AW post - Do my basic fertility workup results look normal?

[meerkatmillie]

Ok, so..you guys are not doctors, this I know. But I appreciate you checking out this post anyways because I know many of you have been through this before and know a lot more than I do about this stuff so I value your opinions. We're going to review the full results tomorrow with our RE and I want to be prepared to discuss anything suspicious and be able to follow along with what the doctor explains.

Do any of these basic fertility workup results shoot up any red flags?

HSG
• Normal, fluid spilled out both sides quickly. Uterus is "tilted"

AMH
• 5.89

Semen Analysis
• ph 7.2
• Volume 6.4 ml
• Sperm Concentration 43
• Total Sperm Count 275
• Progression A 0%, B 35%, C 20%, D 45%
• Motility 55%
• Total Progressive Mo 35
• Motile Sperm Con 23.6
• Total Motile Sperm 151
• Normal Morphology 4%
• Predominant Head Tapered, Large
• Predominant Tail Bent, Cytoplasmic droplet
• Viability n/a
• Agglutination none
• Round Cells 1.7

[cateyes]

Did you have any other tests done (LH, FSH, T4, etc). Those are key.

Your AMH is consistent with PCOS probably (over 4).

The SA is harder to judge as different clinics have different standards so I am less familiar with those results.

Your tubes are open so that's good! Tilted is not a big deal, just the position

[meerkatmillie]

May 28, 2015 20:47:07 GMT -5 cateyes said:

Did you have any other tests done (LH, FSH, T4, etc). Those are key.

Your AMH is consistent with PCOS probably (over 4).

The SA is harder to judge as different clinics have different standards so I am less familiar with those results.

Your tubes are open so that's good! Tilted is not a big deal, just the position

Thank you so much cateyes! I also checked my TSH a couple times over the past 5 years with my general physician, TSH results were .76-1.57 (normal). And vitamin D results were 16 last year, and 22 this year, so I'm taking 2000IU vitamin D supplements. They haven't checked LH, FSH, T4 yet, so thanks for suggesting! I think you're right about the AMH and PCOS thing - I will definitely do some more research and ask the RE about that tomorrow.

[helloerrbody]

Those SA results look fantastic to me! My AMH was 4.95. My RE said this is not too high and does not point to PCOS (at least for me). She was very happy with a high AMH in that range. My tubes are also clear and my ute is tilted as well, which she said does not affect fertility.

[mugster]

My AMH was 6.39 and my RE said that is indicative of PCOS. But since none of my other tests suggest it: lh and fsh are normal, antral follicle is normal with no sign of cysts, acne and hair growth is normal, and weight is normal, I didn't get that diagnosis. Instead I ended up with a diagnosis of ovulatory disfunction, in part because of my amh though and we are going to keep watching for other symptoms of PCOS (mostly looking for 12 or more follicles on an ovary on cd3 ultrasounds).

I agree that your SA looks great!

[meerkatmillie]

May 28, 2015 22:11:59 GMT -5 helloerrbody said:

Those SA results look fantastic to me! My AMH was 4.95. My RE said this is not too high and does not point to PCOS (at least for me). She was very happy with a high AMH in that range. My tubes are also clear and my ute is tilted as well, which she said does not affect fertility.

May 29, 2015 5:48:30 GMT -5 mugster said:

My AMH was 6.39 and my RE said that is indicative of PCOS. But since none of my other tests suggest it: lh and fsh are normal, antral follicle is normal with no sign of cysts, acne and hair growth is normal, and weight is normal, I didn't get that diagnosis. Instead I ended up with a diagnosis of ovulatory disfunction, in part because of my amh though and we are going to keep watching for other symptoms of PCOS (mostly looking for 12 or more follicles on an ovary on cd3 ultrasounds).

I agree that your SA looks great!

Thank you as well helloerrbody and mugster! I was thinking the 4% morphology seemed low in DH's SA, but its reassuring to hear both of you guys say those results look good. Definitely interesting that both of you had >4 for AMH levels and both of your RE's leaned away from the PCOS diagnosis. I'm really curious if my RE is going to do the same. I do have acne and some mustache/chin/chest hairs that seem a bit odd, but at the same time I'm thin and my BBT charts seem to indicate that Im ovulating pretty regularly every 24-29 days. I'll follow up after the appointment to let you guys know what he says.

[mugster]

May 29, 2015 9:22:00 GMT -5 meerkatmillie said:

May 28, 2015 22:11:59 GMT -5 helloerrbody said:

Those SA results look fantastic to me! My AMH was 4.95. My RE said this is not too high and does not point to PCOS (at least for me). She was very happy with a high AMH in that range. My tubes are also clear and my ute is tilted as well, which she said does not affect fertility.

May 29, 2015 5:48:30 GMT -5 mugster said:

My AMH was 6.39 and my RE said that is indicative of PCOS. But since none of my other tests suggest it: lh and fsh are normal, antral follicle is normal with no sign of cysts, acne and hair growth is normal, and weight is normal, I didn't get that diagnosis. Instead I ended up with a diagnosis of ovulatory disfunction, in part because of my amh though and we are going to keep watching for other symptoms of PCOS (mostly looking for 12 or more follicles on an ovary on cd3 ultrasounds).

I agree that your SA looks great!

Thank you as well helloerrbody and mugster! I was thinking the 4% morphology seemed low in DH's SA, but its reassuring to hear both of you guys say those results look good. Definitely interesting that both of you had >4 for AMH levels and both of your RE's leaned away from the PCOS diagnosis. I'm really curious if my RE is going to do the same. I do have acne and some mustache/chin/chest hairs that seem a bit odd, but at the same time I'm thin and my BBT charts seem to indicate that Im ovulating pretty regularly every 24-29 days. I'll follow up after the appointment to let you guys know what he says.

On our lab report it says that 4% (or higher) is what they are looking for with morphology (we also had 4% morph and the RE was not concerned)... I've also heard that morphology is the least significant of the three as far as predicting pregnancy outcomes.


ETA: I also have clearly ovulated every cycle and my cycles are normal length (27 - 32 days)... but, my average ovulation day is 17 and my average lp is 10 days with low temperatures and small temperature shifts, so my charts were never beautiful.

[FDL]

The SA looks great! I did want to mention that if the round cells are greater then 2 million/mL they will want to check to make sure it isn't from an infection or inflammation. To do this they will do a stain to see if the round cells are White Blood Cells or immature sperm. Often times an infection or inflammation can be asymptomatic. Infection/inflammation can negatively impact morphology, though your H's is normal... it could still go up. Our Urologist was least concerned with morphology though. If the round cells are WBCs the treatment would usually be a course of antibiotics and anti-inflammatories. Normally, you see improvement rather quickly. You may want to do another SA just to double check, or ask about the round cells. Overall, I would be really happy with that SA.

My AMH was 12 (yes 12, not 1.2) and my RE was not concerned. My other results came back good, besides mild endometriosis. I didn't have any other PCOS symptoms. My RE explained the AMH levels are helpful tools but they are not an exact science. You have to look at the whole picture (with all the other tests, ect...) and consider AMH as a piece of that picture.

I hope you are able to finish testing soon and you can get some answers!

[meerkatmillie]

May 29, 2015 10:03:55 GMT -5 FDL said:

The SA looks great! I did want to mention that if the round cells are greater then 2 million/mL they will want to check to make sure it isn't from an infection or inflammation. To do this they will do a stain to see if the round cells are White Blood Cells or immature sperm. Often times an infection or inflammation can be asymptomatic. Infection/inflammation can negatively impact morphology, though your H's is normal... it could still go up. Our Urologist was least concerned with morphology though. If the round cells are WBCs the treatment would usually be a course of antibiotics and anti-inflammatories. Normally, you see improvement rather quickly. You may want to do another SA just to double check, or ask about the round cells. Overall, I would be really happy with that SA.

My AMH was 12 (yes 12, not 1.2) and my RE was not concerned. My other results came back good, besides mild endometriosis. I didn't have any other PCOS symptoms. My RE explained the AMH levels are helpful tools but they are not an exact science. You have to look at the whole picture (with all the other tests, ect...) and consider AMH as a piece of that picture.

I hope you are able to finish testing soon and you can get some answers!

Awesome, thanks FDL! I had breezed right over the round cells thing, not paying much attention to it. Its great to have some more background on that and to know its approaching a high level that might be concerning. Ill check on that with the RE today as well.

[FDL]

No problem. Round cells aren't mentioned a lot. It's just worth asking about and a repeat SA wouldn't hurt either way, since SAs can vary a lot. My clinic likes to get at least two SAs even if the first one comes back good, to get an idea of the "average" numbers. It is normal to have some round cells because it's normal to have some immature sperm, hopefully that is all it is.

My H's round cells increased with each SA over time, until they were treated. It was a fairly easy treatment compared to everything else.

[helloerrbody]

My husband's morphology was around 1% unfortunately. Since his count and motility were great, my RE said that the morphology is of no concern and that there are plenty of men who father children with low morph. I am worried about it though and not sure I totally agree that "it doesn't matter."

[mustloveerica]

May 29, 2015 11:24:44 GMT -5 helloerrbody said:

My husband's morphology was around 1% unfortunately. Since his count and motility were great, my RE said that the morphology is of no concern and that there are plenty of men who father children with low morph. I am worried about it though and not sure I totally agree that "it doesn't matter."

DHs morph came back at 1% as well with his other numbers at normal or above normal ranges. The RE is not concerned for now but says we may need IUIs at some point to point the swimmers in the right direction.

[kariann12]

May 29, 2015 11:24:44 GMT -5 helloerrbody said:

My husband's morphology was around 1% unfortunately. Since his count and motility were great, my RE said that the morphology is of no concern and that there are plenty of men who father children with low morph. I am worried about it though and not sure I totally agree that "it doesn't matter."

I agree. MH's was 2%, and since everything else has come back great for both of us, I can't imagine it has no effect on us being able to get pregnant.

[helloerrbody]

May 29, 2015 12:41:15 GMT -5 kariann12 said:

May 29, 2015 11:24:44 GMT -5 helloerrbody said:

My husband's morphology was around 1% unfortunately. Since his count and motility were great, my RE said that the morphology is of no concern and that there are plenty of men who father children with low morph. I am worried about it though and not sure I totally agree that "it doesn't matter."

I agree. MH's was 2%, and since everything else has come back great for both of us, I can't imagine it has no effect on us being able to get pregnant.

This is us exactly. All of our other tests have come back great. She officially gave us an "unexplained fertility" dx. I would love any advice any of y'all have for improving morph!!!

[awkwardturtle]

Just here to say that I hope your RE appointment goes well meerkatmillie

[meerkatmillie]

May 29, 2015 13:02:49 GMT -5 awkwardturtle said:

Just here to say that I hope your RE appointment goes well meerkatmillie

Thanks awkwardturtle, I'm always happy to see you around

[meerkatmillie]

I'm back to report on what the RE said.

Short story: Dx is unexplained infertility with a recommendation to either keep trying naturally, try IUI, or go straight to IVF.

Long story: The RE went over the basic fertility results, said everything looks normal as far as we can tell with medical tests, and that at this point he would consider our situation as "unexplained infertility." He presented the options we have going forward: keep trying naturally with a 4-5% chance per cycle, try with a monitored IUI/clomid induced superovulation cycle with a 12% chance per cycle (for up to 3 cycles), or go straight to IVF for a 60% chance. We went over the process of IUI, IVF and discussed the risks of each treatment.

I did ask about my AMH at 5.89 being possibly indicative of PCOS. He said he's not worried about PCOS for me because I don't appear to have hirsutism/acne (though he didn't test any other hormone levels). I asked if we could run some more tests (i.e. for example LH:FSH, bioavail/free testosterone, DHEAS, SHBG, Androstenedione, 2hour GTT w/insulin levels) just to rule it out, and he said if I insist he'll check for impaired glucose, total testosterone, and 17-Hydroxyprogesterone at the beginning of my next cycle to get a better idea. But he did not encourage me to go down this path. He said even if I had thin-PCOS, unless the glucose test came back abnormal, the treatment options he would suggest for me next would be the same…IUI or IVF (if the glucose was abnormal, he would do metaformin). I'm up in the air on whether Ill order the extra tests… I know a PCOS dx could have other implications outside of difficulty achieving pregnancy (such as a higher risk of heart attack, and gestational diabetes if I do get pregnant), so I might still check it out.

I also asked about the SA results with round cells at 1.7. He agreed with what fdl said, but he wasn't concerned because they're still in the normal range. He said if we do an IUI/IVF, they'll be checked again then/there.

Also got a rough idea of prices of IUI/IVF in our area (southern US) for anyone else thats curious… He said not taking insurance into account the IUI/medicine costs about $800 per try and the IVF costs about $9000 per try, plus about $3000 in medicines for a total of about $12,000.

[helloerrbody]

Thanks for sharing @meetkatmillie! It looks like you and I are in the same boat with the unexplained shit. RE suggested we try naturally a few more cycles and then go to a medicated IUI.

[FDL]

Just so I'm understanding correctly. The only blood test he did for you was the AMH and did an HSG? He doesn't want to order anymore blood tests?

Maybe he is planning on checking LH, FSH, E2 and prolactin at the start of your next treatment cycle? Did he check your progesterone at around 7DPO? Those are pretty basic.

I'm just confused on how he reached the Unexplained Diagnosis without further testing on your part. I would want to know your baseline FSH, LH, E2 and progesterone. Prolactin can be elevated in pretty much anyone and symptoms can vary. I understand the treatment options would basically be the same, aside from elevated prolactin, but I would want to know what I was working with prior to starting a treatment cycle.

The costs estimates are about the same in my area (south east), so I agree with him on that.

I personally would want to be more thorough, even if the results come back normal like he is assuming. Good luck, I know this process is frustrating and overwhelming. I'm sure you and your SO have a lot to talk about.

[meerkatmillie]

May 30, 2015 4:20:31 GMT -5 FDL said:

Just so I'm understanding correctly. The only blood test he did for you was the AMH and did an HSG? He doesn't want to order anymore blood tests?

Maybe he is planning on checking LH, FSH, E2 and prolactin at the start of your next treatment cycle? Did he check your progesterone at around 7DPO? Those are pretty basic.

I'm just confused on how he reached the Unexplained Diagnosis without further testing on your part. I would want to know your baseline FSH, LH, E2 and progesterone. Prolactin can be elevated in pretty much anyone and symptoms can vary. I understand the treatment options would basically be the same, aside from elevated prolactin, but I would want to know what I was working with prior to starting a treatment cycle.

The costs estimates are about the same in my area (south east), so I agree with him on that.

I personally would want to be more thorough, even if the results come back normal like he is assuming. Good luck, I know this process is frustrating and overwhelming. I'm sure you and your SO have a lot to talk about.

Yes, these are the only blood tests he ran (I also had tsh, vitamin d checked by my primary physician). For the basic fertility work up I asked if we could also test fsh and progesterone, but he said based on my positive OPKs and BBT charts those wouldn't be necessary since I'm clearly ovulating with LH detected by OPK and temp rise and I have a normal luteal phase length so I should have plenty of progesterone. He also said he prefers AMH over FSH based on new research that shows its a more reliable predictor of ovarian reserve and a few other things but I can't remember the full details. We haven't discussed E2 or prolactin at all so I'm not sure what he would say if I asked to measure those.

[meerkatmillie]

Just looked up what E2 and prolactin are used to measure. I'm just assuming here, but I'm guessing he would say E2 being a measure of ovarian reserve wouldn't be necessary since we did AMH to check that. And for prolactin it looks like they do that because if it's high it can prevent ovulation so my guess would be he wouldn't be interested since my charts and opk indicate I'm ovulating regularly.

Overall he's pretty conservative on ordering tests. He said he doesn't want to order tests just for curiosity's sake if they won't impact the treatment plan anyway. This is difficult for me because I love lots of data and am curious, but he's been very knowledgable and open so far... He has explained his decisions with research to back it up....so on the other hand I'm thinking I need to take a step back and put some trust in his medical opinion too.

[mugster]

May 30, 2015 5:36:30 GMT -5 meerkatmillie said:

Just looked up what E2 and prolactin are used to measure. I'm just assuming here, but I'm guessing he would say E2 being a measure of ovarian reserve wouldn't be necessary since we did AMH to check that. And for prolactin it looks like they do that because if it's high it can prevent ovulation so my guess would be he wouldn't be interested since my charts and opk indicate I'm ovulating regularly.

Overall he's pretty conservative on ordering tests. He said he doesn't want to order tests just for curiosity's sake if they won't impact the treatment plan anyway. This is difficult for me because I love lots of data and am curious, but he's been very knowledgable and open so far... He has explained his decisions with research to back it up....so on the other hand I'm thinking I need to take a step back and put some trust in his medical opinion too.

Much of your conversation matches the one I had with my RE, except she ran the cd3 blood work and the 7dpo., and prolactin, She told me the tests for testosterone and androgens was not very accurate in women, but was willing to test for insulin resistance. But PCOS or ovulatory dysfunction vs unexplained radically changed your percentages on what might work. For us, if the diagnosis is right, we have a 1-2% chance on our own, a 20% chance with medicated TI (with a less studied bump up for iui) and then a 55% chance with IVF. Medicated TI for unexplained is only 4-5% effective.

[FDL]

May 30, 2015 5:18:01 GMT -5 meerkatmillie said:

May 30, 2015 4:20:31 GMT -5 FDL said:

Yes, these are the only blood tests he ran (I also had tsh, vitamin d checked by my primary physician). For the basic fertility work up I asked if we could also test fsh and progesterone, but he said based on my positive OPKs and BBT charts those wouldn't be necessary since I'm clearly ovulating with LH detected by OPK and temp rise and I have a normal luteal phase length so I should have plenty of progesterone. He also said he prefers AMH over FSH based on new research that shows its a more reliable predictor of ovarian reserve and a few other things but I can't remember the full details. We haven't discussed E2 or prolactin at all so I'm not sure what he would say if I asked to measure those.

I do appreciate that he is taking your charts in consideration. That's good to hear. My RE also reviewed my charts and used them as a starting point for testing. I had clear temperature shifts, positive ovulation tests, cervical mucus/cervical position and a normal luteal phase. All of which pointed to a normal ovulatory function. My RE still did the basic CD3 and 7DPO labs. They did come back normal for me but my RE didn't want to assume anything because he has been surprised in the past. He also wanted to have an idea of how I would respond to a medicated cycle and what medication/dosage would be appropriate. So, that is where our REs differ. *Some* people with higher AMH levels can over-respond, which can lead to canceled cycles and wasted money.

To the best of my knowledge the American Society for Reproductive Medicine and the Society for Assisted Reproductive Technology still recommend testing for ovarian function with FSH, E2, AMH and antral follicule count via transvaginal ultrasound. All of which give a good indication of ovarian reserve and possible response to ovarian stimulation. AMH is a relatively new test, compared to the others. Granted, I'm not sure what research your RE is using to base his opinion on for only using AMH to test for ovarian function. The recommendations could change.

Something else to consider in your situation would be the benefit of doing at least one medicated IUI. You can see how you would respond to a medicated cycle and have an idea of how you would respond to IVF.

I've seen people here that had some testing get skipped or over-looked and ended up wasting time and money. For me, I like knowing everything was done and we know the whole picture. Your comfort level is important, so if you feel comfortable, confident and safe with your RE and the treatment options then that is what matters.

[FDL]

May 30, 2015 5:36:30 GMT -5 meerkatmillie said:

Just looked up what E2 and prolactin are used to measure. I'm just assuming here, but I'm guessing he would say E2 being a measure of ovarian reserve wouldn't be necessary since we did AMH to check that. And for prolactin it looks like they do that because if it's high it can prevent ovulation so my guess would be he wouldn't be interested since my charts and opk indicate I'm ovulating regularly.

Overall he's pretty conservative on ordering tests. He said he doesn't want to order tests just for curiosity's sake if they won't impact the treatment plan anyway. This is difficult for me because I love lots of data and am curious, but he's been very knowledgable and open so far... He has explained his decisions with research to back it up....so on the other hand I'm thinking I need to take a step back and put some trust in his medical opinion too.

Just to give you an idea of the difference between FSH, E2, and antral follicule count vs AMH. AMH is static (generally speaking) it doesn't change much and gives you a gauge of how many pre-antral follicules you have remaining in your ovaries. The other hormones are ever changing and evolving to the ovaries needs that cycle. So, one tells you how the ovary is functioning/responding each cycle but AMH is a gauge of your ovaries potential. Having a baseline of all these hormones gives you a big picture.

How are the ovaries functioning now and what can I expect from them in the future? Make sense?

Elevated prolactin can impair, delay or completely stop ovulation. You can have elevated prolactin levels and still ovulate.

I hope I'm explaining myself well...

[mugster]

Also do you have any coverage? Many people are better covered during the testing phase. If you are, I'd push for cd3 testing.

[cateyes]

May 30, 2015 5:18:01 GMT -5 meerkatmillie said:

May 30, 2015 4:20:31 GMT -5 FDL said:

Just so I'm understanding correctly. The only blood test he did for you was the AMH and did an HSG? He doesn't want to order anymore blood tests?

Maybe he is planning on checking LH, FSH, E2 and prolactin at the start of your next treatment cycle? Did he check your progesterone at around 7DPO? Those are pretty basic.

I'm just confused on how he reached the Unexplained Diagnosis without further testing on your part. I would want to know your baseline FSH, LH, E2 and progesterone. Prolactin can be elevated in pretty much anyone and symptoms can vary. I understand the treatment options would basically be the same, aside from elevated prolactin, but I would want to know what I was working with prior to starting a treatment cycle.

The costs estimates are about the same in my area (south east), so I agree with him on that.

I personally would want to be more thorough, even if the results come back normal like he is assuming. Good luck, I know this process is frustrating and overwhelming. I'm sure you and your SO have a lot to talk about.

Yes, these are the only blood tests he ran (I also had tsh, vitamin d checked by my primary physician). For the basic fertility work up I asked if we could also test fsh and progesterone, but he said based on my positive OPKs and BBT charts those wouldn't be necessary since I'm clearly ovulating with LH detected by OPK and temp rise and I have a normal luteal phase length so I should have plenty of progesterone. He also said he prefers AMH over FSH based on new research that shows its a more reliable predictor of ovarian reserve and a few other things but I can't remember the full details. We haven't discussed E2 or prolactin at all so I'm not sure what he would say if I asked to measure those.

I also have a normal LP (13-14 days) but tested low on progesterone. Just having positive OPKs and a normal LP does NOT mean progesterone is good.