Male factor infertility ?

[Anonymous]

My husband and I are ttc. We've been trying for 7 months and have been told DH's sperm morphology is abnormal (3% on one; 7% on second). We are both 37. I checked out ok (AFC 23, hormones normal). We have two children already.

My husband is reluctant to have any invasive treatment (i.e. IVF) because we've been pregnant before; he wants to keep trying the old-fashioned way.

Have any of you had experience with male factor infertility? Can things happen naturally? I'm scared we won't be able to have another baby.

[Anonymous]

Are you consulting with an RE, or just with your OB at this stage? If the latter, I recommend getting in to to an RE right away to better understand your options, whether natural, IUI or IVF. Though I'm sure you'll find anecdotes of people having children with this type of male factor issue, they're just that -- anecdotes. What you need now is some facts and statistics on your side in order to make the best possible decision if you really want a third child. Those facts and statistics will hopefully facilitate conversations with your husband about realistic next steps. Best wishes to you.

[Anonymous]

What is your husband's total sperm volume? My husband's morphology was a little below the ideal, but several REs told us that because his volume was so high it didn't matter (since even 3% multiplied by a large number of sperm can still yield enough good swimmers). Good luck!

[Anonymous]

My husband's morphology was 1%. Our RE recommended IVF, which we didn't do. I also have PCOS so we had a double strike against us. We adopted our first child and accidentally got pregnant naturally with our second one. I have no idea what happened.

[Anonymous]

Anonymous wrote:Are you consulting with an RE, or just with your OB at this stage? If the latter, I recommend getting in to to an RE right away to better understand your options, whether natural, IUI or IVF. Though I'm sure you'll find anecdotes of people having children with this type of male factor issue, they're just that -- anecdotes. What you need now is some facts and statistics on your side in order to make the best possible decision if you really want a third child. Those facts and statistics will hopefully facilitate conversations with your husband about realistic next steps. Best wishes to you.

Yes, we are consulting with an RE. He recommended starting with IUI/superovulation. But we are not excited about that option since the odds are low (only 16-18% per cycle). We qualify for shared risk IVF so if we do anything, I think we'd go that route. But the risks associated with IVF (based on the info sheet they gave us at Shady Grove) are very intimidating.

[Anonymous]

Anonymous wrote:What is your husband's total sperm volume? My husband's morphology was a little below the ideal, but several REs told us that because his volume was so high it didn't matter (since even 3% multiplied by a large number of sperm can still yield enough good swimmers). Good luck!

good point. normal I believe. Thanks for the encouragement.

[Anonymous]

We have male factor but our issue is very low count (ranges from 100k to undetectable in different samples over the years.) Given our odds, we went straight to IVF and got lucky on our first try. In the years before and after that though, we total more than a decade of trying with no natural success. I'm biding my time and hoping until we can afford to try IVF again or adopt, but I wouldn't spend too much time debating your options since you're getting older. (I don't mean that as an insult at all - our RE has been encouraging us to decide sooner rather than later since female fertility declines with age.)

[Anonymous]

Which RE are you going to? GW is notorious for giving everyone very low morphology scores (I heard this from another RE and a urologist).

[Anonymous]

We have low motility (<20%) but the other values were ok. After a year of trying on our own and two IUIs, we finally had success on our second fresh IVF. Good luck!

[Anonymous]

I agree with the person who said it's important to know the count # too, since 3% normal out of 50 million motile sperm is much better than 3% normal out of 5 million motile sperm. If you're working with an RE, I'm assuming that DH had the semen analysis using the strict Kruger morphology - on that test, anything over 14% is normal.

DH's morphology on that test is less than 1% normal. He also has low count (ranging from 5-12 million motile sperm depending on the test.) Our DD was conceived naturally (despite us being told there was less than a 1% chance of this) and I am currently pregnant with #2 after a 2nd cycle of IVF/ICSI.

My DH saw a urologist specializing in infertility and was told that there are not many interventions (other than IVF/ICSI) for low morphology, although he did have DH start vitamins (you can probably also get them from your RE). Good luck!

[Anonymous]

Okay, I feel like I have too much knowledge on this area!

After about 6 months of actual trying but together for years before that and plenty of fun without birth control - I decided we needed to see someone. I came back fine and dh came back great count, great motility but 3% normal morphology. RE was quite negative but at our visit I did not realise I was actually pregnant naturally. Okay so move on a few years to trying for #2. After a few months, my husband got a testicular infection - epididymitus and got medicine. Dr said no problem it will not affect things. WRONG. His count went to less than 3mil and it had been way over 100mil. They said it would come back. His morpology was still in the toilet. It did not come back and we did IVF. We have twins. Then when the twins were 10 months old and I was b/feeding them, I discovered I was pregnant. RE said 1/200 chance but it happened. We were intrigued and got dh retested but count , morph were stll the same. We thought "miracle" and then at 12 weeks I lost it. Move on 6 months, and sure enough pregnant again. This time I have made it to 13+ weeks and everything looks good.
Sorry for the waffle but having had two children and if all else is okay with your dh, I would say give it the old fashioned try for a while longer - IVF is hard but I know waiting is too.

[Anonymous]

i have to agree with what another poster said, at 37, you're too old to mess around with "the old fashioned way." You always hear these sucess stories of "I gave up and it happened naturally" but that's like winning the lottery. I would suggest going the IVF route if you can afford it or if you can't convince your husband, then tell him to take a multivitamin everyday along with one tablet each of co q-10, l-carnitine, vitamin c, and vitamin E. That combination has been proven to improve sperm count and quality.

[Anonymous]

I disagree that you should be thinking for IUI/IVF at this time, unless you really feel like you're in a hurry. Sperm count and morph can change - my DH was tested 4 times and his numbers were looked at 5 other times for IUIs, and it was all over the place. (I got pregnant just after his morph came back a 10 out of 14, and pregnant again 6 months later after a miscarriage.)

I would take 3-5 months to have him make some changes - cut down caffeine to 1 cup of coffee a day, alcohol to 1-2 glass of wine or beer a week, take a male fertility vitamin, make sure he isn't using a hot tub or taking hot baths, and also not biking. Try using Pre-seed, and think about having him do acupuncture to increase blood flow.

[Anonymous]

POSTER 19:41 here again.

At 37, you are definitely taking a risk to keep trying the old fashioned way EXCEPT for the fact that you have two kids and all else looks great except for your dh's morph, which according to some RE's is not a big problem. You have proven fertility X 2 and that is a huge plus in your corner. For you a spontaneous pregnancy would not be like winning the lottery, it would be totally expected almost. I would take the next 5 months to get your head around possible intervention, IVF that is, and start preparing for it but hope that you won't have to go there. IVF is a huge deal and also you can be left with many hard decisions even after the fact. We have frozen embryos left and now that we seem to be fertile again - it really leaves us in a hell of a position.

Best to you and your family.

[Anonymous]

OP here. Thanks for all the replies. I agree that at 37 I don't have too much time, but I don't think that trying on my own for three more months is going to make that big of a difference in terms of my fertility. The RE agreed with us. I also gave birth <1 year ago (our third actually, but she passed away from a heart defect; hence the rush to try again), so I'm pretty sure my fertility hasn't plummeted THAT much in the interim.

IVF DOES seem like a huge commitment -- financial, emotional, time -- and I think DH needs to be with me 100% before we go down that route. And I think if we've given it a good shot for a couple more months, he will be more likely to agree. We've also initiated the lifestyle changes for DH. THanks again for all the advice and support! Will keep you posted on how this works out.