Sperm Production & the Pituitary Gland- Further tests

[missbrightside]

Hi,

My husband and I have been trying for five years, and have recently completed our third round of ICSI, none of which resulted in a positive pregnancy test or any embryos surviving past day 3.

My husband has a normal sperm count, but 100% are immotile and a very high proportion are abnormal. This has been consistent for the last three years, despite supplements, and changes in diet and exercise.

When we were initially referred to an IVF specialist a consultant (not our own) wrote and suggested that an investigation into my husbands pituitary gland function/ hypogonadism might be worthwhile, but our consultant dismissed it and explained my husband's results as genetic. However given that we are now so close to having to give up our dream of becoming biological parents, I wondered if it is worth pursuing this further.

Has anyone else had this more advanced testing, if so what did it involve and did it yield any useful information/ results?

Our treatment has been so focused on me, that all they have done is a semen analysis for my husband, but as it seems to be the biggest barrier for us I wonder if it is worth trying to get to the root cause? Any advice much appreciated.

[Cinderella5]

My husband has an extremely low sperm count, less than 1 million per ml. Our clinic did some initial testing which included karyotyping to ensure hubby didnt have a genetic condition causing it like cystic fibrosis etc. Hubby's FSH came back as high with low testosterone so we got told there was nothing that could be done to improve things. We think the cause may be due to injury when he was young as everything else was ruled out. You mentioned that the Dr said it was "genetic", has he had other tests or did he give any clue as to what his answer was based on? In saying that the clinics have always found enough good sperm for us to do ICSI. We also had a problem with embryos not getting very far but that was put down to egg quality due to my age unfortunately as I was 38. We have moved onto DE now and our embryos do much better.xx

[missbrightside in reply to Cinderella5]

Thank you for responding, it is helpful to know what other tests are available, as our clinic seems quite dismissive about investigating his side further and have only done the basic semen analysis and bloods, but not really discussed the results in detail. We have our follow up on Wednesday so want to go armed with some questions about other avenues to explore. I am sorry to hear that you have had similar struggles and wish you all the best in your journey xx

[Cinderella5 in reply to missbrightside]

All I can suggest is keep pushing for answers (there may not be any explanation of course) but keep asking why....sounds a bit daft but it might help you get to the bottom of it, that way you can come away from your consultation knowing what you are in fact dealing with. Also ask them lots of questions regarding your embryos and why they think they have failed, is it down to egg or sperm etc. I know what you mean about everything being geared towards the female, as soon as we were found to have sperm issues then nothing much else mattered with me (we just got sent for ICSI) apart from they kept telling me my age might be an issue. I would say however, even if the know the answers there may not be a known "fix" available. The nurse on here, DianeArnold has a list of questions if you contact her directly....might help with some of the things you want covered. Good luck.xx

[Hidden in reply to Cinderella5]

DianeArnold im in exactly the same boat third try. Can’t get past day 3 they think it’s my husband sperm. He’s had karyotype testing he has low quantity quality etc had an undescended testicle and was on lots of antibiotics as an 11 year old.

What sort of questions should myself and @missbrightside be asking xxx

[missbrightside in reply to Hidden]

Hi Boo7, if you direct message Diane she can provide you with some general questions to ask at appointments, some of which are relevant for our situation. Such an uphill battle, but we will get there! All the best of luck x

[missbrightside in reply to Cinderella5]

Thank you, I agree perseverance is essential on this journey! Thank you for your advice and support, I really appreciate it. All the best x

[Kyell2]

We ended up paying for some genetic tests that we couldn’t have on the NHS. They said they were too expensive to run and cost £800 for blood tests.

They showed up a chromosome issue on his 21st chromosome that turned out to be our cause of infertility and then we got referred for NHS genetic counselling after that. Ironically the NHS then repeated the expensive tests for free as they weren’t done by their lab but the results were the same.

I’m not sure why they are dismissing your OH’s issues as genetic as surely that’s worth investigating. We were told that even a tiny genetic change could cause sperm issues. You might need to push them for further investigation or even pay for them yourself. Hope Wednesday gets you some answers x

[missbrightside in reply to Kyell2]

Thank you for sharing your experience. Strange isn't it? The impression I got, was that even if they identified the genetic issue it couldn't be corrected so there was no point. We have just found our treatment to be so 'female centred' which I guess I can't be surprised at when the consultant is a gynaecologist (and she has been great in helping with my endometriosis), but I am hoping we might get a referral to urology or an endocrinologist to help us get some better answers. Really appreciate your reply. All the best with your journey xx

[Kyell2 in reply to missbrightside]

Yes, I think because our sperm count was zero that they had no choice but to refer us directly to the urologist.

I understand that genetics can’t be corrected but we were told the point of genetic counselling is that they can tell you exactly how the genetics will impact you. I think you might need to be pushy and insist on the referral or they’ll drag their heels. Good luck x

[missbrightside in reply to Kyell2]

Thank you, I really appreciate you sharing your experience. Will definitely be more assertive at our next appointment! All the best x

[Billywhizz10]

I would get a full genetic screen of his sperm, it would lay your mind at rest at least.

I was 'lucky' in managing to get my work private health insurance to pay for it under the umbrella of 'urology problems', god knows how I got away with it, but the consultant did a ultrascan of my testes and did bloods for FSH etc and a full genetic screen for Y microdeletions, etc.

It was good, as it showed although low in number, there were genetically good sperm for ICSI.

I wouldn't get too wound up with the sperm, mine was rubbish but still produced a child, the doctors always said we were wasting our time spending so much time trying to improve sperm quality when egg quality is the most important thing.

When we were trying and found I had a low count but my wife was perfectly healthy, we wasted a lot of time with investigations on my sperm, supplements, testing, we even tried a cycle with donor sperm as I was the one with the issue, nothing worked until we did a cycle with a donor egg. My wife was in her late 30's with nothing wrong with her except her age. She was just unlucky in that after 35 its more a gamble to get a good egg, especially using the IVF method of blasting the body with drugs to produce as many eggs as possible.

Looking back, we were using ICSI so they only needed 1 sperm for each egg, so we should have spent more time building up my wife's egg quality, like DHEA etc and using natural cycles.

Look into your husbands genetic screening of his sperm, but also look into ways to improve your egg quality to give yourself the best chance, best of luck xx

[missbrightside in reply to Billywhizz10]

Thank you Billywhizz10 it is reassuring to hear of positive outcomes, and what others have learned, to help inform us of where to go next x