New to this board - MIF

Mrs_Jp

Hello All, I'm sorry we are all meeting like this. I have been a member of the bump for a while but have stopped actively posting for my own mental sanity, though I still lurk most weeks. 

A little of my history:
I have switched OB's recently because I didn't feel the previous one had my best interest in mind (wanted to prescribe clomid after normal FSH test and supposed normal progesterone test, no SA or anything else). The new OB wanted to repeat the progesterone test. After the repeat test the results were something like 9.4 (I think they like to see at least 10?) They want to repeat the progesterone test again and I am currently waiting for that point in my cycle. Checking to make sure my tubes are clear will be after this test.

The new OB did a SA on DH, everything was normal except his count was 11 million and we were referred to a urologist. The Urologist sent DH for an ultrasound suspecting he had varicocele. The results of the ultrasound were not black and white (yes he has varicocele or no he does not). The urologist indicated there are two treatment options, surgery or clomid. He suggested clomid.

My main question is, at what point do we seek out a RE? 

Other questions surrounding the main question:
If we do go with the urologist prescribed clomid, how long do we attempt that treatment?
Should his hormones be monitored while on clomid even if the diagnosis has nothing to do with his testosterone levels?
Should we start his treatment without my progesterone results or checking to make sure my tubes are not blocked?

Any and all advise surrounding any of this would be greatly appreciated. TIA

(also, please excuse my use of varicocele and any grammatical errors associated with past or present tense, in said use)

Irisheyes81

Hello and welcome! So sorry you have to be in this position.  It is so frustrating not having answers.  
My advice: Run don't walk to a reproductive endocrinologist.  OBGYN's are such amazing surgeons but they know as much about infertility as a foot doctor.  Clomid can cause cysts and a thin uterine lining so being monitored is essential to see if everything is going as planned.  OBs hand out clomid like it is candy and for a lucky few, it works and they move on.  For a lot of people, they can have further complications and even less answers.  It isn't recommended to stay on clomid for a very long time so those cycles need to count!  Your husband's count does fit the parameters of an IUI.  Plus, they would tell him all kinds of health related alternatives to improving that count beyond clomid.  Although expensive, a specialist is the way to go. 
Good luck! 

Mrs_Jp

Thank you for your help @Irisheyes81!

It just feels like EVERYONE wants to push clomid on me or my DH and NO ONE wants to talk about the time limit or risks. 

Irisheyes81

That's really frustrating! Good luck! I've found that parenting is all about trusting your gut. We might not have children yet, but getting there is a parenting decision! 

J1006

Welcome to the board, but sorry you find yourself here.

I second what @Irisheyes81 said. 

We are also dealing with MFI. one thing my doctor recommended was a repeat SA just to confirm results.  His low is low but not super low, so it might be worth getting tested again.

As far as Clomid for your DH....we are dealing with low count and morphology problems. We had zero normal sperm in his first test, then up to .3% normal in the second. Our doc was straight with us and said there really isn't any solid evidence pointing to medication that helps with morphology, so it would most likely be a waste of time.  I believe she said any changes in men take about 3 months to detect due to sperm production.  So we would have had to add that time to our care plan which we weren't really willing to do. 

As as long as your tests come back good (mine did as well), you are looking like good candidates for IUI even with DH current count. My doctor wants anything over 10 mil. Might be worth suggesting especially if you don't like the Clomid route. 

One thing I have learned throughout all of this is to speak up for yourself. You know you the best. If you aren't comfortable with something, ask questions and always leave the option for a second opinion. 

Mrs_Jp

@J1006 Thank you for that information! With DH only seeing a urologist at this point, there really has been no discussion around what his numbers actually mean for TTC. The more I talk to people, learn and think about it I think once my testing is done contacting a RE is the way to go. Do either of you have any info on supplements or vitamins that have been recommend to you to support DH reproduction heath?

[Deleted User]

Welcome, OP!  Clomid may help your H but it takes time, as PP stated, to have an effect.  We had him take it and have opted to wait for his retrieval which is almost here!!!  But ours is a bit more dire with zero in the ejaculate.  For iui to be an option for you, your tubes need to be open, tho, so you will need the HSG test first.  I agree - GET THEE TO AN RE POST HASTE!!! ❤

Mrs_Jp

Thank you @Irisheyes81, @J1006, and @BusinessWife!!! It makes so much more sense to have one doctor treating both of us and knowing the whole picture, than to have two different doctors who may not be working in tandem.

missduckie

My DH and I are in the same boat but my progesterone was 5 eight days post ovulation. My husband repeated his testing. His number from collecting his sample at home (sorry tmi) vs at the doctors were way different. Still not ideal but it's amazing how different they can be. So it may be worth having your husbands numbers checked again. 

We went to a fertility specialist/clinic. They are having us do IUI with me on clomid. I highly recommend going to a fertility specialist. They know so much more then anyone at my OB office did about fertility issue. The fertility specialist at my OB office said we needed to go straight to IVF due to my husbands sperm count. The fertility clinic said that was not needed and we should do IUI.

Mrs_Jp

@missduckie is the clomid just so they can monior/better control your ovulation? What are they doing about your low progesterone? 

baker+RN

I agree that going to a specialty RE or IF clinic is your best bet, versus your regular OBGYN (who would take over your care again once you reach 8w pregnancy).

As far as clomid for DH goes, we were told the man needs to be on clomid for 3 months before doing another sample collection to get a real idea of whether it helped. That was from one andrology office that we didn't end up using, but only because they were contracted to work with another IF clinic we did not want to work with. We did not end up using clomid for MFI, and were able to use ICSI for our eggs (granted, it's still early on in embryo development as they're just at 2pn, but still). Clomid won't help motility, from what I understand, or morphology, but might increase count. So if count is your only MFI issue, and he has good motility, you *should* be able to do IVF without ICSI. (Our issue was all 3.) The doctor would rather start your DH on a medication before going straight to surgery for an uncertain varicocele because surgery is a big deal, and medications are more conservative (and in medicine, treatment approaches start at most conservative measures and move up the ladder to more aggressive/invasive measures). The idea being, if his SA doesn't improve after 3 months of clomid, then he more likely does have a varicocele (which clomid won't fix) and would need surgery to repair it. Medications are never without side effects (though what they are and how severe vary from person to person), so if I were you, I would get a second opinion on the testicular ultrasound before agreeing to clomid for DH. But that is only my opinion!

In terms of things to improve male fertility, diet-wise and lifestyle-wise, I would ask whichever RE or IF clinic you go to for their recommendations, and follow those.

missduckie

@Mrs_Jp the fertility specialist said clomid should help my progesterone levels (I suspect also to better control my ovulation and trigger it earlier? I ovulate on CD 16/17). I'm going to ask for the supplement too. I miscarriaged earlier this year due to low progesterone (mine was only 1.8). So I want to do everything I can to make sure my progesterone is up.

Prayingfor2

@Mrs_Jp
My husband was diagnosed with a Variocele in 2014 and had surgery to fix it. One of his Testicles felt like squishy. Three years later the RE and Urologist is stating that once the testicle is damaged, it is generally unfunctioning. He was prescribed clomid for 30 days before completing a TESE to verify morphology of sperm as he shoots blanks 95% of the time. The biopsy was a stab in the heart. 
Please seek another opinion from Urologist to verify Variocele. Clomid did nothing and the decision was unanimous that our IF stemmed from the Variocele. 

Good luck and prayers in your journey.

NandJ4Ever

My O.B. Did the same thing after all of my tests came back normal. She just said my eggs must not be maturing properly and wanted to write me a script for clomid. Well we have severe male factor which is obviously the problem. So clomid never would have been a help and would have just wasted time. I think with a lot of O.B.s it's just their standard step they take to put people on clomid. I think many of them don't have the ability or knowledge to recognize or diagnose more complicated issues.

we are going to an Re and will start IVF in November. Best decision ever because an RE turned out to be so much more knowledgeable, spent way more time researching our background and knew exactly what testing to do and had a much better idea f what the problem could be.

Mrs_Jp

@baker+RN I think you are right. I am going to have DH retested in a few months just to make sure it really is low and not stress or something at the time of the last test. 

@missduckie I'm so sorry to hear of your loss. I have friends who have had the same trouble and I think it has made me extra aware of those potential issues. Maybe even paranoid.

@Prayingfor2 Oh wow! I'm sorry to hear that. Thank you for sharing your experience. I definitely think we will be retesting him to verify and possibly seeing another urologist if the retest shows low count again, just for a second opinion. 

@NandJ4Ever  Thank you for confirming I'm not crazy for wanting more tests done before I jump to medications! 

I just got my hands on my actual progesterone levels for the three tests I've had. My progesterone was under 10 in November and June but above 10 in July. I just feel more confused now. Again, thank all of you ladies for your input, experiences and help!