Update: MFI Uro appt and wwyd? (long)

NMscubagirl · March 2011

So no miracle. Basically he said it is pretty bad, but it is not as bad as it could be. IVF/ICSI really truly is our only option. I think I have been in a bit of denial about that. The real challenge at this point is how to get enough sperm.

Uro has DH on a protocol of Arimidex, HCG shots, anti-oxidant therapy, and acupuncture. I think the Arimidex is supposed to help Testosterone from converting to Estrogen, keeping more testosterone in his body. The HCG is supposed to help increase sperm production. And the acupuncture is for good measure.

He is not super hopeful that the protocol will really do any good, but he said it was worth a shot. The problem is, if DH's condition is something that is in steep decline, us waiting could make it even worse.

The plan right now is to stay on this protocol and then cycle in 6-9 months. Hopefully by then things get better, or at least not worse. He will provide multiple samples to see if there are even enough to freeze, and then on the day of ER will provide 6 fresh samples in 24 hours!!!! Crazy huh?

We can also add a TESE into this where there will remove any sperm they can find from the testicles and then freeze those samples. I think we will include this just to be sure.

The big dilemma right now is what if it gets worse? We could just do the TESE now and cycle right away to make sure we have something, but if we do that, then we will loose the option to see if we can medically improve our situation.

Any advice is greatly appreciated! Our heads our spinning!

On a side note - I LOVED our Uro. He is amazing!!! Way better than my RE!

vanessagorc · March 2011

Yeah, it's a LOT. It took me awhile to wrap my brain around IVF, even when i was doing it.

HUGE HUGS!!!!!

Our URO didn't do any meds. He said DH's situation would never improve past IVF w ICSI, so he didn't want us wasting time.

We moved right into it, hoping to beat the decline. We freeze anything decent we can get, along the way.

GOOD LUCK!

vanessagorc · March 2011

Also, how many were in ur DH's SA? They need very few for ICSI. Mine had 50k at our last IVF, and that was plenty. He was able to avoid the TESE, and we did get pregnant.

NMscubagirl · March 2011

The first one he had 5, the second he had 3. So really really bad. =(

vanessagorc · March 2011

NMscubagirl:
The first one he had 5, the second he had 3. So really really bad. =(

In the whole sample, or per field?

In that case, I would be inclined to go right for the TESE bc ur DH is at least making some sperm now...and I would capitalize on that.

Clearly i'm not a dr, but that's kind of my gut talking.

NMscubagirl · March 2011

vanessagorc:
NMscubagirl:
The first one he had 5, the second he had 3. So really really bad. =(
In the whole sample, or per field?
In that case, I would be inclined to go right for the TESE bc ur DH is at least making some sperm now...and I would capitalize on that.
Clearly i'm not a dr, but that's kind of my gut talking.

That is kind of how I am feeling too, but it seems like when I make impulse gut decisions, they always end up being the wrong ones, and had we just waited things would have turned out better. I don't want to make a decision out of fear.

whitewave26 · March 2011

It sounds like you had a very informative appointment.

I don't really know how many sperm they need for IVF with ICSI, but I would be afraid to wait the 6-9 months for the protocol to maybe work.

Why would you lose the option to see if his condition improves if you cycled now? Couldn't he still take the medication while you cycle to see if anything improves so you could do the same protocol for future children?

ecleptic · March 2011

I think (totally non-professional, non medical person) it might be worth the peace of mind to repeat the SA every 3 months even during treatment to see if it's getting worse. Obviously the hope is that it will get better with the medications but you seem worried about the time frame in case of decline so checking along the way can't hurt.

We're ICSI as well but we've got about 100k in any given sample to work with so I don't have direct experience- if you don't get a lot of replies maybe put TESE in the title and see if you catch anyone else?

Best luck!

vanessagorc · March 2011

NMscubagirl:
vanessagorc:

NMscubagirl:
The first one he had 5, the second he had 3. So really really bad. =(

In the whole sample, or per field?

In that case, I would be inclined to go right for the TESE bc ur DH is at least making some sperm now...and I would capitalize on that.

Clearly i'm not a dr, but that's kind of my gut talking.

That is kind of how I am feeling too, but it seems like when I make impulse gut decisions, they always end up being the wrong ones, and had we just waited things would have turned out better. I don't want to make a decision out of fear.

I felt like we jumped into IVF right after Dx...bc we did. But I am glad we did. My DH's SA's are declining, and I'm glad we didn't waste time.

NMscubagirl · March 2011

whitewave26:
It sounds like you had a very informative appointment.
I don't really know how many sperm they need for IVF with ICSI, but I would be afraid to wait the 6-9 months for the protocol to maybe work.
Why would you lose the option to see if his condition improves if you cycled now? Couldn't he still take the medication while you cycle to see if anything improves so you could do the same protocol for future children?

From what the uro said, doing the procedure that he wants to do, he would actually be removing functioning pieces of the testicles to remove sperm from them. At that point it would be near impossible to increase count or anything else with medication.

whitewave26 · March 2011

By the way, after reading this and vanessas response, I feel like we got a sub-par Urologist. My DH did have slightly low testosterone which was quickly dismissed as nothing by the uro. DH was put on clomid and sent on his merry way. Just doesn't feel right.

Thanks girls for the inspiration. I'm going to talk to DH about getting another opinion.

NMscubagirl · March 2011

vanessagorc:
NMscubagirl:
vanessagorc:

NMscubagirl:
The first one he had 5, the second he had 3. So really really bad. =(
In the whole sample, or per field?
In that case, I would be inclined to go right for the TESE bc ur DH is at least making some sperm now...and I would capitalize on that.
Clearly i'm not a dr, but that's kind of my gut talking.
That is kind of how I am feeling too, but it seems like when I make impulse gut decisions, they always end up being the wrong ones, and had we just waited things would have turned out better. I don't want to make a decision out of fear.
I felt like we jumped into IVF right after Dx...bc we did. But I am glad we did. My DH's SA's are declining, and I'm glad we didn't waste time.

How long from when you decided to cycle did you actually get to retrieval/fert?

whitewave26 · March 2011

NMscubagirl:
whitewave26:

It sounds like you had a very informative appointment.

I don't really know how many sperm they need for IVF with ICSI, but I would be afraid to wait the 6-9 months for the protocol to maybe work.

Why would you lose the option to see if his condition improves if you cycled now? Couldn't he still take the medication while you cycle to see if anything improves so you could do the same protocol for future children?

From what the uro said, doing the procedure that he wants to do, he would actually be removing functioning pieces of the testicles to remove sperm from them. At that point it would be near impossible to increase count or anything else with medication.

Oh, I see. Thanks for the education on that. Geez, that is such a tough decision. In that case, I might be willing to wait at most 3 months before the first SA to see if anything improves.

NMscubagirl · March 2011

whitewave26:
NMscubagirl:
whitewave26:

It sounds like you had a very informative appointment.
I don't really know how many sperm they need for IVF with ICSI, but I would be afraid to wait the 6-9 months for the protocol to maybe work.
Why would you lose the option to see if his condition improves if you cycled now? Couldn't he still take the medication while you cycle to see if anything improves so you could do the same protocol for future children?
From what the uro said, doing the procedure that he wants to do, he would actually be removing functioning pieces of the testicles to remove sperm from them. At that point it would be near impossible to increase count or anything else with medication.
Oh, I see. Thanks for the education on that. Geez, that is such a tough decision. In that case, I might be willing to wait at most 3 months before the first SA to see if anything improves.

The doctor actually ordered a SA after 3 months to see if this is doing anything at all and then we can go from there. If there is no improvement at all I guess we should just cycle right away.

Honestly I think I emotionally need at least 3 months for this. Everything is happening soooo fast.

vanessagorc · March 2011

We got our Dx in june...confirmed in July (repeat SA) and I was supposed to cycle in Aug. My period ended up being really late (i think stress) so i cycled in Sept w ER in Oct.

We used a fresh sample w TESE back up. DH ended up not needing it.

NMscubagirl · March 2011

vanessagorc:
We got our Dx in june...confirmed in July (repeat SA) and I was supposed to cycle in Aug. My period ended up being really late (i think stress) so i cycled in Sept w ER in Oct.
We used a fresh sample w TESE back up. DH ended up not needing it.

You did a TESE with 50K? Can I ask why? Maybe I am confused about what a TESE is.

NMscubagirl · March 2011

whitewave26:
By the way, after reading this and vanessas response, I feel like we got a sub-par Urologist. My DH did have slightly low testosterone which was quickly dismissed as nothing by the uro. DH was put on clomid and sent on his merry way. Just doesn't feel right.
Thanks girls for the inspiration. I'm going to talk to DH about getting another opinion.

Ya, our first urologist was a joke. The one we have now is a MFI specialist and he was freakin outstanding. I don't think I have ever felt so comfortable with a doctor in my whole life. He clearly knows what he is doing!

vanessagorc · March 2011

NMscubagirl:
vanessagorc:

We got our Dx in june...confirmed in July (repeat SA) and I was supposed to cycle in Aug. My period ended up being really late (i think stress) so i cycled in Sept w ER in Oct.

We used a fresh sample w TESE back up. DH ended up not needing it.

You did a TESE with 50K? Can I ask why? Maybe I am confused about what a TESE is.

We did not have to...but bc DH's SAs get worse, he was scheduled for one as a back up. So he gave fresh and they checked it. If it had been just a few, he would have had the TESE. He was prepped for the OR.

He may be having on this go around. We will find out on Tues.

NMscubagirl · March 2011

vanessagorc:
NMscubagirl:
vanessagorc:

We got our Dx in june...confirmed in July (repeat SA) and I was supposed to cycle in Aug. My period ended up being really late (i think stress) so i cycled in Sept w ER in Oct.
We used a fresh sample w TESE back up. DH ended up not needing it.
You did a TESE with 50K? Can I ask why? Maybe I am confused about what a TESE is.
We did not have to...but bc DH's SAs get worse, he was scheduled for one as a back up. So he gave fresh and they checked it. If it had been just a few, he would have had the TESE. He was prepped for the OR.
He may be having on this go around. We will find out on Tues.

GL with it this go around. I hope and pray he doesn't have to. Does he have any frozen from your last cycle?

vanessagorc · March 2011

NMscubagirl:
vanessagorc:
NMscubagirl:
vanessagorc:

We got our Dx in june...confirmed in July (repeat SA) and I was supposed to cycle in Aug. My period ended up being really late (i think stress) so i cycled in Sept w ER in Oct.

We used a fresh sample w TESE back up. DH ended up not needing it.

You did a TESE with 50K? Can I ask why? Maybe I am confused about what a TESE is.

We did not have to...but bc DH's SAs get worse, he was scheduled for one as a back up. So he gave fresh and they checked it. If it had been just a few, he would have had the TESE. He was prepped for the OR.

He may be having on this go around. We will find out on Tues.

GL with it this go around. I hope and pray he doesn't have to. Does he have any frozen from your last cycle?

He does...they want to do fresh over frozen. So that frozen is on back up too.

jillmatheny · March 2011

MH is on a similar coctail and so far I think it is helping. His T is definitely up, and his sperm count is a little bit, too. Good luck!

NMscubagirl · March 2011

jillmatheny:
MH is on a similar coctail and so far I think it is helping. His T is definitely up, and his sperm count is a little bit, too. Good luck!

That is great to hear! I see you did some IUIs. What count did your DH have?

amy1004 · March 2011

A TESE can be major and our uro recommended a week or two off work just in case. It is effective since the uro can dig around and find good quality sperm. Kuleama's husband got something like 8 vials of sperm from their TESE and she is now on PAIF.

We are trying anything to prevent surgery but our uro will recommend a biopsy if the Clomid doesn't work, since the last SA had 12.

I am really glad that you liked the uro. It helps take some of the sting out of why you are there.

whitewave26 · March 2011

NMscubagirl:
whitewave26:

By the way, after reading this and vanessas response, I feel like we got a sub-par Urologist. My DH did have slightly low testosterone which was quickly dismissed as nothing by the uro. DH was put on clomid and sent on his merry way. Just doesn't feel right.

Thanks girls for the inspiration. I'm going to talk to DH about getting another opinion.

Ya, our first urologist was a joke. The one we have now is a MFI specialist and he was freakin outstanding. I don't think I have ever felt so comfortable with a doctor in my whole life. He clearly knows what he is doing!

I'm beginning to realize that our first one may have been a joke too. He is suppose to be a MFI specialist.

NMscubagirl · March 2011

amy1004:
A TESE can be major and our uro recommended a week or two off work just in case. It is effective since the uro can dig around and find good quality sperm. Kuleama's husband got something like 8 vials of sperm from their TESE and she is now on PAIF.
We are trying anything to prevent surgery but our uro will recommend a biopsy if the Clomid doesn't work, since the last SA had 12.
I am really glad that you liked the uro. It helps take some of the sting out of why you are there.

Hey there doll! So did they consider the 12 successful, or would they still recommend TESE at that point? I think we may try to do all 3 because I think we will only have one shot and we want to make it successful. How long has your DH been on Clomid?

Edwina.McDunnough · March 2011

I have no advice, but good luck with moving forwards.

amy1004 · March 2011

NMscubagirl:
amy1004:

A TESE can be major and our uro recommended a week or two off work just in case. It is effective since the uro can dig around and find good quality sperm. Kuleama's husband got something like 8 vials of sperm from their TESE and she is now on PAIF.

We are trying anything to prevent surgery but our uro will recommend a biopsy if the Clomid doesn't work, since the last SA had 12.

I am really glad that you liked the uro. It helps take some of the sting out of why you are there.

Hey there doll! So did they consider the 12 successful, or would they still recommend TESE at that point? I think we may try to do all 3 because I think we will only have one shot and we want to make it successful. How long has your DH been on Clomid?

I forgot to mention that we are OOP, so that is also why our uro is considering biopsy as the next step. We know DH produces sperm since there were 12, so it is a cheaper method of obtaining the sperm. TESE is a very last resort for us and would be done on the same day as the ER. Any surgery has to be done 6 months apart. So make sure to factor that in if you are trying to make a plan.

DH has been on Clomid for 3 months. His T is at a normal level now (b/w confirmed) and he will have another SA and more b/w next week. I simply want enough sperm to freeze and save for IVF.

NMscubagirl · March 2011

amy1004:
NMscubagirl:
amy1004:

A TESE can be major and our uro recommended a week or two off work just in case. It is effective since the uro can dig around and find good quality sperm. Kuleama's husband got something like 8 vials of sperm from their TESE and she is now on PAIF.
We are trying anything to prevent surgery but our uro will recommend a biopsy if the Clomid doesn't work, since the last SA had 12.
I am really glad that you liked the uro. It helps take some of the sting out of why you are there.
Hey there doll! So did they consider the 12 successful, or would they still recommend TESE at that point? I think we may try to do all 3 because I think we will only have one shot and we want to make it successful. How long has your DH been on Clomid?
I forgot to mention that we are OOP, so that is also why our uro is considering biopsy as the next step. We know DH produces sperm since there were 12, so it is a cheaper method of obtaining the sperm. TESE is a very last resort for us and would be done on the same day as the ER. Any surgery has to be done 6 months apart. So make sure to factor that in if you are trying to make a plan.
DH has been on Clomid for 3 months. His T is at a normal level now (b/w confirmed) and he will have another SA and more b/w next week. I simply want enough sperm to freeze and save for IVF.

The Uro said that the procedure would be done before the ER and anything found would be frozen. So maybe a biopsy is what he meant. He didn't actually give a name for what it was, he just kept calling it the testicle surgery. I should have thought to ask, but he was so good at explaining everything I just trusted him.

When is your next appointment? When do you cycle next?

Eriksgal · March 2011

Good luck and it sounds like a good plan! The six samples on day of ER sounds excessive to me since you will be doing ICSI and will have frozen back up. It actually sounds like a waste of money if you are going to be out of pocket for all that. Did the Dr give a reasoning for that? My DH has been on the HCG and Arimidex protocol for Low T since July 2010. His count went from 0 to 9 million in Nov 2010, motility, etc improved too. He also takes Fertility Blend for Men from GNC I'm not sure what is was on at our ER on Fri because they didn't tell us. We had one frozen sample for back up. We may look at. TESE in the future if this IVF is successful for future children so he can go off the meds or change to something else. On the Arimidex if your insurance isn't covering it...check Costco. I called around and wal mart wanted $400 for the generic, same with some of the other pharmacies like CVS and Walgreens. Costco charges $25 for the generic for a 30 day supply. I couldn't believe how much cheaper they were so do your homework!

amy1004 · March 2011

NMscubagirl:
amy1004:
NMscubagirl:
amy1004:

A TESE can be major and our uro recommended a week or two off work just in case. It is effective since the uro can dig around and find good quality sperm. Kuleama's husband got something like 8 vials of sperm from their TESE and she is now on PAIF.

We are trying anything to prevent surgery but our uro will recommend a biopsy if the Clomid doesn't work, since the last SA had 12.

I am really glad that you liked the uro. It helps take some of the sting out of why you are there.

Hey there doll! So did they consider the 12 successful, or would they still recommend TESE at that point? I think we may try to do all 3 because I think we will only have one shot and we want to make it successful. How long has your DH been on Clomid?

I forgot to mention that we are OOP, so that is also why our uro is considering biopsy as the next step. We know DH produces sperm since there were 12, so it is a cheaper method of obtaining the sperm. TESE is a very last resort for us and would be done on the same day as the ER. Any surgery has to be done 6 months apart. So make sure to factor that in if you are trying to make a plan.

DH has been on Clomid for 3 months. His T is at a normal level now (b/w confirmed) and he will have another SA and more b/w next week. I simply want enough sperm to freeze and save for IVF.

The Uro said that the procedure would be done before the ER and anything found would be frozen. So maybe a biopsy is what he meant. He didn't actually give a name for what it was, he just kept calling it the testicle surgery. I should have thought to ask, but he was so good at explaining everything I just trusted him.

When is your next appointment? When do you cycle next?

You have at least 3 months to figure out what he meant!

We are talking about meeting with the financial counselor soon but wouldn't be ready to cycle for IVF until June or July. The uro will probably call us soon for an appt after the SA.

NMscubagirl · March 2011

Eriksgal:
Good luck and it sounds like a good plan! The six samples on day of ER sounds excessive to me since you will be doing ICSI and will have frozen back up. It actually sounds like a waste of money if you are going to be out of pocket for all that. Did the Dr give a reasoning for that? My DH has been on the HCG and Arimidex protocol for Low T since July 2010. His count went from 0 to 9 million in Nov 2010, motility, etc improved too. He also takes Fertility Blend for Men from GNC I'm not sure what is was on at our ER on Fri because they didn't tell us. We had one frozen sample for back up. We may look at. TESE in the future if this IVF is successful for future children so he can go off the meds or change to something else. On the Arimidex if your insurance isn't covering it...check Costco. I called around and wal mart wanted $400 for the generic, same with some of the other pharmacies like CVS and Walgreens. Costco charges $25 for the generic for a 30 day supply. I couldn't believe how much cheaper they were so do your homework!

0 to 9 million!!! Holy Cr@p!! Our Uro said that would be impossible!! I now have so much more hope! and thanks for the pharmacy recommendations! I wouldn't have thought to shop around.

Eriksgal · March 2011

Yes! It is crazy but it worked! Tomorrow I will check my email and can give you DH's stats from his Nov SA and Jan sample we froze. I will page you on here tomorrow!

amy1004 · March 2011

Eriksgal:
Yes! It is crazy but it worked! Tomorrow I will check my email and can give you DH's stats from his Nov SA and Jan sample we froze. I will page you on here tomorrow!

Did you ever receive any reason for why it was 0? Its amazing to jump that much so was there more to it than low T?

NMscubagirl · March 2011

Eriksgal:
Yes! It is crazy but it worked! Tomorrow I will check my email and can give you DH's stats from his Nov SA and Jan sample we froze. I will page you on here tomorrow!

THANKS!!

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