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jessta

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Reg: Dec 6th 2009

Location: Scotland

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Sunday, December 6th 2009, 1:06pm

Could ICSI work - severe male & female issues

Hi

We have been trying to conceive for 18 months. I am 30 and have endometriosis with a large 5cm cyst on my right ovary. We assumed that the problem was with me until my husband had a sperm test. Unfortunately the results were quite devasting. The first test -volume was too little to even test for everything. The second one revealed a low count 12m. 4 % normal morphology and 0 motility. We then got him on all sorts of supplements - mainly those listed above, stopped drinking totally and did everything that you are supposed to do. Even had him eating pumpkin seeds every day! He has been wonderful about this.

When we had the last test we thought for sure that this would have made a difference - if not in count - at least quality. Instead - the volume/ count was lower 0.03. Again- they couldn't determine the other stats as the count was too small.

We are now privately funding ICSI at the GCRM (Scotland). We are just in the innitial stages now. On the plus side - I ovulate and when they scanned my ovaries for follicles - althought they couldn't see the right one due to the large endometrial cyst - the left hand side had normal amount of developing follicles.

My question is - has anyone had similat stats and issues and still managed to conceive using ICSI?

Also - I have already had a laparoscopy which cleaned out all the cysts that I had. My Gyno says that ther is an increased risk that they will need to remove the ovary if they operate? Anyone with similar experiences?

Thanks

Mavis

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Sunday, December 6th 2009, 1:29pm

Hi Jessta,
The good thing about IVF and ICSI is that it does overcome both male and female issues.
Endometriosis should not be a problem. The cyst might have to be drained, but that can be done just before you start the stimulation phase so it won't cause any delays (and they might even leave it there).
I am not too good at interpreting sperm results, but I know that they can do ICSI with immotile sperm (only twitches). Not ideal, but it is done. It sounds like you are in a much better position than that because there is a fair percentage of motile sperm.
Wishing you lots and lots of luck! xfingers
M
x

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Sunday, December 6th 2009, 1:45pm

RE: Could ICSI work - severe male & female issues

Hi, and welcome to FZ.

I am sure that there will be others coming along to tell you of their personal experiences and stories, so I will stick with some facts.

Firstly I need to ask if all of his semen specimens had lowish or very low volumes? This happens when the sperm are passing into the bladder (retrograde ejaculation) rather than coming out as the semen ejaculate (antegrade ejaculation). It is a common occurence when the man is finding it stressful to produce his specimen (and even when making love under stressful conditions), and it has taken him a long time to climax and produce his specimen. When this happens there is no point in submitting his very low volume specimen as the sperm will all be in his bladder and all that he has "forced" out are secretions from the seminal tract plus perhaps old sperm from previous ejaculations still lying along the tract. Such a specimen is not valid and gives a wrong assessment of his sperm production.

The sperm can also go retrograde when the bladder neck muscles do not work properly, in diabetes and after pelvic or groin injury or surgery, but stress is the commonest reason. Sometime masturbating with a full bladder will send the sperm antegrade, if he can do this, but this is obviously uncomfortable. He also needs to have a 2-3 day gap between ejaculations to give his best volume, count and quality. Too long a gap and the sperm quality goes down, too short a gap and the volume goes down. So check these points out before his next specimen

It is clearly very reassuring that you can ovulate spontaneously. Despite your problems and the (apparent) semen problems, a pregnacy conceived naturally may not yet be impossible. One in ten of all naturally conceived pregnancies can take longer than 18 months, so your ttc trying time, whilst worrying, does not yet prove that it cannot happen. It is important therefore that you continue to ttc naturally for your baby between treatment cycles as even ICSI is not a guarantee of success.

If his problems persist, then clearly you need to maximise your chances of a baby by having treatment, and his sperm can be used for ICSI. Being non motile is not too big a problem so long as they are alive (this is different from being motile).

So do not give up hope, and lots of luck to you both.

Paul.
Fertility Scientist and Andrologist
Fertility Counsellor, Holistic Therapist and Hypnotherapist
Providing Fertility Information, Assessment and Enhancement.
Natural family planning teacher.

jessta

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Reg: Dec 6th 2009

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Sunday, December 6th 2009, 2:05pm

Hi Paul,

Many thanks for this. This is quite reassuring to know that we are still in the running especially with the low motility for ISCI. Sample wise - these were the results. Also - there is so little info about male issues on the web so great to have someone like yourself on the forum.

Regarding the tests- we were very confused as to how the second result could be so different from the first and third. I keep thinking that there must be a reason? He hasn't had any injuries or groin surgery.

Funnily enough - the night before the second one he had a sauna and a couple of beers at the pub with a friend. The third one we had done everything right and it was the worst.

We have an innitial appointment on Thursday where he will be providing a sample. Do you have any recomendations. This will be 4 days gap between ejaculations.

What are your thoughts on this? Also - is there any possibility that this could be caused by a varicosele? We saw a specialist on the NHS. He had a quick feel and said nothing there. But I have read that sometimes these are only visible via ultrasound scan. Personally I didn't have much faith in the Dr we saw - he didn't seem very thorough.

Also - will his PH levels make a difference and what are cytoplasmic droplets. In his test he was outside the normal range?

Thanks so much for your help.
Jess


TEST RESULTS

First one (3 days abstinance)
Volume - 0.8
Motility class d - 100%
Sperm concentration - 0.47
Total sperm count 0.38
Normal morphology - TOO FEW

Second one ( 4 days abstinence)
Volume - 0.7
Motility class d - 100%
Sperm concentration - 18.2
Total sperm count 12.7
Normal morphology - 4%
Cytoplasmic droplets - 1.78
PH - 6.8

Third one (7 days abstinence)
Volume - 1.1
Motility class d - 0
Sperm concentration - 0.03
Total sperm count 0.03
Normal morphology - TOO FEW

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Sunday, December 6th 2009, 11:33pm

Hi again,

" we were very confused as to how the second result could be so different from the first and third. I keep thinking that there must be a reason?" -
The sperm picture can easily vary greatly from specimen to specimen. There are two processes which influence what you get in a semen specimen. There is sperm production and then there is sperm release. For many years I was involved in banking semen donor specimens and would find large variations from week to week and even from day to day. Even these healthy, fertile young men with generally high sperm counts and quality could often produce a poor specimen, infertile even, a couple of days after a very good one, usually either around exam times when they were under stress, or when they had been out drinking the night before. (Saturday morning specimens were invariably poorer then Wednesday afternoon because of their Friday night of drinking). This is not due to any variation in production, but how well they released the specimen on the day.

For DH therefore, the second specimen I believe is a truer measure of his sperm production and the other two are invalid. However unless you know of any factor that might have inhibited sperm production in the testes during the time of the 1st and 3rd only (such as a viral infection, heavy drinking, hyperthermia) then the poor results in these two specimens must have been because of poor release and not a sudden drop in production.

"Funnily enough - the night before the second one he had a sauna and a couple of beers at the pub with a friend. The third one we had done everything right and it was the worst." Illogical I know - but it is the quality of his specimen that is varying not the quality of production in the testes, and only he can help to account for this. The sperm tend to be in the first portion of the specimen, so that if he misses the first few drops he will lose most of the sperm.

"We have an innitial appointment on Thursday where he will be providing a sample. Do you have any recomendations. This will be 4 days gap between ejaculations." - He will now be feeling even more stressed by past events. If he does not feel "in the mood" on Thursday, or he does a specimen that he feels is not right, then he is better to apolgise at his appointment and arrange to do it at another time when he and you are more relaxed, and have more time together.

"is there any possibility that this could be caused by a varicosele? We saw a specialist on the NHS. He had a quick feel and said nothing there. But I have read that sometimes these are only visible via ultrasound scan." - In general it needs to be a large varicocele to impact on his sperm production. If he is unaware of having one then this is unlikely to be a factor.

"will his PH levels make a difference" - Not in this situation

"and what are cytoplasmic droplets. In his test he was outside the normal range?" - This is one of the sperm abnormalities one frequently sees in specimens. These are the remains of the original cell from which the sperm developed, and normally most of these are cleaned off as the sperm move through the tract. Sometimes they are indicative of an increased sperm production following a previous slow down, but this does not seem to have been maintained if it was the case.

Regarding semen volume, all men are shocked at how little they produce in the bottle compared to how much it feels during lovemaking. Even under ideal situations volumes of 1.5 ml up to 2.5 ml are the norm for most fertile men. However DH's specimens do tend to be of low volume especially the first two. This still suggests retrograde ejaculation presumably due to the stress involved in doing his specimens. This is never an easy thing to do, and I admire the men for being able to produce on demand. If he is prone to retrograde then this could even be occuring during intercourse and be a factor in your failure to conceive. He should draw attention to his consistently low volume and ask if he can have a specimen of urine examined after he next does a specimen. It is possible that he will find more sperm in his urine than in his sample.

Finally I am puzzled by the reference to "motility class d". This is said to be 100% in the first two specimens and 0% in the third. This does not make sense. "Class d motility" could mean either good motility or bad motility. If it refers to good motility then his first two specimens were 100% good motility, which is impossible, whilst if it means bad motility then it means his third specimen had no badly motile sperm, which is also impossible. So ask about this when you get the chance.

Good luck,

Paul
Fertility Scientist and Andrologist
Fertility Counsellor, Holistic Therapist and Hypnotherapist
Providing Fertility Information, Assessment and Enhancement.
Natural family planning teacher.

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