To wait on urologist or proceed with IVF?

[Anonymous]

We're dealing with male factor infertility here. We've gone through 2 IUIs with no success and were advised to see a urologist before we make our decision to pursue IVF. We had a great appointment with the urologist virtually but the earliest follow up appointment we could get is in April. The follow up will be an ultrasound confirming whether or not husband has varicoceles. He was physically examined by a different urologist who said he didn't see/feel any.

We were hoping to make a decision this month but this follow up is dragging the process out even more. Any advice/insight on if we should go with IVF without the urologist's intervention?

I would feel better holding off IVF if we knew what was causing the issue. Otherwise, I feel like we are just wasting time here.

I am 28 with thyroid issues and would like to have 3-4 kids.

[Anonymous]

We also dealt with male factor. My husband was diagnosed with two varicoles after he had the ultrasound. We were told that we could go straight to IVF or he could have the surgery to correct the varicoles in hopes that his numbers improved (it takes at least six months to see improvement). We went to IVF right away and my husband eventually had the surgery in hopes that we could conceive naturally (or at least try IUI) for the next baby. I am currently 30 weeks and it feels nice to know that when we go to try again, we have embroys waiting if the natural route doesn't work. Good luck!

[Anonymous]

Anonymous wrote:We also dealt with male factor. My husband was diagnosed with two varicoles after he had the ultrasound. We were told that we could go straight to IVF or he could have the surgery to correct the varicoles in hopes that his numbers improved (it takes at least six months to see improvement). We went to IVF right away and my husband eventually had the surgery in hopes that we could conceive naturally (or at least try IUI) for the next baby. I am currently 30 weeks and it feels nice to know that when we go to try again, we have embroys waiting if the natural route doesn't work. Good luck!

This is correct. Even if you get in to the urologist in April, the treatment would be surgery or medication like Clomid, depending on the particular MFI issues, and would take months to schedule and/or see results. Do you want to wait that long? Another thing you could confirm is DNA fragmentation - if that's normal there's unlikely to be sperm issues that couldn't be fixed with ICSI or pICSI during IVF. This is really a personal choice - if you go forward and have a bad cycle, will you regret it? Or if you wait for possible surgery and that surgery doesn't help (it doesn't always), would you regret the wasted time? My hunch is that your 28 year old eggs are probably fabulous and can overcome a lot of sperm issues that older eggs couldn't. Unless the MFI issues are severe, I would probably just go ahead and do pICSI with IVF.

[Anonymous]

If you want that many babies I can't see how getting embryos on ice is anything but a winning strategy.

We tried a urology surgery and ended up being in the 10% of failures and needed IVF anyway (and had a good result). The IVF pregnancies are a little higher risk than natural pregnancies, though, so if you have good insurance I would try to get hubby fixed too.

[Anonymous]

We opted for urologist recommendation to fix varicoele and it didn't improve anything not count, motility, or morphology, and I feel it wasted time. We changed clinics and new RE says he has seen many patients waste time with inept urologist. According to the ASRM it is recommended to move right to IVF, especially if female is over 35.

[Anonymous]

It’s your money on the line. That’s how I’d approach it. If an extra cycle isn’t a big deal, go for it. If it fails, no big deal. If you’ve scraped and saved for the cycle, then why not wait? You’re 28. Unless you know you have DOR, you do have time.