Urologist in London

[beachbum85]

Hi everyone,

My partner and I just received our file back after our failed ICSI cycle and it turns out there was a huge drop in embryo quality between Day 3 and 5. We were told it could be a make factor issue and are looking to see an andrologist privately while we wait for the NHS follow-up.

Any recommendations either than Jonathan Ramsay in London? We've read that he's the best but he does have quite a long waiting list, so I was wondering if there's anyone else who's good and who you might have had success with.

Thanks!

Suks Minhas was recommended by my clinic, he was very helpful with my husband.

www.londonurologyassociates.co.uk/suks-minhas

Thank you very much @Porridgeislife :)

I think there’s another guy at/connected to the Lister called Mr Tet Yap.

I’m talking to Mr Ramsay’s secretary at the moment to get an appointment booked in and the wait time doesn’t seem that bad, but I haven’t heard from her in a few days now, hopefully will tomorrow.

Thanks @thislittlebird! Hope you hear back soon!

I’ve heard really good things about Ms Pippa Sangster. She works at UCLH. My friend is seeing her through the NHS. He was also booked to see Mr Ramsay but managed to get an appointment with Ms Sangster first. We have seen Mr Ramsay and he is lovely, but if I’d had my time again I would have wanted to see Ms Sangster as she has offered things to try that Mr Ramsay didn’t.

www.uclh.nhs.uk/our-services/find-consultant/miss-pippa-sangster

Just saw @lunasunshine's message and it reminded me to say we're seeing Mr Ramsay on May 26th, would be interested to know what your friend was recommended by Ms Sangster, assuming it was for fertility things. It's hard to know who to go to and we picked him because I'd heard his podcast episodes and didn't know where else to go really.

@thislittlebird I felt the same. I think in this ‘male infertility world’ there are a few big names mentioned time and time again, and obviously you want the best treatment and care (and outcomes!) so that’s who you go to. I will say that Mr Ramsay is absolutely lovely - he will listen to you carefully and he really cares about his patients. From my experience, he is very good at working with low sperm counts/infections etc but possibly not the best for the most severe forms of male factor infertility (azoospermia). Obviously I’m not sure what issue you’re dealing with, but I would absolutely recommend him for the former but maybe not the latter.

Ms Sangster recommended my friend take HCG injections to try and make his MicroTESE surgery more successful. HCG is a popular method in the USA and other countries but not used very much over here in males. We were not offered HCG injections with Mr Ramsay, even when the medication that he did try with us had a detrimental effect and we have the exact same condition as our friend. I think Ms Sangster may be slightly more up to date with the latest research into male factor infertility, but of course this is only from personal experience and a gut feeling!

@lunasunshine thanks, useful to know.

Hopefully he'll be fine for us (fingers crossed it doesn't get worse ), husband's count is pretty good but his motility has been low (9% and 14%) so we want tests mostly to see if there's any reason we can get to the bottom of before we venture into IVF/ICSI.

The other reason we chose him is because he works with the Lister and they're who I'm hoping to go with at the moment, just waiting for them to call me back for consultation with a particular doctor.

One of the things he said on a podcast which I suspect is very true is that there's a whole generation of urologists who haven't been exposed to male infertility because of ICSI, and it would explain why there's a few 'names' as such because most people don't need to look into it very much.

@thislittlebird you’re welcome.

Fingers crossed all goes OK and he can get to the bottom of things for you. And yes, I would completely agree with that. Male infertility is woefully under researched and misunderstood. ICSI is wonderful (and personally I would have no hope of ever having a child without it) but it also means that people are using it as a default option instead of trying to really understand WHY the sperm counts are so bad in the first place and what we can do to improve them!

Thanks @lunasunshine!
We need to leave the UK for a while soon (which is why we couldn't wait a few weeks to see Mr Ramsay) and we booked an appointment with a urologist in my partner's hometown. Coincidentally, it's also 26 May, so it would be interesting to exchange notes @thislittlebird :)

I get really frustrated that nobody seems to worry too much about the male factor! My partner's results are generally OK (all good except borderline morphology) but our first NHS round of ICSI failed - we had 7 good embryos on day 3 but no good quality ones on day 5 (only 1 was even gradeable). The embryologists said that although you can't really be sure, and maternal factors could still play a part, slow blastocyst development can be attributed to male infertility... so we thought it's worth at least a check!

@beachbum85 Oh yes, we should definitely do that.

It's so frustrating. I am so worried that when we get to the stage of having some eggs they won't fertilise because no one seems to understand male factor issues at all.

None on day 5? Man, that sucks, and this is exactly what I'm worried about. I have a high ish AMH and I've convinced myself they're all poor quality eggs. Did they say you can have any other tests etc?

Hi all, can I join?
Firstly, I’m so sorry you find yourselves in this position.
We’re seeing Mr Ramsay on 21st May. We found out my husband has Oligoasthenoteratozoospermia, which basically means severely low sperm count, motility and morphology. Also a high % of white blood cells. It’s completely knocked us - as I’m sure with you all, just a massive shock. We thought I was the problem!
When we had the results back we were told we wouldn’t currently be eligible for IVF with these results, but I’m desperately hoping that Mr Ramsay will give us some hope. Until then, I will continue to torture myself on Dr Google.. (why do we do it?)

@Halftime23 I'm sorry to hear that too! I hope Mr Ramsay can help you out and get you to a point where you can try IVF. Let us know how it goes on 21 May! I'm guilty of living with Dr Google too, but I have found the 'Ask the expert' option on the Fertility Circle app much better :)

@thislittlebird we're still waiting for our review consultation, so no advice yet... We had an early blast transferred, but it was nowhere as developed as it should have been and the only gradeable one was a 3CC, and nothing to freeze of course. Quite a shock, especially after retrieving more eggs than I expected for my low AMH, but I don't think there's any way of knowing whether high or low numbers will impact the quality at all, so try not to worry about that just yet! x

@Halftime23 you'll have to update us after you've been! We'll be a few days behind. Sorry you're having to deal with those results, it's hard but at least you're getting some help.

@beachbum85 let us know how you get on once you've had it. I bet it's so hard when you've produced a decent number too. I'm worrying about it all already lol, brain is in overdrive.

@Halftime23 and @thislittlebird how did your consultations go?

We just saw the urologist here and he just told us that my partner's results are all very good and he doesn't see the need for any more tests... even when we explained that we had a huge drop-off in embryo quality between day 3 and 5. So not sure what to think now - great that male factor is ruled out, of course, but confirmation of unexplained is still really frustrating.

@beachbum85 pleased your appointment went well although I can imagine hearing that is quite confusing for you both. I would imagine Unexplained is one of the hardest things to get your head around in terms of thinking what to do next.

We had our appt on Friday. Mr Ramsay was really supportive. Husband had all the test that day, and we have a follow up for test results on 2nd July. Mr Ramsay said 2-3 months of treatment (not sure what, depends on results), work on getting the best quality sperm we can, then hopefully start ICSI in October (ish). We feel more hopeful, but still just waiting really. I’m finding normal life hard to just get on with because I just can’t stop thinking about all of this..

@beachbum85 I guess it's good he thought it was fine. My understanding from an interesting reddit forum I read on understanding sperm analysis was that you can still have DNA frag even with normal count etc so might be worth getting the comet test? I think this is the sub in case you're interested in reading it www.reddit.com/r/maleinfertility/comments/adcxrq/how_to_read_your_sperm_analysis_results_and_what/

@Halftime23 He's really supportive, it was very refreshing compared to my recent terrible gynaecology appointment with the nhs.

My husband didn't have the tests today because he had to go to work, but will go tomorrow. I think we're likely on a similar timescale, but he has been on Impryl for three months already and so far his result got worse but let's see what the next test brings.

We're just waiting too, but he examined DH and said possible small varicocele and that there could be something like bacteria, or the old oxidative stress causing issues so I'm glad we're looking into it now. But yes...a lot of anxious waiting for the time being. He did dictate a letter to the consultant we're seeing next week for IVF while we were there so that was helpful.

@thislittlebird I'm glad you had a positive experience and you have a plan... hope you don't have too long to wait and good luck with the IVF consultation next week. let us know how that goes :)
thanks for that link too! yes, I was expecting him to talk about DNA fragmentation or at least do a physical exam, but it was a pretty superficial chat based on our existing results... very underwhelming to say the least and he's supposed to be an international-level expert. I guess we'll have to see how our next round goes, and if this was an unlucky one-off.

@Halftime23 I'm really glad you had a good consultation too, and that you came out of it feeling more hopeful and ICSI might be on the cards for later this year - excellent news!

The waiting is super tough and feels like it never ends.... but you can do it! :)

@beachbum85 the variation in experience with consultants is frustrating.

Fingers crossed for your next round, I’ll be interested to hear how it goes!

Thank you @thislittlebird! No idea when that will be yet, but I'll come back and update :)
Keep us posted on how your IVF consultation goes too!

"Beachbum sorry to butt in but I have to suggest that you please see a fertility urologist who will consider DNA frag, oxidative stress tests and physical exam. Evaluating these, treating and then going to ivf is the best way.

I've just had a failed cycle in Greece after another failed on in Turkey last year and now going to see a fertility urologist as our embryos arrested after day 3 this time and not so good blast last year.

Thank you for your advice @Delectable! Is this what has been advised after your embryos arrested after Day 3?
I'm very sorry to hear about your problems so far - I hope you get to the bottom of it and get better results next time, if you're planning to try again xx

Yes, we plan to try again and thanks for your empathy. It's a horrid journey. No, we were not advised to see a urologist but I've two cycles I've learnt that one has to advocate for one's self and be proactive otherwise you loose time and money.

It is really tough... and totally agree about advocating for ourselves. It's a shame it has to be that way!
Wishing you all the best... pop back and let us know it goes with the urologist x