Advice on Male Factor Infertility

[Anonymous]

Hi all -

I am 29 years old and my husband (34) have been trying to conceive for nearly a year. I had a feeling something was off so I made an appt. with a RE in October. Turns out that I am fine but my husband has very low numbers (1 million). He went to see a urologist where we found out that he has two varicocele veins. I have a follow up appt with my RE next week to discuss options but I am pretty convinced that IVF + ISCI is probably the way to go, at least for this first (hopeful) pregnancy. I've read that the surgery can help improve numbers but not drastically enough to produce a natural pregnancy. Do I wait and try to do IUI?

[Anonymous]

It depends on your insurance. 29 is young and you have time, if you have good coverage I would go for the iuis. It can take some time to get all your ducks in a row for IVF anyway and you spend months just waiting to start. We were on the waitlist for IVF and decided to do an IUI in the meantime (MFI as the only issue as well) and got pregnant. Good luck!

[Anonymous]

I would highly suggest the varicocele repair AND then IVF with ICSI. The repair will not get his numbers to where they need to be, but the IVF without it might result in some issues due to DNA fragmentation. I strongly urge you to join reddit and join both their infertility group and DNA fragmentation group. Lots of good info there. Most doctors are not versed in MFI and specifically DNA frag, but it is a thing. That said, insurance will cover the varicocele repair even if you dont have fertility coverage, and perhaps you will be an anomaly and get pregnant without intervention. Just be realistic. A repair would have to result in basically a 100000% improvement to put him at normal numbers.

Ps- we did what I suggested above and are 34 weeks.

[Anonymous]

Also IUI complete waste of time with his numbers. They need 10m+ post wash. Any doctor that recommends IUI in a case of MFI should be fired. Run away and find a new clinic if it is suggested to you.

[Anonymous]

My husband has similar numbers to yours. Icsi is the way to go. You also may want a dna fragmentation test.

[Anonymous]

Anonymous wrote:Also IUI complete waste of time with his numbers. They need 10m+ post wash. Any doctor that recommends IUI in a case of MFI should be fired. Run away and find a new clinic if it is suggested to you.

This.

[Anonymous]

OP Here: I didn't meant to imply that anyone was recommending IUI with his current numbers. Obviously his numbers would need to dramatically improve to even consider. My point was whether or not to proceed immediately IVF (our insurance will cover). Really appreciate everyone's responses, especially the thoughts on DNA fragmentation.

[Anonymous]

My DH has two varicoceles one on each side. Sperm analysis is normal but fragmentation is 31% per SCSA test. What should we do? Would TESE help?

[Anonymous]

Tese may help. Also try antioxidants.

[Anonymous]

I was in basically your exact situation. We found this out when I was 28, he was 30. We wasted some time with IUIs. Got the bilateral varicocele repair. Did IVF + ICSI and were successful first try when I was 29yo.

Fast forward 2 years, I randomly got pregnant naturally (the only time that has occurred in 9y of trying) but miscarried. His counts had improved slightly but were still super low. Decided to try him on Clomid to see if that could get his numbers up. It actually worked after about 3-4mos of Clomid. So we tried 2 rounds of IUI and the second one worked and stuck.

Our RE advised against the Clomid route the first time around - he said it could improve his counts OR it could tank it. We decided not to risk it. Second time around I was more open to the risk. So just another avenue for you to consider. Best of luck and big hugs to you!!

[Anonymous]

Thank you so much for this!! Very encouraging to hear.

[Anonymous]

OP - not to hijack the thread, but would you mind sharing name of urologist? We are looking for one that would be helpful (the one my husband saw discounted his low numbers and referred us to find an RE on our own? not sure how that would fix the issue.)

Anonymous wrote:Hi all -

I am 29 years old and my husband (34) have been trying to conceive for nearly a year. I had a feeling something was off so I made an appt. with a RE in October. Turns out that I am fine but my husband has very low numbers (1 million). He went to see a urologist where we found out that he has two varicocele veins. I have a follow up appt with my RE next week to discuss options but I am pretty convinced that IVF + ISCI is probably the way to go, at least for this first (hopeful) pregnancy. I've read that the surgery can help improve numbers but not drastically enough to produce a natural pregnancy. Do I wait and try to do IUI?

[Anonymous]

Sure, my husband saw Dr. Jason Engel here in DC and really liked him.

[Anonymous]

Anonymous wrote:Sure, my husband saw Dr. Jason Engel here in DC and really liked him.

thanks!