WWYD? male factor infertility situation

[Anonymous]

We are trying to decide what to do in this situation and both keep going back and forth. I would be interested to know what others would do in our shoes, to get some clarity.

DH is 35 and I just turned 30, married a while. We would very much like at least one child, and likely two children if possible -- but no more than two. I've been off the pill for a year, and nothing has happened yet. I get regular periods. I've had various testing and it all came back normal.

Sperm testing revealed male factor infertility, with various SA tests giving different results. For example, on one recent SA, motility-morphology both were well below the normal range (motility- 26, normal is 49; morph- 8, normal is 14). Another recent SA, motility was slightly above average (52, normal is 49) but morphology was worse (5, normal is 14). Volume was also low. (All physical exam factors came back normal.)

Based on the SA results, we were diagnosed with infertility. We have some insurance coverage for infertility treatments.

Separate from the male factor infertility issues, as it happens, I am a cancer survivor and we did IVF and froze embryos several years ago when I was in my early-mid-20s, immediately prior to when I started cancer treatment. I ended up having a treatment that wouldn't harm female fertility hardly at all for now, though I couldn't have known that at the time we did IVF and froze the embryos. However, from the cancer drugs I had, I will likely go into perimenopause slightly earlier than I would otherwise -- for example, it isn't reasonable for me to expect to have a child at 37-42 even though many other women in my family have.)

The frozen embryos are six (6) Day 1 embryos. They're vitrified so probably ~95% would survive the unfreezing process (say, 6)... probably ~33-50% of those could make it to a 5 Day blastocyst stage (maybe 2-3).... maybe ~50% of those could result in a live birth (we're basically down to one... more or less.). We had to use ICSI when we did IVF-- due to DH's sperm analysis results at that time (we were aware of that issue since that time).

Sooooooo...... basically we have male factor infertility, but have an extra option of using the frozen embryos now, or trying those later. This month, we're trying Clomid and timed intercourse while we try to decide what to do. Clomid is our $20 option. We can do this for up to 3 (or maybe 6) months while trying to decide on what to do next.

What would you do, and why?
(a) Stay the course w/ the Clomid and timed intercourse before trying anything else (cheap, and if it works - could do FET to try for 2nd child)
(b) FET w frozen embryos now (could get twins which would mean we're done, or have a decent chance at one child - might be done with one. Also incredibly appealing on an emotional/theological basis, plus we'd get to stop paying the storage fees.)
(c) Try up to 3 cycles of IUI, with gonadotropins (a couple hundred bucks each, could give 10% pregnancy odds per month for a 30-40% odds total for not too expensive; could then use frozen embryos to try for 2nd child)
(d) Go straight to another fresh cycle of IVF w/ ICSI now, to avoid expending any more time and money on options that may not be compatible with the male factor infertility issues; and avoid foreclosing the option of having 2nd child. Could freeze more embryos at my current age (30) to have better options in case the frozen Day 1 embryos come up as zero.

[Anonymous]

In your shoes, I would try a couple more months on clomid. If no success after that, I would skip IUI, knowing that with male factor, you aren't adding much in terms of success rates. Then proceed with thawing your current embryos and seeing how many thaw and how many develop to blasts. At that point I would stop and decide if you want to do a SET or put more than one back (given that is an option). From what I've heard, FETs are much less invasive than fresh cycles. So you both get to see where things stand with the current batch, can relieve whatever moral concerns you have about having them around, and still have plenty of time for a fresh cycle 6-8 months down the line.

[Anonymous]

My situation is not exactly like yours (no CA hx, 30 yrs old) but we do have male factor, and did several failed rounds of clomid/injectables with IUI. We are now doing nat cycle IVF since I can't and won't do anymore drugs. Clomid made me insane, although I know many women who had no ill effects from it, and the injectables made me hyperstim even on very low doses. It just makes sense to do NCIVF which includes ICSI since male factor is our only identifiable issue. If I had frozen embies I would consider a NC FET, why should you manipulate your body anymore than necessary???

[Anonymous]

I would do single embryo transfer FET...and find a clinic that will do it unmedicated (I've done two at CFA). If you have regular periods, it's unlikely you'd need hormone support. Since you already have 6 day embryos, the MF isn't a problem with those. And your 25 yo embies are probably in very good shape. Your success for thawing vitrified embies is actually probably higher than 95%...so with 6 frozen you had good odds for even two through SET.

[Anonymous]

Thanks for these responses so far... and for reading through my initial post which was longer than I intended.

I tried to pose the question open-ended because this is a major decision and I want to fully consider all the issues, but using the frozen embryos has been my inclination too.

But at a consult, RE recommended strongly considering trying IUI first and if that didn't work, a new cycle of IVF (to not foreclose the 2nd child option, or have undue pressure to try for a 2nd child soon after a first, IF embryos resulted in just one, not 2/0.) That gave me 2nd thoughts about how to proceed.

I like the idea of natural cycle too and asked about that at my RE consult. That was exactly my inclination, natural cycle FET (for cost reasons and less drugs, not anything to do with cancer survivorship since my cancer was unrelated to estrogen/female matters). I am at SG however and the RE wasn't keen on the natural cycle option. I probably have to stay with SG to get the best coverage from my health insurance, plus I generally am impressed with their practice and numbers.

Are there any SG doctors who are willing to proceed with natural cycle? Or maybe the good SG numbers are based on not doing natural cycle?

[Anonymous]

I have found SG is not the best place to be if you have ideas of your own you would like to pursue. CFA might be a better fit.

[Anonymous]

SG is definitely not the place if you have any ideas of your own, my RE actually got angry when I asked about NC. They have a rant against it on their website, but it seems like more and more places are offering it.

[Anonymous]

CFA (Sacks) will definitely do unmedicated FET as I've done it twice there. I think GW will as well. I misread initially, didn't realize your frozen embies are day 1 (wonder why they froze at day 1).

Personally, I would still start IVF with a single FET, but I am less familiar with survival rates for day 1 frozen embies...so maybe my inclination there is wrong. Your odds with IUIs are probably low, so I would only do them if you aren't ready to move to IVF and cost isn't an issue (FWIW, I did unmedicated IUIs as well).

[Anonymous]

Just want to say that the new guidelines now is 4 or above for normal strict morphology and your husband's morphology is in the normal range for both times. And motility isn't too terrible the first time.

Honestly I don't think you have a male factor problem. You probalby more fall in the unexplained case. I'd go for a few rounds of medicated IUI and then do single transfer FET with the frozen embryos you have.

[Anonymous]

I'm also not convinced your husband's SA results are that dismal. I might get a second opinion from a specialist in male infertility. Agree that Shady Grove is very inflexible.

[Anonymous]

Shady Grove sucks, try GW, CFA or DF for an honest opinion.

[Anonymous]

If you do try IVF or FET, I'd strongly recommend SET. Twins aren't a cakewalk.

[Anonymous]

Anonymous wrote:CFA (Sacks) will definitely do unmedicated FET as I've done it twice there. I think GW will as well. I misread initially, didn't realize your frozen embies are day 1 (wonder why they froze at day 1). )

My think maybe, the clinic froze the embryos at Day 1, because at the time I did IVF, I was a very young woman about to undergo cancer treatment, and they wanted to give me the most optimistic picture, especially if for those embryos, they have pretty much the same exact chance of growing to Day 5 blastocysts before or after vitrification. Medically, it would have been inadvisable to delay cancer treatment another month to do more IVF.

I do wish I'd been given (or requested, in great detail) more information about the expected success rates of these embryos, for planning purposes.

I may look into CFA and GW but have to be cost-conscious/ work with my health insurance benefits. I've already paid quite a bit..

Anonymous wrote:Just want to say that the new guidelines now is 4 or above for normal strict morphology and your husband's morphology is in the normal range for both times. And motility isn't too terrible the first time.

Thank you to the posters who said this - encouraging to hear. I've also, through the year, ramped up from merely being off birth control and hoping to get pregnant, to plotting likely ovulation days on a calendar, to taking temperatures and using OPKs, combined with this month's Clomid. I just downloaded the FertilityFriend.com app for charting (which appears excellent, and is free, btw) and hope that something will stick (no pun intended).

Happy new year and good luck to everyone.