Sperm-O-Coaster

Our journey from SAs 1 to 4 feels a bit like a ride on an amusement park roller coaster-- minus all the fun parts, of course. I'm quite certain that we just finished the all important "first drop." I'm just not sure if we're about to start up another hill before another dizzying drop or whether we're just at a mid-coaster "catch your breath" plateau.

Or, maybe I've just been playing too much Roller Coaster Kingdom on FB lately.

In all seriousness, you've probably guessed by now that our most recent SA results (#4) weren't what we'd hoped for. They were a definite dizzying drop from our hope-inducing third results. Count went from 48 million to 11 million; Motility from 38% back down to 24%. We're still waiting on the all important morphology number...the lab expects to get us that info today or tomorrow. Even without the morph, though, the new numbers look much more back in the IVF range than the IUI range we ever so briefly visited.

There's no logical reason for the decrease. DH is still taking the Tamoxifen/Arimidex combo and his testosterone showed back at normal levels on his most recent lab work. The only medicine change is that he stopped taking one of the anti-depressants. If anything, we would have thought that would've had a positive effect on the swimmers. Silly us for ever trying to predict the path the Sperm-O-Coaster would take us on!

So, we await the morphology shortly and gear up for the 5th SA, with DNA fragmentation testing, on 11/25. I can't help but wonder...another hill or another drop? Either way, according to everything we've been told so far about the numbers we'd need for IUI vs. IVF, the latest numbers (especially the fact that they're pretty much in unison with the other 3, minor hopeful uptick notwithstanding) have IVF written all over them. *Sigh* or perhaps in keeping with the Sperm-O-Coaster theme, I should say *S-C-R-E-A-M*.

No Surprises, but No Great News Either

Count: 5 million (normal 20 million)
Motility: 22% forward movement
Morphology 0%
2 Varicoceles (small to medium)

So, no surprises. The varicoceles were new info, but not a huge surprise to me. I really liked the doctor. Very matter of fact, while still not unnecessarily scaring us. And, he gave us a ton of information to read and think about...which I LOVE!

Basically, we were told that right now our only/best chance was IVF w/ ICSI. However, he's not ready to send us down that path just yet. First, we had bloodwork done today and will do a second SA to confirm the first on Thursday. Dr. B has a hunch that hormonal imbalances may be at play and the blood work will show that. If that's the case, he suggests Tamoxifen to increase count (and possibly morphology). His hope is that he could get us into the range that made IUI possible (20 million count/4% normal morph). He made no mention of getting pregnant naturally as an option for us.

There is also the option of varicocele repair. However, based on what research I've done so far, and Dr. B's description of it's efficacy, I'm not exactly jumping on that train just yet. If the bloodwork comes back normal, I'd almost rather put the money that would go toward the varicocele repair towards the IVF clinical trial going on locally. I don't know...

So many what ifs still. Tamoxifen or not. Varicocele repair or not. IUI or not. Clinical trial or not. I'm not sure what's too early to at least start investigating or get the ball rolling on the clinical trial. I don't want to wait so long that the trial is closed to new patients. But, I also realize that any improve we can make betters are chances of successful IVF if it comes to that. I'm torn on this one. I think I'm off to do some research on Tamoxifen's success rates with morphology improvement...

In the meantime humble readers...did you or someone you know deal with MFI due to varicoceles or hormonal imbalance? If so, what treatment did they choose and did it work?

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

Beauty and Danger in Hope

I was a bit shocked this morning when I went back to check today's status on my CBEFM.  It's my daily routine during the "fertile window"....PIAC, back to sleep, wake up later to the alarm, brush teeth, wash face, dip test stick and place in monitor, take Gracie & Audrey outside, feed them...check monitor.  So, this morning was CD12.  I had High days on CD10 and 11 and expected another.  No Dice...PEAK this morning! 

I must admit that I'm pleasantly surprised that I managed to get through 2 days of High readings without worrying about the BD schedule.  I'll thank Twilight and the bad SA results for that.  I've had moments of snappiness (and bitterness) that are uncharacteristic for me, except at this time in my cycle.  But, all in all, nothing like last cycle.

Peak on CD12 means that I'll likely O on CD13 or 14.  Great!  That's the earliest I've ever O'd, so that's partly why I wasn't expecting it.  But, wait...there's a problem!  No BD yet!!  This realization sent me into a bit of a panic, despite the fact that we still have two, maybe three days to fit the BD in.  I know that the odds of us conceiving naturally this cycle are infinitesimally low....and yet, I refuse to skip a cycle.  Maybe a day will soon come when I can "take a break" and it not cause me great angst.  Now isn't that time.

As awful as the 2ww is knowing that the odds are stacked against us, I can't imagine how it would be if I knew that there was no hope at all.  At the same time, hope seems dangerous to me right now.  Well, maybe it's not the hope that's dangerous as much as the almost certain eventual letdown.  I'm going to try not get over-hopeful, but I think it will take considerable effort.  Even still, hope seems much preferable to despair.  I'll hang on to that...and hope.

Finding peace on the journey...

Yah, cheesy title, maybe. But, that's a pretty good summary of how I'm feeling these days-- at peace, for the most part. As strange as it sounds given the news, I feel like we're exactly where we are meant to be. The SA results were not really a surprise to either of us. For reasons I can't explain, I've always felt like this process would not be "easy" for us. As it turns out, Andy felt similarly, but never let on until now.

After my rather emotional processing of the new information (SA results) last weekend, I realized that there are so many options that I have no doubt whether or not we'll have kids. The only question is when and how. And, it's the when that causes me particular angst. I'm not necessarily sure that I'm mentally/emotionally prepared to be in this for the long haul, but I will learn (not that I have much choice in the matter! LOL!).

But, other than that last, albeit rather big, hang-up, I (and we) have found some peace with where we are on this journey. I think that's partly because it just feels right. I'm still struggling to figure out how something so crappy can feel so right for us, but it does somehow. We are committed to having a family and to learning what we're meant to learn on this journey. It will likely not always make sense and it will likely be frought with more bad news before the good news. But, we'll get through it, just like we always have, and be closer, communicate better, and cherish each other and our future children more, because of it. Of that much I am certain...