Azoospermia straight to ICSI?

[Minniemouse88]

Hi,

I hope everyone is doing okay with their fertility journeys.

I wanted to ask if anyone has experience of fertility consultant moving straight to suggesting ICSI when azoospermia is not fully investigated?

As soon as we had to sperm samples with zero sperm count, my husband and I went private for assessment to speed things up. We've had a consult with a fertility consultant who suggested that even if it is an obstructive/blockage problem, reconstructive surgery has low success rates and so we are being advised to go straight to sperm retrieval and ICSI. We're just awaiting some genetic test results and AMH for me. Husband has had all initial hormone bloods done and they are all within normal levels.

I'm quite trusting, but I find it odd that there will be no scan or referral to urologist to determine if there is another option. I'm just 34 and husband is 37, so we feel time is of the essence and will go ahead with ICSI but it would be good to know what is causing the issue and whether there was any chance we could conceive naturally.

Any similar experiences or advice?

Thank you 🙂

[HollyT7]

i think there just thinking how to (hopefully) get you a baby quicker🤷🏻‍♀️. all the best xxx

[soccerkt6]

Hi lovely

I agree with you that it’s a bit premature of your clinic to push you towards ICSI without first doing further investigations on the cause of the azoospermia and whether it's something that can be treated.

My own experience with clinics and male factor issues is that most fertility consultants are experts in IVF itself, but they’re not male fertility experts and so not super well-versed in how to investigate and address those types of issues. My guess is that your clinic is recommending ICSI straight away because that’s what they’re familiar with. Without (I hope) sounding too cynical, ivf clinics are there to do ivf procedures and they’re not necessarily set up to help people investigate the cause of their fertility issues.

MPum also posted about azoospermia a few hours and there's some good advice on there which you might want to check out. Personally, I would suggest you go private and see a urologist who specialises in male fertility before you jump straight into a cycle. Ultimately, it might add a few months to your timeline if you do end up needing IVF, but that’s a pretty minor delay in the grand scheme of things and you never know what the consult with the urologist might turn up.

Good luck! xx

[Sarakht]

Hi Minnie, my husband has severe male factor 100% abnormal morphology and we are pregnant with ivf icsi. Please please do not waste any time down the urologist route. They had my husband do many tests ect and even prepared for embolization in the end after I would say a waste of nearly 2 years they said you need to do Ivf. I wish we never wasted time with urologists in the NHS so called appointments are every 3 months then a follow up appointment in 3 months. I wish you all the best

[Rollercoastersmiles]

Hey, I would echo sarakht a little. We also had severe male factor and my husband was referred to a urologist at the same time. He’s still waiting for his review with the urology team but lucky for us we had IVF ICSI in the meantime and just had our 12 week scan yesterday. I think if you’re paying privately, there’s an argument for seeing a urologist first. It will give you answers and a more full picture about the issues and options, but on the NHS, I think urology is really understaffed and the wait times are ridiculous. He was referred 18 months ago and has only had 2 appointments with a consultant, and 1 scan of his testicles. It has been slow!

[Missl73]

Similar to others experiences we paid a lot of money for a private urologist and for lots of tests but ended up needing to do ICSI which was always going to be the case for us, my husband wasn’t azoospermic but he did have severe male factor infertility with very low counts that even after we improved following the urologists advice were still never good enough to have any realistic chance at natural conception. It took us 3 years to conceive our son via IVF so if it were me I wouldn’t hang about, especially if you hope to have more than one child.

[HedgehogMad]

I felt similar after receiving the diagnosis of severe MFI. We paid privately to see an andrologist while waiting for IVF/ICSI. I don't think it's worth waiting for andrology/urology first as with regard to trying for a baby it is unlikely to make a huge difference (the fertility specialists have one goal and are very good at trying to achieve it.)My personal view is that it is worth going to see them firstly to rule out anything potentially reversible (unlikely with azoospermia) but mainly from a men's health perspective - is there an underlying genetic issue that could have health implications in the future or be of relevance for any future children.

The answer to those questions for us was nothing could be done and no genetic issues but I feel it was worth it for us to have this explored and receive some answers.

[RoseLodge32]

Hi Minnie, I know this might be an obvious one but I think it really depends on what you and your husband want i.e. does your husband want to avoid surgical sperm retrieval and see if fixing an obstruction is an option instead? If SSR isn't a last resort then it probably does make more sense to go directly to this option.

For us, we wanted to investigate and see if there was anything that could be done ahead of any procedure and so we saw a Urologist privately and tried to balance hormone levels through medication before we moved to FNA Mapping. To be honest, we were both so shocked as well that I think we just wanted to learn more about what was going on.

Maybe you could have an initial chat with a Urologist? That way you can discuss your concerns, understand what all the options are and take it from there Good luck! xx

[Minniemouse88]

Thank you all for your thoughtful responses. We are definitely in the mindset of proceeding with SSR and ICSI to avoid wasting time but like others, we are quite shocked and hoping to find out what the cause may be. Still waiting for genetic blood test results (may have to push back our follow up consult due to delays) and will take it from there, potentially requesting a second opinion from a urologist. One thing is for sure, it's definitely a test of patience and self advocacy! Thank you again for all your advice and sharing experiences 😊

[Jana483]

We also suffer from severe male infertility but not zero sperm count, very low and very bad

My doctor told me no need to even see anyone for my husband and to go straight to icsi

Out fertiliztion rate is very low (12 mature excellent eggs would give us each cycle only 3 day 3 embryos)

So after 2 cancelled cycles right before egg collection (ohss)

2 fresh cycles icsi and I have a daughter

Another 2 fresh cycles and currently 36 weeks pregnant

My husband didn't do any tests, didn't see any doctor cause everyone told us that it's just a waste of time and honestly I am glad we didn't waste time