My husband (41) and I (36) are trying for our second child after the birth of our son 2yrs ago. We had a missed miscarriage back in feb at 8 weeks (stopped developing at 6) and have not been successful since then (appreciate early days, however we have always found it relatively easy to conceive)
Before we had our first we had a semen analysis due to age / my husband has been on long term SSRI and I had read this can impact semen. It all came back fine except from 1% morphology. Fast forward two years and post miscarriage we did another test + dna fragmentation and the results were not as great but all within WHO parameters, but morphology was bad again (2%). We had a SCSA test and that was DFI 20. This was after 6 months of vitamins (fertility for men, ashwaganda & vit d). I had read that was elevated, but I remained hopeful we could conceive naturally but with an increased risk of miscarriage.
We were referred to a urologist who is meant to be one of the best in London but hasn’t been particularly helpful in terms of what that score means or next steps. He put my husband on Impryl (he’s been on this since end of March) and he’s confirmed a grade 2 varicocele and then retested his dna frag last week as he said he only likes to look at the comet test. I’ve had my husband ejaculate every 2-3 days (urologist said he didn’t think this would help) since and the test was on a 60hr hold and came back at ACS 35%. I am absolutely devastated by this but my husband is not concerned as the urologist said the results had not worsened and the two test results are not comparable and the score is just slightly elevated. He said we could try ivf with ICSI if we wanted or we could have his varicocele repaired or we could just keep trying but he wasn’t concerned or pushing either options as best thing to do. He didn’t give us any odds for natural conception or how it might impact miscarriage rates.
I have no idea what our next steps should be. I’m 36.5 and age is not on our side. Should we be exploring IVF or should we try repairing variocele first. We are in the U.K. so IVF will be all self funded.
The fact we have a previous child has always assured me but I found a study last night which was interesting suggesting links between vitality and dna fragmentation (https://rbej.biomedcentral.com/articles/10.1186/s12958-015-0035-y). https://rbej.biomedcentral.com/articles/10.1186/s12958-015-0035-y). Interestingly his sperm vitality was 74% when we conceived gin Jan 2022. In his last test it was 54% (cusp of WHO parameters so not flagged as issue) which is a big decline and if this study is anything to go by might suggest that dna fragmentation was not an issue for us back in 2022 hence why it was so easy to conceive and carry our child to full term.
any advice would be much appreciated as this is such a low researched topic and feel very in the dark. If we we were early 30s I would be wait it out and see but age is def putting pressure on this situation.