Dr. Roseff, I may have a stumper for you...

[atvlady]

Brief background....in June of 2009 I developed PIH, Preeclampsia and HELLP at 20+1. Our newborn lived 80 minutes. I almost died myself. As of today my liver enzymes and BP has been normal. This pregnancy is with my Husband now.

Fast forward to today, we have been TTC since August of last year with no success. Last Thursday we were dropped with these semen analysis:

pH, semen 8.3 (high) Normal 7.3-7.9
Semen viscosity 1 normal 0-1
Volume, semen 0.5 (L) normal 1.5-5.0 cc
motility with 15(L) normal >50%
forward progression (was left blank with no normal ranges)
motility without 10% no normal range listed
forward progression
motility, total 25(L) >60%
sperm count 16.0 (L) >20 mill/ml
morphology (kruger) immature 0%
morphology (kruger) abnormal 89%
morphology (kruger) normal 11%
sperm viabilty 41(L) normal >49%
no other observations.

My OB has referred us to a fertility specialist. We see him August 15th. I am 38 and Hubby is 45. My question is, what does his semen analysis mean, is it bad? Could we still conceive naturally with those #'s? My OB said we would be good candidates for IUI....do you have any idea what our success rate be? Hubby does take meds...Cymbalta, klonopin, metformin, accupril, LDA and we just started him in Zinc and stress B vitamin. Is his #'s that bad?

Ok my ultimate question is....with his abnormal morphology, could that cause Preeclampsia, PIH or HELLP or contribute to it? Birth defect? The reason I say that is our newborn was missing one set of bones in all her left toes. Could his semen contributed to it? We are wanting one surviving child. I cannot believe we are again wearing this type of shoes, again. We are so emotionaly drained. Can you help me and give me more insight....or anyone? Thanks so much. I just need my hand held for a bit!

[Scott Roseff MD]

Hi,

Sorry to hear you're having troubles... No, preeclampsia, PIH, and HELLP have nothing to do with poor sperm morphology, as far as modern science/medicine knows. Most experts believe it is not, per se, related to birth defects either. A Kruger morphology of 11% is actually not that bad at all....

However, poor sperm can be due to genetic issues in the male, so if sperm is very poor, my practice is to check blood chromosomes and Y-chromosome microdeletions on the man (along with other tests). If a man is taking metformin, that tells me he may have diabetes - A low semen volume may be due to retrograde ejaculation, something I see a lot in diabetics.

If you're seeing a superb, board certified RE, he/she should be able to properly guide you and your husband towards the next steps. Remember - All it takes is one, good sperm. As an aside, someone who has had PIH is at an increased risk for having hypertension in her life, as well as repeat PIH in another pregnancy.

Hope this helps - Dr. Roseff in Florida

[atvlady]

Thank you very much! We are grasping at all strings here cause not only are we facing infertility, we also have to keep eye on "will I be able to make it to atleast 28 weeks" or "will I deliver early again and the baby die." So we are having to keep all this in mind.

The lab results read 89% morphology abnormal and 11% morphology normal, would the 11% be bad per say? I am still trying to learn about all this.

If retrograde ejaculation is a result of diabetes, would that be due to poor blood sugar management or is it just the normal with diabetes?

Thank you so much! You all will be seeing a bit much of me. Fingers crossed we are blessed with a surviving child

[Scott Roseff MD]

Hi again,

Did they do an autopsy to find out WHY the baby was missing bones? Was it a developmental abnormality or a genetic abnormality? If it was genetic, did you see a genetics counselor?

According to the Kruger classification of morphology, 14% is considered normal for morphology, so 11% is very close to normal (in fact, Kruger recently lowered the upper limit of normal to much lower than that).

Dr. Roseff in FL

[atvlady]

There was no autopsy on her to check for any abnormalities. I did have a amniosentisis and it came back normal. They took pictures of her and you can defintiley tell she had one bone missing out of each toe. So as far as her diagnosis I have no clue

Ok I understand the morphology now and thank you!

This is becoming a extremeley emotional journey for us.

Thanks so much for the help!