Azoospermia diagnosis

[MrsH14]

Morning all, just over 2 weeks my dh was diagnosed with Azoospermia. At the time it was a huge blow and my dh broke down. I have researched as much as possible but still struggling to see where we go from here. Our NHS don't fund IVF anymore at all but on Friday we received a referral letter to see a gynocologyst. Not really sure what it means but worried we are wasting time with the NHS and that we should just go private. Thanks for reading, needed to get that all off my chest.

[Patientlywaiting1984]

Hello!

I'm a Mrs H too ;-) My husband also has azoospermia so I know exactly what you're going through. In fact, we've just got back from an appointment with a consultant. Please don't despair, you're by no means at the end of the road yet. When we got our azoospermia diagnosis in July, we hit rock bottom too as we assumed there was nothing that can be done and it was a really difficult time for us, but since then we feel a lot better and I hope you do too.

Since the diagnosis, my husband has had the following:

• Another semen analysis to confirm the azoospermia diagnosis
  
• A blood test to check hormone levels (they came back normal, which I have discovered is really good news as it suggests that the testes are producing sperm, it's just not getting out got whatever reason)
  
• An ultrasound scan of the testes to see any obvious blockages (this also came back normal. We found out today that ultrasound scans of the testes aren't overly reliable as they don't show up all blockages and often you can't even see the presence of the vas deferens)
  
• A blood test to check for genetic abnormalities that can cause the testes to not produce sperm, and the presence of a variant of the cystic fibrosis gene which causes some men to not have a vas deferens (these results aren't back yet and we found out today that they might be lost :-( )
  

Our consultant thinks that as the hormone levels are normal, it's likely to be an obstructive issue. In which case, we can try surgical sperm retrieval (TESE or PESE) and, if they find sperm, we can have ICSI. She thinks there's a good chance this will work, so all hope is not lost and it needn't be for you. Also, our consultant is actually a gynaecologist mainly but also does surgical sperm retrieval. I wouldn't be overly worried about being referred to a gynaecologist as I think this often happens- it seems to be that fertility investigations are always in the woman's name, regardless of who has the issue.

I can't believe your area doesn't find IVF- that's awful! Do you know why? If it looks like you'll need to pay for surgical sperm retrieval, followed by ICSI I would try and get all the diagnostic tests done on the NHS so at least you can save money there. Also, see if you can get tests done on the NHS for you too- so far I've had hormonal tests, a scan and a swab test to check for chlamydia. All came back normal- they just did this to rule out problems with me too and also to know what they are dealing with when we get to treatment. If you can get this for free, you'll save a couple of hundred pounds I think.

Please do PM me if you have any other questions. I felt horrendous just after we got the diagnosis, so I know how to feel. If I can do anything to alleviate your worries, just because I'm a little bit further down the line, then please let me know.

Wishing you all the best! xx

[MrsH14]

Thank you patientlywaiting1984, lovely to talk to a fellow Mrs H. His mum was worried when we got the letter through and it was in my name but I just assumed that was normal. I've had hormone tests and an ultrasound already and all came back clear.

The CCG in our area stopped funding last September to save money. They only fund it in exceptional circumstances. It's a huge blow but after looking into local clinics we are thinking about egg sharing as it lowers the cost but also means I will be able to help somebody who is also struggling with ttc.
Fingers crossed all the hormone tests come back ok for us to be able to do ICSI.

I Will keep my fingers crossed for you and your husband and hope all your dreams come true x

[stephc26]

Hi MrsH14 , my fiancé and I are in very much the same position as you. We have been ttc for just over 3 years and had recent investigations. My fiancé had semen analysis done twice where there was zero sperm cells on both. We now have to wait for further investigations to find out why. The only referral we have so far is for me to see a gynaecologist, can I just ask if you have had yours already, what happened at the appointment and whether your husband needed to be there?
We thought there would be an appointment for a urologist for mens infertility so abut confused and my fiancé is self employed so if he doesn't need to be at my appointment he might as well be at work!
Hope you have managed to get somewhere in finding out the reason for your results, it all seems like such a long road doesn't it.

[TwinkleStars15]

I'm a Mrs H aswell :) There's a forum on Fertility Friends dedicated to azoospermia which I'm on and it's full of women really knowledgeable about this issue and at various stages of the process - come join us!Xx

[stephc26]

Hi TwinkleStars15 that would be really helpful for me thanks. Where do I find this? I'm new to all of it ?? xx

[TwinkleStars15]

Steph - google Fertility Friends, then look for Male Factors in Infertility and the azoospermia thread is there. You'll have to join I think but it's easy. See you there :)

[MrsH14]

Hi ladies, we have our gynaecologist appointment on Friday and as our infertility is male related we are both going and also we have looked the hospital site and our gynaecologist deals with everything related to infertility. I think going forward we will both go to all appointments. Once we have had our appointment I will give you an update. I will also join that forum, thanks twinklestar15 x

[TwinkleStars15]

Good luck for Friday MrsH, I'll keep my fingers crossed for you. Do you have any results yet or are you getting them on Friday? I'll hope that they come back normal and it's a blockage which is much easier to manage. I'd ask at your appointment if they are planning on referring your DH to a urologist, as they are much more knowledgeable about male infertility. We had our NHS appointment on Tues and private appointment on Fri and they were more optimistic at that one, which was nice to hear (although we are still only looking at a 10 - 40 % chance of finding any sperm)

Good luck

[MrsH14]

Thanks twinklestar15. No results yet. Friday is our first appointment after the first sample coming back as zero. I'm guessing they will ask for another sample and do blood tests. We have so many questions to ask because our CCG aren't funding any IVF/ICSI so we kind of need to know what the NHS will do and how it will all tie in to going to a clinic and also the waiting time for it all. Feeling nervous for it all. How did you get on at your appointments? X

[TwinkleStars15]

Ah I see, we didn't see anyone until we'd had 2 samples and the blood test via the GP. The blood test you're DH will be sent for will be FSH, LH and Testosterone (maybe some others) but these are the main ones which determine if the azoospermia is non obstructive or obstructive. Ours is non obstructive and they know this because our FSH levels are high. If your DH's results come back normal it is most likely to be obstructive, which is better. They will probably also request genetic testing, to see if it is caused by chromosome abnormalities and these take weeks/months to come back. Ours were normal thankfully.

Take a list of questions because it can be pretty intense whilst you're in there.

I've copied my post from Fertility Friends regarding our appointments (Mr R was our private appointment):

Hi all, we had our appointment with Mr R yesterday, been processing all of the information from both appointments this week. Mr R examined DH and said it was all fine. He went over our test results and recommended we had testosterone checked again as apparently it should be taken early morning (preferably before 9am) and also FSH as one time it was 65 and then it was 54 - there's a very very small chance it might be even lower now. We have to ask our GP for the repeat tests and send him the results. He prescribed Tamoxifen but said not to take it until he has reviewed the results, but we have it ready in case. DH also had another sperm analysis and a urine sample (£370 for both) and we should get the results on Wednesday. He suggested that we go ahead with the m-tese in Southampton but have another sperm analysis in 3 months to see if the Tamoxifen has made any difference. He gave us a rough guess of 40% chance of success, better than the 10% from Tuesday.He was clear that the success of such an operation are nearly impossible to predict; it's all a big unknown. However, given that testosterone is just about okay, LH is normal, teste size is normal and genetic tests came back clear, he'd like to say that this might gice us a few more percentages! I think he was trying to keep our hopes up..It turns out that Mr R knows our urologist, Mr Rees as they are on a consortium of about 9 urologists trying to get micro-tese recognised as the most appropriate treatment; for some reason this has improved my confidence in him.Don't really know what to think, I guess we've just got to go for the m-tese and keep our fingers crossed...

Let me know if I can help in any way