Ivf or explore male factor infertility further??

[closephine85]

Hi all

DH and I are struggling to make the leap to Ivf and I was wondering if anyone has any experience of exploring male factor infertility a bit further with a positive outcome?

For background, we have a 4 year old ds conceived naturally after 6 months. We have been ttc another for 2.5 years now and it's taking its toll on me mentally. We are now at the point where we need to make a decision/take proper action ourselves.

I have had all the tests including AMH and lap and dye, no issues have been found. DH has had a number of semen analyses - the count has varied between 2 million and 14 million, morphology 2-4%, motility I can't remember off the top of my head but I think it was ok and volume between 1-2ml. His testosterone levels are normal, but the lowest normal (10, I think, if that sounds right?), he has had an ultrasound, nothing was picked up apart from a very small cyst they said would be causing no harm. Our dr did point out that he has large testicles/they have good volume.. so perhaps something is obstructing his semen getting out. The Drs however are all gynecologists, no real male factor expertise.

We now need to decide whether we spend a significant amount of money trying to fix something that may not be fixable. Or bypass and go for Ivf with icsi.

I am struggling with the idea of Ivf, putting myself through all that when we have our DS. I just don't know if I have it in me. Plus we worry that if DHs morphology is so low, it may not work anyway.

I guess what I am asking is, what would you do? Investigate further or attempt to bypass with Ivf.

Sorry should have added - DH is fit and healthy. Doesn't smoke, has barely touched alcohol since ttc and has been taking all the supplements under the sun for the last 6 months but we've seen no improvement.

Hi, your best bet is to ask to be reffered to a urologist. They will be able to look into it more.
My DH was diagnosed with Azoospermia and we have been reffered to a urologist.

Thanks MrsH - I don't think we are going to be offered a referral where we live, we are going to have to explore it privately. I think because he has some sperm, the general view seems to be to bypass/look over the issue.

Hmmm that doesn't seem right. We are not entitled to ivf on nhs but my DH was still referred by Gp go urology for investigation based on his semen analysis. Have you checked your ccg policy? It's worth doing as my gps didn't know what they could refer us for so I got the policy directly from ccg and took it to my Gp appointment.

We have male factor infertility and have been referred to mr Ramsay who is considered the best in male factor fertility. You can also see him privately but the costs could mount up quickly. He has been excellent. He is of the view to explore and investigate properly before proceeding with ivf which I agree with. I would say though it's a long process. My husbands hormones are normal but Ramsay has prescribed tamoxifen to see if this increases his count. So we're trying that for 3 months them back to see Ramsay. It is a long process so you have to be patient which is so hard sometimes but ultimately if it avoids ivf or Icsi then I think it's worth waiting. But that's just my view.

My husbands sa showed very low count and poor motility but not zero. Many ivf clinics also just said go with Icsi but they aren't male fertility specialists so all they are looking at is how to bypass the sperm issue and get a baby. My general view, having been to many Ivf clinic open days, is to remember they are selling a service so are unlikely to tell you to try things that would mean delaying them getting their money!

Thanks MrsDarcy, we have been thinking about contacting Dr Ramsay privately. Unfortunately although I live in the uk, we are not nhs so things work a bit differently. I think we could perhaps push for a urology referral here but I'm not sure how helpful they would be. I am keen to avoid Ivf if at all possible and am only 30 so have a bit of time to explore the other options.

If it helps then out Gp referred us to a local urologist . He did a few basic tests and then he referred us on to Ramsay. I thought the same as you, that the local urologist won't be all that helpful, and in a way he wasn't but he did refer on to Ramsay so although it was a Long way round it saved us a lot of money. However, if you aren't nhs then you will be paying anyway so you could just contact Ramsay privately. The drugs he's prescribed are not expensive, I think it was £11 for three months as they weren't available on an nhs prescription. So it may not work out that expensive, especially as you have already had uss and bloods. Ramsay didn't ask is to repeat these so that saves money. The only expensive thing will be if he suggests surgery. However, he has said to us that would be last on his lost to try as he likes to try the least invasive ways first - complete opposite to the ivf clinics !! Good luck. Ramsay was so reassuring and kind. If you can afford it it's well worth seeing him.

Thanks so much for your help, it's reassuring to know that someone out there might be interested in finding out why DH is experiencing these issues. I have sent Dr Ramsay an email this morning. I don't suppose you have a phone number for his office? The one I found on the London clinic website just rings out. No answer phone or anything.

That's the only thing I found, when trying to contact his private secretary it was pretty difficult.

I had this number .. 020 3311 7669

Thanks - that's a different number so I'll give that a go today. No response via email as yet.

Given that you have no issues identified and your DH has a few million sperm, I would recommend taking the leap and getting the ball rolling now with IVF. By all means carry on with investigating ways of improving and increasing his sperm. Our urologist recommended proxeed plus, you can buy it on amazon. It's the zinc, vit c and co-enzyme Q10 which are generally considered important for sperm and proxeed contains it all. Also he's had an ultrasound scan which showed no blockage so nothing to do there and his hormones are within normal limits so nothing much else to do there. I don't know if theres much else a urologist would do.

My story is TTC since Jan 14, DH had a sperm test via GP which showed no sperm. We suspected this as he was born 2 months prem and had an undescended testicle which wasn't operated on until he was 4. We were referred to Liverpool womens fertility serviced. Their sperm testing is much more in-depth but only found a few sperm over 6 samples, like literally 3 or 4, usually dead. Not enough for IVF or even ICSI and they didn't survive the freeze thaw process so it's not like he could just do 50 samples to get 10 decent sperm. This was all jan to may 2015. So then we were referred to urology. Blockage found in the poorly testicle. Both small with low volume. Not worth operating on as the other testicle should be making sperm fine. But it wasn't because he has high FSH so Clomid wont work and low testosterone at 7.2. So we were put on waiting list in Sept 15 for a micro tese where they open the testicles and look for sperm and take a few biopsies to check under microscope. Because they wouldn't survive being frozen we has to plan a fresh ivf cycle. I started long protocol drugs end of Jan this year, no prob with the drugs and stimms, he had the micro tese op the day before my egg collection. Sadly they didn't find any sperm. The next day they did find 3 non motile sperm and I had 10 eggs collected. They icsi'ed the sperm into the eggs, one fertilised and I had it transferred 3 days later at 6 cells but it didn't implant. Sadly our journey is over now as repeated micro teses are not recommended. But hey! Cheer up you! You've got millions of sperm and given time the odds are in your favour x

Hi Laura

Thanks for sharing your story, so sorry to hear it's the end of the road for you. That must be incredibily hard. What's next for you if you don't mind me asking?

Thanks for your advice. We may well end up taking the Ivf road, but we are going to give it a go with Dr Ramsay and see if we can get anywhere. Given that time is on our side, if we can play the long game and maybe increase his count and the chance of a natural conception then we think it's worth a try.