PCOS and male factor - next steps? quit now?

[Anonymous]

We just got news today that on top of my PCOS my husband has low motility (30%). We've been trying for a year and I haven't felt defeated until today. I'm not sure what to do next. My gyn is pretty useless. Her answer to everything is to go to SG. I'm not sure that is the right step - will they try metformin? our insurance only covers diagnostic testing, not even partial coverage for IUI...

Brief history - after years of bc I had 2 normal length cycles then a never ending cycle. Went to my gyn, diagnosed me with PCOS after u/s. 3 unmonitored clomid cycles all unsuccessful. 3 unassisted cycles TTC showed me that I have regular 60-ish day cycles. 6 weeks ago I started acupuncture and chinese herbs. At my last appointment with my gyn she said to give the acupuncture a shot until the fall and if no luck, get my tubes scoped then go to SG. At the same appointment she gave me a lab order for my husband to be tested. We took the sample into the lab directly. Results were good count 2.2 million and low motility - 30% plus high white blood cell count. She said we should just go to SG and they would sort it all out and re-test him there.

Is SG the next best step? Should we see an RE instead? Give up now? We're very open to adopting and if we have to pay a lot of money out of pocket, we'd rather do it towards adoption than something that has a small likelihood of working.

I'd appreciate any advice.

[Anonymous]

Definitely go see an RE. That's the only way to know your chances; I wouldn't even listen to an OB about this. It may well take intervention. First of all, if you have PCOS, you should strongly consider going on metformin whether or not you're TTC. If you do want to TTC, metformin is key and you may well ovulate on your own and not have any fertility treatments. I have PCOS and I think metformin is so important for general health, not just TTC.

Like you, in addition to PCOS, my DH had male factor. In our case, it was very severe morphology problems. For that reason and not the PCOS (our RE did not think the PCOS was a problem b/c I was on metformin, cycling and ovulating on my own), pretty much our only hope was IVF with ICSI. We were young (31) so good candidates. On our second try I got pregnant, stayed on metformin through my first trimester as is recommended now by those in the know, and I know have a one year old child.

Don't give up now. Adoption is a wonderful thing and I wouldn't discourage that if it's your preference, but if you want to know what your options are, go to an RE now. I went to the Muasher Center in Fairfax and had a positive experience there, would recommend it. GL!

[Anonymous]

OP Thanks! I should have added that I'm 29. My acupuncturist keeps telling me I'm young as does everyone else, but that doesn't make me feel any better.

[Anonymous]

Op, I recommend going to an RE to at least get tested and get a diagnosis. Knowledge is power - once you actually know what (if anything) is going on, then you can figure out best path for you. Fwiw, my insurance doesn't cover IUI or IVF procedures, but it covers all diagnostic tests and meds to support those procedures. Maybe yours also covers the diagnostic tests? If so - that takes care of a lot -- and then you can decide whether it's worth paying ou
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[Anonymous]

Pp -fat fingers posted too soon. ....then you can figure out whether it's worth it to pay out of pocket. Fwiw, I think there's a lot that can be done to mitigate male factor issues.

[Anonymous]

OP, I also was diagnosed with PCOS and my husband had 1% morphology in our very early 30s. We were told I would never get pregnant without IVF/ICSI, but the RE still only gave us less than a 40% chance of success. I have a lot of reservations about IVF so we chose to do IUI 4 times. Our insurance wouldn't actually pay for the procedures, though I believe it paid for the medications.

Like you, we would rather have put our money towards adoption rather than something that was not that guaranteed, so we did. We started the adoption process the month after our last IUI and 13 months later, brought our daughter. Ironically, I also got pregnant naturally 3 months after DD arrived. Go figure.

Anyway, the long point of this is to say that I agree with PPs- go see an RE at least to know what your options are. Good luck!

[Anonymous]

go to an RE! gyns are not experts at this. Also, I'd recommend Preston Sacks, not SG.

[Anonymous]

Another vote for an RE. Doing a consult and some further testing does not mean you need to escalate to IUI or IVF. It's just about getting a complete picture of your situation.

Personally, I found it really helpful have someone who sees this stuff day in and day out walk us through it. Gyns can be supportive and it can feel assuring when you have a relationship with them, but they're TRULY no substitute for a good RE.

Where do you live? I highly recommend Dr. Gordon at Dominion Fertility, if that's convenient to you (Arlington).

[Anonymous]

Another fan of Dominion Fertility and Dr. Gordon (haven't seen Dr. DiMattina). I went to two other fertility clinics in the area and Dominion Fertility is the only one that wasn't depressing and discouraging. I love nurses and staff there as well - very kind, caring, and efficient. Don't lose hope yet!

[Anonymous]

Third vote for DF and Dr. G. While it wasn't the case for me, many times your issues can easily be addressed by the RE without IUI or IVF. DF will give you a personalized treatment plan that works best for you...

Dr. G was always optimistic for me...sometimes way more optimistic than I was at times...and with me, he always insisted that I would probably get pg without his help. THAT did not pan out for us, but it was nice to always feel as though he wasn't pushing us into more advanced treatments...but that we were opting for more advanced treatments.
WLD

[Anonymous]

OP here - Thanks for all the helpful advice! I'm trying to figure out what RE to go to. I'm in Silver Spring, but with my insurance my choices are basically SG, Dominion or Columbia. I'm willing to travel if need be. I was thinking of making an appointment with Columbia Fertility for Dr. Sacks, Dr. Butler or Dr. Rifka. I'm continuing my acupuncture and trying to convince DH to try acupuncture as well. I guess we'll wait and see what the RE says. I know gyns aren't specialists in this area, but mine was pushing SG as the answer to everything, not even mentioning other REs as an option.

Thanks again!

[Anonymous]

Re: acupuncture for men. My husband has poor motility and morphology. After almost 3 months of acupuncture, his motility got worse, but the morphology increased from 1% to 4% (I am pretty sure due to him taking Pycnogenol). I don't think we have good fertility focused acupuncturists in this area. Therefore, I would not waste your money on DH's acupuncture.

[Anonymous]

Did your doctor recommend a specific RE at Sg? (mine did.) If so, I'd treat it like you would any other referral (if you value his opinion). Fwiw, I've had a really good experience at sg thus far, but if my doc had recommended any other practice, I would have followed that recommendation. Having said that, if I hadn't liked sg, I wouldn't have hesitated to go somewhere else. If you don't want to try sg, I recommend asking your doctor for a referral elsewhere.