Can male factor be improved?

[Dancingthroughthefire]

We've been ttc dc2 for quite a while. Ds was conceived first cycle. I thought it was something to do with me as I had an infection after the birth. However all my tests have been ok and my cycles etc are normal.

Unexpectedly dh's sa was bad. Very bad. Count pretty high but rapid motility 8% with 82% completely dead and 1% morphology. We have to repeat the sample especially as I took 80mins to deliver the sample and didn't keep it warm (no one told me and I stupidly thought cold would preserve better than heat so didn't put heaters on in car or anything and was -1).
However I'm assuming that it couldn't have been that bad when we got pregnant four years ago with ds. What could cause it to be this bad? Dh has had no infection or accident (no infection as far as we know anyway) so unless we were just super lucky with ds I can't understand it.

Would age make a difference? Could sperm quality decline over four years? Can we improve it in anyway? Dh was drinking a lot around christmas, stressed, smoking and overweight! He has stopped drinkjng and smoking, improved his diet, exercising and lost weight. Although he is still stressed. That said plenty of men who drink and smoke more than my dh was have children so I can't believe that would have such a dramatic effect. I know we won't see improvement in sperm quality for three months after changes. He is now taking a supplement too.

Is it all in vain? Is icsi the only option for us? No one had told us anything except that we will have to pay because we have a child already. The consultant said that since dh had one child he should be able to have another but I'm wondering if ds was a complete fluke.

Has anyone had experiences of sa improving (massively!) or getting pregnant with very poor sa results?

Thanks x x

Bearing in mind that sperm take around 12 weeks to produce it could be that you are still seeing the effects of his christmas excesses.
The cold and time will have affected the motility of his sample, so see what a repeat shows before worrying too much. Also what was the length of abstinence before he produced that sample? Too long (ie more than 5 days) will also affect his motility.
The morphology is a bit less important if his count and motility are high as 1% of a lot of sperm is still quite a lot.
Get him to take well man type vitamins -and avoid protein shakes if he is exercising a lot - we have seen some patients where these shakes have affected semen parameters.
Hope this helps

Thanks.
He abstained for three days before. Is going to try two days next time.
Would they have only checked the morphology of the living sperm?

We worked out that on his current count and morphology and motility he has 50,000 fully functioning sperm! Which sounds loads but apparently isn't... I was concerned because I have read that lots of dead sperm can block the way of the living ones.

If the second result is the same would we likely need icsi?

Thanks again

It is well man he is taking but only for the last few weeks so it'll take a while to show. I've also got him some fertility blend to try. He's 38 by the way.

Yes it can although it depends on the cause. DH's first one showed 0% rapid . It improved a but with a zinc supplement and reducing drink but it was low enough that they did some blood tests. In his case, he had very high prolactin levels. A scan eventually revealed a growth on his pituitary gland - long story short - growth secretes prolactin, prolactin depletes testosterone, low testosterone = poor swimmers. He started on a medication and within 3 months his SA was towards the lower end of normal. I got pregnant within 8 months of him starting the meds.

Obviously you say they're going to repeat the SA but I would push for them to check his other bloods as well.

By the way, we were told even if his SA didn't improve we would be candidates for IVF because they could 'spin' the sperm to get the good ones out!

The consultant said "as long as some are swimming normally we don't worry" which appears to have been a lie and he didn't even mention the morphology!

I think we are struggling because the nhs is reluctant to do anything for us. But I wish they'd just say "look it's never going to happen' and then we can look at self funding, rather than 'you have one child you should be able to have another.' Which is what they said to dh. Also dh is a bit half soaked and tends not to push them. It drives me up the wall!

They check the morphology of all the sperm - the stain stops the sperm moving anyway so you can't tell which were moving.
If the results were the same again then in my clinic we would do ICSI. I don't think any of our doctors would say results like that were OK, sorry.

Thank you. I'd rather know than not...
Would the morphology be affected by the cold conditions and delay in analysis? Or only the motility?
From what I've read it doesn't seem lifestyle choices affect the morphology that much. It seems to be DNA related or infection or injury etc... So I can only assume that we must have been exceptionally lucky to conceive first time round so quickly.

And sorry to be a pain but can I ask if you ever see wild differences in sa from one month to the next? Or if it's as bad as dh's is that pretty much it?

My consultant said smoking and drinking is directly linked to morphology and has advised my husband to give up both. He said Wellman Conception is the best on the market.

I've also heard pine bark extract can help morphology. They sell it in Holland And Barratt, it's called pycegenol.

That's interesting twinklestar. Information seems to vary so much! Dh was drinking too much really, for quite a while and especially around December / beginning of January. Wasn't smoking that much but anything is too much I guess! He is very very stressed at work which may not help but not sure what we can do about that...
He also had a bmi of 32, he's been running loads and eating healthily and it is now 25.6 so much much better.
We will continue with the wellman and try the pine bark too. Worth a shot! If push comes to shove we will look more at Icsi but I'm not 100% convinced we would go for it. I don't know... I suppose I don't know enough about it really. And obviously it is very very very expensive and we may still not get a baby at the end of it.

When DH had to supply a sample for SA we were told he had to abstain for between 72 & 120 hours prior to production. We also had to keep the sample warm (so he put it in his shirt pocket) and bring it to the lab within an hour.

He said he's never gone from bliss to mortification so fast in all his life.

Ha poor dh!
Still it's preferable to the hsg and dildo cam in my opinion :-)

We were told to abstain 48-72 hours but nothing about the temperature. Consequently I shoved it in the glove department, got lost, got delayed, couldn't park and took about an hour and twenty minutes. And not sure how quickly it was then looked at so I guess could have been an hour and a half or more. But whilst that may account for the motility I don't know if it would affect the morphology. I wouldn't think so but don't know for sure...

However if the results come back just as bad next time I think basically we're screwed! It's been completely out of the blue. I was prepared for conception to not be as quick as with ds as we are older and were very lucky with ds. But I didn't think for one moment that dh would basically be infertile which if these results done improve he pretty much is. If anything as time went on I thought the problem might be with me so we are both pretty stunned to be honest. Especially as the results weren't even borderline. They were catastrophically bad.

I almost can't be bothered trying too hard this month as figure our chances are pretty much zero! I certainly won't be using opks or symptom spotting!

That's when it will probably happen - if you believe all the stories!

as cynical as I am about the 'just relax' approach, I got pregnant in a month when I ditched the charting and OPKs....

The time delay may well have affected the SA. With DH's first one, he got there within 15 minutes but it took them 80 minutes to analyse it...then DH was accused of not getting there quickly enough and spoiling the sample! So if you can get there quicker next time it might show an improvement.

Sorry for late reply - they don't let us mumsnet at work!
The cold and late arrival won't affect the morphology only the motility.
Morphology is really a measure of how well the sperm are made. It is also quite subjective and the 'strict' criteria clinics are meant to use now is a bit of a nightmare to be honest. When I first started in the field we used to report normal forms of 40-50% but with the 'new' criteria you rarely see anyone with anything as good as 10% normal forms - it isn't the men that have changed it is the way they are measured. We only use morphology on its own when we see

Dh had below average sperm morphology first test. Six months later it was totally normal. Told it was probably a cold or an infection we hadn't noticed.

Freelance - my OH's morphology was 1%, then 2% with some lifestyle changes. Will cutting out booze and fags and taking wellman and pine bark help?

PS what would you class as normal?

Thank you so much freelance you've been much more helpful than the consultant who basically said you've got one child so go away.

Stuff I've read on morphology seems to question how important it is as long as other factors are normal. So hopefully if our motility improves and the morphology comes up a bit (WHO say 4% and above) we might be in with a chance... I'm trying to be optimistic and succeeding about 1% of the time - the same level of normal spermies my dh has.

Dh also told mere thinks he abstained for about six days before hand in the hope of boosting his sperm count. Idiot! So possibly the sperm count was higher but they had all given up swimming.

Thanks again. We are taking another sample in the end of next week. I fear if it's the same dh may go out and get very drunk with the view that it doesn't matter if his sperm are drunk or not!

Din't worry dp was diagnosed with low sc we conceived first time on icsi, unfortunately lost twins, he was stressed the second time due to financial worries, we sold our house and moved then we got pg naturally so I think the sc has improved.
The worse thing he can do is stress.
Btw my dp usually gas a pint after work and it did no harm, seems like stress is tge msin concern
Good luch x

Glad you fell pregnant naturally in the end Jools.

My dh is stressed a lot, this past few months his stress levels have rocketed due to work issues. Not sure that'll change any time soon.

He was drinking much more than the odd pint, worked it out and shockingly it was at least twice the recommended amount. Some weeks more like three times. So even if it doesn't help us have another baby at least dh will be more healthy, it couldn't have been doing him much good really!

My dh's stats were very similar to yours and gp didn't seem worried. It took us a year but we're now pg. I'm still convinced that the real issue was my thyroid, not the male factor.
If he has good count then he has zillions of swimmers. Which means 1% is still millions. Also I was told clearly to keep sample warm so the fact you didn't Im sure could have affected it. Hope the next sample is more encouraging.

Thanks, that gives me hope!
I am praying that the cold and time delay affected the motility and if that is better and the morphology improves a little through lifestyle changes we might be in with a chance! It seems like a lot of what ifs though. Should no more next week hopefully after the second sa.