TTC - low AMH, low AFC and OH with Oligoasthenoteratozoospermic

[CDiamond]

I am gutted by recent findings and figuring out what to do (ie. whether to start IVF and when). All experiences and advice/thoughts much appreciated; could really use the support right now.

I am 35, TTC naturally for 6 months now. I wanted to start 2 years ago but OH wasn't ready and infact was recultant to have kids at all (he did want them before and was changing his mind). We worked through those issues with couples counselling, etc and in the end he was happy to start trying (6 months ago). Given my age, having not concieved naturually for 6 months, i decided to do some tests this month - sperm analysis for OH and AMH+AFC for myself.

Results:
OH sperm analysis - Oligoasthenoteratozoospermic. This is all 3 issues - low count, low motility and poor morphology (1% regular form). This was devastating news.
My results - AMH 4.1 and AFC showed 7 or 8 follicles

Doctor says we could keep trying but given OH's results combined with my age and ethinicity (apparently women of different ethnicity have different average menopause age and therefore what is considered good with respect to AMH, etc is different), he thinks IVF with ICSI is good route for us. He has ruled out IUI due to OH's sperm results.

I am upset and just processing all this. The journey has been so tough even before TTC, with OH dragging his feet, etc and now whilst I can see the obvious next step is IVF, I am worried again as to how OH is going to react to all this. We haven't discussed it yet since we left the Doctor's office. I am longing to be a mother and have a family but everything seems to just go against it. I despair.

Sorry if this is a bit of a rant. Apologies.

And to add.. I have been on supplements for a few months now (multivitamins incl. folic acid + D3 + C + 3 fish oil) and have cut down booze and caffine.

After seeing the sperm analysis result, OH is also on a supplement regime now and has also cut down booze and caffine (Multivitamins incl. folic acid + D3 + C + 3 fish oil + Coq10 + L-Carnitine + Ashwagandha).

@CDiamond Im really sorry, this is tough news to absorb, especially with a partner who has dragged their feet re having children because this makes it so much harder. It's no longer just sex at the right time but it takes over somewhat.

It's really great that you're both on supplements now and tbh getting the man to do this can be so so tricky so I feel that's a big hurdle overcome. Same with the fact he has already produced a SA... so well done.

How low was count and motility?

Your AMH is low, but your AFC isn't a disaster and this shouldn't impact you conceiving naturally. There are plenty of people who conceive naturally with a lower AMH. I think what this does tell you is don't hang around for too long... have you had your day 3 and day 21 bloods too? Do you think you ovulate every month? Annoyingly no one can say how quickly your AMH will continue to decline.

The difficult thing with sperm and supplements is there are just no guarantees and there are so many options re supplements that this bunch may not work but a different one might (sperm also takes 72-90 days to show improvements). Definitely be really strict with lifestyle improvements. 1 coffee a day, share a bottle of wine a week, no tight boxers, no cycling, no laptops on the lap. Did you OH have a physical examination to check for things like a varicocele or do a urine sample to check for an undetected infection? These things can impact sperm quality.

IVF with ICSI is what I would expect you to be recommended.

Just to give you some background, I have a higher AMH than you but also deemed low for my age. My OH had low count and 0% morphology. After 5 months of lifestyle changes and strict supplementation we conceived naturally and his SA was much better but still borderline on the count front. It took 14/15 cycles total but we got there. Sadly so much of TTC is luck and you'll find a million different scenarios and some get lucky and some just don't. No one can tell you which you'll be so you need to think carefully about a timeline and ask yourselves; how much longer do we try naturally whilst improving your 'health'? Best of luck x

Thank you so much FlyOntheWall89! Its reassuring you conceived despite similar issues. For us, I just dont know if its worth trying naturally for much longer; my fertility is going to decline the longer we go. I am thinking of going the IVF+ICSI route but will have to discuss with OH. I am so worried he is going to go down route of not having kids again.

No I havent done day 3 and day 21 bloods; I have tracked cycles though for 6+ months and do ovulate every month consistently and my cycles are predictably about 29 days.

OH's results:
Count - 5 million per ml (volume was 4.6ml so total count 23 million)
Normal morphology -1%
Progressive motility - 23% (so 23% of 23 million being 5.2 million and if i assume even distribution, then 1% of the 5.2million with normal morphology, which is 52,000)

We could be look at just c. 50k sperm that is progressive motile as well as normally formed. :(

Yes the doctor said same as you that there is no guarantee with supplements; that it can't do harm so can take it but may not do much. Yes, we are making the lifestyle changes; OH is doing dry Janaury so completely no drinking and will be very restricted thereafter. 1 cup of coffee and he always worn loose boxers, etc. Very little cycling or laptop on lap. He hasn't had varicocele or infection checks but one thing that came up was 'undescended testicle'. OH was born with 1 testicle undescended which they corrected/pushed down with a surgery at about 2 years of age. Apparently that can be damaging to the fertility of the testicle in question and Doctor thought that may be the reason. That only 1 of OH's testicle may be fully functioning and the other one (undescended one at birth)impaired. Apparently these days babies with undescended testicles are operated on between 6 - 18 months and the view is it so it as soon as possible. OH was upset his parents had never warned him (I guess we will never know unless we ask his parents if they knew/were warned by the doctors at the time - unlikely we will ask as its irrelevant, anyway.....).

I am thinking of trying to get NHS referral for a Urologist, to try and do more tests for OH in parallel such as testicular ultrasound, DNA fragmentation, etc.

@CDiamond okay ye his numbers are a little lower, but not that far off what we had before supplements and lifestyle changes. Combined with your AMH etc, you should definitely create a quicker timeline.

Yes undescended testicles are a classic one for problems sadly. For any referral to a fertility clinic you'll need to go to the GP for day 3 and day 21 bloods, both of you need an STI check and a sperm analysis. Those are the boxes you need to tick for a referral. It's very unlikely you'll get a referral to see a urologist- I've never seen anyone being able to do this but you could try. There are very few around and I would expect that if they can do that, the wait would be far too long. We paid £280 for a private consultation in London, but the top guy we saw is on sick leave I've read. The NHS don't do things like DNA fragmentation - the treatment for high DNA fragmentation is IVF is what the fertility time so it's a pointless test when you'd already qualify for IVF. You can do it privately but tbh, it's an extra stat that you perhaps don't need.

Hope this helps and pls update if you get anywhere. Keep trying, I know it feels hopeless but where there are still thousands of sperm, there is a chance even though it's low each month. X

Thank you so much FlyOntheWall89!

Yes Doctor said the same re DNA fragmentation; that it was not really needed in our case and that he'd rather genetic test embryos as part of IVF. I am just on hyper solutioning mode and thinking of everything right now; I will clam down. I do know deep down that I just want to get started on IVF say in March (so 1 more natural cycle after current one.. just to lose a bit of weight, embed lifestyle changes and get healthy for it). Will see if I can get OH on board; fingers crossed. Private or NHS, whatever is quicker; the private consutant we saw this week was lovely so probably it'd be the quickest route.

Will keep you posted. x Thank you so much (hugs).

Hi @FlyOnTheWall89 we've been approved for 1 round of NHS IVF... i am torn between waiting a few months and perhaps getting lucky like yourself, or just going for it now. I am leaning towards going for it now.. in March. I am not sure what more lifestyle changes we would make. We're taking supplements (since first week of Jan so in March it will have been only 2 - 2.5 months rather than 3) and have cut down booze, caffine.

@CDiamond great to have already got the approval. Have you had a hycosy or been suggested to have one? Have they said you could book in your nurse consultation or have you had an explanation re which protocol you'd be having? For example, if you do long protocol, the whole thing takes quite a bit longer and I'd assume with a low AMH you'd be recommended long protocol. Remember that you could get to the point of egg collection after 6 weeks of injections and perhaps not be ready for one reason or another for a fresh transfer so you'd have to wait a month or two on top of that and then get a transfer so all these months and week add up.

If I were you I'd probably book everything in.... you can still be trying even when you've started taking the injections. We had had our nurse consultation, I'd scheduled the day of my first injection and my baseline scan was booked.

@FlyOnTheWall89 No mention of Hycosy, etc. They did a 3D scan the other day and they were happy with the AMH and SA we had alreayd done privately. Next steps is they want to do a nurse consultation, some blood tests and baseline scan on day 20; these have all been booked in the diary for Feb (as I just started a cycle 2 days ago). My understanding is all of this will be completed in the next 2 - 3 weeks and they mentioned medicines arriving by post; presume in the appointments they will tell me how and when to start taking them (from next cycle which will be due 28th Feb or soon after). They did not say anything about long or short protocol; what is that?

Althought my AMH is low, both the private consultant in his scanning and the NHS consultant in the recent scanning said I have more folicles than thwy would expect for my AMH of 4.1 (they said they would have expected to see about 4 but they could see 7 or 8); they also thought womb lining, etc looked good.

Yes we still have current cycle to be trying ourselves and will do.

Just to give you a bit of hope. My husband had cancer as a child. After two years of hormone treatment his numbers were: 1million sperm, 60% motility and less than 1% morphology. We were told not to even bother trying to conceive naturally - the chances were less than a couple of percent of it ever happening.

On starting IVF we found my AMH was 5.3 and my AFC was about 4. We decided to do a couple of rounds before transfer to have enough for two kids as I was 32 then and thought the eggs would be better quality than trying for a second in a couple of years. We did two rounds. Between them we got 13 eggs retrived, 7 blasts and 5 passed PGT testing and were graded 6AA or 6AB so amazing quality.

We went for transfer and i stopped responding to the meds. no idea what was going on so cancelled the cycle. turned out what i had thought was my period was an implantation bleed. I was pregnant with fraternal twin. We lost one at 10 weeks but the other is a thriving one year old now!

AMH has very little baring on ability to conceive month to month. The sperm is more of a concern but hope is not all lost.

Hope that was helpful. Please speak to a reproductive urologist as there may be things you can do to help there

@CDiamond that sounds great timeline wise. I can't remember if you're going privately or NHS - presume NHS as you said about funding.

The hycosy was recommended as the last thing to tick off to see if we could conceive naturally as although the scientific research is limited, even the doctors / nurses in the hospital said you've got a better chance after the hycosy even if you've got clear tubes. We conceived the cycle after.

You should definitely know if you are doing long or short protocol because there is quite a big difference in terms of injections and timeline and the amount of 'medicine' in your body. Better to google it for specifics. I actually read Big Fat Negative on holiday in the April before we were due to start - super digestible and easy to read, would really recommend it.

Remember you can ask to start a month later - don't feel pressured to start right now just because the funding has come through. We were told the funding lasts for a year so we just needed to start within that timeframe. X

@Bells3032 amazing story thank you for sharing. Curious - how can you get naturally pregnant if they have collected all the eggs out of the follicles? Was it bauce you had a gap of a cycle (or more) between your second collection and FET?

There was a gap between our second round and the transfer. Got pregnant in the month I'm between

@FlyOnTheWall89 You are right. We could take some time given its all such new news and we are rapidly progressing into IVF. Equally, I am getting (and feeling) older; I have had an awful couple of years with various life issues. I guess I am rushing it because I guess I am (stupidly) clinging on to the pregnancy being the kind of good news that will lift us out of the gloom.

Alao, OH didn't want kids and finally came around for this to then happen. I also worry he might change his mind again if we spend several months plodding away at it again.

@FlyOnTheWall89 yes its NHS...

@CDiamond once you have the eggs collected and you've made embryos, I think this must take the pressure off somewhat ... obviously we didn't get to that point but with friends I think it allowed them to suddenly believe it was all possible and this sense of urgency dulled down. Not sure what the hospital would say if you delayed a transfer to give yourself more time, I guess you have every right to do that. Plus then the AMH / age thing is behind you as you'll have your frozen embryos.

@FlyOnTheWall89 yeah that is a good suggestion to bear on mind. Its NHS though so not sure if they'll allow me to delay my trasnfer without their asking me to do (eg. if something isnt right and they ask me to do FET later). They have already said ICSI may not be needed (will decide on the day) and PGTA not needed. The private consultant we had seen had said we would need ICSI and PGTA so a bit concerned about the differing view of the NHS consultant.

@CDiamond with his current numbers you 100% will need ICSI but yes if for some reason they've improved, they can literally decide in the moment not to do ICSI. I wouldn't expect you to need PGTA though... you can call and ask for sure as I'm sure you could delay in between but tbh once you've done all the jabs and made the embryos, you may just want to get on with it... and again, your notes should specify if you're doing long or short so just call the nurses.

@FlyOnTheWall89 I rang - short protocol with high doses.

How are you getting on @CDiamond hope everything is working out well whatever way that looks like xx

@LAURAPAX - Thank you for the message.. we had a failed round in March.. that plus various arguments during that cycle just totally broke us. We took a break and are now hoping to do a round again this month. Baseline scan last week showed a post ovulation cyst so they want to scan again on day 1 to confirm the cyst is gone and that we can start.

@CDiamond hello, I’m just catching up on this thread. How did round 2 go? We are doing round 2 next month.

@Blossomofhope - 3 rounds have failed now; taking a break. This is a tough tough journey.

@CDiamond Ah im so sorry. It sure is.