The 2% Moved my Cheese

An update on my slightly tipsy Saturday night post...I woke up Sunday morning with barely a headache.  I think I just felt a bit worse than I really was because I didn't have much food the last hour or so.  All in all, it was a fun, well worth it, time!

Tying up lose ends from last week, we FINALLY got the morphology results!  As the title suggests, it was 2% normally shaped.  As the lab technician so eloquently put it "that's still abnormal," but it's our best yet.  We're now leaning towards some IUIs early next year before moving on to IVF.  Improving morph is one reason, finances are another, but I'll save that for a different post.

Finally, you'll recall that I was expecting some news on "exciting updates" at work yesterday.  Well, it was about what I figured.  My job scope will increase (ultimately a good thing), my title will change (a great thing), but my manager will also be changing (this makes both me and my manager sad!)...and no one can tell me whether or not it will be a lateral move or a grade level increase.  I'm still hoping for the latter.  Even if not right now, though, I'm assured that it will happen soon.  Soon is a relative term, though.  All in all, it was a rather anti-climactic meeting with a lot of build-up for mostly nothing. 

I'm excited about the changes, but not excited about the manager change.  Not the least of the reasons why is that now I'll have to re-explain the IF situation to the new boss.  Luckily, that person, though not officially named yet, will be someone I already work with who I think will be understanding and flexible.  Still not looking forward to rehashing it, though.

So, my cheese got moved at work-- better in the long-term, a bit painful in the short-term.  And, I suppose, in some ways, the 2% morph results moved our IF cheese, too, though in a good way.  It just kind of caused us to re-evaluate and be a little more encouraged to give IUI a chance.  I guess it also potentially falls into the "better in the long-term, a bit painful in the short-term" category, though. 

Ever get that feeling where you really need something (anything?!) to just be quick and easy?  That's kind of how I feel this week!

In Its Own Divine Time

Three things for this post...all which will happen "in their own divine time," as Hubby reminded me yesterday.

Issue number one...Hubby and I talked a bit about yesterday's issue. I sincerely thank each of you that offered your thoughts and thought processes. We left things in the "think on it" category. Exactly where I expected them to be, and exactly where they should be for where we are in the process. I should also add that after our conversation tonight we're leaning a bit more toward a few IUIs and then perhaps the next IVF clinical trial sometime after first quarter 2010. But, when the RE shares with us the percentages of successful IUI, I may change my mind on this...again. In time all of that will be clear, I trust,

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Issue number two...I'm fuming about the fact that we're still waiting on the morphology results from last Saturday's SA. Perhaps we've just been spoiled by the uro who could get us results, all of them-- including morphology, in an hour or two. But, seven days later seems more than excessive...and unacceptable. We've called a few times; they just haven't gotten to it yet. I guess it comes down to this: If they're going to take seven days to tell us it's another 0% normal, I will be even more PO'd. However, if the results are better, they can take all the time they need to count the little guys.

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Finally, issue number three...This is the one that Hubby actually said "all its own divine time."  Ironically, it has absolutely nothing to do with TTC.  Though he didn't say it, I do think he thought it was a message that wouldn't hurt to be applied to more than just one aspect of our current lives.  It's a message I can often stand to be reminded of.  Patience is not my forte.

Anyway, back to the issue at hand...On Thursday, my manager was called into a meeting with our director, the two other directors from our department and the VP to discuss "changes, all good changes, coming to the department."  I just had a hunch this was going to have something to do with me.  Sure enough, on Friday I came into work to find a meeting request for Monday with the same group (manager, three directors and the VP) to discuss "exciting updates" coming our way. 

My department is sort of in the midst of a reorganization and I've been openly pulling for cross utilization of my role since the beginning.  I suspect this meeting has something to do with that.  It's almost certainly a positive thing for me.  I'm expecting anything from a promotion to a title increase to a job diversification without promotion or title increase.  Any of them would be a step in the right direction (though I'd prefer either of the former to the latter).  My biggest concern, though, is it may include a change in managers, which is something I'll be pretty disappointed about.  My manager and I have a great working relationship; I don't want to give that up just yet.

So, just to prove to you all what a worrier I am...here I sit on Saturday morning worried about undoubtedly good news I'm (hopefully) going to receive around lunch time on Monday.  Such a silly girl!  This is about the time Hubby said that whatever the change is, it will be positive, and though my path may not be the one I expected, it will all happen "in its own divine time."  Since we did he get to be so philosophical, you ask?  It was something his grandma used to remind him.  Wise hubby; Wise grandma!

SA Results: Count, Motility, and Morphology Explained

In an effort to get my thoughts untangled before the urologist appointment this afternoon, I thought it might be helpful to write them down here. I plan to take this cheat sheet with us to the doctor tomorrow so that I can make sense of all of the numbers he throws at us. Because this post is likely to get long, I'll probably post two separate ones later this week or soon thereafter...one on morphology in more detail (the most concerning item for us since we currently have 0% normal morph) and possible "treatments"/remedies for MFI issues (though there seem to few and they seem to be mostly a crap shoot!)

The process of interpreting SA results or figuring out how to improve them begins with collecting the sample. With that in mind, this excerpt from Dr. Mark Perloe's "Miracle Babies" gives some great tips on how to make sure the best sample possible ends up at the lab. The exercept doesn't give too many specifics, though, so I'll direct you here for more specific instructions. Of course, if your doctor gives you different instructions, use those! The only tip that we were given that doesn't appear in those resources is that if your collecting at home and transporting the sample to the lab, be sure to keep the sample at body temperature (tip: keep the sample cup in DH's breast pocket, for example).

So, now the all important collection is done and your doctor calls with the results. Motility, morphology, volume and count...what the heck does all that really mean? Here are the "normal" ranges that I've been able to find. Keep in mind that the categorization "normal" seems to be somewhat subjective depending on the clinic/doctor.

Sperm Count/Concentration
Sperm count is the number of sperm typically found in a milileter of fluid.
Normal range: 20 million to 150 million. Average is 60 million.
Low: Greater than 10 million; Less than 20 million.
Very Low: Less than 10 million. This is otherwise known as oligospermia.

Motility/Mobility
Motility is a measure of how many sperm are actively moving at certain times after ejaculation. The better the swimmers swim, the more likely they'll be able to reach the egg.
Normal: 50% moving at one hour post-ejaculation.

The WHO (World Health Organization) further categories motility into the following four categories:
Grade a (fast progressive) sperms are those which swim forward fast in a straight line.
Grade b (slow progressive) sperms swim forward, but either in a curved or crooked line, or slowly (slow linear or non linear motility).
Grade c (nonprogressive) sperms move their tails, but do not move forward.
Grade d (immotile ) sperms do not move at all.
More excellent information on motility here (the reference source for the above).

Volume
Volume is just the total amount of fluid in the sample. This measure is also why all of the SA instructions stress the importance of making sure that the entire sample is collected.
Normal Range: at least 2 milileters

Morphology
Morphology is a measure of how the sperm or shaped. Normal sperm have oval heads, a connecting middle piece and long, straight tails. Anything not meeting those specifications is considered abnormal. The morphology measurement is the percentage of abnormal sperm in the sample. The more normally shaped the sperm are, the more likely they will be able to fertilize the egg.

There are two standards for categorizing morphology. You can read more about the WHO Criteria vs. the Kruger Strict Criteria here.
WHO Criteria
Normal>60% normally shaped

Kruger "Strict" Criteria (sperm must be perfect to be considered normal)
Normal>15% normally shaped

Particularly useful Kruger categories from fertilitydr.com:
>=15% normal: Normal range - Good prognosis
5-14% normal: Sub optimal range - Prognosis is fair to good, however, the lower the percent normal, the lower the chance of successful fertilization
0-4% normal: Poor prognosis - Will usually need IVF with ICSI

There is conflicting information about the importance of morphology, which is why I'm planning to talk about morphology in more detail in a later post. In brief though, if the count is high, 20% normally shaped may be more than enough to get the job done. 20% normal morph with a count of 100 million still leaves 20 million normally shaped sperm. That's in the adequate range. However, the lower the count gets and the higher the number of abnormally shaped sperm get, the fewer "good" sperm are left to do the job.

For us, for example, we have low count (number to finally be disclosed at this afternoon's uro appointment) along with 0% normal morphology. Even if we can get the count up, we've still got zero normally shaped sperm. That's obviously a big problem. We'll see where the urologist stands on the morphology controversy soon enough.

That's enough for now. More on treatments, morphology and possibly varioceles at a later date. I hope that this proves to be helpful for others who find themselves in a similar situation in the future! Please feel free to add any useful resarch that you've unearthed (or other blog posts you've found with helpful information) in the comments!

The rest of the resources used in this post can be found here:
IF Optimist, Then (kudos to my fellow blogger IF Optimist for some equally great research!)
WernerMD
Your Total Health (iVillage)
Bluegrass Fertility Center
Malpani Infertility Clinic

Dominoes

After taking a bit of time to process the not-so-good SA results, I realized that we had to find a way to get through the next three weeks (until the appointment) with both or our sanity still intact. I had done the research...I knew that our options are limited if we can't improve the morphology. However, what my research also showed me was that there was HOPE!

Sure, worst-case, long-term scenario took us all the way to the most expensive, most in-depth of all the fertility treatments...IVF w/ ICSI. But, rarely do we not put up a fight when things aren't going our way! What my research also showed was that there are things we can do to help ourselves...
- Eat more fruits and veggies.
- Take a specific blend of vitamins, or a highly recommended multi specifically for our situation.
- Cut out cigars (depending on who you ask, a "hobby" or a habit ;)
- Start exercising more!
- De-stress to whatever extent possible.

Those ar the things we can do ourselves in the next three weeks to make the time go by faster. There are other things the urologist will want to do...another SA, probably, blood work, etc. I nervously await his thoughts. But, in the meantime, we don't have to lay down and take this. We can work together, like we always do, to make our dream of starting a family a reality NOW, even when everything looks pointed against us.

So, one new, healthy thing a day...That's our challenge! Hopefully, eventually one new thing will turn into a domino effect of many healthy things without too much effort. I hope!

Just the beginning...

Depending on when you start counting, we're either 8 months or 5 months into our TTC journey. It was 8 months ago that we decided that we were both ready. There was one "minor" detail that had to happen first...my exploratory laparoscopy. That happened in March. No endo=GREAT! Adhesion removed=GREAT! I had to wait until after my surgery to go off the pill, on doctors orders...So, April was when we really could get the TTC show started.

Knowing that there were fertility issues on both sides of the family, we sat some milestones from the beginning. The first one was the lap before we got started. The second, was a four month SA. I've always had the feeling that this wouldn't be easy...every month just made that nagging voice louder. Four months came and went....and hear we are.

I got the call I never wanted, but was somehow not surprising. It went something like..."low count, low volume, low motility, 100% abnormal morphology. Call the specialist as soon as you get off the call with me (my nurse) because your chances are extremely slim without help." My heart sank and I felt some where in between tears and throwin up...

But, I held it together for Andy. We shared a tearful embrace, each trying to be strong for the other. And, then we reminded each other that this wasn't a huge surprise and that we would work through it--together--just like so many things before this.

I started researching the problem. Andy decided to wait until the appointment with the specialist to decide just how much to worry. That's fine, we're two very different people with very different, but extremely compatible personalities. I suppose you could say that we're the epitamy of "opposites attract." I take comfort in talking abou the same thing, even if there's no resolution yet....turning to others who are dealing with the same thing...writing about my feelings...and researching. Andy prefers to take it one step at a time and not worry too much until he's given reason to worry. I hope that our 8/25 appointment with the urologist does NOT give him a reason to worry!

Either way, it is becoming more and more clear that despite the fact that we're on month 5 or 8 (depending on who you ask), we're really only just beginning. And, it's that fact that I'm struggling with this week...