TGH responds:

Dear Kathryn:

Sperm counts change dramatically from month to month, most of the time we do not know why.

You can ask your R.E. if there are significant white blood cells—this can be associated with a subclinical prostate infection, easily treated with antibiotics and can account for sudden changes such as those that you describe.

More commonly, however, we assess “sperm quality” through not just one test, but multiple tests. Perhaps a third IUI attempt would be in order, and then a longer discussion with your R.E. as to whether or not significant male factor subfertility is suspected.

Loved the information here I’ll have this bookmarked and will be back to read more….

25% normal morphology is low. But did he do his test at Mount Sinai? Interesting thing: the way MSH Urology processes samples, morphology often comes out low-normal or low. My advice:

*ask to have the test repeated, along with a DNA fragmentation assay.

*your husband could take antioxidant vitamins. A list of suggestions for improving sperm quality is here.

*for the final word on sperm, you need to speak to a Urologist. Ask for a referral to MSH Urology to see if more can be done.

In the end, 25% normal morphology may be amenable to intrauterine insemination cycles (IUI). For most programmes, IUI will have about a 10% overall success rate (ranges are 7-22.5% depending on the clinic and other factors) and IVF about 32% (range 20-78% in your age bracket) per cycle. Yes, IVF has the better success rate, 3 or 4x better, but many people will try IUI first because it is less interventional and less expensive.

I’m sure you are worried about the high-normal FSH levels. I strongly recommend making sure you know the results of the other tests of ovarian reserve. If it is indeed true that you don’t have a great number of eggs, well, that is not ideal, but your age alone would be highly suggestive that eggs are, if not numerous, then of good quality.

Best,

Tom Hannam

My husband and I are 31 years of age. We have conducted several preliminary infertility tests. Two results were abnormal: my husband’s semen analysis - numbers are there but poor morphology (75% abnormal). Also I have had 2 FSH tests - one at 11.2 and the other 10 (borderline values). My RE didn’t seem too concerned about those FSH values. I’ve tried clomid for 2 cycles with timed intercourse - no success there. What do you recommend as our next step?

Any suggestions are very much appreciated.
RR

We have been unable to find a semen analysis lab that would take our test. Our doctor didn’t give use any suggestions, and only said “to take a test in any lab”. Making appointments has also been unsuccessful for us, labs on the phone say one thing and then do not take our test when we try to submit it,… anyways, can you suggest a lab, preferably open on saturday, somewhere in Richmond Hill or Woodbridge?

thank you

TGH replies:

Dear Nataliya,

I asked Michelle, my manager of clinical operations:

“The couple should be advised to go online to either Gamma Dynacare or LifeLabs and look up the patient service locations. They need to call prior to going to confirm that samples are accepted and if there are certain days and times that samples are accepted”.

Recently, we became pregnant naturally! Unfortunately, we just found out that the baby has down syndrome. Despite Dr.s telling me it is not a result of DNA Fragmentation I’m not so sure. My last test I was around 70%. I am 43 and my wife is 38. Really would appreciate your opinion.

TGH replies:

Dear Perry

Trisomy 21 (Down’s syndrome) can affect any couple, at any age, though we have known for years that risks increase with maternal age.

More recently, it has been suggested that risks increase with paternal age as well.

That said, we have not yet made specific risk assessment tables related to paternal age and/or DNA fragmentation. We just don’t know how tight these associations are yet. A New York Times article captures the concerns, but not really what we should be doing about it…or how we should be counselling patients.

I would suggest that if you and your partner had intentions to have more children, that you do so. But if you need more information, you might consider seeing a genetic counsellor.

TGH