New to this, blurry eyed and need advice / experience

[FlyOnTheWall89]

Hi all,

We recently received news of my partner SA.

Motility - well above average
Concentration - just below average
Morphology - 0%

We are devastated. The doctor didn't have any advice or insight so we have been referred but they said it would take at least 3 months, probably longer.

What should we expect next with these results? ICSI? IVF? Can we realistically increase SA results? I have so many questions. How long did you wait for your referral appointment? What other tests might they do?

All my results are deems normal, although AMH is 10.7 so on the lower side of normal and some deem it to be 'low'. All other bloods very textbook.

Both early 30s, no health issues. My partner takes nicotine pouches which I think is probably the cause of these results and whilst he has cut down, he didn't quit by any means. He threw everything away today. Hoping this could help too...!

Any advice would be greatly appreciated.

Hi
So those results actually aren't too bad, even if it may feel like it. Morphology is the least important parameter, it varies quite a bit anyway from sample to sample. My husband's has gone from 2%, 1% and 0%. Normal is 4%, so not too much lower really. It could just be in that small sample they looked at there were no normal forms, but in another sample there will be. If you have a normal (or just below) concentration and total count then you still stand a chance of conceiving naturally. You need another SA first before anything else. Smoking has a massive impact on sperm so this will definitely help. Also no cycling, loose boxers, improve diet, get him on a supplement like Impryl and regular ejaculation (every 2 -3 days).
Xx

I have to agree with @Narwhal88. The motility is good which is important and the morphology is definitely not as important. There’s other factors too but quitting any nicotine products and working on diet, antioxidants and taking things like impryl should help. What was the count like? @FlyOnTheWall89

Thanks so much @Narwhal88 and @thislittlebird a seeing 0% at the bottom of the form was just heartbreaking. Thanks for your insights.

Volume was way above average
Concentration: 8 million
Sperm per ejaculate: 45.6 million (bracketed as 8 ish mill above the figure they give as a reference)
Round cells: too few to accurately measure

To be honest i have had to do a lot of googling because I didn't know anything about any of these different terms and I'm still not sure I totally understand.

He doesn't cycle. He does wear tight boxers so we are switching to loose ones. I'm pretty on it in the kitchen so we have a varied healthy diet of fish, veggies, eggs and grains with a little meat.

Regular ejaculation - on this subject, what is best for conception? Some say every day is newer evidence and some say you can't have sex too often because there isn't time to replenish?!? It's all so confusing.

Thank you again. Xx

@FlyOnTheWall89 male factor is frustrating tbh, my DH doesn’t smoke or cycle or eat badly, he is 40 now and he’s mostly veggie with the occasional piece of fish.

I think if you have a lower sperm count every day isn’t advised. We saw Mr Ramsay and he suggested every day for my DH is fine because he has a good count (180/concentration 48 for example, 124/concentration 47 another time) but very poor motility so they need refreshing more often, they’re not good at swimming. We definitely saw an improvement and I mentioned the morphology going from 2.5 to 8% the other day, but his motility went from 9 to 26% too so we really did see an improvement over six months. But we haven’t tested those improvements with ivf yet, hopefully it’ll be positive.

Is sperm per ejaculate the same as total sperm in the sample? I think so but it’s been a while since I saw these results.

So these are the WHO guidelines

The results of the semen analysis conducted as part of an initial assessment should be compared with the following World Health Organization reference values:
• semen volume: 1.5 ml or more
• pH: 7.2 or more
• sperm concentration: 15 million spermatozoa per ml or more
• total sperm number: 39 million spermatozoa per ejaculate or more
• total motility (percentage of progressive motility and non‑progressive motility): 40% or more motile or 32% or more with progressive motility
• vitality: 58% or more live spermatozoa
• sperm morphology (percentage of normal forms): 4% or more

So 8m/ml is low compared to the guidelines of 15m/ml but still not that bad. The reason the total count is normal is because the volume was above average which means basically there are less sperm per ml. I think you stand a good chance of being able to improve things. Make these changes, wait a couple of months and test it again.

So my husband is under the care of Jonathan Ramsay and he is the UKs leading male fertility doctor, he recommended ejaculation every 2 days. Having sex everyday isn't really needed and could be a bit much. Doing it regularly improves the quality, however by doing this you reduce the quantity of sperm. So your issue is probably more quality over quantity since it is the morphology that is lower. I hope that makes sense! Don't try to worry about it too much though as you stress yourself out planning sex!

@FlyOnTheWall89 you need to get a DNA fragmentation test and if it’s high get a referral to a urologist. You might need to pay for this privately but it’s important. There could be an infection or varicoele affecting the sperm quality. My DH had to have an operation to correct this. Also he needs to go cold Turkey on the nicotine. It takes 3 months for sperm to improve so if it’s going to take 3 months to be referred then you need to have it improved. Put him on a good course of vitamins too - high dose omega 3, vitamin d and something like proceive max. Also would be best to cut out caffeine and alcohol.

We aren’t having sex every day btw @Narwhal88, it’s self administered 😂. Ramsay was happy with every day-ish ejaculation for my DH because of the specific poor motility issue but I think most people is more like 2 or so days as you say. I’d definitely go to see Mr Ramsay if you can @FlyOnTheWall89.

Mr Ramsay ran the dna fragmentation test for us too btw, but obviously other specialists are available!

@thislittlebird ahaha yes my husband is self administering as well but every other day. He hasn't seen any action in weeks now because I've been on IVF meds oops. We also had DNA frag test with Ramsay. We are like a Ramsay fan club 😂

We really are @Narwhal88, the JR cheerleaders lmao. Mine too 👀. I start IVF stims on Saturday all being well, need to see if the improved sperm remains improved!

@Narwhal88 @thislittlebird @Dochas1211 thank you all so much.

I've seen Mr Ramsay mentioned so many times so I've emailed his PA to try to get an appt. Any one know what an initial consultation costs, roughly? I want to join the fan club haha.

Yes I would like him to have a fragmentation test - another scary result no doubt.

He always takes 1000mg Vit D, and has been on Vital DHA (from Zita West) for a while. I've added Proxeed and 1000mg vit C and ubiquinol 200. We will spend a bit more time at the weekend making sure we have got the balance right. I'm wondering if he should take a broad fertility tablet too like WellMan or something.

My AMH is 10.7 and I'm 32... you guys probably have way more experience. Is this okay or might this be a bit of a factor too?

Is there a level that we have to get the sperm up to for higher chances of success if we do have to go down the ICSI route?

@thislittlebird there is a measure for volume, concentration of sperm million/ML and then sperm per ejaculate - so many different things! Vitality it just says N/A - no idea why. Motility is 69% so that gives me a bit of hope.

X

My husband had low morphology (1-2%) and he was prescribed 1 x Impryl and 1 x Proxeed supplement each day by another urologist (Prof Minhas) which was a successful treatment.

Definitely try and see Mr Ramsay as it’s important to rule out varicoceles etc. If you do have IVF, they’ll use ICSI to find the best looking sperm and as someone said, sperm samples do change month to month.

It sounds like you’re on top of the lifestyle factors but things like laptops on laps have to go as well. I bought my husband a modern version of what used to be called a “TV dinner tray” and even after IVF he still uses it on the sofa If he drinks, unfortunately alcohol needs to go as well.

Frequent ejaculation definitely helps as well. We can’t conceive except through IVF due to my issues, but in our most successful rounds he was releasing every second day for two weeks, then every day right up until the night before egg collection. I know our clinic have prescribed this over 3 months for couples with known DNA fragmentation as well.

@FlyOnTheWall89 the PA warned me up front that the tests + consultation is about £900 I think. I think the consultation is £300 roughly. It’s a lot, but I was glad she warned me.

Another one I’m aware of who is a urologist + andrologist like Mr Ramsay is Mr Tet Yap but I’ve not seen him myself.

There wasn’t a lot wrong with my DH that could be found so his motility issue didn’t really need further investigation just time, but we were essentially “cleared” to start ICSI after the results came back. Other people need meds or procedures, so it depends on what the specialist finds.

They only measure vitality when motility is low. So for my DH not only were lots not swimming well but a good percentage weren’t alive either.