MFI help

[cheezee]

I think I have seen a few on here that are dealing with MFI.  Hoping you can just give some advice/support.  Backstory....DH has low testosterone and has been getting injections for a couple years now.  When it came time to TTC we knew this would be an issue so his doc put him on clomid.  This always made me a bit antsy because there was never a SA done.  A couple months into TTC I was hounding DH to get one done because I wanted proof this clomid was working.  Well the SA results today showed a pretty low count...little less than 1 million.  Everything else was normal.  The plan now is to completely stop the testosterone injections and continue the clomid.  We're hoping with some more time his counts will improve.  He'll have another SA in two months.  Is it reasonable to think we'll be on the bench for a couple months?  Would you even continue to do all the TTC things with a count that low?  Is there any sort of blood work that should be checked on DH or do they just monitor the SA?  I don't even really know what to think right now.  

[ghostmonkey]

You shouldn't need to be on the bench necessarily, you just won't have as good of chances.

It takes 3 months for sperm to mature. At this point there is no need to test you. See where you can get with his and minimal intervention before moving to anything else. If there isn't an improvement after his retest then it may be time to consider consulting an RE and finding out your options there.

[FDL]

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My H has hypogonadotropic hypogonadism, which means he has both low sperm count/quality as well as low hormone levels.

Did they ever try to find out the cause of his low T or did they just put him on Testosterone injections?

Your H should be seen by a Urologist who has experience with MFI. They should test his levels of Testosterone, LH, FSH and estrogen. This should be done before he starts treatment and about 4 weeks after he starts a new treatment to make sure he is on the proper dose. Prior to starting treatment he should be evaluated to find out the cause of his low testosterone and sperm count. This typically includes bloodwork, SA, physical exam and an ultrasound. Our Urologist wouldn't do a repeat SA until after 3 months of treatment.

For example, my husband didn't respond to Clomid alone, Clomid with Arimidex, or Clomid+Arimidex+HCG injections. His testosterone went up but his sperm count did not. He only responded to Gonal (FSH) injections. This would be similar to a female patient that only responds to injections. My H's pituitary just doesn't make the appropriate amount of hormones on it's own to produce enough sperm. If we hadn't worked with an experienced Urologist, our only option to conceive would have been IVF.

My H will stay on HCG injections to keep his testosterone up until we are done having children. After that he can be put on testosterone.

MFI treatment can take a lot of time. It took about a year for us. I wouldn't mess with a Doctor that isn't thorough. If he has been on Clomid for a while and hasn't seen improvement, there should be a dose change or treatment change.

We were still encouraged to TTC even with low counts. You shouldn't be benched but your chances would be lower.

If you have any questions, feel free to PM me.



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[cheezee]

Thank you FDL that's a lot of helpful information. No they've never tested for the cause of the low testosterone...just started injections. I'm not a fan of this doctor at all...DH is so we are battling. He is an endocrinologist who specializes in andrology. I really want him to get to a urologist. He has been on Clomid for 5 months now and I forgot they did start HCG injectios as well.
I was the one that had fertility issues when we were TTC #1 so this is all foreign and frustrating to me.

[goldenlove3]

cheezee I don't have any advice but wanted to say that there is a MFI check-in on the 3T/IF board. You might find it helpful.

[FDL]

Sept 10, 2015 8:29:28 GMT -5 cheezee said:

Thank you FDL that's a lot of helpful information. No they've never tested for the cause of the low testosterone...just started injections. I'm not a fan of this doctor at all...DH is so we are battling. He is an endocrinologist who specializes in andrology. I really want him to get to a urologist. He has been on Clomid for 5 months now and I forgot they did start HCG injectios as well.
I was the one that had fertility issues when we were TTC #1 so this is all foreign and frustrating to me.

I really question a doctor that would put a patient who is reproductive age and not done having children on testosterone injections. There can be physical causes of low T, sometimes within the testes, that needs to be addressed by a Urologist. He should have been evaluated for the cause of his low T prior to any treatment.

Did the Doctor keep him on the testosterone injections while he was on Clomid? That seems really odd. If his body isn't encouraged to produce testosterone naturally (because he is on the testosterone injections) that can interfere with his sperm production even while on Clomid.

The HCG injections will help if he has low LH. HCG injections can help increase his testosterone levels naturally, while encouraging sperm production. If he hasn't had labs to see what his hormones are doing his Doctor is making assumptions.

Stopping the testosterone and adding HCG with the Clomid could help your H, but if there is an underlining physical condition that isn't being treated it could be a waste of time.

My RE wouldn't touch my H, even with 20+ years of experience. I hope that your H considers seeing a Urologist in the future. I know how frustrating MFI can be, I'm sorry you are going through this.

[cheezee]

FDL yes they kept him on the testosterone injections but lowered the dose when the Clomid started. Now they are completely stopping the injections. I thought it was so odd that he did that but I was trying to trust the doc knew what he was doing. Now I don't want this doc to touch DH with a ten foot pole. This guy didn't even want to do a SA! We had to ask for one.
DH is being quite stubborn about all this and I think it was a big blow to his ego. With us just getting the results yesterday I've been frantically reading too much and most likely overwhelming DH. I'm hoping things will settle and he'll realize he needs to see a better Doc soon.

[FDL]

cheezee, give your H sometime. I know mine was in denial for a while. Give yourself sometime too since you just got the results yesterday, it isn't easy hearing bad news.

Maybe try talking over everything again when emotions aren't so high? Maybe you could come to a compromise... Try this treatment for two months and if there is no improvement, agree to see a Urologist?

[piccyami]

cheezee, there are a lot of emotions involved. My H is still struggling with the diagnosis. We've been doing a lot of talking to work through the feelings we both have. His problem is motility, not count, so we have next to no chance without intervention. We stopped focusing on TTC so we could focus on us for a while.

I agree with FDL. Try talking when you're both calm. Let him know how you feel and ask him how he's feeling. You might be able to make a compromise happen.

[cheezee]

Thanks so much for all your advice. I think we've decided to just see how his repeat SA looks in November.

[firefly]

cheezee, I'm sorry that you're going through this. We are going through some similar issues with my DH. We discovered last year that he has low testosterone when he went to see a Urologist for the first time. All of his other hormone levels came with within normal range at that time. Because we were TTC, the Urologist started him on Clomid as a way to increase his testosterone. Several months after starting the Clomid, he had repeat blood work and all of the sudden his estradiol levels had gone too high. The urologist did nothing to address this, just kept playing with his Clomid dosage, and honestly seemed unconcerned with our troubles conceiving.

Fast forward a couple of months to when I was at my RE's office for IUI#3. DH's post-wash SA was pretty awful as compared to his previous results. I mentioned to the RE that he was having trouble with getting the right dosage of Clomid and how his hormone levels weren't right anymore. The RE said that high estradiol can subsequently cause a decrease in sperm production and that might explain why his SA had gone downhill. This RE was new to the clinic and told me he specializes in the MFI patients. So now we've started to see him as of a few weeks ago and he's now monitoring my husband and switched his medication because we don't have ANY decent Urologists in my town that actually specialize in male infertility. So frustrating!!

Anyway, so the whole point of my story is that MFI can be really tricky to manage if not done by someone who has a lot of experience with it, so don't be afraid to go see someone else for a second opinion! Also, I definitely wouldn't stop TTC in the meantime! There's certainly no harm in trying and I'll bet his parameters will likely improve within a few months after stopping the testosterone injections!

[cheezee]

Thank you firefly - I have read about all this treatment going in the opposite direction. That is really why I was pushing DH to get a SA in the first place. A friend sent me a rec for a local urologist that specializes in MFI and I sent DH his info. Without me nagging him he made himself an appointment for next month. So I feel sooooo much better that we will get him into a great doc that knows how to properly treat this. The waiting is definitely going to suck!

[firefly]

Sept 11, 2015 8:48:25 GMT -5 cheezee said:

Thank you firefly - I have read about all this treatment going in the opposite direction. That is really why I was pushing DH to get a SA in the first place. A friend sent me a rec for a local urologist that specializes in MFI and I sent DH his info. Without me nagging him he made himself an appointment for next month. So I feel sooooo much better that we will get him into a great doc that knows how to properly treat this. The waiting is definitely going to suck!

That is great news!! Hoping you get a good plan in place at that appointment!