What to expect

[Emma09]

Not sure if this is in the right spot....

Here goes *deep breath*

My DH and I have been TTC for 13 months with no luck.
DH has a severely poor sperm count. (99% duds)
All my tests were normal
Our first FS app in coming up in March- what should I expect?
Will the FS want the 'usual' tests done again?
Are we good candidates for IVF?
Will this even be an option with such a poor sperm count?
Will the FS just dive straight in?

Please, share your experiences before I drive myself bananas with the 'what if'

[Emma09]

Just bumping this

[~TT40~]

*hugs* that you are this leg of the journey.

We knew for sure that DH had NO sperm, so he didn't have to give samples or anything, but I would say the FS would want another one from you DH. The FS also checked me out, just dildo cam, which came back normal, he also did a papsmear even though I wasn't due for another 6mths, he was there and I said it was all good to do it.
We then saw the nurses who were the ones who actually told us our options. ICSI was our only one (because DH had no sperm in his ejaculations, they get the sperm straight form his boys, like a biopsy, you know big needle) This may just be a back up option for you guys, once they see your DH SA (Ive found FS like to do their own tests rather than just reading/using other peoples) they might be able to get enough sperm from it, and then you have IUI as an option too. It would really depend on the numbers and what your FS reccomends.
We then saw a finace person who went through all the money bit so we knew prices and when things would be due etc..

Some places make you go to a Councillor too, ours didn't but was an option if we wanted it but wasn't compulsory.


I'd advice you to write down everything you think of now, keep adding to it over the next month. Questions, what you already know etc.. That way its all there and when you go in you will feel a bit more in control, plus that way you can get answers you want rather than sitting there trying to think what it was a month ago that was keeping you up at night.

In terms of diving straight in, it is a slow process, and does go by your cycles etc.. so for me we saw the FS as I was ovulating (which he actually saw which was nice to know I do it and its all good), but I had to wait til my next period to start things, then it wasn't for a couple more cycles before it got to the actual putting a baby in me part.

hope that helps a little bit.

GL!!!

[Emma09]

Thanks Teirae.

DH's SA was referred by the GP, but done at the FS clinic, I had assumed that they would want another anyway- something may have changed.

Another dildo cam for me? Awesome!

Thanks again!

[Strawberry55]

I would say they would do another SA, and then maybe a lap for you as well?

I have just started seeing a FS and the first appointment he ordered an SA for dh and is doing a tracking cycle for me, then when I go back to see him, he will book me in for a lap and then with those results he will decide the treatment options available for us

Good luck!

[Lily Dust]

Hi Emma

13 long months, huh such a confusing time. So Im assuming you have just had basic tests done by a GP? So your first consult with a FS is probably gonna be a big chat about whats been happening and generally (at least in my experience) re checking things that your GP may have already done, probably a Laporoscopy etc. I reckon DHs sperm will be analysed again too. Our FS was big on using his 'own labs' to determine results. Once all the tests are complete and you guys decide a plan of attack you can just jump right on in determining results etc may take a couple of months though. ICSI is another option your FS may consider if DHs sperm count is as severe as has been found.

We had unexplained infertility so from when we had tests done we went home and continued to try a further 3 months before going back for2 rounds of IUI, followed by IVF.

Gosh, I hope this all makes sense. Im trying to write whilst my visiting mother is yappin at me So if its not clear please just ask for clarification!

Good luck with it, hun

[Emma09]

Thanks so much everyone!

I just want to get stuck into the next phase.....

[Pholi]

Emma, you're right where i was in Spetember last year - waitng for the FS appointment, knowingDP had a pretty low sperm count.

When the appointment came, he got a separate health and reproductive health history from each of us, noted that DP's beard suggested his testosterone level were ok, and asked me about pms symptoms. He was keen to see my ff charts, which I'd printed and brought along, and confirmed that it looked like my sysles were reasonably consistent, I was ovulating fine msot of the time, and had a good length of LP.

He discussed DPs low count for a while, and then asked to do a quick physical check on DP- basically had a feel of his testicles in standing and in lying (maybe don't tell your DH about this bit, huh?) DP has an easily felt cyst that kind of feels like a third ball which the FS said could well be respionsible for partaillly blocking his tubes. He ordered further SA for DP (like others have said, he trustd his own lab to be accurate, and if you're making major decisions based on the figure - eg, ICSI vs IUI, you want to be really sure) and also more bloods for us both, and an US for DP to check the cyst.

Straight away he said that he felt we wouldn't probably need to do any further tests on me, as my cycles look fine on paper, and blood tests were all ok, and if DPs count stayed the same ( 6 mill/ml) or lower, he'd be recommending we go straight for ICSI, which bypasses the need for me to have open tubes anyway - and why go through expensive and invasive tests for something which won't affect the decision we make or the outcome? I respected him greatly for this wise and considerate point of view. He could easily ahve made more money by suggesting the tests (US on me and lap dye).

DPs second test was indeed worse (3 mill/ml), the cyst was confirmed to be totally benign, but surgery was unlikely to increase the sperm count, so no point in that, and so we went straight for ICSI as soon as my cycle came round to the right timing. We only saw him twice in his rooms, the next time was in the theatre, he was all scrubbed and ready to do my egg pickup.

I would guess, with DH's poor count and your cycles seeming ok, that you guys will be in a similar place to us: offered ICSI straight up. Interestingly, DPs libido picked up once he knew the chances of us concieving were really low anyway. It's like the pressure came off, and it could just be for fun again.
I totally get how you just want things to get started now, though; I felt exactly the same way. But time does keep moving along, and you will get there. 4 months after that first FS appointment, I've found myself 8 weeks pg, and i really, really hope that you'll be able to say the same thing!

I'll be stalking.

[jacklicky]

Our first FS appointment was a SA for DH. Then another one..... both came back zero....

Because we had a daughter naturally a year earlier the FS didn't need to/want to do any tests on me (except the standard BT).

We pretty much knew it was going to be DH's issue (vasectomy reversal site had scared over). We got referred to a male fetility specialist who ran some tests and did a biopsy and found 'plenty' of sperm.
Then back to the original FS for IVF/ICSI. For lower'good' sperm numbers they would suggest ICSI I would think....

Yep out FS jumped straight into IVF as soon as we found out DH had a blockage (that said we started investigations in April and our first cycle was October by the time all the tests and mandatory appointments were completed).

Goodluck

[Emma09]

Pholi- congratulations on twins! Wow!

Hope you don't mind me asking- what drugs did you have for ICSI?
What was the worst/most painful part?

Thanks for your response jacklicky and congrats to you too

[~TT40~]

for me the most ...well wasnt painful, but physically hardest part was when they make you have a month of menopause (the down reg cycle) basically they suppress all your hormones so the next cycle they put them in over drive.. the hot flushes were killing me...

[Emma09]

for me the most ...well wasnt painful, but physically hardest part was when they make you have a month of menopause (the down reg cycle) basically they suppress all your hormones so the next cycle they put them in over drive.. the hot flushes were killing me...

Oh no!
Is that for ICSI as well?
That doesn't sound fun

[nothing2lose]

Emma, ICSI is exactly the same as IVF except after egg harvest a sperm is injected directly into each harvested egg. With regular IVF the sperm and egg are left alone in a petri dish to do their thing.

Also, there are different IVF protocols. Not all require down regulation. All mine, for instance, have been antagonist cycle which doesn't require a month on birth control pills to start.

Hope this helps!

[Emma09]

Thanks so much N2L.
That makes great sense.

I'm nervous and excited and I still have 4 weeks to wait!

[myturn]

My FS was happy with all the tests the GP had organised already, so all he wanted to do was the Laparoscopy for me , surgery to check everything internally. In our case it's my PCOS that's the problem - but as yours is pretty clearly a male issue, he/she may just go to the next step.
I think it's hard to have questions at the beginning sometimes, but if you can write things down, and feel comfortable to ask - even if you think they are silly, you will feel much better for asking.

unfortunately, you will have to have lots of drugs and stuff to make sure they have control of your cycle to know when you are ovulating, so that they can get his 'sample' right to the eggies and make sure they fertilise. There's lots of information on some of the fertility clinic websites (Melbourne IVF, City Fertility, Monash IVF) that explain some of the processes, which won't make a lot of sense to start, but if you become a little familiar with it, and then be willing to 'go with the flow' it will just happen and be okay. It helped me, and meant I didn't put too much pressure on myself for the first one to work (even though I hoped) it was nice just to let it happen and in the end, know how it works.

some people have lots of side effects and others have very few - personally (and I've done two different types of IVF cycles now), for me the down reg cycle (which i did most recently) wasn't too bad side effects wise - it was the waiting that was a pain - I had a few headaches on the syneral (nasal spray) I was on, and then when they pump you full of drugs to make the follicles grow, that can mean your ovaries get very tender... but I've kinda of had the attitude that - well... I am going to experience these symptoms when I'm pregnant, so I better get used to it!!

it's not as scary the 2nd time, for sure... just as much pressure/desire for it to succeed, but certainly less scary! the unknown is always scary!! There is a lot of paperwork that you have to get when they do send you down the IVF etc path, so just keep that in mind. I saw my specialist on 24th august last year, and didn't get to start my first IVF antagonist cycle until 12th october - and that happened pretty quickly, as we were quite organised.

sorry you have to wait until march for your FS appointment! it's a shame you can't get in any sooner. Good luck! keep your chin up and best wishes xxx

[Malyna]

the other thing they can do, is to cut open DH's testies and see if there are any mobile sperm in there - Not a nice option at all (can't remember the technical term for this).

Get copies of all the tests you've had to date. The FS is likely to want to run some bloods on you to make sure everything is okay at your end (unless you have some recent copies of blood tests).

The FS will ask questions like "When did your mother have you or when was her last pregnancy and what were her pregnancies/births like." - so he can get a picture of what your fertility will be like. - In my case, my mum had me naturally when she was 43. I told him that two of my sisters had fallen pg at 38 so he pretty much said "Well you seem okay" but he still sent me off to have routine bloods taken. But then my brief to him was "Not getting any younger here doc, want to get a move on with this."

The other thing you need to think about is a rubella booster - but your GP can organise that - i think, from memory that there is a waiting period attached to that.

Also start to think about things like what is going to happen if DH's sperm isn't able to fertilizer an egg - will you use donor sperm? How does DH feel about that. I say this last part because for DH and me, this was the hardest part of the whole IVF process - getting used to the idea that donor sperm would be involved. Plus this took the longest for DH to get past.

The nuking of my hormones on IVF was terrible for me. I had a huge reaction to the drugs. My nickname was goldfish - I couldn't even remember my name. Had to take time off work because I'd get out of the car and then think "wow I don't even remember driving here".

Everyone said it was great because I was responding to the drugs. Only got 5 eggs picked up, 4 fertlized but it only takes one. I hit the jackpot the first time, but because of the nuking of my hormones had to take crinone for the first 10-12 weeks of pregnancy until the placenta took over.

All the best for your FS/IVF journey.

[MummyNaomi]

Em,

All my fertility testing came back normal. DS has really poor sperm morphology and motility (shape and movement)
Male factor issues are often easier to treat - especially if you are considering ISCI (in laymans terms the sperm is injected into the egg so it gets to the right spot and then the fertilised embryo is transferred back)
Our FS explained to us that of all the myriad of fertility issues, ours was an easier one to treat because the cause was easily determined and then easily fixed (with ICSI)
Ask about ISCI
We've done two ISCI cycles and had two successful pregancies, there is a very high chance you will have similar success based on the info you've given.
We were told that while there is a chance we can get pregnant naturally, based on DHs sperm results our chances were significantly reduced, which is why we went down that route

If you ever want to chat, let me know

Nay x

[Emma09]

Thanks!

MN- now you have said I can ask you questions, I probably won't be able to think of any!