Q & A Sessions: Male Infertility
Our experienced Penn Fertility Care physicians answered
your questions about male infertility.
To learn more, read about our male
infertility services.
Adam asks:
I'm 41, have two children (ages nine
and five) who were born after naturally
achieved pregnancies, and my wife
and I have been trying unsuccessfully
for the last two years to have another
child. After being checked I was
found (at least six times the last
year) to have zero sperm count and
have had two TESE operations in which
four sperms with no motility where
found each time. IVF was tried once
with no success. I have high FSH
and LH levels.
My questions are:
- What could be the reason
for the disappearance of sperm
production (I've had no serious
illness or injury)?
- Is there any way to induce the
testicles to start functioning
again?
Christos
Coutifaris, MD, PhD responds:
High FSH and LH levels imply primary
testicular damage. In the absence of
illness, injury, chemotherapy, radiation
therapy, etc within last 5-6 years
when most recent child was conceived,
then we must consider some unrecognized
environmental insult.
Increased FSH, LH usually mean the
testicles cannot be restarted and hence
there is no role for aspiration/ICSI
technology. Would recommend thorough
physical exam especially assesment
of testicular size and possibly testicular
biopsy for definitive diagnosis.
|
TE asks:
My husband and I have been trying to
conceive for a year. A semen analysis
revealed poor morphology and a recent
ultrasound confirmed varicoceles.
Is surgery the only answer to conceive?
How effective would assisted reproductive
technology (ART) be?
Richard
Tureck, MD responds:
Assisted reproductive technology
can be extremely effective. There
are a variety of ways to treat male
infertility. We would be happy to
meet with you to discuss your medical
history and determine a course of
action to help you to conceive.
|
Paris asks:
I am 32 almost 33. My husband and I have
been trying to have a baby for over
one year with no luck. I was recently
on Clomid one month 50mgs and month
100mgs both were taken on days 3
through 7. When the doctor upped
my mgs to 100mgs they did the inner-ultrasound
and also gave me a HCG shot.
Two days later they did an intrauterine
insemination (IUI). They did a progestrone
day 21 lab and said the results were
19.2 "very good," but
still no luck because I recently
got my period.
We were told by the doctor that my
husband's sperm count was 1 million
with 50 percent motility and moderate white
blood cell count (WBC). In your
opinion should we keep trying this
route or should we try and get his
sperm count up before we procede?
Kurt
Barnhart, MD, MSCE responds:
One way to increase your husband's
sperm count is to use insemination.
However, if the count is one million
after the "wash" used for
the insemination, you may want to consider
more aggressive treatment. If the count
is below four million (total motile
count), the success is greatly lower.
One consideration is in vitro fertilization
(IVF) with intracytoplasmic sperm injection
(ICSI). |
Mrs. Cap asks:
My husband has a 70 percent mobility
rate but a very low sperm count.
I am 37 years old and have previously
conceived. Also, my FSH on day two
was 15. Is is possible to get pregnant
using other means besides donor egg?
Kurt
Barnhart, MD, MSCE responds:
Of course much depends on the specifics
of your circumstances, but in general,
there are two obstacles working against
you. One is your husband's sperm
count. Depending on your husband's
sperm count, he may be a candidate
for intra-cytoplasmic sperm injection
(ICSI), which could be performed
with your eggs or that of a donor.
The second issue is your follicle
stimulating hormone (FSH). Women
with a high FSH value (in our hands
above 11.4) have a much lower pregnancy
rate, however it is not zero.
The decision to try IVF or to use
an egg donor is a difficult one. I,
or the other physicians at Penn Fertility
Care, would be happy to talk to you
about this and help you make a decision.
If you would like to consult with a
Penn fertility specialist, please call
1-800-789-PENN (7366) or schedule
an appointment online. |
Mickey asks:
I have been diagnosised with endometrosis
and have been on Depo Lupron for
four out of the past six months.
My husband was born with one sac
not descended and had surgery at
the age of three. He now is diagnosed
with extremley low count and mobility
of his sperm. His morphology is 90
percent. I was told that I have a
six month window to conceive after
my Depo Lupron is done which begins
at the end of December 2003.
I am wondering what are our chances
of conceiving and if I will most
likely get endometrosis back after
the six month window if I am unable
to get pregnant? Our timing seems
to be extremly important. What are
our next steps?
Richard
Tureck, MD responds:
I recommend that your next step would
be for your husband to be seen by a
male fertility specialist. Artificial
insemination or in vitro fertilization
are also be options to consider in
the future and depending on your medical
condition at the time, may increase
your odds of conceiving. |
Tracy asks:
My husband and I have one child together and are trying to have another. The
problem is that when my husband has an orgasm, the ejaculate is present after
he's down and out, and at that, it's very very little. We had no problem
conceiving our first child six years ago. Since then, his sperm production
is very minimal, sometimes, it is not even present.
My husband is a larger
man in weight, but his build is extra
large anyway. Could that be the problem?
Is there anything he can take for increase
in sperm production? What can we do?
Response:
One of the most important aspects of conception for men is the sperm count, not
necessarily the volume. I would recommend a formal semen analysis in which
we would test the number of sperm, the percentage that are moving, as well
as their viability.
Volume does matter, but we can often
overcome that with an insemination
or IVF. I would recommend a complete
evaluation from a reproductive endocrinologist.
Depending on the semen analysis, it
may be necessary to have your husband
see a urologist. |
S asks:
My wife and I are trying to start a family.
I had my sperm analyzed and the result was
an irregular morphology on the heads of
94 percent of the sample. I did some research online,
but have no idea why it is like this. I
am extremely heathy. I do not do drugs or
drink. I do not have chronic exposures to
chemicals. I take vitamins regularly. The
only thing I can think of is that I did
smoke cigars over the summer. How bad is
my condition? Can it be treated? Is it permanent?
Response:
If you had only one sperm sample analyzed,
please repeat it. Sperm quality can
change markedly from one sample to
the next, and from one institution
analyzing it to the next. If you
would like to make an appointment
with a specialist at Penn Fertility
Care, please call 1-800-789-PENN
(7366) or visit pennhealth.com to schedule
an appointment online. |
Vanina
asks:
My husband had a hernia on one of his testicles
when he was
an infant. The doctors told his mom he would
have about a 50% chance of conceiving. I
have been off the pill for 14 months and
I can't get pregnant. Is there any hope
that my husband and I could conceive? We
are both 28.
Richard
Tureck, MD responds:
The first thing I would suggest would be
for your husband to obtain a semen analysis
to check his quality, mobility etc of sperm.
In addition, if you have not yet been to
a fertility specialist, I highly recommend
you see one. A fertility specialist can
best determine reasons for infertility and
a positive course of treatment. If you interested
in seeing a Penn Fertility Care specialist,
simply call 1-800-789-PENN (7366). |
Kristina
asks:
My husband and I recently found out that
he only has five percent normal morphology (done by
strict criteria) and everything else is
normal. Would intra uterine insemination
be a treatment option or should we proceed
directly to ICSI with IVF?
Richard
Tureck, MD responds:
Although IUI may be an option, the
best option for a successful outcome
related to this type of infertility
issue in vitro fertilization. |
Red asks:
My husband suffers from anejaculation. We do have one healthy
child, but have been unable to conceive due to his condition for one year.
Who do we need to see regarding assistance (i.e. vibratory stimulation
or electroejaculation)?
Kurt Barnhart, MD, MSCE responds:
I am sorry to hear about your difficulties in starting a family. I agree
that your main issue may be getting your husband to ejaculate. Our staff
works in conjunction with a urologist who specializes in male infertility.
Your husband needs a complete evaluation, and if that is determined to
be the only problem, we will likely be able to help fix the problem and
obtain enough sperm to use in an intrauterine insemination. However, we
do not want to overlook any other issues on the female partner's side (i.e.
potentially blocked tubes or irregular ovulation).
Penn Fertility Care
offers a comprehensive evaluation and extensive fertility services to
assist you. I hope that we can be of service
to you. If you would like to consult with
a Penn fertility specialist, please
call 1-800-789-PENN or request
an appointment online. |
Amit
asks:
I have been married since April 2004.
Earlier we had intercourse without
any protection but I used to discharge
the semen outside the vagina. From
October 2004, I started discharging
the semen inside my wife's vagina.
Meanwhile, my wife has had three delayed
periods, first in May 2004, then in
October 2004, and finally in February
2005. This delay was of 12 days.
In February, we went to the doctor
since my wife was unable to conceive.
The doctor started us on various medicines
which were to be continued for three
months. I also had my semen test analysis
done. My volume is 0.5 mL; total sperm
count is 45 million/cc; active is 15
percent; non-motile is 60 percent.
My report says that I am having oligospermia.
I am taking medicines for that. My
wife also had HSG done which was okay.
Please tell me what should we do. What
are my wife's chances of becoming pregnant?
Samantha
Butts, MD responds:
Actually your sperm count is in the
normal range (20 million per ml or
greater is normal) but the motility
or percent of sperm that are moving
appears to be low. I would not base
any final conclusions on just one semen
analysis and if a test is abnormal
in any way it is good to repeat it.
It's difficult for me to comment
on exactly what you should do next
without more detailed information.
However, if there is a concern about
sperm count or function, an initial
procedure that is often combined with
fertility medications/ovulation induction
is intrauterine insemination. The benefit
of inseminations are they allow for
the placement of sperm inside a woman's
uterus very close to the time she is
ovulating. The procedure also involves
washing the sperm a process which helps
select the ones that are moving the
most. Good luck to you. |
Baxter98 asks:
I recently had a miscarriage at 10 weeks. The month we conceived we had seen my ob/gyn because we had been trying for eight months with no success. She ordered a sperm analysis which my husband had done. I recently received a copy of my records with the report from the analysis. While he had a good sperm (62 mill/ml) count with good motility (62%) the report said he had only 3% normal morphology and that basically we wouldn't be able to conceive on our own.
Seeing as we did conceive twins, I'm confused. Is this something we should look into further? Could it have contributed to the miscarriage? The report said he should have the analysis done again but my ob/gyn never told us this. I'd like to get it done again as my husband is upset but I'm wondering if we shouldn't look into seeing a reproductive endocrinologist.
Clarisa
Gracia, MD responds:
It is possible that the abnormal morphology contributed to the delay in pregnancy. Whether it had anything to do with the miscarriage is unlikely. I would not be very concerned about the morphology, but would recommend repeating the analysis in one to two months. Hopefully, you will be able to conceive again quickly! |
Jill asks:
If a normal sperm count is 40M and normal morphology is 30 percent, does that mean you have 12M capable sperm? What if you have a sperm count of 100M and morphology of 15 percent? Does that mean you have 15M capable sperm and therefore are better than the normal one? I'm trying to understand if one part of the analysis is good will it help offset another part that is bad.
Kurt Barnhart, MD, MSCE responds:
There are three main parts of the
semen analysis; count, percent, motility
and morphology. All independent can
have an impact on fertility. If any
are very low, that in itself is bad.
If one part is only mildly abnormal,
it may be compensated by the others.
The one calculation that helps is "total motile sperm".
If the count is 10m with 50 percent
motility than there are 5 million
total motile.
A rough cut off for success when
using and insemination is the need
for 4 million total motile sperm. Morphology
is not so easy to add to the equation
as you do not know how many of the
abnormal shaped sperm were motile or
not. If the morphology is low, you
should seek evaluation by a fertility
specialist regardless of the count. |
Jenna asks:
My husband had leukemia as a young child and after radiation his testicles had to be removed. We are wanting to use a donor's sperm that we know, however he has had a vasectomy and doesn't want to have a reversal. What options do we have to extract the sperm? What implantation options do we have?
Samantha Butts, MD MSCE responds:
While it may be reassuring to use the sperm of a known donor, your situation has several challenges that you should know about up front. First, with a known donor the process takes at least six months because the donor has to be tested for infectious disease early on and then six months later. This is routinely done at sperm banks to protect the patients from any preventable diseases that could be transmitted during the treatment of infertility.
The second issue is that your prospective donor has had a vasectomy. If it is not reversed the only way to extract sperm from him is through a minor surgical procedure. At the same time, you would have to undergo in vitro fertilization because the number of sperm harvested from men with vasectomies is very small and the only reasonable odds of pregnancy is with in vitro fertilization. Give these issues some thoughts as you are making your decision about using the donor you have identified. |
SAS asks:
My husband and I are both 30 and have been trying to get pregnant for just 11 months. Luckily, my doctor was proactive and sent my husband for an SA. His count and motility came back good, however he had just 3 percent normal morphology using strict criteria. The research I have been doing before we're able to meet with the infertility specialist made me believe that IUI would not be an option for us.
However, I've read something in your
posts that make me believe I'm wrong?
Are they able to concentrate my husband's "normal" sperm
and have a successful IUI? Have you
seen this happen in your practice?
Samantha Butts, MD MSCE responds:
First, it might be reasonable to repeat
your husband's semen analysis before
settling on the thought that he has
abnormal morphology. There can be
lot of variability in sperm production
and its reasonable to have more than
one study to confirm whether or not
this is a problem.
If your husband truly has a problem
with the morphology of his sperm, the
washing process that goes along with
IUI may be of some benefit, but it
is impossible for us to know how much
because we cannot test for sperm morphology
with this procedure. If the other parameters
are normal, IUI may be a good first
place to start but if this is not successful
after several tries it might be reasonable
to try another treatment. |
Buffy1983 asks:
I am 23 and my husband is 25. After being unable to conceive after six months of trying, we both got tested. My results were good (bloodwork), but my husband's semen analysis results were very poor. pH=8.5, sperm count=1M/ml, total motility=32% (15% rapid progressive, 11% slow progressive), normal morph=10% (ref range 30-100%).
I'm concerned by a footnote on the results regarding abnormal morph which says "binucleated spermatozoon; absence of acrosome." Does this apply to every sperm, or only the 90% that are abnormal? Is IVF/ICSI a possibility considering these results? Also, my ob/gyn handwrote on the results sheet "positive for azoospermia." This doesn't seem correct to me, considering he has 1 million sperm per ml.
Kurt Barnhart, MD, MSCE responds:
Sorry to hear about your difficulties in getting pregnant, and finding out about the abnormal semen analysis. You are correct in that if there is 1 million sperm, your husband is not azospermic. The abnormal morphology noted is an example of what was seen, it is not in all sperm.
In short, in vitro fertilization or intracytoplasmic
sperm injection ICSI is a good option for you as it can
overcome these abnormalities. I would also recommend your
husband see a urologist so as to exclude any other heath problems
(like testicular cancer). Good luck to you both. |
Mary asks:
My husband is 35 and I am 30. My husband
has been diagnosed with partial testicle
failure due to some toxication. There
are suspicions by the urologist that
this has led to his only one percent
sperm count, zero motility, and extreme
low morphology. We did a ICSI cycle
recently, I have 14 eggs, but only
one fertilized embryo with 4 cells.
We did an embryo transfer on day
three.
Unfortunately, the cycle failed.
I am considering a second cycle again,
and would like to know if there is
any protocol that may enhance the ICSI
success rate. Does the embryologist
and the laboratory play an important
role in my situation? Kindly advise.
Samantha Butts, MD MSCE responds:
ICSI is an excellent treatment for
severe male factor infertility. It
can often very successfully treat
patients in which the male partner
produces very few sperm but is not
perfect and there are cases in which
fertilization is poor. Sometimes
this can be because there is diminished
quality of the eggs from the female
partner but in many instances it
is because the sperm is not fully
capable of causing normal fertilization.
I would recommend discussing your
previous cycle with your physician
and asking him or her which of these
possibilities is most likely in your
case so that appropriate adjustments
can be made. |
Gary asks:
My sperm morphology is 24% normal forms by WHO method. Can my wife get pregnant even with this amount of normal sperm or is there any way to improve the morphology. Does Pycnogenol really help improve morphology? Does it have any side effects?
Kurt Barnhart, MD, MSCE responds:
Sorry to hear about the abnormal lab test. Abnormal morphology is associated with difficulty getting pregnant, but pregnancy is possible. One option is for you to consider concentrating the normal sperm in the form an intrauterine insemination, or even consider in vitro fertilization (IVF).
In the case of IVF, sperm are closer to the egg, thus increasing the chance that they will fertilize. I do not know of any objective avoidance that pycnogenol improves sperm morphology, or the chance of getting pregnant. |
Susan asks:
My husband and I just received his semen analysis, and his sperm count was severely low (200,000). My doctor referred me to try in vitro fertilization (IVF). With a sperm count that low, is it possible to conceive at all? Thank you.
Samantha Butts, MD MSCE responds:
Yes, it is possible to conceive with
a sperm count of 200,000, but it
will definitely require IVF with intracytoplasmic sperm injection (ICSI).
You should have these procedures
explained to you in detail by an
infertility specialist so you can
understand the indications, risks
and benefits of them. |
kab830
asks:
I have
a boyfriend who got a vasectomy about six
years ago. I do want a baby with him. Will
he be able to give me one?
Kurt
Barnhart MD, MSCE responds:
Since we do not know the medical
history related to you or your boyfriend,
we cannot say if you will be able to create
a baby together. However, in vitro fertilization
is far preferable, and more likely to succeed
than trying to have his vasectomy reversed
by a urologist.
The procedure your husband
would need is called PESA (percutaneous
Epidermal sperm aspiration). A needle is
placed in the epidiimus (just above the
testis) and sperm are obtained. The procedure
is performed with your husband under sedation
(not general anesthesia). We at Penn Fertility
Care would be happy to assist you with these
procedures. Feel free to contact us at
1-800-789-PENN (7366). |
Mammen asks:
I have been unable to have children, diagnosed with left varicocele and varicocelectomy
was done. There is still no improvement in semen analysis, please advise
what treatment to follow.
Kurt
Barnhart MD, MSCE responds:
I am sorry to hear about your difficulty
in having children. Often the repair
of a varicocele does not have a dramatic
positive impact on the parameters of
the semen analysis.
Your next option depends on the
results of the semen analysis. If
the numbers are mildly below normal
an intrauterine insemination (with
sperm washing) may help. If the numbers
are very low, or insemination has
not worked, in vitro fertilization
(maybe even with ICSI) may be helpful.
Good luck in your efforts. |
Darris asks:
A few years ago, I was a patient at Penn for IVF. I had my eggs retrieved, and
a few hours later my husband had a procedure done to aspirate sperm. Unfortunately,
we were told my husband didn't have any sperm, and the donor sperm program
was suggested. My husband doesn't want to use donor sperm.
Is there any medicine that he can
take to produce sperm? Any procedure?
He's a healthy black male, and out
of the millions of sperm cells that
most men have, my husband has none.
Is there any way we can concieve
without the use of donor sperm?
Clarisa
Gracia, MD responds:
It sounds as if he is no longer producing sperm. There is no doubt that your
best chance of having a baby is by using donor sperm. This is really a very safe
and relatively inexpesive option, even though the child will not have your husband's
genes. Unfortunately, in cases of complete testicular failure, it is not possible
to increase the sperm count with medications. However, there are some conditions
that do respond to medications such as hcg. You should contact the office to
find out if that is a reasonable option for him.
In addition, it is possible that
there are a few sperm in his testes
that were not seen because the physician
was only able to biopsy a small sample.
There are some urologists that dissect
the testicles under a microscope
to try and identify areas with sperm
production. One program that offers
this service is at Cornell in NYC.
You may want to consider the option
of having a second opinion. |
Natalie asks:
My boyfriend had a vasectomy approximately
11 years ago. We are now discussing
having children. He does not believe
this is possible because it has been
so long and his age (42). He is otherwise
in excellent health.
He has also
been told that whatever chance we do
have of conceiving there is a possibility
of severe birth defects. I am desperate
to find out if the possibility does
exist for us to finally conceive. What
needs to be done to make this dream
become reality?
Clarisa
Gracia, MD responds:
We know that vasectomy reversals are less successful the longer a man waits.
However, I would definitely not give up hope. You should make an appointment
with a urologist to discuss the procedure. Alternatively, he may have sperm removed
easily without undergoing extensive surgery and used to fertilize your eggs using
in vitro fertilization. |
Mrs. V asks:
My husband and I had our first child in 1999. Since 2000 we have been trying
to conceive another baby but we have been unsuccessful. The doctors say my
husband has a low sperm count. Is there any kind of vitamins or anything
we can take for us to get pregnant?
Richard
Tureck, MD responds:
There are a variety of therapies to address a low sperm count. To answer your
question in an appropriate manner, we would have to know your husband's health
history (i.e. semen analysis results including count, motility, and morphology,
etc).
If you would like to move forward
with a fertility consultation, we
would be happy to help. To schedule
an appointment with a Penn Fertility
Care specialist, please call 1-800-789-PENN
(7366) or schedule
an appointment online. |
CZ asks:
I am 31 and my husband is 36. He has had cancer (Hodgkin's) three times. He has
undergone chemo and had a bone marrow transplant. We would like to have a
baby. We know the chances are slim of having our own. Where do we go from
here?
Richard
Tureck, MD responds:
I would suggest getting a semen analysis
as a first step. Then you will know
if his sperm are viable. Depending
upon your husband's test results, there
are various procedures that can be
performed. A fertility specialist could
detail what may work for you. We would
be happy to help you. |
Tweety asks:
My fiance is 50 years old and does not have kids. He was told years ago that
he has no sperm count or dead sperm. He went to a doctor years ago but the
doctor laughed at him about his situation. We would like to have a child.
Please let me know how you could help.
Pasquale Patrizio, MD responds:
As you well know fertiity issues are not a laughing matter. Male infertility
accounts for 40 percent of all infertility problems. I am well-versed in male
fertility diagnosis and treatment and would be happy to assist you both in
finding out if your fiance is truely lacking sperm or if his sperm count is
simply low.
Fertility
treatments have come a long way in
only five years so if your husband
was seen years ago, the doctor may
not have had the knowledge we have
today. Please contact us at
1-800-789-PENN (7366) and we will
be happy to discuss your situation
with you. |
Kay asks:
My husband was diagnosed with maturation arrest. His testicular biopsy showed
only a few sperm, but they were not coming to a mature state. Is there any
hope of us concieving through IVF with ICSI? He is 34 and I am 33. Also,
I have three children from a previous marriage.
Pasquale Patrizio, MD responds:
Unfortunately, if the diagnosis of
maturation arrest is correct and
confirmed, there are almost no chances.
Please contact us if you would like
an evaluation for a second opinion. |
Terry asks:
My husband was diagnosed with azoospermia. He got a testicular biopsy and they
found no sperm. We chose not to pursue anything further at that time and
pursued an adoption. Is there a possibility that we still can have a child
if we pursue ICSI? If they did not find anything during the biopsy, is that
it, or could there still be a chance?
Pasquale Patrizio, MD responds:
We would need to review the slide and the pathology report. We can definitely
provide you with a second opinion and look into your spouse's condition further.
To schedule an appointment with one of our fertility specialists please call
1-800-789-PENN (7366). |
XiXi asks:
I am a 31 year-old female. The results of my husband's sperm analysis shows abnormal
morphology (only 2 percent normal with Kruger Strict); other parameters are
normal. Is ICSI our only option? If we want to try ICSI after 6 months, do
I need to do a HSG now?
Christos
Coutifaris, MD, PhD responds:
This is an excellent question. Given
your age, an argument can be made that
no further evaluation is needed unless
there is a history of pelvic infection,
which may have damaged your tubes.
However, with such poor morphology,
the likelihood of fertilization is
very low and therefore the best approach
is IVF with ICSI.
If at the time of IVF many eggs
are retrieved and the semen sample
has excellent numbers and motility
of sperm, some of the eggs can be
separated and inseminated conventionally
to see if spontaneous fertilization
can occur. If the sample is poor,
ICSI should be performed on all the
eggs.
If you have further questions or
would like to schedule an appointment
with a Penn Fertility Care specialist,
please contact 1-800-789-PENN (7366)
or request
an appointment online. |
Suzanne asks:
My husband had a vasectomy reversal two years ago. We recently found out that
his mobility rate is 15 percent and that he has a sperm count of 400. Is
it impossible to acheive pregnancy with these rates? Is IVF an option with
that rate of mobility?
Clarisa
Gracia, MD responds:
I would need to know exactly the semen parameters to answer your question. If
you mean 400 million sperm/ml, with 15 percent motility, that is a very high
count, even if the motility is low. The overall number of motile sperm are probably
sufficient to achieve pregnancy. What about the sperm morphology -- was this
normal? All of these issues may play a significant role in allowing pregnancy
to occur.
IVF requires very little sperm.
Using IVF with ICSI, one only needs
a few sperm to achieve pregnancy.
Best of luck to you! |
Joni asks:
Have you done any research on the benefits
of pycnogenol in treating male infertility?
My husband's had two semen analyses
done — first said zero percent
normal morphology; second said 15 percent
normal after three months of taking
the pycnogenol. He has an 11 year old
daughter, so we know that his sperm
were normal at one time.
We have
tried IUI twice, thinking that our
chances had improved, but then we were
told two different test methods were
used in his semen analysis. Is IUI
even worth doing with this level of
morphology? I am ovulating regularly,
but I'm almost 40. How would the procedure
called ICSI benefit us, if at all?
Richard
Tureck, MD responds:
Some recent reports suggest that antioxidants
such as pycnogenol may improve the
morphology of sperm. I would need additional
information regarding your husband's
the sperm count and the progressive
motility of his sperm to answer your
questions regarding IUI and ICSI. We
would be happy to meet with you to
discuss your fertility options. |
Jade asks:
My boyfriend and I have been trying to conceive for the last eight months. We
have started the preliminary infertility checkup. He has to get a semen analysis
done, but on Monday we did the post coital test after having intercourse
40 min prior to the test.
The doctor told us that my boyfriend's
sperm were immature. What does that
mean and is that the reason we are
having a hard time getting pregnant.
How long does it take for sperm to
mature and where can I find information
on immature sperm?
Kurt
Barnhart, MD, MSCE responds:
The diagnosis of immature sperm is rare and should be made with a "formal"
semen analysis. If sperm are premature
it may be a problem of how they are made
(in the testicle). How much this contributes
to your difficulty in getting pregnant
is best answered when you know the results
of the semen analysis. It may be a very
significant problem, it may not be a problem
at all. I feel very strongly that the diagnosis
of "immature" sperm cannot be
made on a post coital test. |
Jennifer asks:
My husband had a vasectomy 10 years ago and now we'd like
another child without having a reversal, are there any options for us?
Samantha
Butts, MD responds:
Without resorting to a vasectomy reversal
the only way to conceive is to use
in vitro fertilization in combination
with a percutaneous epididymal sperm
aspiration (PESA). In other words,
a urologist or a reproductive endocrinologist
specializing in male infertility would
have to perform surgery on your husband
to obtain sperm from the epididymis
which is an area next to the testicle
where sperm are stored prior to ejaculation.
Once the sperm are obtained (a small
needle is used and your husband is
asleep) they are incubated with your
eggs so that fertilizaton can occur.
This requires doing in vitro fertilization
because the number of sperm that
are obtained this way are small,
requiring the use of special methods
to increase the odds of fertilization
and pregnancy.
If you would like to schedule an
appointment with a Penn Fertility
Care specialist, please contact 1-800-789-PENN
(7366) or request
an appointment online. |
Heather asks:
I am 32 years years old. My husband has azoospermia so we've done donor inseminations
twelve times. The fifth time took but was an ectopic pregnancy. We really
can't afford IVF. Is it likely that if we continue the IUI then I'll become
pregnant?
Samantha
Butts, MD responds:
It is certainly possible that you could conceive but what I think needs to be
evaluated further is what has been the barrier to you getting pregnant normally
after so many attempts with donor insemination. You might need additional laboratory
evaluation or a hysterosalpingogram (to evaluate your fallopian tubes).
It's also possible that you might
need to be treated with medication
(if you haven't been already) in
addition to having inseminations.
All of this would require you to
sit down with your infertility doctor
and ask these questions to see if
your treatment is going in the right
direction. |
Jen asks:
I am 28 years old, and my son is 14
months old. We were told that my
husband's sperm count (1 to 1.5 million
with 30 percent motility) was extremely
low, and that our chances of natural
conception were very slim, but we
were so fortunate to have been able
to have a child without any intervention.
However, we have been trying and
want to have another baby.
Under these circumstances would
you recommend trying IUI? Would that
be with or without injectibles? From
a financial standpoint, we want to
spend money on what is best for conception,
but on the other hand I do not want
to put my body through all of the
medications associated with IVF if
it is not necessary. What do you
suggest?
Samantha
Butts, MD responds:
The sperm count that your husband has
would make it very difficult for even
inseminations to be successful and
is usually associated with requiring
IVF to conceive. If your husband has
not yet been evaluated by a urologist
or by an infertility specialist who
also specializes in male infertility,
he should definitely be evaluated to
try to determine what the cause of
this low count is.
Once that is done, I think it is
advisable for the two you to be seen
by an infertility specialist to go
over his evaluation and to review
your history as well. Then you can
get all of the information required
to make an informed decision about
how to proceed. |
Baby world asks:
I am 22 years-old and my partner is 27. We have been together for six years and
have been trying for a baby for two years now. The first test my partner
did, I received his results with his consent while he waited outside. The
doctor told me he had <1 ml semen, and no sperm. She was of no use, really — she
laughed at me, as well.
I was so hurt and shocked by this,
and moved to another doctor. He told
me to try again and do a second test.
After the first test, I told my husband
that the results didn't come out
and that we left the semen too long
before going into the lab. Now I
finally took in the second semen
test to the lab today and am so nervous.
I can afford in vitro fertilization
(IVF), although I don't want it.
I feel like so much bad luck has
happened this year already. If my
husband's results are unfortunate
again, what should we do? I've had
all of my tests done and everything's
fine. I noticed though on his second
test that the semen wasn't too high.
It looked like 1 ml, max 2 ml this
time. I'm so nervous, although I
pray to God that something can be
arranged for us to conceive naturally
or through IVF with his sperm. Please
help me with your great advice.
Samantha
Butts, MD MSCE responds:
I think the best thing for you to do, if you have not already, is to be evaluated
by an infertility specialist. They are best qualified to interpret the semen
analyses that your husband has had up to this point. It seems like he would also
benefit from being evaluated by a urologist or an infertility specialist who
specifically evaluates male infertility. This will allow you to get to the bottom
of his problem, if he truly has one, and to discuss the various treatment options
available to you. |
Jerry asks:
I have been diagnosed and found to be having features showing wide-spread, advanced
spaermatogenic atrophy. Can this be cured or reversed.
Steven
Sondheimer, MD responds:
I am not certain what was meant by
the description you used, "advanced,
wide spread spermatogenic atrophy".
I assume this was a diagnosis made
after testicular biopsy. You may have
meant testicular atrophy. Testicular
atrophy has a number of causes some
of which may be helped by specific
medical therapy but some of which are
not treatable.
Nonetheless if there are sperm recoverable
either in the ejaculate or after
testicular biopsy pregnancy may be
possible through in vitro fertilization
of eggs retrieved after stimulation
of your female partner. Each egg
can be injected with an individual
sperm. You should be examined an
evaluated by a urologist or reproductive
endocrinologist who has experience
and interest in treating male infertility
problems. |
Nici asks:
Is it possible to use sperm aspiration
for intrauterin insemination (IUI)
if my partner has had a vasectomy?
I have read in some places that it
isn't possible, but I don't understand
why. Can the sperm be aspirated after
an orgasm so the "little guys" are
revved up?
Samantha
Butts, MD responds:
Once a man has had a vasectomy, two
options exist to allow for pregnancy.
The first is to attempt a vasectomy
reversal and this is done by an experienced
urologist. Afterward, several semen
analyses are performed to see if
the procedure was successful. In
many successful cases, couples can
get pregnant without fertility treatments.
The second option is to collect the
sperm from the testicle and use it
during the process of infertility treatments.
Even after a vasectomy, sperm are still
produced by the testicle, the vasectomy
just blocks the sperm from being ejaculated.
Despite the fact that sperm can be
collected this way, the numbers that
can be collected are usually not enough
to do an artificial insemination and
in vitro fertilization has to utilized. |
Amanda asks:
I am 27 years old and my husband is
43. I have had children and have
no fertility problem. My husband
had a vasectomy 18 years ago and
just had a vasectomy reversal. We
would love to have children together.
I'm a little concerned that the doctor
said at the time of the reversal
that there was no sperm seen in the
vas deferens.
The doctor didn't say anything about
a block or anything. He said everything
went great. What else could make him
not produce sperm? Will he produce
sperm again? What are our chances of
having a child together?
Kurt
Barnhart, MD, MSCE responds:
If the first attempt to reverse a vasectomy
was not successful, there is an even
lower chance that a second attempt
would work. While it is possible that
some sperm may be seen at sometime
in the future, the count will be low,
and that will make it a lower chance
you will conceive.
Another option for you is to extract
sperm form “above” the
blockage of the vasectomy and use that
sperm to fertilize your eggs in a process
called testicular sperm extraction
(TESE). TESE, in combination with intracytoplasmic
sperm injection (ISCI) and in virtro
fertilization (IVF), has a very high
chance of working. You should speak
to a sub specialist about this. Penn
Fertility care would be happy and capable
of providing these services for you. |
Denise asks:
My husband is 32 and I am 31. I was diagnosed
with endometriosis a few years ago
and had laser surgery. I was told
on a scale of one to four that I
was a two. We have been trying to
conceive for two years. We have been
through four cycles of clomid and
inseminations prior to the surgery.
My husband's sperm is not always
consistant. I was told to come back
in April but I have not returned.
I was hoping that it would happen
on its own. Should I start fertility
treatments again? What do you consider
a low sperm count? How soon will
the endometriosis come back? How
many laser surgeries to remove it
can you have?
Richard
Tureck, MD responds:
Regarding your first question, we would
need to see you and your records to
offer helpful advice and to make an
educated diagnosis and treatment decision.
Regarding a low sperm count, a low
count is less than 20 million/cc, but
motility and sperm progression are
also very important determining the
overall potential of the sperm to penetrate
the egg and reproduce. |
Yvonne asks:
My husband has been diagnosed with an abnormal seminal tube that is high in the
prostate and it is most likely causing the sperm to back up into the bladder.
The doctor wants to remove part of the prostate with the hope that the tube
will fall into place. We are not sure if we want to go ahead with this procedure.
What are the chances that this will correct our problem?
Luis Blasco, MD responds:
For an outcome to be successful, the
skills and expertise of the surgeon
performing this operation are very
important.
The overall success with this type
of operation is low. However, we would
need to see the specifics of your case
to determine a more definitive answer. |
Jess asks:
I'm a 21 year old female and I have been with my partner for four years.
We have been trying to have a baby for two years. I have been to my doctor
and he did some testing, everything on my side came out with no problems.
My tubes are good and everything is good so far.
They tested my partner and he came
out with 49% of his sperm is normal
and 51% is abnormal, they treated
him but did not make it better. How
many good sperm does he need to have
to be able to get me pregnant?
My doctor refered me to an infertility
doctor but I wanted to know what
is the possible percentage, that
I could get pregnant with out help?
Is there is a chance or not? The
infertility doctor said that insemination
may help, I would like to know what
is the chances of that working for
me the first time?
Richard
Tureck, MD responds:
There are many parameters to be evaluated in a semen analysis. I have listed
the normal values:
Volume (2-6ml)
Count : > 20 Million /ml
Motility: > 50% progressively
moving
Morphology: > 50/60% normal
Hopefully this information will
be of help to you. I would not be
able to give you a specific percentage
as to your chance of conceiving.
Your young age is a great benefit
to you. Procedures such as in vitro
fertilization may be of benefit as
well. |
kab830 asks:
I have been on birth control after my last child for the first time for one and
a half years. I have been off the birth control now for two years. I still
have not gotten pregnant. I had tried the oral clomide and the HCG. I had
tried IUI (intrauterine insemination) but still nothing. My husband and I
were told we were both fine by my ob/gyn and a fertility specialist but still
no explaination on why we do not have a baby.
I did hear from a friend of mine
that has been trying for almost as
long as I have. She is now pregnant
with her second. Her husband was
told he had a low sperm count and
that they could not get pregnant
again but it happened. She said that
her specialist told her that sometimes
a man has more fluid then he has
swimmers — is this true? Also,
her husband had a vericose vein which
was stopping the sperm. How do you
know if a guy has that?
Pasquale
Patrizio, MD responds:
To give you a more definitive answer
as to your condition, we would have
to see your records. However, regarding
your question about vein obstruction
and infertility, your friends husband
may have had what we call a varicocele.
A varicocele is a condition in which
the valves within the veins (blood
vessels) of the male reproductive system
disintegrate. This allows heated blood
from the abdomen to back-up to the
testes, making the temperature too
high for sperm production.
We
would diagnose the condition and
treat the problem using a technique
called internal spermatic venography
and embolization. This radiological
procedure involves plugging the affected
vein with a coil. It is similar to
a needle puncture to draw blood,
requiring only a local anesthetic.
Both the right and left sides can
be fixed through one puncture. Patients
can return to normal activities within
48 hours. Correction of the varicocele
frequently improves the liklihood
of pregnancy.
|
Angelmommy
asks:
My husband and I have conceived 2 children fairly easily. While I was pregnant
with our second child he went on Paxil. He has been on Paxil for 3.5 years now,
with the dosage ranging anywhere from 10mil to 30mil. For over a year now we
have been trying to conceive, but without luck. Could the Paxil be affecting
his sperm count/quality?
Steven
Sondheimer, MD responds:
In general, Paxil and medication in this class have not been reported to change
sperm quality. These medications occasionally cause difficulty obtaining an erection
or problems with ejaculation. Talk to your doctor about tests to evaluate you
and your husband's fertility. |
Joy asks:
What is your opinion on the use of Clomiphene to treat male infertility? My husband
and I have been getting worked up for infertility; my results have been normal.
He has a very low sperm count with normal hormone levels, and Clomiphene
has been recommended. I'm wondering if we should pursue this or look for
other alternatives.
Steven
Sondheimer, MD responds:
In general, clomiphene citrate has
not been demonstrated to be helpful
in your husband's situation. Infertility
treatment has become very successful
in treating fertility problems like
you describe. In vitro fertilization
presents the opportunity to directly
fertilize each egg with an individual
sperm from your husband. This procedure
called ICSI makes fertilization possible
even with a very low sperm count. This
would be my first choice for severe
male factor infertility, i.e. a very
low sperm count.
Occasionally sperm quality does
improves over time. Your husband
should be examined by an urologist
or reproductive endocrinologist with
experience in male infertility. |
John asks:
My wife and I have been trying to get
pregnant for about four years now.
My semen
analysis came back basically
normal (65 million), but the viscosity
(or thickness or resistance of flow)
was "4" after one hour when it should
have been "0". Is a viscosity this
high a hindrance to getting pregnant?
Scott
Edwards, MD responds:
The semen
analysis parameters that are
most clearly associated with fertility
are sperm count, motility, and morphology
(the percentage of normal or abnormal
appearing sperm when examined under
the microscope). A count of 65 million/ml
is reassuring if the motility, volume,
and morphology are also normal. The
impact of a "hyperviscous" semen
sample is less clear and may not
be playing a role in the infertility.
Some experts recommend performing
a simple test called a "post coital
test."
If the sperm have been able to swim
into the cervical mucous then there
is likely no significance to the
increased viscosity of the semen.
Furthermore, most initial infertility
treatments involve preparing the sperm
for intrauterine
insemination (IUI). This involves
washing the seminal fluid away from
the sperm and suspending the sperm
in special medium (liquid) which can
then be placed directly into the uterus.
Viscosity is no longer and issue when
the sperm is suspended in the medium.
IUI allows the most motile sperm to
be placed beyond the cervix in close
proximity to the egg (fertilization
occurs in the fallopian tube). Best
to you.
If you would like to schedule an appointment
with a Penn Fertility Care specialist,
please call 800-789-PENN (7366). You
can also request
an appointment online. |
Monica asks:
We have been trying to conceive for
some time now. In my previous relationship
I was able to conceive the time we
had unprotected sex. I went on to
miscarry in the first month. My husband
and I decided to get a sperm analysis
done since they told us everything
was fine with me. His sperm analysis
test showed that there were no sperm.
My husband's dad got his mom pregnant
at 50, so we are not sure if this
is genetic issue. He also doesn't
have any previous surgeries, nor
did he have mumps. He does have pain
in his left leg from time to time
that shoots into his left testicle
occasionally since he travels a lot
for work. Could it be possible that
the test is wrong?
I am not even sure where to start.
We have an appointment with a fertility
doctor, but since he has no sperm according
to the test, does this mean I can never
get pregnant?
Suleena
Kalra, MD, MSCE responds:
You are on the right track to finding
the answer to many of your questions.
A fertility specialist will be able
to try to identify the cause of the
abnormal semen
analysis. Although it is possible
the test is wrong, it is unlikely to
be in the setting of complete absence
of sperm. Even so, we do recommend
that any abnormal semen analysis should
be confirmed on two separate occasions.
As such, it is likely that your specialist
will ask that you obtain a repeat semen
analysis. In addition, he or she will
also order blood tests in your husband
to check for genetic abnormalities
that are associated with absence of
sperm.
Finally, your husband should be evaluated
by a urologist.
Once these initial tests are completed,
your doctor will be able to discuss
your options regarding pregnancy. Even
in the setting of complete absence
of sperm on ejaculate, in some cases,
urologists are able to surgically retrieve
sperm from the testicle.
Even small numbers of retrieved sperm
can lead to successful pregnancy utilizing in
vitro fertilization (IVF) with intracytoplasmic
sperm injection (ICSI). ICSI
is a technique that can be used
to inject a single sperm into the
egg to create an embryo. This advance
has helped many couples get pregnant
and is readily available at any
IVF laboratory. Best wishes to
you both... |
Michelle asks:
My husband is sterile and we want a child. We looked into sperm banks but we
want to know - do you do the procedures to insert the sperm, or what do you
suggest we should do to get a child?
Clarisa
Gracia, MD responds:
Yes, if you want to use donor sperm, then you should schedule an appointment
to discuss the procedures involved. Essentially we insert the sperm into the
cervix and or uterus at the time of ovulation each month.
In order to schedule an appointment
with a Penn Fertility Care specialist,
please contact 1-800-789-PENN (7366)
or you can also request
an appointment online. |
Frank asks:
I just had a semen analysis and my
results were above normal except
for morphology. My doctor thinks
my wife and I need to look into donor
sperm. We're waiting to see a fertility
specialist. I've included my results
and what the report uses for reference.
| | |
