INSEMINATIONS

QUESTION
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
ANSWER
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:

* Make sure that you do see a physician who has proper training in the management of infertility difficulties.

* Make sure that your husband receives the proper medication for his thyroid difficulties in order to maintain his general health. It is always important that the general health comes first before anything else.

* The specimens at semen collection should be obtained at intercourse and via the use of a seminal collection device. This will enable him to produce a superior specimen. Also this will allow your husband to feel a bit more comfortable with the undergoing treatment.

* He may continue to take Proxeed. The improvements that were noted corresponding to his taking Proxeed could be due to both the Proxeed and the thyroid medication. Variations in thyroid activity in both male and female could inhibit the ability to produce sperm for the male and eggs for the female.

* Along with the male being evaluated and treated, one must consider the fact that it takes "two to tango" and therefore make an effort to make sure that you (the female factor) are healthy and do not contribute to your infertility difficulties.

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

QUESTION
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
ANSWER
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

 


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