Low Morphology

[daniellemm]

Hi Doctor Roseff,

I am 33 years old and my husband is 32. We are trying to conceive using OPKs for the last 6 months. No success. My husband had an history of varicocele and therefore we thought it would be useful to perform a sperm analysis. He went to an urologist here in Manhattan and he asked for an ultrasound and sperm analysis. The ultrasound showed small varicoceles in both sides. But very small. The urologist could not feel them, but he heard it. The sperm analysis showed above normal levels of sperm concentration and volume, good motility (69%) but low morphology (WHO - 14% and Kruger - 7%). On the Kruger analysis, 7% were normal and 9% were slightly abnormal. The rest (84) were very abnormal. Mainly head abnormalities. In addition, my husband had some blood work and everything was normal, except estradiol (74). The doctor said not to worry about the estradiol.

Now the urologist said that he does know what our chances of getting pregnant naturally are. He thinks that we should decide if we should do the varicocele surgery or to go IVF. He does not think that IUI would work since the washing procedure would not wash the abnormal sperms.

I never did any invasive exams. My period is very regular (28). Luteal phase is normal (12-13). No history of STDs or infections. Vaginal and abdominal ultrasound were normal. Hormones exam was normal. I did a 3rd day FSH Home test and it was normal. Therefore, I do not know if I have problems as well.

I know that you are not my doctor, but maybe you could help us with some directions. My questions are:
1. What should we do next?
2. Do we have a fair chance of getting pregnant naturally?
3. Do we have a chance with IUI? If yes, how many times should we try?
4. Should I be tested (HSG, Lap, progesterone on the 10th day, FSH)?
5. Should we do something about his estradiol levels?
6. Should he proceed with the varicocele surgery? Even if his problem is only related to morphology?
7. Is IVF our only fair chance?
8. Would recommend any RE in New Jersey? We live there, close to NY.

Thank you very much for your time. Danielle (sorry about possible grammar errors, English is not my first language)

[Scott Roseff MD]

Hi,

Your grammar was excellent! To answer your questions:

1. What should we do next?
==> It's illegal for me to tell you what to do. I can only give you broad generalizations and guidelines. My patients who have similar backgrounds to what you described typically undergo IUI, with or without injectable fertility medications.

2. Do we have a fair chance of getting pregnant naturally?
==> There's too much about you I don't know to give you a prognosis for getting pregnant on your own. I would need to review your history, examine you physically, and review all test results to date to give you a prognosis and tell you what your best option is for achieving a timely pregnancy. If you want a "second opinion" here, let me know.

3. Do we have a chance with IUI? If yes, how many times should we try?
==> From the limited information you gave me, my patients in a similar situation may benefit from IUI. The number of times to try depends on many factors that I don't know about you.

4. Should I be tested (HSG, Lap, progesterone on the 10th day, FSH)?
==> Cycle day 3 FSH, estradiol, AMH, and antral follicle counts are important tests (as are prolactin and TSH). My patients usually have an HSG done, too. Laparoscopy is ONLY done when patients have severe, incapacitating pain with their periods or a high suspicion for endometriosis. I have amongst the highest success rate in the country, and very, very few of my patients undergo laparoscopy at all.

5. Should we do something about his estradiol levels?
==> No. Is he overweight or obese? That's a common finding in obese men.

6. Should he proceed with the varicocele surgery? Even if his problem is only related to morphology?
==> Can't tell him what to do (it's illegal). Again, as a generalization, small varicoceles are NOT typically related to fertility improvement after surgery. My patients with poor morphology are often placed on a supplement (such as, and not limited to, Pycnogenol). My published study showed significant improvement in sperm morphology after the men took Pycnogenol (see www.reproendo.com/pdf/pycnogenol.pdf). If that link doesn't work, try http://www.reproendo.com/pdf/pycnogenol.pdf

7. Is IVF our only fair chance?
==> Can't say for sure. Again, most of my 33 year olds with your similar history don't need IVF.

8. Would recommend any RE in New Jersey? We live there, close to NY.
==> Having practiced in NJ for 17 years before relocating to FL, I've found that most of the patients I "left behind" who went to other RE's were unhappy and have made the trip down to Florida to see me.

I hope this is helpful,
Dr. Roseff in Florida

[daniellemm]

Thanks

Thanks so much doctor Roseff. Since I live in NJ, if I go there to have an appointment with you, how many days I need to set a side for a initial exam?

Thanks again.

[Scott Roseff MD]

A complete workup for the male can be completed in one day (as long as he abstained from ejaculating for at least two days). The workup for the female starts with her menstrual period and is completed within about two weeks (so it takes up to two weeks for her workup to be done).

I hope this helps,
Dr. Roseff in FL