TTC#2 but just found out DH low sperm count - what to do?

[blackcherries]

Hi, not sure if this is the most appropriate board so apologies if not.
I'm 35, I conceived DS1 on first cycle nearly 3 years ago (cannot believe how blasé I was about that at the time!).

Been ttc #2 for 10 months now, started getting concerned a couple of months ago so got all the 'basic' tests done privately - HSG etc. Mine have been fine so far but just got semen analysis results and DH sperm count is low - 5 million (apparently 15 million is on the low side of 'normal'). Motility is good.
I don't know where to go next. He's healthy, doesn't drink much or smoke etc so all he can do is start taking the vitamins (and stop carrying his phone in his pocket) but I have no idea what our chances are of conceiving naturally.
I always wanted an age gap of 2-3 years so time is fast running out for that. I'd be more relaxed if I knew it would happen but would just take longer - but I don't want to spend another year trying then end up going for IVF or something when I could just start all that now.

On the other hand part of me doesn't know if I could go through all that with a DS to deal with and whether we should just accept that we'll stick with one (we both REALLY want two, though).

Is there any chance of IVF/IUI/etc on NHS for a second child? I thought not but a few posts I've read on here suggest perhaps otherwise?

I'm just a bit shellshocked I think, panicking!
Also - any advice as to how often to dtd? We were trying every other day from day 8 or so then every day for the three days around positive OPK. Now I'm wondering if we should've gone for quality over quantity (fairly sure the fertility consultant told us there's no such thing as too often, though)...

[blackcherries]

Anyone? Is it really rare to conceive ok first time then discover low sperm count second time?

[Chattycat78]

I can't comment much on your specific issue I'm afraid- I'm sure someone who knows more will be along soon.

However, I do know that the NHS only offers ivf if you don't have children already unfortunately- and not always even that. Where we live now there are no free rounds at all on the NHS, even if you have no Children.

I'm sure you could get the gp to refer you to the fertility clinic though- then you'll be able to find out what your options are.

[Scottishgirl85]

Hi blackcherries! I feel your pain. We're kind of similar in that we have a DD (22 months) and are facing a very low sperm count ttc no.2. Although for us the low sperm count has always been there (due to testicular cancer treatment), we conceived DD naturally just before starting IVF with a count of less than 1 million which is incredibly unlikely!! We've been trying for no.2 for 14 months and have decided to privately fund IVF in the Spring, as the chances of a second miracle are so low and we just want to get things moving rather than being in a constant state of limbo while watching our DD growing older with an ever-widening age gap.

You won't be able to have NHS IVF since you have a child, that's for definite. I think in your case I'd get a repeat sperm count done as they can vary and it could have been a poor sample. You may get tests etc done on NHS so might be worth saving some money where you can! After you know if it really is a low count and not just a spurious result, you could both go and see your doctors and see what, if anything, you would be offered. They may be able to find the reason why your husband's sperm is low, and rectify it. Or it may have always been low and you were lucky with your first child. A count of 5 million is very low but not impossible to get pregnant. The way I try and think of the numbers, they need at least 5 million to do normal IVF (i.e. put eggs and sperm in a petri dish in the lab and let them do their thing). Any less than 5 million they do ICSI which is injecting the sperm directly into the egg. So in my mind any less than 5 million is unlikely naturally, given it doesn't even normally work in a petri dish under perfect conditions (optimal chemicals, temperature etc). This is why we aren't wasting too much longer trying naturally, despite having the optimism that we had DD with less than 1 million. I don't know anything about IUI, as hubby's sperm is just too low to bother with that, but this may be applicable in your case.

We are going to go to Reprofit in Czech Republic as the cost of IVF is at least half of what it is in the UK. For us it is a way of moving things forward and getting on with our lives and it makes me so happy to know that we'll only try naturally for another few months - I'm naively excited! We are prepared for it not to work though, I'm 31 so hoping we have time on our side even if it takes several rounds.

Oh and for dtd, there is a lot of evidence that every other day throughout the cycle is much better than every day with a low sperm count, even during fertile window. So we dtd every other day from day 8 to 24ish even though it kills me not to do every day during the days I can tell I'm really fertile. Every day doesn't give enough recovery time. The fertility consulatnt that told you there isn't such a thing as too much was talking rubbish, please change consultant!

Sorry for mammouth post...

Wishing you all the very best x

[2014newme]

Icsi is what you need. Good luck 🍀

[Scottishgirl85]

Wanted to edit the above to say - dtd every day is fine for those with normal sperm counts, but definitely not good with low counts, in case I cause confusion!

[blackcherries]

thank you everyone!
Scottishgirl it's so lovely (if you get what I mean) to hear of someone in a similar situation - it's really hard to google!! All of that info is so valuable. Millions of good luck wishes for the treatment.
I'm ready to start thinking about it (ICSI) and impatient to meet with consultant again. (Last time we met and she gave that advice we hadn't had any tests).

Weirdly I am at least feeling less pressured now as I think it won't happen naturally. (Still going to try obviously, bit annoyed I've probably been 'doing it wrong' by doing every day around fertile time... but haven't strictly kept to that).
We've both been low-level ill loads over this year (child at nursery, apparently it comes with the territory) and had D&V about a month ago so wondering if sperm was affected by that. It is very low though, as you say.

One round is affordable, 2 or 3 will wipe out our savings that we've been building up and will possibly need in the near future, but trying not to think about that.

[closephine85]

Hi blackcherries, I am in a slightly similar situation but a little further down the line. It took us 6 months to conceive our DS (we were starting to get a bit concerned then I fell pregnant, happy days). Fast forward 5 years and we are into our third year trying for a second. DH has a low count (ranges from 1million to 13 million) with poor morphology (a couple of 0%'s up to 4% on a good day) - what was your DH's morphology? We are going to Serum in Athens for IVF in January. They seem very clued up on male factor infertility and are also much MUCH cheaper than the uk (4,000 euros for 2 rounds including IMSI). If I could give myself any advice when I look back on all this, it would be to make the jump to IVF much quicker than I have done. I've kept hoping for that miracle but the odds really are so low it's like I've been waiting for a lottery win really.

That said, has your DH had any further investigations/an ultrasound to see if there are any reasons why his count might be low? In some cases there may be things that can be fixed, so worth exploring that first if you can.

For iui they tend to say anything less than a count of 10million it's unlikely to work. We tried 3 rounds (it's free where I live but there's no IVF facilities or funding at all) with no success and VERY low counts each time (I think less than a million on one go). To be honest, I wouldn't recommend it if it's something you'd have to pay for.

Sorry I think I'm waffling now. I hope some of what I've said is helpful!

[Scottishgirl85]

Yes it is comforting to know we're not alone! Quick sums on the Reprofit costs is about £3k for icsi including everything, flights, accommodation etc (and you may get some embryos to freeze, FETs are cheaper than doing another fresh). I just want to crack on with it now! Good luck to you, you never know, you may not need icsi but it's good to be realistic. Another positivity fact for you - male factor infertility has the best success rates, as icsi essentially solves it. Coupled with the fact we've had a child already, the stats don't get much better really. So we have a great chance of success! Good luck! 😁 xx

[blackcherries]

thanks both. No, we literally just had the results of the SA a few days ago. Motility was good, think morphology was ok - just low count. I'm in similar boat in that I'm kicking myself for not doing all this 6 months ago.

The whole thing has been coloured by the fact we conceived straight away - first cycle - with DS who is 2. So obviously we thought we were super fertile and didn't start trying until we were ready for a 2nd (and I had a minor procedure that wouldn't have been able to do if pregnant - recent HSG shows it hasn't had a negative affect which would have been unlikely anyway).

Thanks for the recommendations. Hadn't considered going abroad but will definitely bear in mind. Why is it so much cheaper there?!

[blackcherries]

Got appointment with fertility consultant in a couple of days. Hopefully that'll give us a few pointers for where to focus our efforts. AF on its way today so a bit gloomy.
(Managed to do Ikea in 2 hours with a toddler this morning, though, so feeling like we've achieved something!!)

[Blueroses99]

Good luck with the consultant blackcherries. Ask specifically about how they deal with male factor infertility, ICSI is widely available but some clinics offer advanced techniques such as PICSI and IMSI. Also, sperm results can be improved - vitamins are a good start (not everyone agrees but they improved my DHs results hugely) - consultant might have other suggestions. And it's a good idea to get the test repeated to make sure it wasn't just a blip.

[blackcherries]

Thanks. It's all a bit of a whirl. The clinic is very highly regarded and does ICSI and IVF but they recommended IVF out of the two, due to some risks of abnormalities with ICSI and everything apart from sperm count being very good (morphology normal and motility good). Can get started asap! The costs are more than I thought, even though it's cheaper than ICSI.

If we didn't have one child already and we weren't both getting older (!) I'd possibly be happy to wait but I really want to avoid trying for another year and being in the same boat. I know IVF has no guarantees but at least we're giving it our best shot. All results on my side are really positive, nothing wrong at all, so it does feel a bit like using a sledgehammer to crack a nut to me... but not really any other options other than Clomiphene which doesn't really raise our chances that much...

[Blueroses99]

Great that you can get started straight away! Good luck! xx

[blackcherries]

Thanks! Well 'straight away' means no waiting list but it will still take a couple of months. Not sure what I don't know, tbh. Still not sure how sensible we're being, DH is fine with all of it but I know it's a lot of money and stress, and generally worried how we'll cope with that + work + toddler.

[blackcherries]

How is everyone doing? I'm just waiting for AF so can book in dates for ivf but of course she's late this cycle. (Bfn the other day so not for a good reason). Think I didn't ovulate this cycle as well :(