2nd opinion WDYT?

[ozma]

Soo hai ladies, first post in a while and first on this board! In Dec H had another SA which was apparently worse than the first one. unfortunately I don't have the details as H spoke with the doc but low morph, low count, low everything. When I asked the RE if there was anything we could do to improve he said "Nope, only option is IVF.."

There aren't a lot of options for 2nd opinions where I am at and my OB all but shoved clomid down my throat. Luckily thanks to this board I found the RE because I was NOT doing unmonitored cycles of clomid. To think she was handing me clomid and other meds when Hs sperm count was already so low, it would have been pointless!

For those with MFI, was there any treatment YH had to do that helped his numbers? I just feel like the RE isn't even trying to do anything about it when maybe something could be done that could at least give us the option to try other things before moving on to IVF.


What do you think? Are there cases that just cannot improve and that's why he said IvF only, or is he being lazy/wanting to take our money?

[BunnyBerry]

MH went to the uro and was put on clomid shots for a few months because his testosterone was borderline /low. It didn't make a difference in his sa so we stopped. I would get the actual numbers from the RE so you can compare it to recommendations for iUI numbers. We are within IUI parameter but failed IUI so we should now do ivf but I know many women go straight to ivf as being more cost effective with severe mfi.

[waterbaby]

Doctors often seem to balk at supplements but I have done some reading on them for semen as DH has low morphology. He is taking a daily multi, Maca, Vitamin C, CoQ 10, Tumeric, Milk Thistle, and Gingko. Not sure if they have helped yet but a SA will be repeated soon and then we'll know for sure. Good luck.

[bluefairy5]

ozma MFI is complex and most of the answers here would depend on what causes YH's low everything. If he has low testosterone that can sometimes be corrected with Clomid or other drugs; if he has a blockage or varicocele that can be treated with surgery, but we've had posters whose husbands went that route and didn't end up showing improvement. There are some supplements and lifestyle changes that can sometimes show improvement, but certainly not always. And if YH is on certain classes of Rx meds such as anti-convulsants or SSRI/SNRIs, there is some thought that those affect morph and motility (and other factors, depending on the drug), but no one can totally agree.

For the RE to be telling you IVF is the only option, I'm of course not an RE but my thinking is YH's numbers would have to be REALLY low. MH has low everything too, and we're only at IVF already because it was time to move on from oral OI meds and my ridiculous AMH level makes it almost pointless to attempt inject IUIs without developing way too many follies for an IUI.

If you'd feel more comfortable with a second opinion, there are RE practices that take patients from out of state all the time, so some or all of them can probably set up phone or Skype (or whatever) consults.

I definitely understand the feeling of "are they just trying to take all my money??" But I get the sense that REs are often happy to move to IVF because of its success rate relative to other treatments, not just as a money thing. (Of course, I'm sure the $$ component doesn't hurt them!)

[tptbabe]

The first thing I'd reccomend you do is to get an appointment with a urologist that specializes in MFI. REs are great for doing the treatments to get you pregnant, but they don't generally treat the underlying cause, especially if it's male factor.

A urologist (again, make sure it's one that specializes in MFI!) will do a full workup, similar to what a woman does for a fertility workup. Bloodwork, ultrasounds, physical exam, all that fun stuff. If they find anything that might be able to be improved, then they may suggest another treatment plan prior to attempting IVF, or they might agree with your RE. In our case, we are dealing with severe MFI as well, but weren't ready to dive right into IVF/ICSI, which is what our RE said was our only option. We tried the ND route first, which was a massive fail. We then went to a urologist (tops in the country!) who found that DHs testosterone was low, and put him on Clomid, which increased his count by 600% and almost within "normal" range! Unfortunately for us, his other parameters were still too low to attempt anything other than IVF/ICSI. DH also has hemochromatosis, so that's likely the cause of the issues, which we wouldn't have discovered without pushing for another opinion.

In the end, we're not sorry that we tried other options first. There aren't alot of options for MFI, and it's a long process if you do try them, but it's not a waste of time to at least find out *if* there might be another option. It doesn't mean you have to follow it, but at least you'll have more information to make your decision Good luck!

[lemonliz]

Has YH been to see a urologist? I've heard that many uros are more proactive about MFI than REs.

I will let you know in about 2 days if any of the lifestyle changes MH made a difference. They were not substantial changes: added a multivitamin and switched to boxers and "tried" not to drink more than a couple drinks per day. My guess is that maybe the changes made some small difference, but nothing dramatic.

[deelopi9]

I'm sorry your DH numbers came back low. I would recommend seeing a urologist that specializes in fertility before setting up the IVF consult.

[remylove1011]

I think PP's covered a lot of the options for MFI and the treatment will really depend on the numbers and the cause. MH is now taking a vitamin ConceptionXR motility support to see if it will help. I'd probably want to get a second opinion if we'd been told to go straight to IVF, so I don't blame you for wanting to do that. Our numbers are within range that an IUI can be successful (or so we're told) so we're going that route for right now. I vote for second opinion and for MH to see a urologist to see if anything can be done for his numbers. We have coverage for IUI's, but not for IVF so that weighs into my suggestions as well and is something to check on. Hope you're able to get some answers.

[ozma]

thank you ladies. I will have to get a copy of those results so DH can talk to a urologist. We called a urilogist once but he said that he doesn't specialise in that area sooo...now to find one that does. being overseas it's difficult to find but I'll get there

H was resisting when he found out his numbers were low he didn't want to get anymore tests done and just told me to drop it since IVF ISCI Was our only option. After a couple conversations I finally pointed out that of there are a couple of other roads we can go down first it may avoid IVF completely. He hears what I am saying but doesn't understand why I don't want to just go ahead with IVF. I guess it's nerves and its money. but at the same time we could end up spending lots on less invasive treatment too.

IThanks for sharing your experience. I'll be able to tell him some of what I read and we will look for a urologist

[ronniesgirl]

What about a phone consult? The worst case would be if the second opinion agreed with the first, but I think this will give you the confidence to move forward. I also agree about the IF urologist. We saw an awesome one in Baltimore.

This is just an anecdote, but we both cut out wheat from our diets and my husband's count went from good to holy shit. I can't remember the actual numbers, but it was something like 100 mil to 350 mil. I asked the author/MD behind the book Wheat Belly and he theorized that without wheat, his stomach lining healed allowing greater absorption of nutriets and a higher testosterone level. I'd put this in the category of can't hurt and might help.

[LavishPeach]

I don't have any experience with MFI, so I'm not help there. And the other ladies seemed to cover it really well.

But I wanted to just say I know how difficult being overseas can be, especially when dealing with IF. I hope you are able to find a urologist that specialize in MFI.

Good luck.

[ozma]

Jan 19, 2015 10:35:44 GMT -5 ronniesgirl said:

What about a phone consult? The worst case would be if the second opinion agreed with the first, but I think this will give you the confidence to move forward. I also agree about the IF urologist. We saw an awesome one in Baltimore.

This is just an anecdote, but we both cut out wheat from our diets and my husband's count went from good to holy shit. I can't remember the actual numbers, but it was something like 100 mil to 350 mil. I asked the author/MD behind the book Wheat Belly and he theorized that without wheat, his stomach lining healed allowing greater absorption of nutriets and a higher testosterone level. I'd put this in the category of can't hurt and might help.

A phone consult would still make it hard to get any prescriptions needed as we have to use the pharmacy overseas and they would not recognize a US prescription, as far as I know. but I am sure I can find someone who specializes in MFI somewhere. we may have to drive of course but I'm we wouldnt be the only ones who have had to.
Thank you LavishPeach (hope the tag works!) I appreciate it, the healthcare here is awesome but its still hard to get the hang of who to see and where to go as many local doctors only refer to those they know in the surrounding areas

[fightersince83]

My RE had DH take supplements. His issue is morphology though, so that generally is not improved. As far as what difference we noted his count and motility went up but the morph stayed the same. We did one IUI with injects and then opted to do IVF with ICSI partly due to MFI and partly d/t all the other shit we have going on. The uro appt is a good idea, it doesn't hurt to see what they can do.

[lemonliz]

Update: I didn't need to wait 2 days to give you a SA update after 9 months of vitamin supplements. It didn't really do very much. In the past, we've had SA as high as 76mi count/12% motile and as low as 12mi count/36% motile (longer abstinence = higher count, shittier motility). Anyhow, today it was 2 day abstinence pre-wash 39mi count/26% motility. Sort of somewhere in the middle of where we were before the vitamins. Except that today was the shittiest morphology report we've had yet. So vitamins def do nothing for morph.

Like everyone else mentioned, it would be good to get a second opinion even if its by Skype appointment. I hear lots of REs are doing that these days.

[ozma]

Jan 19, 2015 11:00:32 GMT -5 lemonliz said:

Update: I didn't need to wait 2 days to give you a SA update after 9 months of vitamin supplements. It didn't really do very much. In the past, we've had SA as high as 76mi count/12% motile and as low as 12mi count/36% motile (longer abstinence = higher count, shittier motility). Anyhow, today it was 2 day abstinence pre-wash 39mi count/26% motility. Sort of somewhere in the middle of where we were before the vitamins. Except that today was the shittiest morphology report we've had yet. So vitamins def do nothing for morph.

Like everyone else mentioned, it would be good to get a second opinion even if its by Skype appointment. I hear lots of REs are doing that these days.

After reading those numbers I see why the RE might have said IVF. H had 3% Normal morph and less than 1 million (can't remember the Numbers without the results in front of me. ) basically that's nada, on top of my PCOS.
I'll still look for a second opinion just to have one but...yeah his are super low

[lemonliz]

Jan 19, 2015 11:21:40 GMT -5 ozma said:

Jan 19, 2015 11:00:32 GMT -5 lemonliz said:

Update: I didn't need to wait 2 days to give you a SA update after 9 months of vitamin supplements. It didn't really do very much. In the past, we've had SA as high as 76mi count/12% motile and as low as 12mi count/36% motile (longer abstinence = higher count, shittier motility). Anyhow, today it was 2 day abstinence pre-wash 39mi count/26% motility. Sort of somewhere in the middle of where we were before the vitamins. Except that today was the shittiest morphology report we've had yet. So vitamins def do nothing for morph.

Like everyone else mentioned, it would be good to get a second opinion even if its by Skype appointment. I hear lots of REs are doing that these days.

After reading those numbers I see why the RE might have said IVF. H had 3% Normal morph and less than 1 million (can't remember the Numbers without the results in front of me. ) basically that's nada, on top of my PCOS.
I'll still look for a second opinion just to have one but...yeah his are super low

Our RE has said that they like a post-wash count of 10mi but will work with a 5mi for an IUI. We are also a male-female IF combo (endo and DOR for me) and went straight to IVF. But our IVF cycle just collapsed on about day 9 of stimming and we immediately converted to IUI. With YH's count in the 1mi range, I'd seriously think about getting his testosterone levels tested (because they can put him on something to boost that level) and an ultrasound to check for a blockage. GL, let us know how things go!

[Bombonny]

Jan 19, 2015 10:35:44 GMT -5 ronniesgirl said:

What about a phone consult? The worst case would be if the second opinion agreed with the first, but I think this will give you the confidence to move forward. I also agree about the IF urologist. We saw an awesome one in Baltimore.

This is just an anecdote, but we both cut out wheat from our diets and my husband's count went from good to holy shit. I can't remember the actual numbers, but it was something like 100 mil to 350 mil. I asked the author/MD behind the book Wheat Belly and he theorized that without wheat, his stomach lining healed allowing greater absorption of nutriets and a higher testosterone level. I'd put this in the category of can't hurt and might help.

As with PP, I would also recommend seeing a urologist to get a full work up done (even if you go with IVF.. it's worth knowing the reasons for his overall health), and work with him to see if you can make some improvements!  However, I am going to tag along to ronniesgirl 's anecdotal thoughts.  We saw a nice change in MH's SA from Jan 2014 to Nov 2014.  We made several other changes toward eating healthier, such as cutting out processed foods/added sugar/etc, and cut wayyyy back on gluten/wheat the last year, and only whole grains when we do.  Unlike Ronnie (I'm assuming, haha), MH often eats a sandwich with whole wheat bread at work, so he eats more than I do (I've almost completely cut it out) but dinners rarely (if ever) have wheat/grains in them.  We also stopped using plastic to heat up things during that time frame... we've made a lot more changes to eliminate harmful chemicals in our home this month, but can't really speak to that as much since it was after the 2nd SA/improvement.  He also takes a daily multi vitamin + vit C.  My husband had a morph issue that went from 1% (Jan) to 8% (4% is normal) in November.  He wasn't being directly monitored to see if these lifestyle changes had an impact, but I really attribute them to that improvement, since all other things held steady.  My new RE said she would have only recommended adding a daily multi-vitamin... again, REs don't specialize in SA!

Now, it does sound like YH's MFI is a little more severe (all other numbers were good for MH), but it could only help to make some lifestyle changes!  Have you read 'It starts with the Egg'?  They have a chapter on things that men should think about changing.  I'd also evaluate YH's eating habits to make sure he is not eating anything that contains high levels of estrogen-mimicking hormones like soy, etc, as I've read quite a bit on the negative impact that could have as well.

[Smootiepie]

If YH's count it at 1M, you're about where DH was, and we were told IVF was our only option. They though DH's could have been due to a varicocele, but he had surgery on that 2+ years ago and the best pre-wash count we've ever gotten was 7M (still out of IUI range).

I agree w/ PPs - if you can get a uro appt to try and figure out the underlying cause, it could save you some $$ on skipping IVF. GL!

[bluefairy5]

ozma Yeah, I can see why your RE pushed IVF with that count, too. My RE prefers to see post-wash 20MM, and I don't think they really do IUIs with post-wash lower than 7 or 8.

lemonliz Interesting news about the counts today, after short abstinence and months of supplements. I also had no idea they could evaluate morph during an IUI wash. They never shared any of the morph numbers at my IUIs.

[lemonliz]

Jan 19, 2015 15:58:23 GMT -5 bluefairy5 said:

lemonliz Interesting news about the counts today, after short abstinence and months of supplements. I also had no idea they could evaluate morph during an IUI wash. They never shared any of the morph numbers at my IUIs.

Yeah, I was perplexed because usually his count goes way down and his motility and morph go up with shorter abstinence periods. Today's post-wash was 9mil, 78% motile, and 39% morph on the Krueger scale, whereas pre-wash morph was 9%. That was his worst morph yet. I don't know what to think.    

[bluefairy5]

lemonliz 39% Krueger morph post-wash, though?! That's really good!

[waterbaby]

Yeah I don't know what to say either. MH had 2.5% morph but 140mil count so the RE said that the count saves him. Your DH morph is great at least there's that. Good luck on the IUI, keep us posted.

[yoshijo28]

I don't have any good advice (I'm in the same boat as you, possibly straight to ivf) but I wanted to say good luck!!