PCOS and Poor Semen Results - any hope out there?

[SusieNI]

Hi ladies xx

First time poster. Me and my husband recently underwent fertility testing and got our results yesterday.
I have known since I was 19 I had PCOS so I knew when the time came it might be a bit of a battle to have a baby.
Our results confirmed my ovaries have lots of follicles and my AMH levels are sky high (which means I'm very likely not ovulating according to our Dr.)
What we werent expecting was my husband results, his sperm count from a volume and numbers count was all ok but his motility was 46% (of which 26% where the strongest and the aim here would be at least 32%) and morphology was 2% (aim here would be at least 4%). We are 33 and 35, have been trying for a year and are pretty healthy otherwise. This is the only analysis my husband has had.
I was hoping we would be prescribed Clomid but because of the male fertility factor the dr has said this wouldnt be suitable and reccomended ICSI. Just very disappointing.

I just wanted to know if there are any success stories out there of conceiving naturally with a similiar situation?
We have had a pretty tough year, my dad passed away from Covid 2 weeks after our wedding so we were really hoping for a bit of good news/luck from these tests. :(

Any ray of hope or advice on anything, even experience of improving sperm quality etc, any positivity would be so welcome right now ❤️ thanks ladies xx

What sort of doctor did you see?. Is this person a consultant gynae on the NHS for instance?

The semen analysis should be repeated, one is not enough to make a full determination.

How are they planning to deal with the cystic follicles on your ovaries?. Have they not suggested anything other than ICSI?

Hey, we went private and so this was a Gynae Consultant from the clinic, so tests were carried out in the private clinic then a virtual consultation with the Consultant a week later (who rocked up 20 minutes late....but lets not dwell on that!)

He just mentioned i'd need minor stimulation but I just assumed ICSI goes hand in hand with IVF? no?

there is always a chance of a surprise natural conception but it could take years and I don’t think it’s worth the wait. Some people with PCOS have poor egg quality but others get lots of eggs which translate into lots of embryos.

re your DH I would get him a DNA fragmentation test and seen by a urologist (Jonathan Ramsey is the top guy here) to ensure there’s no underlying infection causing issues and if all ok go ahead with ICSI or try get IMSI which has better magnification.

you could also book in with a fertility dietician - Melanie brown is very good and she will guide you both on food and supplements. Easy fixes now are caffeine and alcohol free and obviously no smoking/vaping/drugs

OP, I could have written your post (in fact, I think I did about a year ago). My situation is so similar - father died a few months before my wedding, husband's sperm motility is poor and we were advised to go for ICSI.

I'm currently in the middle of my first round, going in for egg collection tomorrow. It's been uncomfortable, but ok.

Here if you want to PM me/ask any questions about how it's gone so far. I'm sure there will be a couple of good news stories along in a minute - try and stay positive, there is hope.

Thanks for the advice, so kind! I'm based in Northern Ireland so not sure if that doctors based in England? Options over here are few amd far between :(

Thats so horrible but nearly lovely to hear that theres someone else out there who knows what this full combination of 'gunks' can feel like when they all hit u at once! Am so sorry you are r in such a similiar boat to me. Please god everything goes well for you and I have everything crossed for you for your egg retrieval tomorrow!! ❤️xx

Based in Ireland went to U.K. for treatment. Lots of Irish girls have been to Jonathan Ramsey and Melanie. Just travelled over to London for it. Unfortunately not good options in Ireland north or south!

Hi @SusieNI what was the count abs concentration? I don't think the results are THAT bad. 2% morphology is obviously the weakest but it's the easiest to improve. My partners went from 0% to 9% in 2 months. He is taking Proxeed which is generally recommended for sperm issues along with: Vit D, Omega 3, Pycnogenol, ubiquol. It's sounds like a combination of you and your partner - you could see a different doctor to try and get clomid because if you're not ovulating even with better sperm results you're not going to get pregnant. We have a borderline count issue which hasn't changed with supplements as yet. We have also been advised to go for ICSI - my OH is currently getting his head around that and then hopefully we will begin! Good luck!

@SusieNI just read some of the other comments. We have been to see Johnathan Ramsay and personally we didn't rate him. It's £280 and for every person he sends you off immediately for another £900 worth of testing... some of which was totally unnecessary for us. ICSI is the treatment for high DNA fragmentation and that is your treatment advice at the moment anyway, so except from taking the vitamins above, you don't really need to know about the fragmentation (we literally just went through all this with our consultant). Do get some bloods taken for generally fertility, but if count is fine, it's unlikely to be testosterone. A urine culture could fine a bacterial infection which could help a bit. He should be checked for a varicocele - this is done via an ultrasound. We did these 3 things on our private health care, and personally I don't think those things need to be done in London when you're not based here... any clinic could do that. X

@FlyOnTheWall89 I disagree with your advice on dna fragmentation. We were also told ICSI is the treatment and dna frag didn’t matter’. We spent €14k on two rounds of ICSI and all embryos disintegrated on days 4-5 so zero embryos. When we did a fragmentation test it came back very high which meant we were referred to urologist who found a huge varicoele which once embolized we started making embryos and top grade ones at that. If you had a urine culture and varicoele check then you are taking steps to lower dna fragmentation whether you know the number or not so it’s disingenuous to say there’s no treatment other than ICSI. Many women pay for the dna frag test as if it’s normal they then don’t need to pay for ultrasounds, urologist etc. We learnt the hard and expensive way to ignore the ‘oh just do ICSI it’s the treatment’ advice from our first clinic (our second and third clinics said this was nonsense btw). Also in Ireland the clinics don’t do these tests. You need to see a urologist and as the waiting list for the main guy (there are only 2 ) is so long many opt to go to U.K. to be seen quicker instead.

I think it was 57 million??
Ok thats good at esst there are steps to be taken for the morphology piece!
Your saying exactly what we thought it was only our first set of tests so we thought to jump straight to ICSI when DH has only had one sample was s bit extreme?? I worry things are a bit 'salesy' in the private sector :(

@SusieNI Hello. I also have PCOS (only found out by chance even though Belfast Fertility Clinic would have known a year earlier but didn't bother to tell me - just kept trying to sell ICSI - long story!) and my husband has low morphology at 2%.

We tried In-Ovo as well for help and they were as useless as Belfast Fertility. I highly recommend that you don't go to either of them!

I saw Dr Cleland at Ulster Independent Clinic and she was excellent. Put me on Metformin in July of last year to control PCOS.

We then went to Waterstone Clinic in Kildare in September last year and I met with Dr Eithne Lowe who was excellent. She specialises in PCOS. She prescribed Clomid with monitoring scans to ensure I didn't over stimulate, trigger shot (again after scan to show one dominant follicle was ready to pop), and progesterone pessaries to help things along. We were to try this for 3 cycles then move to ICSI. I'm now 31 weeks pregnant from our first cycle and we spent no more than 600 euros in total (including the drugs). Im about to turn 41 and husband is 38.

Prior to this, we spent thousands at the NI clinics with such poor service. I had also been given Clomid with no monitoring scans in NI which is really irresponsible with PCOS! I had a missed miscarriage in Feb 2021 and bleed for 70 days heavily and the NI clinic didn't want to know or offer help. In fact, I'm still waiting on an urgent callback to this day. That's why I went to Dr Cleland.

When I had my consultation at Waterstone Clinic, Dr Lowe said that she was happy I'd been on Metformin for a few months as it improves egg quality. Between Dr Cleland at UIC and Dr Lowe at Waterstone, miracle workers so I HIGHLY recommend.

Happy to answer any questions you may have 😊

@SusieNI ps that's twice I got pregnant with husbands 2% morphology - it only takes 1 good one to get through so I agree with previous poster that ICSI would be a last resort or at least way down the line if other methods don't work.

I'm sorry it seems really tough, everything pilling on to you... Sending you love and hugs Xxx

Aw MiniArm your message is exactly what I needed to see thank u so much!! We completely for a 'salesie' vibe from our consultation and to jump straight to ICSI just seemed a bit extreme...and the doctor was 20 minutes late for our virtual consultation....only I rang the clinic twice I dont think he was for joining!
Did yoy have to go down to Kildare for scans etc?
You poor poor thing but congratulations on your upcoming baba!! So pleased it has all worked out for u!Xx

@SusieNI I'm glad my story gives you hope, it should! It's so possible!

We did have to go down to Kildare - probably made the journey about 5/6 times which was a full day trip (we are just outside Omagh) but it was worth it.

It's funny you say about the virtual consultation. Our first consultation at Belfast Fertility was a phone call and the Dr was clearly so bored and just rhyming off the same speech he always does.

At Kildare, it was face to face only. We had a head start as, like you, we already were armed with test results. They didn't even try to sell us tests - just straight to an action plan - and when you're dealing with infertility, an action plan is what you need to keep positive I felt. When we left after our first consult, we had the private prescription in our hand for the meds we would need (Dr Lowe scanned me at that appointment). I just then took that to my GP, and he converted it to an NI NHS prescription so the drugs were free!

I would honestly give Waterstone Kildare a call. The fertility nurse is called Martina and is such a lovely woman. When I first called to make an appointment she chatted for ages, answering loads of my questions. Just so helpful and reassuring and such a different experience to NI.

They also have a clinic in a Dublin City. If you did need ICSI, you have to go to their Cork branch (but hopefully it wouldn't come to that).

Hope I don't sound like I'm selling them btw - I just have been where you are and we struggled to get help for so long and they were a good send 😊 xx

Oh no it doesnt sound like that at all it is just a relief to hear you had a similiar experience and impression of the whole thing! We also just heard that SA's can be negatively impacting when in recovery from Covid which my DH had just had 2 weeks before which the clinic also knew and never mentioned or took into acocunt before highlighting ICSI as our only route! I only went to then as mt GP said the waiting lost for Clomid was an age and she advised going private, I just wanted a prescription and monitoring :(

Will def look into the Kildare place, thank you!x

@SusieNI The other place you could go is Dr Quinn at Mid Ulster Womens Clinic. He is very nice and will prescribe Clomid (6 months worth).

He would scan you before treatment and mid cycle but it wouldn't be as much monitoring as Kildare would, and he doesn't prescribe the trigger shots either. He is a consultant at Antrim Hospital but also runs a small private clinic.

I'd still deffo pic Kildare as the first choice for Clomid and monitoring :-)

Keep me posted on how you get on xx

Hi All,

I just got diagnosed with PCOS based in Ireland. My clinic is awful so not going to name them but I will be moving. They keep pushing treatments and tests. they made me have two ultrasounds in two weeks just for the extra money. Rant over.

So I'm now on metformin, myo inositol and coq10, chemist tried to charge 400 for it managed to source it myself online bar the metformin which was fine.

Partners sperm count was low now on proxeed plus and numbers and morphology has improved. Now in normal range. not saying it will work for everyone but did for us.

We had DS in 2020 after trying for 20 months, was put on a high dose of folic acid month previous and pregnant next month. I thought it was a coincidence but turns out that can help.

Maybe I'm being stupid or naive to think that this might be enough to get us over the line. but currently we aren't in a position to go with ivf or icsi as trying to buy a house.

We are thinking of moving to waterstones

Will def keep you posted, I think we are going to give it until end of August to give all the supplements a chance to kick in, get DH retested then head elsewhere, probably Kildare as the reviews are fab! :)

Yeah rory87, its nearly immoral how salesy private clinics can be :( so expensive! thanks for the tips also! Fingers crossed for us both!