First Fertility Clinic Appointment Tomorrow

[dogmam]

Me and my partner have our first appointment with our fertility clinic tomorrow!

We went to the GP after a year of TTC and after 21 day bloods and partners SA, we were referred straight away to the fertility clinic. GP tests were in October/November so it's moved along quite quickly so far.

Feeling slightly nervous but also excited to hopefully get some help! My partners SA showed low motility and morphology so I assume that will be discussed..
What else should i expect from this first appointment? Is there anything I should be asking?

Thanks in advance! I'll update this after the appointment tomorrow as I know there are a few others on here who are in a similar position and might find it useful.

I don't know if these are of interest to you @dogmam (or your DH) but we've been listening to them while we've been away and it's interesting to hear what the doctors have to say on this topic, I guess.

news.sky.com/story/spermageddon-could-men-be-infertile-by-2045-12267743

agoraclinic.co.uk/sperm-sex-sport-and-supplements/

www.thefertilitypodcast.com/rich/

FYI my understanding is a "cycle" includes all FETs too. I'm looking at Access fertility packages because they include unlimited FETs and that might work out better value for us.

And this was a good link on "rounds" or "cycles" of IVF I read the other day. natalist.com/blogs/learn/what-does-a-round-or-cycle-of-ivf-even-mean

@dogmam I'm about to have a shower and then I'll put my feet up! Sure I deserve it....
@thislittlebird we only get 1 round too here. Which is shite if you don't manage to get any eggs frozen at the same time! It does seem unfair. Our nhs doesn't do it there, we have a choice of 2 clinics to be referred to. So if it doesn't work I guess they've got your info if you decide to pay for a further round, which will save a bit on the faffy stuff. But it's not ideal at all.

@thislittlebird I haven't listened to the 2nd one but the spermaggedon one is interesting. She's basically saying a count of less than 40 million is very bad. Our SA only has a lower reference range on which is 15 million. Ours was way above that at 29 million, so I assumed ok. But then actually is it? When you combine that fact with the low motility problem we have. That then seems pretty bad! No wonder we have issues!

@paintfairy what was your DH’s motility?
You need to take all the factors into consideration rather than just count for sure and they like men to have 33-46 million + (from what I recall) overall and 15 million per ml. My husband has loads more but they’re mostly duffers . He had 48 million per ml where they only wanted 15 million per ml, but it’s irrelevant when he’s got such low motility. His 124 million count at his last SA gets dragged down to only 9% of that number swimming right, then only a couple of percent shaped right, and less than half of those alive 😔.

I think she was saying it’s declined generally to the 40 odd millions, wasn’t she? Over the last 40 years? It’s a couple of days since I’ve listened to it. It’s such a huge issue that we aren’t really talking about as a society in general.

I don’t know who would do our IVF here, maybe Guys or Kings, or private, really not sure. I’m just really hoping they let us have our one nhs round.

@thislittlebird yes she said from 60 its dropped to 40 million, and if it does lower than that, there's a big problem. Although I'm not sure if she's talking total count there or per ml? My DHs first one was 25% motility and 29 million/ml and 2.7ml. Other figures ok but progressive motility was also under average.
I never saw the second sample results but the motility on it was 35% she told me, so better than 25% at least.

www.reddit.com/r/maleinfertility/comments/kf1jju/how_to_read_your_sperm_analysis_results_what_does/

This one is interesting too - that basically says donor counts tend to be in the 80-150 million/ml and to be very worried if below 20.

@paintfairy it just blows my mind that I’m only hearing about this huge sperm decline issue now we’re having to deal with it.

I think she must mean the total number in a sample because the current parameter per sample is 33-46mil so it must have declined from 60 odd over the years.

This is the thing, I don’t think GPs seem to understand semen analysis results whatsoever based on their responses to ours. They must see a number tick a box and then say that’s fine when it really isn’t when you start to break it all down.

Well, I’m glad my DH is beating the donor numbers I guess lmao. Now I just need to get his quality up 💪.

The person I spoke to on here who works in the field suggested investigating it because it could be something we could improve. Part of me is in a rush and wants to crack on, but the other part of me understands the logic of spending some money to get him checked out while we’re waiting and aiming to get the best sperm quality from DH before we start IVF or ICSI.

Thanks @Juno231 I’ll check it out

Oh no you said per ml, so he’s not beating the donors but he’s not doing terribly either on the count front. Just the shape and movement that’s the issue.

The donor guy at the start of that Sky link...just wild, what a job to go round providing your sperm and taking 35 supplements for day for your “work”.

God we might as well give up now. 🤣 Why are the nhs ranges so low then? Making out over 15milliin/mil is fine?
And getting it better is definitely worth doing but that's hard when the clinic etc tell you it's fine?! My DH is under the illusion his is fine because its in the ranges. But I really don't think it is?!

I know 😩 @paintfairy. I feel so annoyed that they told us it was fine and then a private fertility person said it wasn’t fine. I think they tell everyone it’s fine 😂

NHS follow WHO guidance afaik but they don’t seem super interested in sperm counts because it’s either “fine” or straight to assisted conception. You only need one and all that but....we can’t get that good one through 😔

Ok this subreddit is interesting @Juno231

@thislittlebird our second one was all in the normal ranges but I'm not sure the nhs ranges are really that correct at all?

I guess they’re WHO guided which is fine but....a bit low???? Check out that link @Juno231 shared @paintfairy and compare it to your DH’s results. I think they don’t really worry about the men’s sperm much at all really because they send you off for ivf.

@thislittlebird right? Tbf I love reddit so I'm partial.

I get the impression that the WHO numbers are almost the bare minimum? God knows.

I haven't checked the previous links but I thought the decline in sperm over the last however many decades was well known? Something to do with all the female hormones in our drinking water due to our use of the pill? Sounds crazy now that I think about it. But hey, built in population control right? 😅

@Juno231 I love reddit too!

Yeah certainly looks like the numbers are bare minimum.

I can’t say I knew anything about any of this male fertility decline thing and no one I’ve mentioned it to since finding out has known either. Especially not the 60% count decline stat. According to doctor on the sky link it’s likely more to do with the infiltration of plastics into everything in the world everywhere. From the polar bears to the bottom of the sea, adding extra hormones into everything.

Obviously it’s likely a number of other things too. It was an interesting listen.

@thislittlebird yeah that's just depressing. 🤣 I've spent ages thinking its my shitty eggs and reading that I'm not so sure! I mean- yes it only takes one. But? I suppose ivf technically will work. But what's the world coming to when people can only conceive that way? Its ridiculous!?
@Juno231 DH has been spouting the water issue for years. He won't drink tap water. But she doesn't really blame it on that on that link.

@thislittlebird thanks for those links, I'll listen tomorrow and thanks for the info on how the rounds/cycles work, it's much more clear for me now. I'm in the North East, pretty much all CCG's here offer 3 rounds, so really lucky.

It is crazy how much the parameters have changed in terms of what is considered 'normal', when it comes to sperm.
Out first SA breakdown said the Total number should be anything over 39mil, and we were pleased to have a huge 113mil, so didn't think too badly of the 15% (progressive and non-progressive). But now this time around, the Total is just 21mil with 2% motility, so a huge difference.

Does improving the sperm ready for ICSI make a difference though? As if they are picking out the 'good ones' anyway and injecting the egg, then as long as there's enough for them to do that, then does it need to be improved?

Really lucky, I wish it was us, I’m shitting it tbh about how many rounds we could need 😬. A good reason to try to boost his sperm/fix issues.

Someone on here in the field told me (and I can DM you what she said if that’s useful) that essentially you should try to improve them as much as you can because it will improve their (the embryologist) chances of picking a ‘good’ one. I guess they’re just using their eye and don’t really know which motile, correctly shaped sperm would get there so it’s helping them a bit???

She also suggested trying to improve it and if it gets up sufficiently going for IVF not ICSI so natural sperm selection can take place and the best one will get through. But this is the sort of stuff I need to have a good think about really, and we have a few months to work on his SA, get some tests to see if anything is going on we can fix and decide nearer the time.

Has anything changed for your DH in that time? Seems like a big difference from one result to the next.

Sorry forgot to @ you @dogmam

Although I guess that’s where the 50/50 ICSI IVF split is useful for low motility.

I started listening to the fertility podcast (third link) one earlier and just listened to a bit more now. I think we’re likely going to book the husband in with this doctor on the podcast episode since we have some time to wait still.

@paintfairy sorry missed your reply last night. It’s super depressing. And humans only have ourselves to blame 😭.

It’s probably useful to think we all need some help I guess and help our bodies as much as we can??? I’m super torn over supplements generally and whether they do much but I guess time will tell with his SA.

@thislittlebird mine takes wellman conception. I take things too. I suppose its just knowing what really helps and what doesn't? Everyone has a different opinion. And some of the man ones work out at £70 a month. Which is a lot of money if its not even going to work. If you knew it would, you might be more inclined to try.
And yeah people have themselves to blame. Well, not always directly, but I do think there's just a lot to be said for the whole thing generally. Pollution, chemicals, pesticides, GM everything, crap in water, technology (WiFi, Bluetooth, anything else sending invisible impulses thorough the air). It all adds up. And it'll be too late by the time they decide to do anything about it.