Need Help/Advise about IUI

[mave73]

Hi All,

Sorry for the slightly long post. I need some advice on my situtation.

I am 32 year old male and me and my wife who is 31 have been trying to concieve for about 15 months. I went for my first SA about 5 months back. It came back with

Count - 66 mil/ml
Morphology - 73%
Motility - 10%

I was prescribed clomid for 3 months by my Urologist but that had no significant improvement in my motility

Count - 71 mil/ml
Morphology - 57%
Motility - 15%

I went to see a reproductive spealicist and he mentioned that we could try IUI and I went for an evaluation SA, the count was real suprising

Count - 18 mil/ml
Morphology - 3% Strict Kruger
Motility - 20%
Motile Sperm Count - 2.2 million

The RE suggested IVF/ICSI since the motile count was less than 5 million. I was really shocked since I did not expect the count to drop, I suggested that I go through two rounds of IUI before IVF. I had my first IUI this past week.

Count - 36 mil/ml
Motility - 25%
Morphology - 12%
WBC count - 6-7 %
Motile Sperm Count - 2.4 million

The recovery was only 8% because of sperm clumping. This is something that has never happened before and I was wondering about the cause. I only thing that I noticed that the WBC count was pretty high and clumping which probably points to an infection of some sort.

I want to avoid IVF since it would be very stressful on wife since she hates medication and needles and I am not comfortable with the thought of a very unnatural pregnancy.

Anybody have any similar experiences with clumping of sperm. Any advice is appreciate. Also, since the total motile count is staying around a very low number, should I just chuck it and go for an IVF.

Thanks for your help.

[littlefish]

Mave 73:

Good questions and summary!

My husband's SA count was low at 7 million so we started to see our RE. We did IUI 2 times so far.
1st IUI on Clomid: Failed
2nd IUI on injectables: miscarriage (but at least it worked).
This is what I have noticed: S/A counts, motility and other numbers constantly change! My DH is now above 20 million....which is much better than 7 milliion.
I would continue to try the IUI if I were you. Also, your wives follicles will develop much better and your chances are better if your wife does injections. Clomid didn't do anything for me.

Take a look at our "IUI Thread" for additional information and stories.

Also, our RE said that it only takes one little sperm to make it work. Is your doctor monitoring your wife closely with ultrasounds and bloodwork leading up to the IUI?

How many IUI's do they do and what hours?
MY RE does 2 IUI's. 1st one 12 hours at HCG trigger and 2nd IUI 36 hours after trigger.

[mave73]

We did only one IUI during this cycle.

My wife actually had an ultrasound done and had two follicles with Clomid.

Also I have been on 3 gm of Vitamin C a day for about 2 1/2 months and have started on a supplment called Proxeed for about 20 days now. I am planning to
200 gm of Pycnogenol for the morphology.

[littlefish]

Mave 73: I have heard that Zinc helps out with SA issues. Not sure but you could probably Google "Sperm zinc"??

How large were the follicles and did they do the HCG trigger shot?
Are you going to a RE doctor or GYN?

[mave73]

The follicles were about 12-13 and my wife did get a HCG shot.

I am currently working with a RE who seems to very inclined to jump to IVF/ICSI

[littlefish]

Mave73:

They did the trigger the same day the ultrasound showed the follicles at 12-13? That seems too early. My RE and other ladies RE waits to do the HCG trigger until they are around size 18.

[rich]

Dear Mave,
Infection in the system will lead to a large drop in count. A good urologist or internist could clear the problem of possible infection but definately inflamation in the area. You are now facing the problem of the different standards in judging morphing as in the strict anything borderline is considered bad while WHO it is considered good. Clumping is the product of either lack of Vit C or male factor antobodies from the infection/inflamation. Folic acid/zinc combination has been shown to increase normal sperm amounts by 78% in 6 months. The clumping is common in prostatitis, did they give any indication of viscosity problems or the sample being off color.

Rich

[mave73]

I am now not sure about the size of the follicles now. It was the 14th day after her periods and there was a bold line on ovulation predictor.

That was the only day when she had ultrasound monitoring done.

[mave73]

Thanks for your reply Rich.

The latest SA that was used for IUI showed a 12% morphology by WHO, whereas my morphology has typically been around 60-70% as early as two months back.

They did mention moderate agglutination and viscosity as being the reason for very low sperm recovery (8%, 30 million total motile sperm and 2.4 post wash motile sperm). The sperm color was yellow and I don't have any swelling but there has been some minor irritation for a couple of days.

I am wondering whether the low morphology is tied to the clumping or they are separate factors.

I have been on 3 gms of Vitamin C for about 70 days and I have also started out on a supplement called Proxeed for about 20 days. I am wondering whether I should start on 200gm of Pycnogenol or just wait for a visit to my urologist to check for infection.

[rich]

Dear Mave,
Yes , both motility and morphing drop if infection is present. The infection/inflamation cause the formation of free radicals which attack the boys in sito as they go by as it is easier for the radicals to reacts with them instead of stuff in the fluid. Feeling things aren't right down there is indication of problems. See a Uro and get a culture of of your stuff to see what your battling. I'm not saying you won't have to do IUI with your wife but IVF should be out.
Hope this helps.

Rich

[mave73]

Thanks a lot Rich.

I have an appointment with my Urologist this wednesday and I hope to learn more. This does give me great hope and I want to do everything to avoid the IVF treatment.

[jerseymom]

Hello - I am not an expert by any means - I just want to tell you my story.

My husbands counts have always been around 20 million (ranging from a low of 16 at one test to a high of around 25). His motility has ranged from 15% to 20%. I honestly don't remember the 3rd number.

Anyway in 2001 he was sent to the urologist...but we conceived (me on clomid) before he even got the results.

In 2004 we conceived naturally again (me on clomid) but that ended in m/c.

In 2005 we tried iui but our clinic also PUSHED us to IVF/ICSI telling us with his numbers it was really our best chance (they ran 2 more SA with results similar to what we got in 2001)...now remember we conceived the "old fashion" way twice before.

After much debate we gave in and did the IVF/ICSI (which I want to add was nowhere near as bad as I thought it would be...I expected the worst and it was not that big a deal, really!). Anyway - that failed in August 2005.

In Sept/Oct 2005 I was waiting for my next cycle to attempt FET since we froze 2 from the IVF...but low and behold I conceived NATURALLY that cycle.

I am not sure what my point is - if anything - don't let the doctors push you into anything (which we did). Don't lose hope (it really does only take one).

The only thing we did was to get on a strict scheduale of any type of "activity" every 3 to 5 days...no more no less. Since more can hurt counts and less can hurt quality.

I wish you luck - and please know your wife does not blame you. I know my husband always felt like eveything was his fault and I had to go through IVF because of him...but I NEVER felt that way - not for 1 minute. It was OUR problem and WE had to solve it.

[mave73]

Thanks for that encouraging note.

I hope things work out.

[mave73]

Hi Rich

I met the urologist today and he looked at my SA and opined that this may be an infection.

He however did not suggest a semen culture since he felt that would be inconclusive, he mentioned that it would much easier to just prescribe antibiotics for a week. He has prescribed me co-trimoxazole, 2 tablets a day for 7 days.

I am wondering whether this is the right course of treatment and whether the antibiotic would have any adverse effects on my sperm quality.

thanks,
mave73

[Esperanza]

Hi Mave73,
My Dh and I are having similiar issues with the SA and were told that are best option is IVF w/ICSI. I want to avoid it, if at all possible but once we reach our threshold (of trying naturally) I will have no problem with IVF. I just need to make sure that we cover our bases before sorting to IVF. There is nothing wrong with IVF but I do think Dr's quickly jump to surgical procedures- as their only forte.

My DH had zero motility on his SA, we are waiting to have another SA once he recovers from an ongoing fever he's had for about 6 days. And that reminds me his WBC was a little elevated at 2-4 and not sure if his body just finally started fighting this low grade infection he has had. This may due to the supplements he just started taking over 2 weeks ago (Pycenegol) and maybe it activated his own immune system to fight it. We won't know for sure but the reason why we think this is a possibility is that his fever is not accompanied by any other flu like symptoms or any other sympotms. He's taking antibiotics and will see if the results are any different after this passes.

Just thought I'd chime in. Best of Luck!!

[rich]

Dear Esperanza,
Depending where this low grade infection was, it may be the answer to your motility problem. Whenever you have infection it effects counts in some part of it. In the case of low grade fever for a period of time motility goes down the tubes. Higrade fever for a period of time kills sperm. So don't think of any procedures for at least 3 months preferably 6 months to get his counts back to normal. The vits/minerals will cause the prostate to work and if the infection was there this causes a case of what they call acute prostatitis where high fever similar to the flu comes for a long duration. It has a fever which aspirin doesn't bring down. Any infection with genito-urinary system causes these conditions. So keep the faith.

Rich

[Esperanza]

Thanks Rich!

My DH has had a high fever for about 5 days (102-104F) and seems to have settled to a low grade fever now. I will look up acute prostatis. He was also taking tetracillin (sp?) so it seems his spermies will need to take some time to recover. This is the 4th month taking the vits/supplements, I'm all for it if they kicked his prostate to work again. We'll keep taking the vits and supplements and hopefully his motility improves.
Before he got this fever he was always really warm and would sweat at night, I remember you mentioning no hot items near the testes, so I'm wondering if his own body was cooking his spermies.

[rich]

Dear Esperanza,
The fever alone for that length of time would raise havoc with the fertility of any male as the heat kills. Now the night sweats unless he really tosses and turns in that bed at night are sometimes an indication of a low grade infection in the system which is now showing itself. I have a feeling since he didn't show flu symtoms but straight fever and the tetracycline as the drug given that a urinary tract was present and things will straighten out for the better.

Rich