Zero morphology and severe psoriasis - what next?

[Shadoworshade]

DH and I have been actively ttc for 17 cycles - not even a smidgen of a positive. I have recently had bloods done (fine), AmH (7.2 - apparently a bit low but not unexpected for my age - 38) and hycosy (fine).

DH has suffered from psoriasis for many years, but it’s been getting worse over the past few years and now with signs of psoriatic arthritis (swollen knuckles and ankles). Sad for someone who used to climb mountains to be reduced to walking small distances at an old man’s speed. No amount of moisturiser or light therapy (he has a machine at home) has worked. He saw an NHS rheumatologist earlier this year - they wanted to put him on methotrexate which is clearly contraindicated for pregnancy, with males advised to come off it at least six months before ttc. He refused to take it, pointing to my age /our not having time for him to try it. Instead of offering him biologics, they just said they would monitor the psoriasis - I think because biologics are expensive and his scans did not show bone loss (but that could well happen if left untreated 🤦‍♀️).

He recently had a SA done - count and mobility were fine but morphology was zero per cent. The lab report said chances of natural conception were reduced or delayed and recommended IVF plus ICSI.

Don’t know what to do next. I have booked us a consultation at our fertility clinic, but imagine we will get pushed heavily towards ICSI/IVF.

We could go down the urologist route and see Mr Ramsey (who looks like the go to consultant for male factor). I wonder if a DNA fragmentation test would be worthwhile, as I understand ICSI may not be viable if the sperm has DNA frag, ie the embryos may not progress. There also seems a correlation between varicocele and psoriasis.

We could try a private rheumatologist and see if they would consider biologics / possibly write to his NHS consultant to recommend them? I feel we will likely get fobbed off again if we try the NHS. As far as I can tell biologics are not contraindicated for ttc and can actually help in reducing inflammation which is helpful from a sperm quality perspective.

DH is currently in middle of a massive psoriasis flare up, covered in scales and shedding lots. I feel our dream is so far away, and that we lack any joined up medicine for this situation. So many factors at play…

Any thoughts or experiences hugely appreciated. I never thought this would be our reality but trying to find a way through.

Not actually had these issues but there is other avenues you can look down first if you dont want to try ivf, the only issue is if age isnt on your side then you could possibly waste years trying to find specialist and other medical partnerships to figure out how to fix your partners sperm when in the long run ivf could be your only option. I think it won't hurt to talk to a fertility specialist because there is so much options in ivf and everyone is different and they can get more tests run quicker under them rather waiting for someone for each individual test that might need to be done. I wish you all the best and I hope my comment bumps your post so that someone with more knowledge can give you more answers.

I think he would likely get biologics privately from a rheumatologist but they’re very very expensive drugs! The nhs has set criteria I think about having tried certain previous treatments before they will fund biologics so maybe that’s the issue? Agree it does not follow common sense though.

Thanks so much for replying @Miraclemuma03 and @NiftyAmberLion .

Thats’s the thing, @Miraclemuma03 - we don’t have time on our side! I’m thinking about trying a round of ICSI (to see how any embroyos get on - if they don’t progress I guess that could point to DNA issues?) and also seeing Mr Ramsey in parallel to do the DNA frag test and try to find a path to improving DH’s morphology.

@NiftyAmberLion , the NHS were pushing methotrexate hard and didn’t care about the fertility side of things. And as you say they won’t fund biologics unless he’s tried it. There doesn’t seem to be any flexibility for his situation.

We’re at our wits end - any experiences or knowledge would be massively helpful.

Hi @Shadoworshade I’m sorry to hear that you’re in this situation having been down a somewhat similar road myself. Except it’s me (the female partner) with autoimmune arthritis.

Unfortunately reading other people’s stories, prescription of biologics seems to depend on which consultant you get which isn’t fair. I put off taking medication due to TTC which of course ended up in an unexplained infertility diagnosis and IVF. When I finally begged for medication (I was in a bad way) they said that I could skip straight to biologics as it was the only safe option for TTC. It sounds like you’ve been given bad advice/treatment options. Just to say that my health board (Scotland) obviously have the power to circumvent prescribing procedures where necessary.

I wish I had put my health first and pushed for proper treatment before the arthritis became more advanced.

I’m sorry if this wasn’t very helpful. You have my sympathy. You could try also posting in the autoimmune diseases board as you might find a more knowledgeable audience there?