Qus & Ans: Inseminations

Qus and Ans: Inseminations

My husband has a low sperm count and low motility.(8.9 Mil after wash for IUI). This has progressively incresed since the first IUI we had done (2.8Mil after wash). He found out after the first IUI that he has low thyroid and he has begun medication, in the mean time, he has been taking Proxeed (male vitamin, supposed to help w/ motility) and we have started to see the increase. We got cocky after the second IUI (4.5 Mil) and he stopped taking the Proxeed. Obviously that one didn't work, or the third one. Do you think his increase in sperm count could be related to the Proxeed or the Thyroid medicine? He also is a tobacco user (coppenhagen) and he drinks every day (ave. 2-3 beers) could this be affecting his count also? Thanks for any help you might have! Caryn

Dear Caryn:

We have reviewed your case very diligently and analytically and it is obvious to me that you do have a male factor difficulty with your case. You are presenting me with a variety of factors that could be involved in your husband's difficulties and, as you may realize, it makes it very difficult to predict and/or point out the involvement of Proxeed and the thyroid deficiency in your husband's low sperm count. Furthermore you are superimposing a tobacco use and also alcohol use as possible contributors to the problem as well.

Let us sort out your case with the little information that you provided us with. First, you are referring to the sperm count and the motility as being low and those numbers that you provided us (8.9 million and 2.8 million after wash) are corresponding to numbers of sperm that are used for IUI after the sperm was processed. It is very important to know the sperm numbers and the volume and the percent motility before the specimen is washed and prepared for IUI. Depending upon the mode (method of semen preparation) via which the sperm is prepared, that mode alone could eliminate a large number of sperm cells that could be otherwise used for insemination.

My recommendations to you are as follows:

The bottom line in your case is that you need to be persistent, to keep the spirits up for both of you and, most importantly, to make sure that "you take the car to the right mechanic" - by that I mean you always need to make sure that your doctor is on top of the situation and is able to guide you in the right direction. I wish you the best, and please remain persistent.

Dr. Panayiotis Zavos
Director, Andrology Institute of America
Associate Director, Kentucky Center for Reproductive Medicine & IVF

My question is what is normal in men's sperm count? My husband was told, by the urologist, he had a count of 30 million and moltility of 50 percent, which was too low. He said it should be at least 60 million and 80%. He is 28 years old. I have heard so many stories that I don't know what to believe. We have been married 10 years with no protection, but just recently are in the position to persue infertility treatments. My husband was also told he needed the vein surgery(forgot name of it), so he had it done 2 weeks ago. My doctor recommended IUI, which leads to my next question. When are IUI's performed? (day of ovulation?). My doc also put me on clomid days 5-9, what kind of odds do i have to become pregnant? How sucessful are IUI's?
Thanks, Pamela

Dear Pamela:

We have reviewed your case and inquiry very carefully and your concerns are very much in line with what patients like you experience when they visit a doctors office and they are not given the facts as they may appear. Let us take your case on a step-by-step basis. First, when your urologist is referring to the sperm measurements as being normal or abnormal, the numbers need to be clarified properly in order for them to become meaningful and can be used constructively towards the proper evaluation of any difficulties that may exist. When your doctor indicated that the count of 30 million is "low," then he would need to define whether he is referring to the count of sperm cells on a per mL basis or the total sperm count in the ejaculate. A man must have 20 million sperm per mL and his total sperm count should be 50 million in order to be normal. Therefore the count of 30 million, if it is expressed on a per-mL basis, is normal but, if it is expressed on a per ejaculate basis, then it is abnormal. On the other hand the 50 percent motility is normal and he does not have to have 80 percent of his sperm being motile in order to be normal.

Your husband, being 28 years old, is by no means aged, and I trust that you are young couple seeking infertility treatment. You should be seeking the appropriate doctor with appropriate expertise to assist you. A second opinion is always a good thing, and I believe this is what you are doing by seeking additional information from us.

Your husband has undergone treatment for varicocele and I hope that it is successful.

The recommendations for pursuing IUIs can assist both of you by correcting your husband's seminal deficiencies and possibly fine tuning your ability to produce an egg every month and release it. The Clomid treatment is for you to ensure proper ovulation induction (produce an egg), but you need to remember that producing an egg alone is not good enough. You must release that egg at the proper time of ovulation in order for the female factor to be doing her "home work" properly. One must realize that IUI treatment of infertility, although it may sound simple, it can be very tricky if any of the steps for ovulation induction, prediction, IUI insemination and subsequent embryonic implantation are not taking place properly and (just as importantly) are not monitored properly. Going to the right doctor can make the difference. Have faith in your physician, but also feel comfortable inquiring about the various steps of your infertility treatment. If everything goes well and all deficiencies are corrected your chances for pregnancy every time you attempt an IUI (per cycle) are no more than 25 percent.

Please do not lose focus, remain committed, and have faith in you, your husband and your treating physician. I wish you all the best for a very positive and prolific future.

Dr. Panayiotis Zavos
Director, Andrology Institute of America
Associate Director, Kentucky Center for Reproductive Medicine & IVF

Dear Doctor,
I had my first IUI a couple of months ago with no success. Since my insurance does not cover any infertility treatment, I was wondering if we could do without the "sperm washing" portion of this procedure. When we asked the nurse about this, she told us that I would go into shock if we did not wash the sperm. Could you please explain this to me? I don't understand why in the doctor's office I would go into shock when I don't go into shock at home when we have sex. Thanks!

The semen must be washed to remove certain substances, such as prostaglandins, that would cause a terrible allergic reaction if injected directly into the uterus. During intercourse, these substances would remain in the vagina, and not climb up to the uterus in high enough concentrations to cause problems.

Alan B. Copperman, M.D.
Director, Mount Sinai ART Program
New York, NY

My husband and I have been trying to conceive for 6 1/2 years (since I was 19 - him 24). We did basal charts, progesterone test, and hysterosalpenogram (spelling?). Everything shows to be normal. My doctor recently moved so I have to find a new doctor. Should I just go ahead to an infertility clinic (1hr away) or a local doctor I found who has done much treatment in infertility? Also, what would you suggest as a game plan? My doctor who moved said the next step for me would be laproscopy. I feel as though there are many other "smaller" tests which have not been done which would cost alot less. What do you suggest?

Dear Patient:
Thank you for your note that I read with interest. I don't believe a laparoscopy would be a reasonable next step in your testing or therapy. I don't believe that going through other steps that are not proven to be extremely successful would be reasonable either.

I believe that the next step should be to make an accurate diagnosis. We should be able to accurately list the reason for your infertility. Then, by correcting them, you should be successful.

Please fill out the enclosed preliminary questionnaire and email your address so we can send you more detailed questionnaires. This will allow us to have a more accurate view of the potential reasons that contribute to your infertility.

Before suggesting any testing, I would prefer to carefully review your medical records. If you can either mail or fax a copy to me (615-321-8877) I would really appreciate it. Please would you kindly fill out the questionnaires that I am attaching. This will allow us to outline the therapy to you.

We must rule out any other factors if we expect a high success rate per treatment action (in our program there are only 1.2 treatment actions per birth, including patients up to age 44 using their own egg and 54 using egg donation).

Jaime Vasquez, M.D.
Voice: (615) 321-8899 ~ FAX: (615) 321-8877

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