hiya
My partner’s sperm morphology and count is low and we’ve had an unsuccessful round of Icsi on nhs (I also have pcos but egg quality was good, thankfully). Fortunately we have funding for another cycle.
What I’m a bit confused about is beyond basic sperm analysis there’s been no additional explorations to find out the cause - no physical examination or anything…
Has anyone had any experience of explorations into male infertility on the nhs? What do we need to ask (or push) for?
Thanks
Hi BingoCat! When my husband and I started our journey his sperm was similar to what you’re experiencing, we did however find out he had a genetic condition which caused low sperm and poor mobility amongst other things which meant that we were offered PGT (pre genetic testing) to test if that gene will be present. So it might be beneficial to ask about PGT or further testing regarding the sperm. Hope this helps ❤️
Thanks PinkLily! Do you mind me asking how you discovered the genetic condition? Did the initial sperm analysis prompt exploration it was that a separate thing?
So this was picked up from his initial sample, which is making me wonder why they haven’t investigated it for you both as I think there’s a number of factors that can contribute to low sperm/quality/mobility etc. And although this added another path to our journey we knew the reasons why it hadn’t happened for us. I would be asking why the sperm quality is not great and even what can be done to look into it/improve it. Going through a cycle is so precious and you want to ensure everything possible is being done in hope that it is successful 🤞🏼
Karotype testing and DNA fragmentation would be my two choices. NHS do Karotype but it takes a long time but they dont do DNA (in my health board). We had to do that privately.
we went to see Jonathan Ramsey, I would highly recommend. If you google him, he has done podcasts etc. Big fat negative talk about him too. You have to pay to go private but definitely worth it.
Yes! However they can go through private medical insurance if “hubby says he experiences dome pain etc in order for the initial claim to be spproved” 
we were using proxeed men. And it’s really improved. But I am still confused why its seman volume is high . It’s better to go urologist but it’s really long wait we are still on waiting list even after year wait. 😭
We were in a similar situation and also went to see Jonathan Ramsay. As Blossom_4 says above, it’s private so you have to pay but 110% worth it. We learned more in the couple of hours we were there than in a year with the NHS.
Also have a look at testing for ureaplasma. We just bought a test and the antibiotics online. My husbands parameters all improved significantly after we treated it.
Thanks so much. Do you mind me asking how much that cost? (Feel free to Dm me if you prefer ☺️)
Of course! My husband had an ultrasound, a normal sperm analysis, they tested his hormone levels, did the DNA fragmentation test and tested for infection (think that’s everything!). We were £300 for the consultation and £1,400 roughly for the testing. So it’s expensive but not completely out of reach. We were referred via the nutritionist Melanie Brown and were seen within four weeks but that may have been a flook! Give me a shout if you have any other questions ☺️
We paid private from the off and no make tests were done other than the initial sperm count! It came back as low everything and poor quality but my eggs came back ok. Yet still no tests performed. Baffled me! After 3 failed ivf rounds, we paid private in London to see a urologist which also included tests (x ray, blood tests, physical examination). During the first test (x ray) they could already see the issue, varicocele veins to both testicles. Required surgery but again, nhs wait was over a year just for consultation on this so ended up paying privately. Waited 6 month recovery time recommended, started 4th round of ivf and conceived straight away. The clinic said his numbers had massively improved.
I think paying for tests is well worth it if you can afford to otherwise you’re just paying for rounds of ivf not knowing the outcome.
The clinic also used ‘oocyte activation’ as we signed up to a study and those results came back as most likely missing this in his sperm too.
Try proxeed plus for men
long story short - NHS fertility clinic referred internally my hubby to a urologist who did physical examination, hormone tests, karyotype and X ray and identified his Testosterone was low and he has varicoceles on both sides. They gave him Clomiphene 25mg daily which seemed to improve the sperm count and motility I think but they did not suggest to do varicoceles embolisation and move straight to ICSI which resulted in a miscarriage. He was taking Impryl too.
Then thanks to some nice people on these forums… we decided to check it further and we understood we need to see a reproductive urologist for further tests and treatment. We said to the Private medical that hubby has discomfort down there and they sent him to urologist. We asked whether Jonathan Ramsey was on their list and he was however there was a long wait time for him as he is very good and famous, like over 3 months. Then our clinic suggested we see Tet Yap (meanwhile we moved from NHS to a private IVF clinic).
After seeing Tet Yap, he didn’t do many further tests because what he had from the NHS urologist was enough to know where the problem was. He only changed his Clomiphene to be 50mg every second day (alternative) and he suggested to do varicocele embolisation. It took 2-3 months to have the varicocele procedure privately through the private medical. One day before the procedure, I found out I was pregnant naturally 🤭😅 he still did the procedure. We did a semen test 3 months after and to be fair the parameters were not much changed, just little bit. We now have a beautiful baby daughter from the natural conception. If you have any further question feel free to message me. Good luck 🤞
There is also male factor on our fertility journey. Proxeed plus for men has helped, ICSI failed first time, so second time they used calcium ionophore which helped activate fertilisation with the eggs, which helped. Although we had a day 5 embryo transferred, implantation failed. This time they will use a technique called IMSI, extra magnification to select sperm with best morphology as well as a frozen back up sample. All on the NHS. There are many supplements he also now takes recommended in the book Its all about the egg. On the waiting list for varicocele embolisation but we have been advised not to wait for that before next cycle as it may not make much difference. I hope some of this info helps. Be assured that you are not alone and there is success at the other end.
I’d say definitely get a dna fragmentation test ASAP, it takes 4 weeks to get results and then 3 months to make any meaningful lifestyle changes to improve sperm. We had normal sperm analysis, so went ahead with multiple rounds of IVF that weren’t yielding many blasts. Later learned we had high fragmentation and needed PICSI. This was all done privately, but well worth doing the test so you don’t waste any precious eggs!
Good luck x
I have spoke my clinic and they said DNA fragmentation test don’t worth. Because when you give one sample for dNA fragmentation test next sample will be totally different. So don’t matter. Just Chnage diet. They said change diet and add some parental multivitamins these are the treatment for DNA fragmentation.
I wish just changing the diet would work for us, but we have been doing IVF for 18 months and eating really clean and taking supplements. There are other factors besides food that affect the fragmentation, like age, stress, environmental factors etc. My point being that the test will give you more answers, and to me, more data is always helpful. To each their own 
Which multivitamins you were taking
hi I hope you’re well, thank you for posting this , all the answers seem very helpful, we also have MF and the same happened to us no further tests were made on this, we now have had 3 unsuccessful transfers so I’m raising this. Another lady in here who had similar experience recommended dna fragmentation test, if the results are not good we need to see an urologist. As others have said private seems to be best route, dr Ramsay seems to be the expert urologist for fertility issues. Do you mind me if I ask how do you know egg quality is good, did you do any tests for that?
Wishing you all the best of luck !
Hi, we have the same issue, 4 failed transfers over the last year, 4th failed resulted in Dna fragmentation testing which we did privately this cost 500.00 due to all my husbands numbers been very low and getting worse everytime he had them tested, 3 in total. Hes been on supplements for a year and half also with no improvement. Little background been trying for 5 years, i have 3 children from my previous relationship, im 34 also, so consultants saying still young, but i still decided to do all the additional blood tests for failed implantation just because things can change has we get a little older, so definitely worth asking your consultant if they think you may need some additional tests just to check a few things. Your gp may do them for you. Mine did, then it was recommended for dna fragmentation testing due to his numbers and his age 43 (no biological children) next month that showed really high fragmentation, consultant said even with the supplements hes on its obviously not going to improve much cos it hasnt so far, so my husband himself made the decision to move onto Donor sperm. We start a fresh cycle with Donor next month, which will include blood thinners, steroids, aspirin, embryo glue and endo scratch, i would definitely recommend Dna fragmentation and also chromosome testing, unfortunately they arnt cheap but definitely worth it in the end and also ask about the additional add ons.Good luck with your next steps and hope you get your little miracle soon xx
Your situation sounds very similar to mine. My husband has a very low sperm count and I have very mild pcos, but my egg quality and ovarian reserve are very good. We had multiple failed transfers on the NHS so went private to do some more testing. Tests were run (ALICE, EMMA, etc), and they discovered I needed an extra day of progesterone and vaginal probiotics before transfer. They also discovered I have an autoimune disorder (despite having no symptoms) which I needed treatment for (steroids) before and after transfer. I'm now 6 weeks pregnant. The NHS couldn't have run those tests for us, so they actually advised we go private. Best of luck! X
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