Hi guys. Can someone talk to me about semen?

[coribelle26]

This is my first post on this board, though I pop onto GP.  I'm really sorry my first post is about semen.

Our doctors are being weird (RE wants GP to explain it to us, GP doesn't totally know how) about interpreting H's recent SA and I was wondering if anyone can provide any insight/anecdotes from your own experience.

They're calling it low morphology at 14%, which seems like the really high end of low based on their scale and what I've read online.  Motility is 78%, which seems fine from what I can tell.

The part that's throwing me for a bit of a loop is that the sample was viscous.  I haven't been able to find as much information on that, but the subject of IUI with washing came up as a possible solution?  Has anyone done that?  The results say "consider IUI" but I feel like that's jumping the gun when things are only borderline, as it seems they are (unless I'm misinterpreting). 

I think our next step is going to be to wait until the 12 cycles mark (Cycle 10 just started today, but all were well-timed attempts so we decided to just go ahead with the SA) and then start the testing for me plus a repeat test for H.  Right now though, I was just hoping to hear a little more from people who have had the test done and actually got decent information from their doctors.

[G22]

Your title of this post made me lol

My H has low motility and just low count in general (though I can't remember his numbers). With my H's low counts IUI was our recommended first option. His numbers are too low to try and just do medicated cycles, but not too low that IUI shouldn't work. I also have some ovulation issues, so we just did our first medicated IUI and are in the 2ww to see if it worked.

I would have him do a repeat SA eventually to see if his numbers are still that low. I find it a bit weird that neither of your doctors can't explain it well. Isn't that their job? If they run the test, they should be able to explain it in a way patients can understand. Have you tried talking to either of their nurses? Sometimes nurses have better people skills than doctors and they might be able to help.

[Deleted]

I'm not much help in the semen department, as far as decipehring the component parts. The first red flag is that your RE won't sit down and discuss the results with you in a manner that you can fully grasp and understand your circumstances. Is your husband being referred to a urologist? Unfortunately, I'm not much help with semen/sperm counts, since that's our missing piece.

[lola]

Hi Cori! Welcome.


I know nothing about semen (what with our diagnosis of, "You're both perfect! So sorry this is happening, but sometimes there's just no answer!" MFers...lol), but I with Bons in that if your RE won't sit down and talk this through with you it might be worth 1. trying to find a new one or 2. (if #1 isn't possible) scheduling an appointment and refusing to leave w/o some answers.

I hope you get a resolution/treatment plan soon.

[coribelle26]

Thank you, I know this whole results thing is total BS. I think the problem is that the RE isn't considering us "her" patients, and that he was simply there to take the test. She came highly recommended from my GP, who I love, so I want to see what happens if I make an appointment to actually meet with her (H never even met her, he just dropped off the cup to the lab) before I look for someone new. Doing the SA first is what everyone says to do, but the process was just weird and now I'm thinking we should have thought to ask for a consultation appointment first to get on her radar.

Gumby, I have my fingers crossed for you that the IUI was successful!

[coribelle26]

Also, "not much help in the semen department" made me laugh. It's like a customer complaint at the worst store ever.

[discogranny]

May 2, 2013 11:05:07 GMT -5 lola said:

I know nothing about semen (what with our diagnosis of, "You're both perfect! So sorry this is happening, but sometimes there's just no answer!" MFers...lol), but I with Bons in that if your RE won't sit down and talk this through with you it might be worth 1. trying to find a new one or 2. (if #1 isn't possible) scheduling an appointment and refusing to leave w/o some answers.

This is me too, Lola is totally right though about getting a new RE.

I can add though that we did an IUI with semen washing and they were able to basically extract all of the stellar sperm for insemination. Since your DH seems to be fine numbers-wise this might work well for you guys.

[Deleted]

May 2, 2013 11:39:24 GMT -5 coribelle26 said:

Also, "not much help in the semen department" made me laugh. It's like a customer complaint at the worst store ever.

Hey this IF bullshit sucks sometimes, gotta do something to break the tension.  Seriously though, find a new RE.  Our first one sucked donkey balls and the one we went to for our second opinion was light years better.  We won't be pursuing treatment, I just can't get comfortable with the third party reproductive options we have, but if we were I'd go back to the second doc in a heartbeat. 

[KaraOrNot]

H has low testosterone, motility and morphology. I feel like I should be able to decipher the number better, but I still have a hard time reading SAs. I think it is crappy that the RE isn't sitting down to explain the numbers. I would consider setting up a consult meeting w/ her to review the results and come up w/ a game plan if you don't get pregnant w/o intervention. Alternatively, your H could see a urologist. If there are issues w/ a SA, they usually recommend a repeat, as so many things can interfere w/ sperm. The RE referred us to H's urologist and he specializes in IF, so he was really good about interpreting the SA and how it could effect getting pregnant.

Also, this is from the Bump, but I read it like a million times when H was first diagnosed.

Semen Analysis:
Your husband/significant other should have an S/A done during the testing phase, even if you have already been diagnosed with another issue.

The World Health Organization (WHO)’s 2009 report considers the follow results “normal”:
Volume: 1.5ml or more
Concentration: 15 million or more (per ml)
Motility: 40% or higher
Morphology: 4% or higher* (this depends on the method they use. 15% or more used to be “normal” but that has been updated in the new report.

Here is the link to the WHO report for more detailed information:
www.who.int/reproductivehealth/topics/infertility/cooper_et_al_hru.pdf

And here’s a great discussion of the numbers (specifically morphology) from an RE at NYU: infertilityblog.blogspot.com/2010/07/sperm-morphology-new-guidelines.html

What do I do if our S/A comes back abnormal?
1. Repeat S/A. Have another S/A done several weeks apart because one test cannot give you a full picture and several lifestyle issues can effect sperm (including temporary illness).
2. See an urologist. Have YH see an urologist who specializes in fertility to see what if, anything can be done to improve the numbers. The urologist should be getting his entire medical history, S/A results and should be doing a physical exam and taking blood to test hormone levels, etc.
3. Consider vitamins/supplements. Some couples have found that vitamins/supplements have helped increase sperm quality/quantity. It is not a magic bullet, but it may help. Fertility Blend for Men is one we recommend (it's available online and at GNC stores). You might also look into: pycnogenol (especially for morphology), CoQ10 and L-arginine (which aren’t in Fertility Blend).
4. Consider lifestyle changes. Again, some couples have seen improvement in numbers when lifestyle changes were made. Quit smoking, decrease drinking, switch to boxer shorts, no hot tubs or hot computers on the lap, healthier diets, increased exercise, etc. Also, some men have seen success with acupuncture.

**Remember, it takes approximately 3 months from the time sperm is "born" to when it's released so any lifestyle/medical/vitamin changes will take three months to show up in a sperm analysis. And if YH was sick 3 months before your S/A, it may affect the results.

[coribelle26]

Thank you so much for posting that. (Of all the googling I did, I didn't go over to the bump, lol.)

So if 4% is the newer standard (and I did see that on a few different articles, too), then it REALLY seems alarmist for them to recommend IUI.

Ugh. I may not even waste my money getting my own appointment at this place (we're 100% out-of-pocket) and just find someone else.

[jewel]

First off, do not apologize for asking about sperm. I think you win for best intro thread :-) The questions around here get much weirder and grosser.

Regarding viscosity. I had about a 2 minute conversation with my RE about this, because my husband's report came back abnormal a couple of times. From what I understand, viscosity is a measurement of the liquification of the semen. After 30 - 60 minutes, semen should liquify from the gooey way it comes out, to very thin liquid. If it doesn't, it's much harder for the sperm to swim through, which is why it affects fertility.

That said, the doctor wasn't concerned about this measurement. Our results have come back in the normal range for viscosity many other times. We have plenty of other sperm issues, so IUI is a logical treatment. At my doctor's recommendation, I keep the sample between my boobs from the time it's produced, until I drop it at the clinic (1 hr lapse time). The body heat really helps with making sure the semen liquifies, and we've never had an issue with viscosity at the IUI. At that point, the sperm are washed and separated anyway, which usually negates any issues with viscosity.

I don't think that attempting IUI after a year of unsuccessful TTC, even without any sperm or other known issues, is too unusual. I'd probably change REs though, just because this one doesn't sound very helpful. If I'm paying out of pocket, the service better be great.

Good luck, and welcome

[mae141]

My RE can be difficult to talk to when I'm trying to just get results- he makes me schedule a consult to go over things. But when I do go for the consult, he sits down and focuses on everything and will explain any questions I have. So it's annoying to have to have an appointment after an appointment, but it's just how he rolls I guess.

As far as the newer standard for the results- it's actually a different way to classify the sperm, or something. DH got his original SA done at Labcorp, and my RE made him do another at his office (which wasn't covered by insurance, Labcorp was) because he said Labcorp uses an outdated way of looking at the sperm and he wasn't able to get the info he wanted from that report. There ended up being a big difference in the numbers when we had the new test done.

My DH did have viscous semen, too, although I'm not totally sure what that means. The RE did say "after you have sex, it probably comes out in clumps" and I was really weirded out to be talking to another man about that, but he was right. Because of that, and some low-ish numbers, he recommended IUI. We did 3 before moving to IVF.

[coribelle26]

jewel, so I was talking to H last night about keeping the sample warm on the way to the office. (Okay, it actually started out with me telling him how it took me longer than I'm proud of to piece together that you kept it between your boobs IN THE CUP. Omg. Yesterday was a long day, I'm honestly not that stupid. Usually.) Anyway he was like, "Oh yeah! They said to keep it in my shirt pocket and I didn't have a shirt pocket so I just set it on the seat next to me." Well, mystery solved on that one, lol.

[awkwardpenguin]

Usually the first step is a repeat SA. If there are any problems with the sperm part they'll usually recommend IUI, so it's not crazy that they recommended it. If viscosity really is the problem, the washed IUI would help.

Our experience is the people at the lab who write weird stuff on the SA results are a little alarmist. Our donor's SA was 10% morph, and they wrote "teratozoospermia" across it in big letters. But our RE (who was still using the old value of 15% at the time) was like "that's a little low, but probably not the reason you're not getting pregnant".

Our RE was super awesome about explaining things - she had a sheet with all the things that need to "go right" for us to get pregnant, and then an explanation of which tests tested what and what "normal" was. There's a lot of disagreement about what's normal for morph, but the most recent recommendation is above 4% (or 4% or higher?) using the Kruger "strict" morphology method. I don't know much about how viscosity affects things - that seems an uncommon one to be the only problem, but would be solved by IUI.

[awkwardpenguin]

Oh, I missed part of my point, which is that you really do want an RE who will explain things to you, and I'd probably look for a new one. The "first step" after 12 cycles will also be a bunch of tests for you, and you'll want good explanations of those too.

[FastHands]

Hey girrrrl. lol. I have no advice or experience but I hope you find an RE that doesn't suck. I wonder if you are right that they can't discuss results because u aren't their patient? Since your gp ordered it, they are sort of acting just like a lab, and u wouldn't expect someone at say Labcorp to interpret your results, right? Idk. DH goes for his next week but it's just at a lab.

[coribelle26]

May 3, 2013 22:17:21 GMT -5 FastHands said:

Hey girrrrl. lol. I have no advice or experience but I hope you find an RE that doesn't suck. I wonder if you are right that they can't discuss results because u aren't their patient? Since your gp ordered it, they are sort of acting just like a lab, and u wouldn't expect someone at say Labcorp to interpret your results, right? Idk. DH goes for his next week but it's just at a lab.

Hey ute twin!  I do think that's what's up.  I may give her a chance and make a real appointment with both of us before I move on to the next RE.  It is just bothering me way more than it should that they're using the 15% guideline, and then, like awkwardpenguin said, it was like "TERATOZOOSPERMIA - ABNORMAL" in big old letters on the report.  Slow your roll there, lab people, even on your own damn form it says "4%-14% sub-fertile to fertile."  Anyway, hopefully we'll know more in a couple of months when I go see her (or someone else). 

I hope you and your H get good news!