 20% per cycle, ours must be pretty much zero.

It was only a few months ago we'd just started TTC no2 and now it feels like it really might not happen and I'm so scared. Mostly feeling bad for my DD (though I know we're so lucky to have her) that she might not have a sibling

We'll try and do what we can with vitamins and diet etc and i'll book a fertility clinic appointment to see if ICSI would help us.

Re the tests -yes it was his first sample so I guess it'll need to be repeated

I think timing of the day 21 test was OK, as will probably work out as 7 DPO and 7 days before AF (not sure as AF not arrived yet).

Thanks for the support, really appreciate it

[lucieloos]

Definitely get your dh's test redone they can vary so much! I know it's all a bit of a shock but try and remain positive I'm sure it will happen for you even if you need a bit of extra help. I have been to a private clinic and found them very helpful. Book in a consultation and ask what they recommend x

[SilverStars]

If you are in London there is an excellent urologist ( NHS C&W and private) - a Mr J Ramsey. he prescribed medication that doubled my dh's sperm count and got him from 0-3% normal forms which was critical. Semen analysis can vary so worth having them repeated - our gp got us one 6 weeks after first then we went private to urologist!

It is worth noting when AF comes this month and if it means your day 21 was too early get it tested later next cycle.


My gp refused to refer us to NHS fertility as we had one child and they would not fund any fertility treatment - we took 7yrs for dc1! Best thing she did as meant we did not waste a valuable 6-12 months in a system that would not treat us. much depends on age and finance.We chose no holidays and kept our ancient car running to try for our second child ( am pg after 2yrs). Our choice. when we did NHS first time it was great for checking if my Fallopian tubes were blocked ( not), but frustrating waiting 3 months to see a dr, different every time, to just get more bloods ordered and another wait. If you have the time that is ok, but they will not find IVF or ICSI.

If you are London you have great choices - some places cater more for different issues - eg Zita West for immune issues, ARGC is seen as very " hard core, last chance etc by some". the Lister I have read good things about. Think there is a Care clinic there now as well - CRM? And create. have you discovered the forum " fertility friends?" - vast amount of wisdom from people at all these clinics who can advise. I used ZW due to my issues.

[SilverStars]

The urologist said that research showed l-carnitine improved sperm - get it in proxeed. Did not say not to take others so dh did 1000 of vit c and the Zita West supplements as well.

Despite my age, my issues and dh's sperm being initially too low even for ICSI my Bfp is natural - with immune support ( which is pricey sadly!)

[furtivefeline]

Wow thanks so much for such an informative post silverstars and great to hear things have worked out for you in the end.

Hard to take it all in now as am a bit in shock and done too much googling. I might need to come back with more questions tomorrow.

We are in London so lots of clinics to choose from as you say. Hard to know what our biggest issue is though in order to choose a specific clinic - male factor, lack of ovulation... Have done an email request for an appointment at the Lister as it seems to get good reviews. At least I can feel like I've taken a step towards getting some help with this.

Thanks again silverstars and lucie for being so supportive.

[Shellster52]

furtive we have so much in common. I too am struggling with secondary infertility.

SPERM ISSUES
My husbands sperm is also 0% normal forms. At first everything was low. Like you I was shocked and started researching. I gave him supplements and everything improved except the stubborn morph which remained at 0%. My friends husband also had 0% normal morph and the supplements improved everything except the morph. He then got a health scare, went to the gym and ate healthy and soon after his morph went from 0 to 1%. My husband has recently gone on a health kick so I can only hope the same thing happens to him.

Silverstarts, after trying so many supplements for hubby and it improving everything except morph, I had given up it every improving and thought ICSI was our only option. I am amazed to hear of your urologist providing medication that improved sperm from 0 to 3%. Do you know the name of the medication? Also you say he took L-Cartinine and Vit C. Was that at the same time as the medication and could have helped as well or was it definitely the med that improved normal forms?

OVULATION ISSUES
I found out about DH's sperm at the start of a cycle and didn't ovulate that cycle or the next two cycles. I can only put it down to the stress of that diagnosis. With my non ovulation cycles, they were not my standard 26-28 day cycle, but were all over the place. So if you normally have a regular cycle and this one isn't normal length, then this could be a one off thing.

I too have heard that the LH/FSH ratio should be close to 1:1. My first one was but I have since done several IVF cycles LH/FSH has not been 1:1 ratio recently. But I am not sure what exactly this means if they are not. Do you have any insight into this?

Hmm, I am not actually any help at all here. Just wanted to post as we are so similar so nice to chat with someone who understands. If its any reassurance, the sperm has been fine for ICSI. Just haven't had success yet as I don't produce many eggs and the embryos that were made have not survived to day 5. Currently working on high protein diet to improve that before next IVF in Dec.

[furtivefeline]

Hi Shellster. Really nice to hear from someone in the same situation (though of course I'm sorry we both have to go through this.) I was also wondering about the medication that silverstars DH was given to improve morphology.

To be honest, I don't really understand the morphology thing at all. Is it right that even in a normal sample the majority of sperm have abnormal morphology and only around 4% are normal. Why is this? it seems really inefficient?!

Also don't really understand how or why DH now has 0% normal morphology. There must have been at least one functioning sperm produced at some point as we have DD who was conceived fairly easily. What's changed?

Shellster is there any evidence out there that a healthy lifestyle/exercise etc is helpful for improving sperm? (it seems logical that it might be, but I may need hard evidence to persuade DH as he finds it hard to get motivation to exercise.)

And finally, re seeing someone at an infertility clinic, do we book an appointment specifically with an andrologist/urologist or one of the other doctors dealing with female infertility (since we potentially have both)? Hopefully they would confer with each other if needed...

Thanks for all the help and advice, will check back later.

[Shellster52]

Hey furtive. Have to be quick. I finish work in 10 minutes and still have to get things done. So will give a more thoughtful answer later. But just wanted to post so that you know I am still here.... I agree it's so nice to chat to someone in the same boat.

I think the same thing that obviously my husband must have had at least one functioning sperm produced at some point as we have DS. I remember on hubbys old semen reports, they used to say that at least 15% needed to be normal. Then when the latest one said at least 4%, I wondered what was going on for the reference to jump from at least 15 to just 4. Like you, I thought it seemed that naturally men should be making more than 4 out of 100 normal. Apparently the WHO assess men who have produced babies within one year and since these mens sperm was at least 4% normal, thats how they create the reference ranges. The last time they did an assessment, men had at least 15% normal, but now if the range was still at 15%, most men would be considered abnormal. In the last 50 years, mens sperm health has gone really down hill.

I remember reading one article that showed hard evidence what men (and women) ate in the lead up to IVF had a big influence on the success of the cycle. But I can't find the link at the moment. My hubby sounds like yours and it was so frustrating watching him eat junk and not exercise after that diagnosis. It was like watching him sabotage my dream.

I am in Australia so not really sure how your system and clinics work to give advice. Is your period overdue yet to indicate that this lack of ovulation was just a one off?

[SilverStars]

Hi, if you " google" Mr Ramsey you can see he is an expert for over 25yrs in male infertility. I rarely mention anyone's name but was thankful to read so much about him before we paid to travel and see him privately!! he did a more detailed SA than the NHS had done, blood tests and a scan to check no blockages and a physical ( bizarrely no examination ever done by NHS just a semen analysis!!) My dh saw him 3 times, plus email contact for queries, over about 9 months I think.

he orescribed him proxeed for l-carnitine - you can buy it without prescription. Research is ongoing by a team of dr's about supplements and l-carnitine is the one they say can make a difference. So my dh used proxeed, which is a sachet to mix with liquid. When diagnosis was made ( no variocles/blockages etc but only one functioning testicle due to childhood issues) of low sperm count and low morphology and too high abnormal forms in simple language we thought that was it. Apparently increasing spermatozoa count is possible so we were prescribed a course of tamoxifen - which is used to treat cancer. Thankfully no side effects. Surprisingly on private prescription not expensive!!!! After 6 months on that his number rose e ought to do ICSI and to avoid surgical sperm retrieval!! But still below 15m, which is what NHS classes as just normal. And all other areas improved too. My dh has had over 6 SA around this time - 2 NHS, 4 private so we saw numbers rise.

Not saying it will work for everyone - as depends on issues and you would need to see a consultant. No idea how easy to see a urologist on NHS - my gp refused to refer, but we are a long way from London and have had to travel for fertility reasons!!

[SilverStars]

Rose enough to

[SilverStars]

Furtive - you may find of on NHS your dh never sees a urologist/andrologist! Most fertility clinics just do a simple semen analysis and if sperm count etc is lower say go straight to ICSI. Think only time see a urologist is if need surgery to retrieve sperm and that is mainly for private funded patients. In our 7yrs of infertility to have dc1 we were never seen by male infertility specialist!!

But for £200 to see a person at top of their field ( one off fee, tests cost more etc) it could have saved us years and ££££ on ivf!! Though I need immune treatments so not so simple!!

[naty1]

Echo silverstars. We never saw anyone about dh count of

[furtivefeline]

Thanks so much for these replies! Definitely don't feel quite so alone in this now. I need to go out soon but will read all messages again and reply properly later.

[furtivefeline]

Shellster Thanks for your reply. I have been so wrapped up in our own issues the last couple of days. I'm sorry to hear that your IVF attempts so far haven't been successful. Although we have similar results I can only imagine what you have gone through with all of that. It's good that you are making even more positive changes before your next attempt though I imagine it might be hard to stay positive all the time.

Re the sperm morphology. Yes my DH's report had normal range as 3-4%. I've been doing (far too much) reading online myself and I gather there are 2 different scales or criteria used to assess sperm morphology - WHO and Kruger. I think Kruger criteria is more recent and stricter so when morphology is measured by these criteria, the tiniest abnormality (which may have previously been considered normal) leads to the sperm being labelled abnormal. So expected % of normal sperm is much lower with 4% being OK (though obviously higher better). Assume that my DH morphology was measured with Kruger criteria. Unfortunately 0% doesn't look good whichever way you measure it!

Period still not arrived from this cycle and was expecting it sometime this weekend so not really late yet however my cycles are so hard to predict - anything between 22 and 35 days. I had been religiously doing OPKs unto 4 times daily trying to pinpoint ovulation and never getting a proper +ve result so I was just going by whichever day had the strongest test line and assuming that ovulation was happening around that time (wishful thinking that maybe the lack of +ve was due to dilute urine or not quite getting the timing right.) It makes much more sense that actually I'm not ovulating at all and the "periods" I have been having are just breakthrough bleeding - they are always very light.

Sorry I don't understand the LH/FSH ratio thing either. The only thing I've picked up is that FSH tends to get higher closer to menopause and high levels seem to be associated with lower IVF success. A high LH is common in PCOS I think. If anyone reading this can enlighten us on the FSH/LH ratio that would be great!

Silverstars thanks for your advice. I will definitely make sure DH gets a urology assessment. It seems crazy that couples are being referred for ICSI/IVF without investigating the cause of a low sperm count/morphology. The consultant we are booked to see at the Lister has male factor listed as one of his areas and he has published several papers alongside Mr Ramsay so I will see what he is able to offer in terms of investigating/improving the SA and if at all in doubt will book an appointment with Mr Ramsay too. I should have mentioned that during the last 12 months my DH has had bouts of epididymitis and was given antibiotics but only short courses. I wonder if it is a chronic infection that is causing the sperm issues. Just hope that if that is the case, the damage is reversible.

naty No we definitely won't qualify for IVF on the NHS as we have a child already. Fortunately we have some money saved and should be able to afford one or maybe 2 rounds of IVF/ICSI if we reign in spending elsewhere. I keep daydreaming that maybe my non-ovulation can be fixed with clomid plus healthy lifestyle and DH's issues might improve with antibiotics etc and that it could be worth us trying naturally for a bit longer to avoid the huge expense. But on the other hand it all seems quite unlikely, I'm not getting any younger and we had really hoped for a second DC before the sibling age gap gets much bigger.

Sorry, huge post. Thanks again everyone for all the support. I really appreciate it.

[SilverStars]

Furtive - sounds good that AF not come as means you may have ovulated as your day "21" test was obviously done too early. I would let gp know this and get an NHS blood test form to do them again ( or at least the day 21 but do much later) whilst wait for private consultations!

I think ivf/ICSI has become the " solution" to infertility ( and thankfully it often is) and NHS do not do any advanced tests or treatment on sperm and rarely in private practise - the clinics that just do fertility treatments make money ultimately from interventions, not from getting people naturally pregnant with support! Not totally true - some consultants are different but I know when I got pregnant naturally this time my ivf clinic ( not ZW!) I used before refused to prescribe intrallipids/scan/bloods or all other meds needed - even with me paying consultation fees and all private costs!! Thankfully my consultant in London sees things differently so got prescriptions etc, to support pregnancy that I need.

Lister sounds a good choice from your research. My opinion is everything that can improve sperm will improve ivf/ICSI outcome, as hopefully better fertilisation rates.

[SilverStars]

Should add there are various blood tests a urologist will order for your dh, to look at infection issues, hormone issues ( that you will not get offered on NHS to see if those factors causing reduced sperm quality/count).

[Shellster52]

Hello Furtive

We are probably confusing you more with opinions coming at you left right and centre! Hopefully you don't feel so alone though. I think everyone's opinion is different based on their circumstances. Silverstars saw improvement in sperm and her opinion is very valid to recommend a urologist. I spent months doing supplements for hubby with no improvement and as I have not been getting any younger while doing IVF and I see the effect this has with low egg count meaning lower IVF success, I wish I had started ICSI sooner - so I would suggest wasting no time going down that route.

Silverstars is very right - makes sense that everything that can improve sperm (and egg quality!) will improve ICSI outcome. Really does sound like perhaps you are not ovulating with your cycles being so varied from month to month. Again, like you, my cycles used to be all over the place before DS - anywhere from 18 to 35 days - which I had no idea at the time meant I probably wasn't ovulating regularly. No idea how we got our son with my cycles like that and hubby's sperm. The pregnancy somehow sorted my hormones out as I have since had regular cycles. However my period is very light and I wonder if this is adding to our issues. Like you say, they are very very strict with the sperm criteria and we do have our children, so with your lack of ovulation to add to your issues, it's hard to know if the sperm really is that bad, or if you were ovulating, perhaps you would be pregnant and be none the wiser. But 0% is definitely a worry.

Good luck with whatever option you choose. I remember how stressed I was when we first got our diagnosis so I can only imagine your head is swirling with all sorts of thoughts right now.

[SilverStars]

Oh I agree totally about starting ivf route ASAP as well - I too wish we had not spent 12months before seeing gp for NHS referral for 13 months in basic tests before getting diagnosis and then sadly stuck in more queues for first ICSI treatment. Not ideal
When in mid thirties and already been ttc for several years! Then listening to the consultant who said pay for 2 more goes ( as one free cycle) before doing immune testing. We needed immune treatment for me we then discovered. So I think my biases are sadly for going private if time not on ones side - the urologist is just something in hindsight I wish we had considered first time round when waiting 13 months to even start first cycle. apologies if I think urology the answer - I think it is a useful part of the process that can be overlooked if male infertility is part of the issue and can be part of the journey to ttc. it is also ( for us) e cheapest part of e treatment - and some people in London can get NHS referrals to top urologists on NHS. Know without 2yrs plus ttc, a whole heap of supplements as well as urology medication for dh and several thousand pounds of medication for my immune issues I cannot get a Bfp or continue past 5 weeks.

But you have booked an appointment and hopefully they can look at results and give a useful professional opinion on chances and treatment options.

[furtivefeline]

Hi SilverStars and Shellster Thanks both of you for the support. I'm still struggling with all the "what ifs" and keep finding myself crying out of the blue every now and then. Time is going so slowly at the moment, I can't take my mind off it all and I feel that there is nothing I can do to help matters - so just waiting impatiently for the appointment! Hopefully when we have the appointment at least there'll be some sort of plan and I can gather some facts about the actual chances of us being able to have a baby. Do either of you know if there are any reported stats for the success rates of ICSI when there is both male factor and ovulation issues too? Can't seem to find this anywhere online...

In the meantime I have emailed to request a urology appointment for DH with Mr Ramsay. I was going to wait and see what they say at the Lister but agree that it's probably likely that they will focus more on pushing us straight to ICSI. We at least want to do what we can to deal with the poor morphology as it would be helpful to improve that whether we're going to try naturally or do ICSI. And given that it takes 3 months or whatever for any improvement to show up in the sperm I guess it's best done ASAP.

I was thinking that maybe if we follow whatever advice we get from the urologist to improve the sperm and then if/when it improves a bit maybe see if we can try a few cycles with clomid - do you think that would be worth a try or am I being too optimistic?

The other part of me just wants to jump to ICSI straight away (after a few months of sperm-improvement meds.) But I don't want to pin all my hopes on that in case it doesn't work. Aaargh - so stressful! What would you both recommend timing wise? (I'm 34 next week so hopefully have a bit of time on my side but not much and am certainly feeling the urgency as I don't think I can cope with being this stressed for the next couple of years!)

Whatever we do will have to be paid for privately Silverstars. GP won't prescribe clomid and won't do any more bloods e.g. AMH, prolactin. Referral on the NHS was going to be at least another couple of months and wouldn't cover IVF anyway. After hearing so much about NHS delays we decided to go private from the start. I'm sorry you had to go through so much waiting-related stress and thanks for giving me the benefit of your experience. What is immune testing by the way and how do I know if I need it? I'm dreading that there could be any additional things wrong with our fertility apart from the problems we've already discovered...Must stop worrying.

Oh and still no sign of period, doesn't even feel vaguely imminent. Definitely don't think I ovulated as -ve OPKs and closed cervix since around day 17.

Thanks again both of you. It's quite therapeutic for me to even just write all this stuff down, but to get so much lovely advice back is really helping me right now.

[furtivefeline]

Last thing, do either of you have any tips on getting my head round the fact that DD might be an only child? This is the thing that's upsetting me so much as I have a great relationship with my sister and cannot imagine not having her.

I think I want another baby more for DD than for me, terrible though that might sound. I have been on the "one child families" board on mumsnet and am desperately trying to change my outlook and see the benefits of only having one. Am probably jumping ahead here. Just wondering if I can spare myself loads more upset by accepting what might be.

[Shellster52]

I can totally relate to time going so slowly.
I have been TTC #2 since Sep 2011. Every 2ww was forever. I tried to be practical booking appts to try to get answers (I guess the phase where you are now at) and they all took forever to come around. Here I am, 8 IVF cycles later, and still impatiently waiting for my BFP.

Personally, I wouldn't at all stress about the success rates of ICSI where there are male issues and ovulation issues. I couldn't imagine there are statistics for male + ovulation issues. The fact that you don't ovulate has nothing to do with your IVF cycle. The hormone injections will completely control your cycle to get your producing eggs. In fact, with with PCOS who don't naturally ovulate, often have larger ovaries and more eggs because they aren't being ovulated every month and hence, these women are at risk of producing too many eggs for IVF or ICSI. So your lack of ovulation will not hinder your ICSI in any way. The number one factor that affects eggs is age.

It's up to you to decide if Clomid is right for you. But we had tried to conceive naturally for 6 months before the first SA revealed DH's sperm was 98% abnormal morphology. So it didn't happen for us even with those 2% normal sperm and me ovulating naturally for 6 months. (It has since gone to 100% abnormal and not changed).

We then actually did Clomid ourselves but to no avail. It was quite stressful as you have no idea what is going on and no idea where things went wrong when each cycle failed. But I have learned a lot from our ICSI because you are monitored with blood test and ultrasounds up until egg retrieval. Then everything happens in the petri dish. So you can see exactly where things are failing and work to improve them for future cycles.
I discovered I didn't make many eggs and have since taken Aspirin in the lead up to my IVF cycle to double my egg count. My first ICSI, my embryo didn't even make it to day 2. I am vegetarian so started trying to find more vegetarian sources of protein. My next IVF, the embryos made it to day 2 transfer but weren't great quality. I then gave up vegetarianism (the thngs we do for a baby!) and chowed down fish and chicken. My next IVF produced an embryo that made it to day 2 and was top quality. (Still a BFN cycle but I could see improvement. I won't go on with all my IVF details but as you can see, it really gives an insight into what's going on and there are practical things you can do. So from my experience, I would move straight to ICSI rather than Clomid. Albeit, I know ICSI is expensive and I am working between ICSI cycles just to fund the next cycle. It's horrible that our desire to have a baby has to be determined by the size of our wallets.

As for the immunes testing, I have researched it, but from what I've read, it seems these women generally have repeated miscarriages. The fact that I got DS tends to show me that I have no immune issues. Perhaps Silverstars can suggest if this is worthwhile investigating for you since she has been through it. And if she thinks it is worthwhile for us, I am happy to be informed.

I too want another child for my DS more than for me - that doesn't sound terrible at all. Nothing wrong with loving your daughter and wanting the best for her. Tips on how to accept our situation... hmm... I have absolutely none there! Here I am about to embark on ICSI cycle number 9 so I guess that tells you that I am unable to accept the cards I've been dealt! The one thing that I have found is that as I read your posts, it sounds like exactly how I would have felt 2-3 years ago. Somehow, after 8 cycles of ICSI, I am just now starting to get over all of this and feeling like perhaps it might be okay if I forget it and move on. But this is me speaking now with fresh hope as I start taking tablets to prepare for my next ICSI cycle in 17 days. I might be completely different as the cycle ramps up and I am desperate for it to succeed.

I am glad that chatting here has helped. I too find this a great source of support. So please feel free to type away and let it out. Happy to listen. Also makes me feel like I am not alone so thank you.